Closed reduction and percutaneous pinning in proximal humerus fratures-assessment of results using constant-murley shoulder scoring scale

The aim of the study was to assess the results of closed reduction and percutaneous pinning in proximalhumerus fracture using Constant-Murley shoulder outcome scoring scale. Experimental study. This study was conducted at KMSMC/AIMH and National Bones and JointsHospital Sialkot from July 20 1 3 to Dec 20 1 4. 20 patients having proximal humerus fractures were operated and closedreduction and percutaneous pin fixation was done. Out of 20 patients,1 1 patients [55%] were male and 9female [45%]. Right side was involved in 14 patients [70%] and left side in 6 patties [30%]. Age rangedb/w 30-50 years with an average age of 38.4 years. Mechanismsof injury were RTA in 10patients [50%], fall from height 6 patients [30%], fall while walking/stair climbing 4 patients [20%]. Thefollow up ranged from 6-18 months with an average follow up of 9 months. The patients were assessed postoperatively at the end of follow up using Constant-Murleyshoulder outcome scoring scale.12 patients [60%] had excellent, 5patients [25%] good, 2 patients [10%] fair and 1 patient [5%] had poor result. The mean Constant-Murley score at the end of follow upwas 88.2 points. The complications observed were; pin track infection 3 patients [15%], loosening of pin2 patients [10%], mild fracture displacement 1 patient [5%] and shoulder stiffness 2 patients [10%],Whereas, deep wound infection, avascular necrosis, hetrotophic ossification and neurovascular injurywere not seen in this study. All the fractures unite satisfactorily b/w 8-14 weeks with an average of 10weeks postoperatively. Closed reduction and percutaneous pin fixation in displaced fractures of proximal humerusis safe and effective procedure with negligible complications and should be adopted as the first line oftreatment if facilities are available

Results of hemiarthoplasty in basicervical fracture neck of femur [gardon type-III and IV]using austin moor prosthesis and their assessment in terms of charnley hip score and harris hip score

Objective: To determine the long term results of Hemiarthoplasty with Austin Moor Prosthesis and to evaluate the results in terms of Harris hip score and Charnley hip score

Study Design: Experimental study

Place and Duration of Study: The study was conducted at Khawaja Muhammad Safdar Medical College/Allama Iqbal Memorial Teaching Hospital, Sialkot from January, 2001 to December, 2011

Materials and Methods: Total 55 patients 40 male [72.72%] and 15 female [27.27%] were selected for study after Hemiarthroplasty with Austin Moor Prosthesis in elderly patients. The age range from 60 to 95 years with an average age of 68 years. 34 patients [61.81%] had Gardon type-III and 21 patients [38.18%] had Gardon type-IV fracture neck of the femur

Results: Post operatively, all patients were assessed radiologically as well as clinically with dual assessment scale using Harris hip score [pain 44 point, function 47 point, deformity 4 point, range of motion 5 point] and Charnley hip score in terms of pain, movement and walking ability with scale of 1 to 6. One being totally disable and six being a normal status. According to H.H.S. we noted 78.18% excellent, 14.54% good and 7.27% poor result at five years follow up and 70.83% excellent, 14.58 good and 14.58% poor results between five to ten years follow up in our study. As per Charnley hip score scale we noted 96.85% satisfactory results and 3.63% poor results at five years follow up and 77.08% satisfactory results at 5 to 10 years follow up in our study. The complications noted during follow up include; infection in 5 patients [9.09%], pain 10 patients [18.18%] shortening in 03 patients [5.45%], scatic nerve injury with foot drop [0%]. According to radiological assessment, we noted dislocation in 1 patient [1.08%], acetabulum protrusia in 2 patients [3.63%], osteolysis 5 patients [9.09%], calcar resorption 5 patients [9.05%], loosening of implant patients [12.72%]

Conclusion: Hemiarthroplasy in type-III and IV Basicervical fracture at the neck of femur with Austin Moor Prosthesis is simple, safe and cost effective method with low incidence of mortality and morbidity in old age patients and gives safely 8 to 10 pain free years to the patients