Anti-Inflammatory diet reduces bone loss, hip fracture risk in women

With age, people tend to lose bone mass, and postmenopausal women in particular are at a higher risk of osteoporosis and bone fracture. However, there are things we can do to prevent this. A new study suggests that a diet rich in anti-inflammatory nutrients may reduce bone loss in some women.

Osteoporosis is a condition in which the bone strength is reduced, leading to a higher risk of bone fractures - in fact, the disease is the leading cause of bone fractures in postmenopausal women and the elderly.

Most bone fractures occur in the hip, wrist, and spine. Of these, hip fractures tend to be the most serious, as they require hospitalisation and surgery.

It used to be believed that osteoporosis was a natural part of ageing, but most medical experts now agree that the condition can and should be prevented.

New research from the Ohio State University found a link between nutrition and osteoporosis. The study was led by Tonya Orchard, an assistant professor of human nutrition at the Ohio State University, and the findings were published in the Journal of Bone and Mineral Density.

Analyzing the link between diet and bone loss

Orchard and team investigated data from the Women's Health Initiative (WIH) study and compared levels of inflammatory nutrients in the diet with bone mineral density (BMD) levels and fracture incidence.

The WIH is the largest health study of postmenopausal women ever conducted in the U.S. Women were enrolled in the study between 1993 and 1998.

The researchers used the dietary inflammatory index (DII) and correlated the measurements with the risk of hip, lower-arm and total fracture using data from the longitudinal study.

They then assessed the changes in BMD and DII scores. The researchers distributed food frequency questionnaires to 160,191 women aged 63 on average, who had not reported a history of hip fracture at the beginning of the study.

Researchers used BMD data from 10,290 of these women and collected fracture data from the entire group. The women were clinically followed for 6 years.

Orchard and team used Cox models to calculate fracture hazard ratios and adjust for age, race, ethnicity, and other variables.

Low-inflammatory diets benefit younger white Caucasian women

The scientists found an association between highly inflammatory diets and fracture - but only in younger Caucasian women.

Specifically, higher scores on the DII correlated with an almost 50 percent higher risk of hip fracture in white women younger than 63 years old. By contrast, women with the least inflammatory diets lost less bone density during the 6-year period than their high DII counterparts, even though they had overall lower bone mass when they enrolled in the study.

These findings suggest that a high-quality, anti-inflammatory diet - which is typically rich in fruit, vegetables, fish, whole grains, and nuts - may be especially important for younger white women.

"By looking at the full diet rather than individual nutrients, these data provide a foundation for studying how components of the diet might interact to provide benefit and better inform women's health and lifestyle choices.

However, it is worth noting that the study did not associate a more inflammatory diet with a higher risk of fracture overall. On the contrary, lower-arm and total fracture risk were found to be slightly lower among women with higher DII scores.

Although the study was observational and could not establish causality, a possible explanation ventured by the authors is that women with lower inflammatory diets may exercise more and have a higher risk of falls as a consequence.

Correct Trauma Principle in Joint Replacement give Excellent Results.

80year old male presented with pain and inability to bear weight on left Lower Limb since 2 days

Pre Op Xrays

Diagnosis : Severe OA Left knee with Displaced Stress Fracture in Upper Tibia

PLAN : Primary TKR with Extension ROD 

OPERATIVE PEARLS:

• Guarded Knee Flexion for Tibial Cuts
• Use of POLLER SCREW technique to get the alignment of Intramedulary Rod in Proximal tibia.
• Finishing the Femur cuts to Get Space for Entry into Proximal Tibia
• Serial Reaming after putting the Poller Screw and checking reduction under Carm guidance
• Using intramedullary Guide for Proximal Tibial cuts
•  Using large Extension Tibial Rod for Tight fit
• Checking Correct Rotation and Patellar Tracking before final Implantation

 Post Op Xrays

Correct TRAUMA PRINCIPLES in JOINT REPLACEMENT give Excellent Results.

Surgery Performed by Dr Ajay Shah and Dr Kunal Shah

KNEE REPLACEMENT - PRE AND POSTOPERATIVE REHAB

PRE OPERATIVE REHAB

•  Educate patient about knee surgery & procedure to reduce anxiety & stress.
•  Importance of Pre operative exercises :-

1. Ability to build up strength in the knee muscle around your knee prior to surgery will have great impact on speed & quality of recovery. 
2. And it did help in many other ways, pre-operative therapy strengthened his core, hip & quadriceps, the muscles surrounding knee joint.
3. All the muscle that was needed for speedy recovery was prepared for action. 

POST OPERATIVE REHAB

• A regular exercise program is a key part of recovery from operation. 
• Regular exercise to restore your knee mobility & strength & gradually return to everyday activities is important for full recovery.
• When you build up strength in the muscle around your new joint, it will help you get back to your normal activities. 
• It is recommended that exercise approximately 20-30minutes, 2/3 times a day & walk 30minutes.

BENEFITS OF POST OPERATIVE REHAB

1. Restore normal range of motion.

2. Build up strength in the joint & surrounding muscles.

3. Ease pain and swelling.

4. Let you get back to normal activity.

5. Help with circulation, so you don’t have blood clot problem.

POST OPERATIVE CARE

• Post surgical pain usually subsides after a week of rest and strengthening exercises.
• Surgical wound should be kept clean and dry until area heals 
• Patient should avoid soaking for about 2 weeks after total knee replacement.
• Physical therapist involves movements and exercises to help the patient adjust to the new joints and gradually make patient walk.
• Swelling is normal for 2 to 3months after total knee replacement, elevating the leg for 30 to 60 minutes every day can help.
• Patient should be sure to eat a healthy diet and should follow specific dietary instructions.

DO’S

• Walk and exercise daily. 
• Use an ice pack for pain and swelling. 
• Elevate your leg 1hour 2times in a day for swelling 
• Proper use of cane/ stick/ walker 
• Use western toilet 

DONT’S

• Do not twist your knee.
• Avoid putting unwanted load or stress on your knee. 
• Don’t put a pillow or a roll directly under your knee while you are a sleep. 
• Always keep knee out straight while lying down. 
• Avoid a sitting cross leg position 

Dr Purvi Thakkar
B.P.T., STOTT Pilates Trainer
Consultant Physiotherapist
Ashutosh Hospital

Recovery From An MCL Injury?

The medial collateral ligament or the MCL is a large ligament

running along the inner side of the knee. The MCL helps prevent the knee from caving inward. MCL injuries can occur from being hit on the outside of your knee. An MCL injury can also occur if our leg slides to the side and our knee caves inward. Your recovery from an MCL injury can vary from weeks to months depending on the severity of the tear.

The MCL is one of the strongest and largest ligaments in the knee. Anatomically there are two separate parts to the MCL, the deep and superficial portions. The MCL is commonly injured in isolation. Most MCL injuries are usually mild in severity. MCL injuries can also occur in combition with ACL injuries, but that is not a common injury pattern. Unfortunately, MCL injuries are one of the most painful knee injuries.

Types of MCL Injury

MCL injuries are graded 1-3. Grade 3 injuries are the most

severe and represent a complete rupture. The ligament has completely torn into 2 parts. Grade 1 injuries are the least severe and only a small portion of the MCL has torn. Grade 2 injuries are somewhere in between. In grade 2 MCL injuries, nearly half of the ligament is usually injured, stretched or torn.

Treatment of MCL Injury

Most MCL injuries do not require surgery. Most MCL injuries are grade 1 or grade 2 tears. Because of the pain that occurs when the MCL is stretched we will typically put you in a brace for a few weeks to support the ligament and ease your pain. Most of you can be started in physical therapy to rehab your knee soon after the injury. Grade 3 injuries might require a longer period of bracing and in some instances a grade 3 complete MCL tear might require surgery to repair the tear.

Recovery From An MCL Injury

Recovery from an MCL injury is very dependent on the grade of your MCL tear. Recovery from a grade 1 MCL injury can be as short as a few weeks. Once your range of motion and strength have recovered most grade 1 MCL injuries can anticipate a full return to sports. MCL injuries do tend to be painful so the pain from the injury might linger on for a month or two.

The recovery from a grade 2 MCL injury will take a while longer. A grade 2 injury might take between 2-3 months until you are comfortable, the knee is stable and your motion and strength have returned to normal. Once you have sustained a grade 2 or 3 injury it is also very important to focus on sports specific rehabilitation and neuromuscular rehabilitation to make sure that your knee is ready to compete.

The recovery from a grade 3 injury can take up to 6 months to recover from. Especially if surgery is necessary to repair the ligament. If surgery was not necessary then you may recover between 3-5 months after your injury. Once again, sports specific and neuromuscular rehabilitation is critical to your recovery and minimizing the risk of reinjury when you return to play.

Know the Warning Signs: Early Symptoms of Osteoarthritis of the Knee

Osteoarthritis is a disease where the cartilage of the joints wears away, and the bones start to rub together. The knee is the biggest joint in the body, and it carries a lot of weight.

As people get older, the task of carrying this weight can wear down the cartilage that covers the ends of the bones in a joint.

Cartilage is the tissue that makes sure the bones pass over each other smoothly. It also acts as a kind of cushion or shock absorber.

If the cartilage wears away, the bones will rub together. This can lead to osteoarthritis (OA), the most common type of arthritis.

OA causes pain, swelling, and stiffness. People with OA of the knee may find it hard to exercise, climb stairs, or even walk.

Symptoms that can appear at the early stages of knee OA are:

• Early symptoms of knee OA include pain, swelling, and stiffness.
• Pain, especially on bending and straightening the knee
• Swelling, caused by a buildup of fluid in the joint, or by bony growths called osteophytes that form as the cartilage breaks down
• Warmth in the skin over the knee, especially at the end of the day
• Tenderness when pressing down on the knee
• Stiffness when moving the joint, especially first thing in the morning, or after a period of inactivity
• Creaking or cracking on bending, known as crepitus

Activity can make symptoms worse, leading to pain at the end of the day, especially after a long time of standing.

If the knee is red, the person has a fever, or both symptoms occur, the problem is likely to be a different condition to osteoarthritis.

Treatment of OA depends on how serious the condition is.

There are some home remedies and over-the-counter treatments for OA of the knee that can be used at home and are readily available from the pharmacy. 

These treatments include:

• Applying heat or cold. Heat relieves stiffness and cold can ease pain. The heating pad or ice pack should be covered with a towel so as not to burn the skin.
• An assistive device, such as a cane or walker, can help take some of the weight off of the knees. Holding the cane in the opposite hand to the painful knee is most effective.
• Pain relief medications are available over the counter. These should always be used with caution as they can cause side effects.

For some people, pain and other symptoms are severe enough to interfere with daily life, and over-the-counter medications do not help.

People should see a doctor if their knee pain and other symptoms begin to interfere with daily life.

The next step is to consult a general physician, who may refer the patient to a rheumatologist or orthopedic surgeon.

The doctor will examine the knees, moving them forward and back to note the range of motion, and to find out which movements cause pain.

There are a number of tests to diagnose osteoarthritis:

• Joint aspiration involves using a needle to draw a sample of fluid from the joint. That fluid is then checked in a laboratory for signs of other joint problems such as gout or infection.
• Magnetic resonance imaging (MRI) can provide detailed images of the person’s knees, which may show fluid buildup in the thigh or knee bones.
• X-rays can reveal whether the knee joints have been damaged in the later stages, but may not reveal damage in the early stages.

There are some lifestyle changes that can relieve the pain and stiffness caused by knee arthritis:

• Losing weight can relieve pain and prevent further joint damage
• Exercise is one of the best ways to relieve arthritis pain, especially low-impact exercises such as walking, riding a stationary bicycle, or swimming
• Swimming is ideal because the buoyancy of the water takes pressure off the joints, while the warmth soothes them.

OA is a common but painful condition that affects many people as they age. Pain, stiffness, swelling, warmth, or cracking in the joints may be signs that it is time to seek medical help.

Brachial Artery Injury In Distal Humerus Fracture Treated without Vascular Intervention

A 35 year old patient had a RTA and sustained injury to Right Elbow and Arm. He was primararily treated elsewhere and came to us after 8 hrs of injury.

X-rays

But Radial Pulse was not palpable on the right side. Finger movements were full and SPO2 in the fingers showed 94% saturation.

CT Angio showed blockage of Brachial artery at the level of elbow with good distal flow in the ulnar and radial artery in the forearm.

CT ANGIO

Operative Pearls :

- Surgery through Posterior approach

- Bony spike of proximal fragment touching the Brachial artery.

- Spike lifted and Torn Brachialis muscle repaired

- Artery found to be pulsating

- Fracture fixation done

- It is important to visualize the Brachial artery from Posterior approach

INTRA OP PICTURES

POST OP XRAYS

Post operative the distal SPO2 improved to 98% and Patient’s Limb Survived Without VASCULAR INTERVENTION.

After 2 weeks of Surgery, PULSE was WELL PALPABLE and Patient had a full recovery.

Medial Collateral Ligament (MCL) Injury

What are the different types of medial collateral ligament (MCL) injuries?

An injury to a ligament is called a sprain. Like any other sprain, MCL injuries are graded by their severity. When the fibers of the ligament are stretched but not torn, this is referred to as a Grade 1 sprain. Grade 2 sprains are when the ligament fibers are partially torn. When the ligament is completely torn or disrupted, this is a grade 3 sprain.

Because of the anatomy and how the MCL is related to the medial meniscus (cartilage) and the ACL (anterior cruciate ligament), these two structures may also be damaged in association with an MCL injury.

What are causes and risk factors of medial collateral ligament (MCL) injuries?

MCL injuries are the most common ligament sprain of the knee. They are often sports-related and can occur in any age group. Contact sports are the most common risks, including football, hockey, wrestling, and martial arts. Males tend to be more at risk than females.

MCL injuries occur usually from a sudden impact to the outer part of knee. The injury may be either due to contact, being hit on the outside part of the knee, or non contact due to twisting, cutting, or stopping suddenly (deceleration).

What are medial collateral ligament (MCL) injury symptoms and signs?

Pain is the first symptom of an MCL injury. It typically occurs almost immediately and is located along the course of the ligament. Sometimes this is associated with swelling within the knee joint. Occasionally, swelling develops in a matter of minutes. The Pain of an MCL sprain will also cause the person to limp in order to protect the knee joint.

What tests are used to diagnose and assess medial collateral ligament (MCL) injuries?

The diagnosis of an MCL sprain is usually made by history and physical examination. The patient often knows the mechanism of injury, that is precisely what they were doing and what position their body was in when the injury occurred. 

This helps the health-care professional understand the stresses that were put on the knee joint. Other questions might include whether the patient was able to walk, whether the knee began to swell, and how long it took for that to happen after the injury.

The physical examination includes looking at the knee to see whether or not it is swollen and touching the knee in various places to find places of tenderness and pain. With MCL sprains, there is tenderness along the course of the ligament on the inner aspect of the knee.

The ligament can also be stressed on physical examination. By pushing on the outer side of the knee, the examiner can determine if the MCL is stable or unstable. This can be a rough assessment of the grade of sprain, where a grade 1 sprain is stable and a grade 3 sprain is unstable.

Physical examination concentrates on the knee joint and the hip and ankle to identify any other associated injuries.

Plain X-rays of the knee can be used to identify fractures of the femur and tibia bones. An MRI is the best way to actually visualize the MCL and determine the grade of sprain, but it is not always necessary. If there is concern that there is also a tear of the medial meniscus or anterior cruciate ligament, an MRI may be appropriate.