Minimal invasive plate osteosynthesis of close fractures of distal tibia

Background: The limited soft tissue, subcutaneous location and poor vascularity render the tibial fractures very challenging. Treatment of distal tibial fractures using minimally invasive plate osteosynthesis [MIPO] technique may minimise damage to soft tissues and the vascular integrity of bony fragments, leaving comminuted fragments out of the mechanical construct, preserving soft tissues with limited operative exposure. This descriptive study was conducted to assess the outcome of patients treated with MIPO technique for distal tibial fractures. Methods: Seventy three cases of multifragmentary fractures of the distal tibia admitted in Bahawal Victoria Hospitals, Bahawalpur between April 2009 and October 2010 were included in this study. Patient's outcome in terms of period of radiologic union of the fractured segments and period of full weight bearing capacity were accessed. Results: There were 66 males and 7 females of mean age 43 years. The mean follow-up period was 13 weeks. [Ranging from 9–16 weeks]. All patients were fully weight bearing at 16 weeks [ranging 9–16 weeks] showing radiological union. There were two superficial infections treated successfully using oral antibiotics and no failures of fixation. There were no cases of rotational malalignment. Conclusion: MIPO is an effective method of treatment for distal tibial fractures. The use of indirect reduction techniques and small incisions is technically demanding but decreases surgical trauma to soft tissues. Keywords: Distal tibial fractures, Minimally invasive plate osteosynthesis, MIPO

Results of non anatomical fixation of unstable pertrochanteric fracture femur

To evaluate the results of union in unstable pertrochanteric fracture of femur in nonanatomical reduction and fixation. A descriptive study conducted at Department of Orthopaedic surgery Bahawal Victoria Hospital Bahawalpur. In the present study, we had 30 patients with unstable intertrochanteric fractures of either sex. Patients were treated by nonanatomic reduction, either by Dimon Houghsten or Sarmiento osteotomy depending upon fracture geometry, and fixed by dynamic hip screw. Out of thirty patients, 21[70%] were male and 9 [30%] were female. The average age of male patients was 74.9 years and that of female was 61.2 years. We included patients with Jensen's type IV fractures having osteoporotic grade of four to six according to Singh's index. Patients were followed up for minimum period of 20 weeks and evaluated for radiological union and functional outcome using Sikorski and Barrington's pain and mobility scale. Out of thirty patients, only 25 completed the follow up. Four patients had limb length discrepancy. 88% of the patients had excellent to good functional outcome. Anatomical reduction must be tried in all cases. However, to avoid the complications of implant failure and loss of reduction with varus union in unstable fractures, non anatomical reduction should be considered