Return to preinjury status after routine knee arthroscopy in military population

BACKGROUND

Knee arthroscopy is frequently advised procedure for knee-related problems in serving soldiers. The scanty published literatures have documented wide range of recovery duration ranging from nine days to four weeks even for routine uncomplicated arthroscopy. However, neither of these studies evaluated military population, where arthroscopic procedures are frequent and physical demands are different. The aim of this study was to ascertain the time required to return to unrestricted physical activities in serving military population.

METHODS

This was a prospective descriptive study enrolling 51 patients who underwent two portal arthroscopic procedures like diagnostic arthroscopy, meniscectomy, loose body removal and excision of plica or combination of these. A uniform home based physiotherapy protocol was used for everyone. All of them were followed up at 2nd, 4th, 6th, 8th and 12th postoperative weeks. At each follow up, 2000 International Knee Documentation Committee subjective knee evaluation form was filled and submitted for analysis.

RESULTS

Although all of our patients were able to walk around without any support at two weeks follow up, 88% had restriction to activities of daily living because of knee related problems. The mean International Knee Documentation Committee score was 41 at 1st follow up, which gradually improved to 64, 86, 94, 94 at 4th, 6th, 8th and 12th week follow up respectively. At 6 weeks 91% resumed their preinjury status which reached 94% in eight weeks.

CONCLUSIONS

Most of the soldiers return to unrestricted activities within six to eight weeks after diagnostic arthroscopy, meniscectomy, loose body removal and excision of plica or combination of these procedures.

Reduction of Acute Anterior Shoulder Dislocation Using Intraarticular Lidocaine(IAL) and Stimson’s Technique

Introduction: Shoulder dislocation is common injury requiring urgent reduction. For the reason that patient is not nill orally and anesthetists are not available, reduction under intra venous anaesthesia is not possible. This study was aimed to evaluate the effectiveness of intraarticular lidocaine and stimson’s technique of shoulder dislocation, which could be performed without anesthetist and irrespective of nill orally status. Methods: A prospective observational study was performed from December 2009 to December 2010. Under all antiseptic precautions 20 ml of Lidocaine was injected intraarticularly and reduction was performed by Stimson’s technique. Visual Analogue Score, time for reduction and failure to reduction by this technique was recorded. Results: Out of 27 dislocations 22 were successfully reduced and remaining required added scapular manipulation. The mean VAS scor was 2.3±1.26 and the mean time of reduction was 17.96±1.9 minutes. Conclusion: Stimson’s method with Intraarticular Lidocaine is effective, safe, less costly and can be performed in periphery where anesthetist and monitoring facilities are not available. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6406 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 6-8

Femoral neck stress fractures in military personnel

INTRODUCTION

Stress fractures are common during military training but femoral neck stress fractures are uncommon and sometimes pose diagnostic and therapeutic challenges. An incomplete stress fracture with excellent prognosis, if left unprotected, can lead to displaced femoral neck fracture with almost 63% complication rate even with best of the treatment. The aim of this study was to analyze various aspects of the femoral neck stress fracture so that early diagnosis can be made to prevent devastating complications like osteonecrosis and non-union.

METHODS

The four year army hospital record of 16 patients with femoral neck stress fracture were studied. Their demographic profile, type of fracture, presentation delay, on set of clinical symptoms and complication of femoral neck stress fracture were critically analyzed.

RESULTS

The mean age of the patient was 19.94 years. Total 74% of them developed first symptoms of stress fracture between four to seven weeks of training. There was 3.4 weeks delay from the clinical onset of symptoms to the diagnosis of stress fracture. The type of femoral neck stress fracture were compression (31.25%), tension (18.75%) and displaced (50%). Out of eight displaced type of fractures, 5 (62.5%) had developed complications (3 osteonecrosis and 2 nonunion).

CONCLUSIONS

Femoral neck stress fracture occurs in initial four to seven weeks of training. The high index of suspicion in initial period of training can help to detect and decreases significant morbidity.

Femoral Neck Stress Fractures in Military Personnel

Introduction: Stress fractures are common during military training but femoral neck stress fractures are uncommon and sometimes pose diagnostic and therapeutic challenges. An incomplete stress fracture with excellent prognosis, if left unprotected, can lead to displaced femoral neck fracture with almost 63% complication rate even with best of the treatment. The aim of this study was to analyze various aspects of the femoral neck stress fracture so that early diagnosis can be made to prevent devastating complications like osteonecrosis and non-union. Methods: The four year army hospital record of 16 patients with femoral neck stress fracture were studied. Their demographic profi le, type of fracture, presentation delay, on set of clinical symptoms and complication of femoral neck stress fracture were critically analyzed. Results: The mean age of the patient was 19.94 years. Total 74% of them developed fi rst symptoms of stress fracture between four to seven weeks of training. There was 3.4 weeks delay from the clinical onset of symptoms to the diagnosis of stress fracture. The type of femoral neck stress fracture were compression (31.25%), tension (18.75%) and displaced (50%). Out of eight displaced type of fractures, 5 (62.5%) had developed complications (3 osteonecrosis and 2 nonunion).Conclusions: Femoral neck stress fracture occurs in initial four to seven weeks of training. The high index of suspicion in initial period of training can help to detect and decreases significant morbidity.Key Words: displaced stress fractures, non-union, osteonecrosis, recruits