Outcome of Isolated PCL Avulsion Fractures Treated with Cancellous Screw Fixation.

Background: Isolated PCL avulsion fractures are uncommon. The road traffic accidents (RTA), sports injuries are common causes along with domestic trauma. Methods: We conducted a prospective study with sample size of 34 patients to evaluate the outcome of isolated PCL avulsion fractures treated with cancellous cannulated screws over washers. Results: Our study included 47.06% RTA, 26.47% sports trauma and 26.47% domestic injuries. Standard Burks schaffers approach was used in all 34 cases. Delayed union was found in 5.88 % beyond 16 weeks although none needed revision or reconstruction. The delayed union was obvious in patients with comminuted fractures, which were fixed with washers on screws along with pull through sutures. All the cases were evaluated using Lysholm, IKDC and objective PDT manual examination. Conclusion: The isolated PCL avulsion fractures treated with fixation have good Lysholm and IKDC scores, although objective laxity is present in significant number of cases without subjective disability. The isolated PCL injuries have good results if managed surgically.

Transdeltoid Approach in Proximal Humerus Fractures: Outcome in 35 Cases and Review of Literature.

Background: Displaced proximal humerus fractures generally result in long-term functional disability. Recently, the advances in treatment for proximal humerus fracture have involved minimally invasive plating which offer minimal soft tissue damage and rapid and improved healing of the fracture. In recent literature, there has been a shift towards the deltoid splitting approach for the fixation of proximal humeral fractures due to the increased visualization of the posterior fragments as well as the less amount of soft tissue stripping. We used the deltoid splitting approach to evaluate the feasibility and outcomes as regards to axillary nerve injury, complications and functional deficits. Methods: Out of a total of 35 patients included in this study, 28 were male and 7 were female; with a mean age of 44 (range26 - 62yrs.). Results: In patients, the fracture of the proximal humerus was classified as type III; while 30 % (n=6) had type II fracture, according to Neer’s classification. Depending upon the fracture anatomy and the need for exposure, the skin incision was a continuous long incision in 7cases, with complete exploration of axillary nerve in the substance of deltoid; while in 13 cases, fixation was done using two separate skin windows. The mean follow up period was 26weeks (range 18-32 weeks). The average time to radiological union was14 weeks (range12-2 0 weeks). At final follow up, there were no cases of nonunion. There were 2 cases (10%) with varus malunion of the head fragment, and 1 case (5%) of acromial impingement. Axillary nerve palsy or deltoid dysfunction was not seen in any of the patients. The mean Constant- Murley score of shoulder function, at final follow up, was 78 (range 64-84). Graded according to the Constant shoulder score grading criteria, by calculating the difference of score between the involved shoulder and the uninvolved shoulder, 60% patients(n=12) had excellent, 35% (n=7) had good and 5% (n=1) had fair functional results. Conclusion: Thus deltoid splitting approach allows a feasible way to treat proximal humerus fractures with minimal axillary nerve injury, complications and functional deficits.

Cemented Total Hip Arthroplasty: A Study of 100 Cases.

Introduction: The cemented total hip athroplasty (THA) has been in existence for about three decades; however, objective outcome analysis of patients subjected to this procedure in India is lacking. At Joint Replacement Centre, Military Hospital (MH), Kirkee, Pune, Maharashtra, India, a large database of total hip arthroplasties exists. The cemented hip arthroplasties are being done regularly at MGM Medical College & Hospital, Kamothe. However, the functional results of cemented hips operated from 2003 to 2015 have been analyzed to assess the objective outcome. Materials and methods: A prospective and retrospective study of 100 cemented hips in 92 patients between 26 and 78 years of age was carried out. Sixty-one (74%) patients were in the age group of 50 to 70 years. The diagnosis of these patients was avascular necrosis: 40; rheumatoid arthritis: 15; ankylosing spondylitis: 8; osteoarthritis: 12; fracture neck femur: 16; and fracture femoral head: 1. In all patients, cemented THA using Indian Orthopedics (INOR) indigenous and Zimmer implants were done. Three types of implants were used, Charnley 22 mm head, 26 mm head using INOR modular system and collarless polished tapered Zimmer system. Eight cases had bilateral involvement. The cases were followed up for varying periods from 1 to 10 years. Results: The results were assessed by utilizing Charnley activity and pain score. There were 83% excellent, 8% good, 5% fair, and 4% poor results. Three cases required revision, two because of frank loosening, and one due to acetabular malpositioning. Charnley pain score improved from 2.2 preoperatively to 5.2 postoperatively (+ 28.3% change). Conclusion: The cemented THA is an excellent salvage procedure for advanced hip disorders resulting in pain and disability, especially in late age groups beyond 50 years.

Level of Recovery after Stable and Unstable Intertrochanteric Hip Fractures.

Introduction: Hip fracture is a major public health problem because of its prevalence, economic costs, and health consequences. Intertrochanteric hip fractures account for approximately half of the hip fractures in the elderly; out of this more than 50% fractures are unstable. Displacement and stability of an intertrochanteric fracture are an important determinant of treatment. Aims and objectives: To find out the level of recovery in different types of intertrochanteric hip fractures and to assess the functional capacity of patients who had an intertrochanteric hip fractures of different types. Materials and methods: Fourteen subjects who underwent hip surgery for stable or unstable intertrochanteric fracture with internal fixation since 6 months to 1 year in the age group of 40 to 60 years were analyzed using the Harris hip score (HHS) to assess the level of recovery of the patient. Results: Fourteen subjects with intertrochanteric fracture were recruited for the study. The pain component of HHS depicts that stable type of an intertrochanteric fracture displays a better mean pain score of 40.00 (SD = 0.00) compared to unstable t ype with a mean score of 3 6.29 (SD = 6.05) and the score for activity limitation concludes that there is less activity limitation in stable type compared to the unstable type of an intertrochanteric fracture with a mean score of 34.86 (SD = 6.69) and 23.86 (SD = 14.06) respectively. Deformity infers that stable type of intertrochanteric fracture shows less deformity at a score of 0.000 as compared to unstable type at 0.571 (SD = 1.51) and score for range of motion (ROM) is limited in stable type with a score of 3.86 (SD = 0.72) compared to 4.13 (SD = 0.55) scored by unstable type of intertrochanteric fracture group. The results for HHS shows stable type of intertrochanteric fracture displays a better HHS at 78.71 (SD = 6.18) compared to 64.85 (SD = 16.33) scored by unstable type group. A statistical comparison of HHS using Mann-Whitney U Statistic shows that there is no significant difference at 0.05 levels between stable and unstable type of intertrochanteric fracture groups. Conclusion: This study concludes that a descriptive statistics of HHS mean scores falling in favor of stable type of intertrochanteric fracture, but a statistical comparison using Mann-Whitney U Statistic shows that there is no significant difference at 0.05 levels between stable and unstable type of intertrochanteric fracture groups.