ABSTRACT
Background: Fractures of the tibial shaft are important for tworeasons. The first is that they are common, the second is thatthey are controversial - and anything that is both common andcontroversial must be important. Fractures of the shaft of thetibia cannot be treated by following simple sets of rules.Because of its location tibia is exposed to frequent injury and itis the most commonly fractured long bone.Objective: To evaluate the treatment of open tibial shaftfracture of Gustilo IIIA grade by Trans osseous osteosynthesistechnique with Illizarov External Fixator as a primary anddefinite mode of treatment.Methods: Clinical trial (Quasi Experimental study) fromJanuary 2009 to June 2010 (18 months) at National Institute ofTraumatology and Orthopaedic Rehabilitation Purposivesampling was done according to availability of the patients andstrictly considering the inclusion and exclusion criteria andsample size was 17 no of cases.Results: 14 male and 1 female patient between 17 and 51years were studied. Most common age group in this serieswere 26-35 year age group ((53.33%) and average age of thepatients was 30 years with SD of ±8.67. Most of the patientswere male and road traffic accident was the leading cause ofinjury (70.58%). Left side involved in (58.82%) most of thecases and 2 patients had bilateral fractures. Commonest site ofthe fractures were middle third (58.82%) of the tibia. Most ofthe fractures were comminuted type of fractures (47.05%).Most of the patients were operated on the day of admissionand in some cases within 4 - 7 days of admission. Averageduration of hospital stay was 8.06 days ranging from 1 day to28 days. Total duration of treatment was average 186.66 days(26 weeks) highest 291 days (42 weeks) and lowest 140 days(20 weeks). Most of the patient had soft tissue healing bygranulation tissue formation (35.29%). Others were treated byprimary closure, Delayed primary closure, secondary closure,partial thickness skin grafting.Conclusion: In this study the results of open tibia fracture(Gustilo IIIA) by Transosseous osteosynthesis technique withIlizarov External Fixator has been found to be satisfactory.Though there were a few minor complications with the fixatorthe dynamisation and compressing ability of this stable frameprovided good union without any second surgical procedure orbone grafting and prevented any malunion.
ABSTRACT
This was a clinical trial (quasi experimental) study carried outat the National Institute of Traumatology and OrthopedicRehabilitation (NITOR), Dhaka, between July 2004 to June2006, involving 16 patients with habitual dislocation of thepatella. All these cases were managed by Madigan operativeprocedure. Aim of this study was to evaluate the effectivenessof the madigan procedure in the treatment of habitualdislocation of the patella. Out of these 16 patients 2 weresubsequently lost from follow up. So, the study finally consistedof 14 patients. In this study non-random purposive techniqueas per inclusion and exclusion criteria was followed irrespectiveof sex. Most common age group in this study was 6-10 years(62.5%). The mean age of occurrence was 8.25 years.Repeated intramuscular injection on the thigh was thecommonest cause of dislocation found in 37.5% cases. Thesecond most common cause of dislocation was history of boil.Abscess or cellulitis on the thigh followed by contracture of thequadriceps muscles. Various postoperative complications likehypertrophic scar constituted (18.75%), stitch granuloma(6.25%), restriction of knee motion (6.25%) and re-dislocationoccurred in (6.25%) cases. Functional outcome in themanagement of habitual dislocation of the patella wasanalyzed by using the Hospital for Special Surgery (HSS) kneescore. Regarding the final or overall results in this series, therewere 71.43% cases were found satisfactory and the remaining28-57% were found unsatisfactory result.