Short term outcome of open reduction and internal fixation with plating in displaced intra articular calcaneal fractures

Background: Calcaneum fractures constitute the majority of the tarsal bone fractures worldwide. There is no gold standard consensus as of now for the management of the displaced intra articular calcaneal fractures. Open reduction and internal fixation with plating is one of the management options available.Methods: Authors studied the results of open reduction and internal fixation with plating in 22 calcaneal fractures in a study with a minimum follow up of 6 months. Outcome was studied using Maryland foot score.Results: Authors observed excellent results in 5 patients (22.72%), good results in 12 patients (54.54%), fair results in 4 patients (18.18%) and poor result in 1 patient (04.54%). Authors encountered wound infection in 1 patient (4.54%), heel varus in 1 patient (4.54%), heel broadening in 1 patient (4.54%), reduced range of motion at ankle in 2 patients (9.9%) and persistent heel pain in 1 patient (4.54%).Conclusions: Open Reduction and Internal Fixation (ORIF) with calcaneum plating, through an extensive lateral approach, for displaced intra articular fractures of the calcaneum is an effective treatment modality with very good results in experienced hands.

A Prospective Randomised Controlled Study For Assessment Of Use Of Pneumatic Tourniquet In Above Knee Amputation Of Ischemic Limb In Peripheral Vascular Disease

This is a prospective randomised controlled study for assessment of use of pneumatic tourniquet in above knee amputation of ischemic limb in peripheral vascular disease. The use of tourniquet is said to be a contraindication during surgeries involving amputations in peripheral vascular disease as they might injure the already compromised arteries above the planned level of amputation. Taking into consideration the promising results from some previously done studies, we assumed that the use of a pneumatic tourniquet has potential to improve the outcome following trans–femoral amputation without jeopardizing the healing of surgical stump wound. We selected forty patients for our study. All of them with non salvageable limb due to peripheral vascular disease. They were further randomized to either tourniquet or no tourniquet (control) group. Various parameters noted were intra–operative loss of blood (P<0.0001), post–operative need of transfusions (P<0.037), post–operative fall in haemoglobin(P<0.0001), wound healing, wound dehiscence/ eakdown and revision of amputation. Results of the trial showed that the use of a tourniquet during above knee amputation in peripheral vascular disease significantly reduces intra operative blood loss consequently reducing fall in post operative Haemoglobin and need for blood transfusion

Management of displaced transverse fractures of the patella using tension band wiring with or without circumferential cerclage wiring: A comparative study

Background: Transverse fractures of body of the patella are by far the most common fractures of this bone. Surgical fixation is the recommended treatment in displaced fractures with extensor lag. Although, tension band wiring (TBW) technique is the gold standard for these fractures, few surgeons recommend augmentation with circumferential cerclage wiring to improve the strength of the fixation. We compared the results of the internal fixation of displaced transverse fractures of the patella using TBW and circumferential cerclage wiring with those treated with TBW alone. Methods: We treated 54 displaced transverse fractures of the patella at our institution. We segregated the patients into two groups: Group 1 (n=23) included fractures treated with tension band wiring (TBW) along with augmented circumferential cerclage wiring while as Group 2 (n=31) included fractures treated by TBW alone. Outcome was studied, graded and compared on the basis of knee pain, knee stiffness, quadriceps wasting, loss of flexion and loss of extension. Results: 73.90% patients among group 1 and 70.96% among group 2 showed excellent to good results (P value < 0.1). Fixation failure and need for revision surgery among group 1 and group 2 was found to be 8.69% and 9.67%, respectively (P value < 0.6). Infections and non union occurred among 4.34% patients in group 1 whereas in group 2 it was 6.45% of the patients who encountered the same (P value < 0.6). Conclusions: The use of circumferential cerclage wiring along with tension band wiring for displaced transverse fractures of patella seems to have no added advantage over fixation with tension band wiring alone. Keywords: Patella fracture, Tension band wiring, cerclage wiring