Intramedullary nailing for open fractures of the tibial shaft

Interlocking intramedullary nailing has become a popular method of fixation for closed tibial fractures, and a series of reports has confirmed excellent results with this technique. However, the use of intramedullary nails for open tibial fractures is controversial. The standard treatment for these injuries has been external fixation, particularly for fractures associated with more severe soft-tissue injuries

Objective: The purpose of the present study was to compare the clinical and radiographic results of intramedullary nailing of open fractures of the tibial shaft after reaming with those of nailing without reaming

Material and Method: This was follow-up comparative study. Thirty patients who had thirty-four open fractures of the tibial shaft were randomized into two treatment groups. Sixteen fractures [nine typeI, three type-II, two type-IIIA, and two type-IIIB fractures, according to the classification of Gustilo et al.] were treated with nailing after reaming, and eighteen fractures [ten type-I, four type-II, two type-IIIA, and two type-IIIB fractures] were treated with nailing without reaming

Result: The average diameter of the nail was 10 millimeters [range, nine to eleven millimeters] in the group treated with reaming and 9 millimeters [range, eight to ten millimeters] in the group treated without reaming. No clinically important differences were found between the two groups with regard to the technical aspects of the procedure or the rate of early postoperative complications. The average time to union was 30 weeks [range, thirteen to seventy-two weeks] in the group treated with reaming and 29 weeks [range, thirteen to fifty weeks] in the group treated without reaming. Two of the fractures treated with reaming and three of the fractures treated without reaming did not unite. There were two infections in the group treated with reaming and one in the group treated without reaming. More screws broke in the group treated without reaming four, per cent] than in the group treated with reaming [Three; 9 per cent]. The functional outcome, in terms of pain in the knee, range of motion, return to work, and recreational activity, did not differ significantly between the groups

Conclusion: We concluded that the clinical and radiographic results of nailing after reaming are similar to those of nailing without reaming for fixation of open fractures of the tibial shaft, although more screws broke when reaming had not been done

frequency of nonunion and avascular necrosis in fracture neck of femur in young adults, treated with cannulated screws

Objectives:- The objective of the study was to document frequency of nonunion and avascular necrosis in fracture neck of femur [NOF] in the young adults, treated with cannulated screws

Methodology: It is a descriptive case series study, carried out at Department of Orthopaedic Surgery Sheikh Zayed Hospital [PGMI] Lahore. Forty patients were included in this study, reported within two weeks of injury. All patients with Garden type I, II, III and IV fractures neck of femur, aged from 18 to 55 years, from May 2012 to November 2012 were included with the consent to undergo osteosynthesis with cannulated screws

Results: KOFU [Japan] hip scoring system was used to evaluate results. Total 34 fractures [85%] achieved radiological union on an average of 3 months. Out of these 34 patients, 11 patients were with Garden type I, 10 patients Garden type II, 8 patients with Garden type III and 5 patients with garden type IV fractures had union of fracture. Total 6 patients [15.0%] had complications. Out of these total 6 patients, 2 patients were Garden type III and 4 patients were Garden type IV. All these 6 patients [15%] had nonunion, and 2[5%] patients ended in avascular necrosis of head of femur also but in 4 patients head of femur remained viable. There was no case reported with implant loosening in our all treated cases

Conclusion: With cannulated screw fixation all garden type I and II fractures achieved union and garden type III fractures have minimal frequency of nonunion and garden type IV fractures have variable frequency of nonunion. So cannulated screw fixation is best method of treatment in fracture neck of femur in young adults

Fixation of thoracolumbar fractures by fixator internae

Study included 20 patients with instable burst fractures presented in Accident and Emergency Department, Shaikh Zayed Hospital, Lahore. Twelve patients were male and eight patients were female. Age ranges from 15 to 29 years. Ten patients were without neurological loss, five were partial neurological involvement and 5 were complete neurological cases. All these patients were operated and stabilized with posterior interpedicular system called fixator internae developed by AO. This instruments allows stable fixation limited only two adjacent spinal segments. With fixator internae it is possible to add distraction or compression to the involved segments. It is able to reduce effectively the middle column by ligamentotaxis. All patients in this series had a minimum follow up of one year. Most patients in this series had a near anatomical reduction of all three columns in the involved segments. It was also possible to reestablished the normal Lordosis of the lumbar spine. AO International Classification of thoracolumbar fractures were followed. 10 patients without neurological loss were mobile after 2 weeks. Five patients with partial neurological loss recovered fully and 3 patients complete neurological loss, one patient recovered partially and but 2 patients remained paraplegic and bed ridden. Results were satisfactory and cost effective