Results of proximal humeral locking plate fixation in Neer’s two and three part proximal humerus fractures: A retrospective analysis of twenty patients.

Background: Fractures of the proximal humerus have been a challenge to orthopaedic sugeons with treatment modalities changing from time to time. Locking plates have revolutionised the treatment of these fractures. Currently proximal humeral locking plates (PHLP) and proximal humeral interlocking osteosynthesis (PHILOS) are two types of locking plates available for fixation of these fractures. Aim of this study was to evaluate the results of proximal humeral locking plate (PHLP) for Neers’s two and three part proximal humerus fractures. Material and methods: Neer’s two and three part fractures treated by open reduction and internal fixation with proximal humeral locking plate from August 2012 to April 2014 were retrospectively evaluated for complications, time to radiological union and final functional outcome using Constant Murley Score (CMS). Results: Twenty (12 male; 8 female) patients with 8 Neer’s 2-part and 12 neer's 3- part fractures managed by open reduction and internal fixation with proximal humeral locking plate (PHLP) with an average follow up of 23.2 months were evaluated. All the fractures united at an average of 16 (12 to 20) weeks. Eight complications were seen in 5 (25%) patients, namely, inadequate anatomical reduction (n = 1), superficial wound infection (n = 1), deep infection (n = 1), subacromial impingement (n = 1), axillary nerve neuropraxia (n = 1), adhesive capsulitis (n = 1) and secondary varus collapse (n = 2). There was no patient who developed avascular necrosis (AVN), non- unioun, primary or secondary screw perforation, implant failure and vascular injury. Average Constant-Murley Score at final follow up was 84.75 ± 11.6. 85% patients had very good and Good functional results. No patient had poor functional results. Conclusion: Proximal humeral locking plate (PHLP) is an excellent implant in Neer’s two and three part fractures of the proximal humerus. Complications can be minimized by meticulous Surgical technique and proper placement of screws and plate. In case of medial comminution, use of PHILOS with placement of medial support screws and bone grafting should be preferred to prevent varus collapse.

Anatomical variations of coronary artery and frequency of median artery: A cadaveric study from Northern India.

Introduction: Clinicians and anatomists have been examining coronary artery variations for a long time. However, there is still no consensus on the normality or abnormality of coronary arteries. The present survey was therefore conducted to find out the variations in left coronary artery (LCA) and right coronary artery (RCA) branches, the existence and occurrence of the median artery in northern Indian population.Material and methods: The present study was planned and conducted during March 2012 to September 2014 at Department of Anatomy, Major S. D. Singh Medical College, Fatehgarh; a tertiary care teaching hospital. The hearts of 40 adult northern Indian cadavers fixed with 10% formaldehyde were used. To determine the dominant circulation, the artery that supplies the posterior inter ventricular sulcus was investigated. Dissections were performed under a dissection microscope and photographed. Results: LCA branched out of the aortic sinus in all the hearts and had an average diameter of 4.44 ± 1.79 mm. In 45% hearts, the LCA was separated into the anterior inter ventricular branch and the circumflex branch (bifurcation). In 42.5% hearts, in addition to the anterior inter ventricular branch and the circumflex branch; there was a median artery that coursed on the front wall of the left ventricle (trifurcation). In 10% hearts, branching occurred as in trifurcation but with two median arteries emerging from the LCA (quadrifurcation). Myocardial bridges were found on the LCA branches in 19 of the 24 hearts in which the median artery existence of the median artery and myocardial bridges. The median artery might be important as it may not result in any clinical symptom for many years in a large number of subjects. Knowledge of individual and racial variations in coronary arteries is essential for the diagnosis and treatment of coronary artery patients.

Anatomic variations in the origin of the left circumflex coronary artery with angiography in Northern Indian population.

Introduction: Knowledge of the normal and variant anatomy and anomalies of coronary circulation is definitely a crucial component in the management of heart diseases. Complex cardiac surgical repairs demand enhanced understanding of the basic anatomy to improve the operative Outcomes Material and methods: The present study was planned by Department of Anatomy and was executed in collaboration with Department of Internal Medicine and Cardiology during 2010 to 2014 at a tertiary care teaching hospital located in western Uttar Pradesh. The angiographic data of 5,532 patients who underwent coronary angiography were considered for anomalous origin of the left circumflex coronary artery (LCx). Results: The incidence of anomalous origin of the LCx was found to be 0.36%. The LCx arose from the left coronary sinus of valsalva (there was separate orifice for the LCx and the left anterior descending coronary artery) in 45.0% patients, from the right coronary sinus of valsalva, (there was a separate orifice for the LCx and the right coronary artery) in 25.0% patients, from the proximal part of right coronary artery in 30.0% patients. Conclusion: On the basis of findings of the current study it can be concluded that, the anomalous origin of the LCx may not be benign all the time. In case where ischemia does not resolve accurately after successful treatment of a coronary stenosis, anomalous coronary arteries must be considered.