ABSTRACT
Introduction: The dual plate osteosynthesis technique for fixation of inter-condylar distal humerus fracture is now considered an accepted treatment modality. It provides a rigid fixation of fracture fragments to enable early post-operative mobilization for good outcome
Objective: The purpose of study is to assess the morbidity and clinico-radiological outcome of the dual plating osteosynthesis technique used for fixation of inter-condylar distal humerus fractures [DHF] via trans-olecranon approach
Methodology: This perspective cross sectional study was carried at Department of Orthopaedic Surgery, Dow Medical College / Civil Hospital Karachi from June 2014 to March 2016. A total of 21adult patients with comminuted inter-condylar fracture of the distal humerus operated with dual plating osteosynthesis technique via trans-olecranon approach were evaluated clinically and radiologically for functional outcome based on Jupiter criteria including alignment and fracture union after a mean follow-up of 8 months. Post surgical complications were noted. Fractures were classified according to Muller et al [AO]. Patients with polytrauma, pathological fracture, open fracture and a fracture more than 2 week old were excluded from the study
Results: Out of the 21 patients, 38% were female and 62% were male. 52.3% had left elbow while 47.6% had right elbow involvement. The mean age was 31 years [range 20 - 50 years]. Mean time between injury and internal fixation was 4.8 days. The mean follow-up period was 8 months. As per AO classification, 10 cases were C1, 7 cases C2 while 4 cases were in C3. The most common cause of fracture was road traffic accident in 13 cases. All fractures achieved anatomical restoration of articular surface and were united in average 14.6 weeks. The clinical results were evaluated for functional outcome based on Jupiter criteria. According to that criterion, satisfactory results were obtained in all patients. We had no instance of postoperative deep infection and neurological complications, only Backing of olecranon K-wires were noted in 5 patients [23.8%]
Conclusions: We conclude that dual plate osteosynthesis technique is an effective procedure for fixation of inter-condylar distal humerus fracture, achieves rigid fixation and hence, early mobilization. Additionally use of olecranon osteotomy offers best fracture exposure of distal humerus. Complications were minimal and healing satisfactory
ABSTRACT
Objectives: To analyze the comparative results of dynamic DHS fixation in stable and the unstable intertrochanteric fractures at LUH. Study Design: Comparative study. Setting: Orthopedic unit I of LUH Jamshoro. Period: 26[th] May 2010 - 25[th] August 2011
Methodology: All 40 patients with femur intertrochanteric fracture were enlisted. All cases isolated in 2 groups every having 20 patients, group A stable fracture and group B unstable fractures. After complete physical examination, examinations and fracture arrangement evaluation, patients were readied for operation. Fracture table was used in each operation. Fracture reduction was initially attempted by close manipulation and was successful in 30 [75%] cases. Lateral approach for proximal femur was used in every case. All fractures, whether stable or unstable, were reduced anatomically without any type of osteotomy and then fixed with 135o dynamic hip screw
Results: Mean age was 62.8.2 years of the cases. Gender ratio was 3:1. According to mode of injury were found RTA in 21 [70%] patients. Postoperative complications were recorded as; superficial infection noted in 2 [5%] patients and there was no case of deep infection. Average stay of hospital found 16.5 days in 17 [42.5%] patients belongs to stable group and 06 [15%] patients belong to unstable group. All [n=40] patients were pain free on their discharge from hospital. In all [n=40] patients we achieved union and there was no case of delayed union or non-union. We assessed functional outcome of our patients on the base of Stinchfield Hip Assessment system. According to SHAS 28 [70%] patients were excellent, 05 [12.5%] patients were good, 04 [10%] were fair and 03 [7.5] were poor. We had not found mortality in our patients
Conclusions: According to our conclusion DHS is the best implant for intertrochanteric fracture fixation. No matter; whether fracture is stable, unstable and fresh or old
Subject(s)
Humans , Male , Female , Middle Aged , Adult , Femur , Incidence , Bone ScrewsABSTRACT
To determine postoperative complications including with ambulation improvement and condition in elderly patients with fracture neck of femur treated by Austin-Moore hemiarthroplasty during 6 months period postoperatively at Peoples medical university Hospital Nawabshah. Descriptive case series study. This study was carried out at Peoples Medical University Hospital Nawabshah and Liaquat University Hospital Hyderabad from July 2012 to July 2014. Total 100 elderly patients with femoral neck fracture with the age of above 60 years were included in the study. The patients were followed for a period of 6 months postoperatively and all the postoperative complications were documented in the proforma. This study was contains total of 100 elder patients with femur neck fracture majority of male 72%. Most common 69% age group of the elder patients was 60 - 69, years of the age. Fractures were present 55% on the left sides while 45%. Majority of the cases were found with co morbidies 58%, and according to the post operative complications wound problem was found most common 21% along with implant infection 9%, 2[nd] most common complication was bed sore 11%. On the outcome excellent results were found 32.60%, good results were 42.70%, while fair and poor results were as 16.30% and 8.40% respectively. While 17%, death was recorded during 6 month of postoperative time. Austen Moor Hemiarthoplasty is the good surgical technique of the management for the fracture of the femur. It is very cost effect treatment along with very small amount of morbidity and mortality
Subject(s)
Humans , Male , Female , Hemiarthroplasty , Aged , Postoperative Complications , Patient Outcome Assessment , Walking , MortalityABSTRACT
To evaluate the short term results of open reduction and internal fixation with cross k-wires in type III supracondylar fracture of Humerus in children in our setup
PATIENTS and METHODS: This prospective study was conducted at Department of Orthopaedic Surgery and Traumatology, Liaquat University of Medical and Health Sciences, Jamshoro from March 2012 to March 2014. Total forty-seven patients with type III supracondylar Fracture Humerus were evaluated in this series. All were treated with open reduction and internal fixation with cross k-wires. The children followed regularly and the cosmetic and functional results assessed according to the Flynn criteria
RESULTS: The mean age in our series was 7.4 years. There were 35 boys and 12 girls
The most common mode of injury 72.34% was fall during play. In 95.75% of our cases injury was extension type and in 4.25% flexion type. Grade I pin tract infection was noted in only 3 patients. 69% cases have excellent cosmetic and functional results, 22% were having good cosmetic and functional results according to Flynn Criteria
CONCLUSION: Open reduction and internal fixation with cross k-wires produce excellent to good results in Gartland type III supracondylar fracture especially in the areas where image intensifier facilities are limited
ABSTRACT
To evaluate the comparative results of open diaphseal tibial fractures treated with A.O fixation and N.A fixation. Comparative and experimental study. This study was carried out at Orthopedic Department of Liaquat University Hospital Hyderabad from February 2011 to January 2013. Total 50 cases were included in this study. All the cases with diabetic mellitus and associated head and abdominal injuries were excluded from the study. All the cases were divided in two groups equally 25 patients in group A, treated by N.A fixator and 25 patients treated with A.O fixator were selected in group B. Initial resuscitation, splintage and primary care for the wound was provided in the emergency department, any bone fragments that were protruding out were covered with sterile dressing. After counseling the patient and attendants regarding the condition of injury, its importance and possible complications, also explained about the method of treatment selected [Group A or Group B] then the patients were taken to the operating room. The mean age +/- SD in group A [NAEF, n = 25] was 35.4 + 9.22 years and 32.10 +/- 9.69 years in groups B [AOEF, n = 25], Out of total cases, male were in majority. Majority of patients were found RTA in both groups. In the group A [NAEF], pin tract infection 5[20.0%] cases, pin site osteolysis 5[20.0%], pin loosening 5[20.0%], pin site inflammation were in 3[12.0%] cases, which were cured by curettage of the outer cortex and oral antibiotics for a short period, 1[4.0%] patient went in infective nonunion and converted into Illizarrov external fixator. Knee stiffness was found in 2[8.0%] and Ankle stiffness was 3[12.0%] cases, in group A [NAEF] and 3[12.0%] in group B. Five [20.0%] patients of group A [NAEF] had mild limitation of ankle motion [mainly dorsiflexion] and 3[12.0%] were with Limited Flexion, patients of group B were without limitation of knee motion with a flexion ranges of 5[20.0%]. AO external fixator is much better than Naseer Awais External Fixator. It is simple and safe to apply, cost effective and successful management of open tibial fractures
ABSTRACT
Objective: The aims and objectives of the study are to compare the results of tibial plateau fracture treated by plaster of paris cast and percutaneous screw fixation. Study design: Comparative study. Place and duration of study: Study was carried out at the Orthopaedics Unit-II, Liaquat University Hospital Hyderabad / Jamshoro, from January February 2010 to october 2011
Methodology: Between February 2010 to october 2011, 31 men and 9 women aged 20 to 40 years with means 28.25 years underwent plaster of paris and percutaneous screw fixation for schatzkar type I closed tibial plataue fracture in Orthopaedics Unit-II, Liaquat University Hospital Hyderabad / Jamshoro. Data was analyzed through SPSS software version 16.0
Results: In both groups 31[77.5%] men and 9[22.5%] women with male: female ratio of 3.4:1 and aged 20 to 40 years with means 28.25 years. Union time range 10 to 24 weeks in both groups[p value 0.001]. The mean healing time in PSF group was 11.6 weeks while in POP group it was 13.9 weeks. The complications seen in this study were pain during walking [5 [25%] patients in POP VS 3 [15%] patients in PSF group], knee stiffness [4[20%] patients in POP VS 2 [20%] patients in PSF group ], ankle stiffness [3[15%] patients in POP VS 1[5%] patients in PSF group], delay union [2[10%] patients in POP VS 1[5%] patients in PSF group ], non union [2[10%] patients in POP VS 0[0%] patients in PSF group ] P value 0.040. The longer duration of hospital stay about -10-20 days in 13[65%] of POP patients as compared to PSF cases where majority 16[80%] were discharged within 1 to 10 days[ p value 0.148]. The patients with complications had still longer stay in both group. The mean hospital stay in POP group was 14.6 days and PSF group was 8.4 days. The clinical results seen in this study were excellent [5[25%] patients in POP VS 13[65%] patients in PSF group], good [8[40%] patients in POP VS 5[25%] patients in PSF group], fair [5 [25%] patients in POP VS 2 [10%] patients in PSF group ] and poor [2[10%] patients in POP VS 0 [00%] patients in PSF group
Conclusions: We conclude that percutaneous screw fixation gives better results in type I schatzkartibial plateau fracture compared to plaster of paris cast. The complications were seen higher in POP cast
ABSTRACT
OBJECTIVE: To observe the results of chondrodiastasis / physeal distraction in the management of pseudarthrosis of tibia by Ilizarov ring fixator
PATIENTS AND METHODS: Nine patients, seven males and two females, with congenital pseudarthrosis of tibia were treated from February2008 to April 2012. The age at the onset of Ilizarov treatment was 10 to 12 years. Meticulous and complete resection of the sclerotic bone ends and surrounding fibrous hamartoma, and reopening of the medullary canals was done. Two navigation wires were passed through both the malleoli. Generous autogenous bone graft was placed, harvested from the ipsilateral iliac crest. Advanced hybrid Ilizarov ring fixator was applied. Acute compression at the pseudarthrosis site was done. One ring was applied in the proximal tibial epiphysis. Fracture was done at proximal physeal plate by rotatory movements. Fibula attached proximally and distally to proximal and distal rings. Distraction was started on the 5th day at the rate of 0.5 mm/24 hours for 10 days. Later on distraction rate was accelerated to 1mm/day with a rhythm of 0.25 mm/6 hourly. Ankle deformities were addressed accordingly
RESULTS: Union was achieved in all the nine cases at the time of frame removal. All the other associated deformities were addressed simultaneously while the frame was on. Leg length discrepancy was addressed by physeal distraction. Growth was not arrested in all cases after physeal distraction
CONCLUSION: Ilizarov ring fixator remains the treatment of choice to achieve refracture free union till 4 years in congenital pseudarthrosis of tibia, one of the most perplexing and challenging orthopedic problems. And there is no physeal arrest after physeal distraction to treat leg length discrepancy
ABSTRACT
Object: To evaluate the risk of lag screw cut out in unstable intertrochanteric fractures
Material and Methods: This study was conducted in the Department of Orthopedic Surgery and Traumatology [DOST] Liaquat University of Medical and Health sciences Jamshoro from January 2006 to December 2009. Unstable intertrochanteric fractures type A2 and A3 of AO classification fixed with DHS in stable [anatomic and wayn county] reduction, were included in study. All patients were assessed on six months follow up x-rays for cut out failure in different positions for placement of screw in femoral head. For placement of screw, femoral head was divided in 9 columns/zones on antero-posterior and lateral plane x-rays
Results: Out of total 66 study subjects 45 [68.1%] were males and 21 [31.8%] were females, 56 [84.8%] were of A2 and 10 [15.2%] of A3 type. Mean age was 65.41 years. Forty [60.6%] patients were fixed in anatomical reduction and 26 [39.3%] in wayn county reduction. The screw placement was 24 [36.3%] in central -central, 9 [13.6%] in central -inferior, 17 [25.7%] in posteriorinferior and 16 [24.2%] in remaining off central [unsatisfactory] zones. The cut out was in 2 patients [8.3%] in central-central , 0% in central inferior position , 3 patients [17.6%] in posterior inferior and 4 patients [25%] in remaining off central zones [all cut out were in superior zones of femoral head]
Conclusion: We conclude that placement of lag screw in inferior on AP and central on lateral view in femoral head gives excellent results after achieving stable reduction, having maximum bone to plow for cut out. But it is difficult and time consuming so if it is aimed in lower half on AP and central on lateral view in femoral head it will give better results