Intramedullary Hip Screw (IMHS) for the Treatment of Intertrochanteric Hip Fracture: A Retrospective Study

Background: Intramedullary hip screw (IMHS) is a cephalomedullary nail used for surgical treatment of hip fracture for the past two decades but only a few studies have been reported. Aim of the study: To evaluate the effectiveness of IMHS for intertrochanteric fracture in Thammasat university hospital. Materials and methods: Ninety-two intertrochanteric fracture patients were retrospectively reviewed. Results: Mean operative time was 87 minutes (45-154 min) with an average blood loss of 150 ml (50- 300 ml). Intraoperative femoral shaft fracture was found in two cases which required the immediate exchange to long IMHS intraoperatively. One displaced large greater tuberosity fragment during nail insertion was treated by tension band wiring and five lateral cortex fractures were managed conservatively. Failed IMHS were found in 3 cases with two cases screw cut out the femoral head and one fracture extending from intertrochanter to the superior neck. All of these three cases were changed to hip prosthesis. Most of the patients stayed in the hospital for 3 weeks (61.4%), younger patients tend to have shorter hospital stay (<1 week) and preexisting medical complications may prolong hospitalization (>1 month). From this study, IMSH can safely treat a hip fracture patient and Sunyarn Niempoog, Sukanis Chumchuen, Chayanin Angthong, Krit Boontanapibul. Intramedullary Hip Screw (IMHS) for the Treatment of Intertrochanteric Hip Fracture: A Retrospective Study. IAIM, 2019; 6(8): 51-61. Page 52 its complications can be avoided by correct entry point, over-reaming and manually pushing the nail with use of a hammer and a centering sleeve.Conclusion: IMSH is a choice of treatment for hip fracture in Thais with a satisfactory outcome, and complications can be avoided by locating the correct entry point, over-reaming and manually push the nail while using a hammer and a centering sleeve

Local injection of dexamethasone for the treatment of carpal tunnel syndrome in pregnancy.

OBJECTIVE: To evaluate the results of 4 mg of dexamethasone acetate injections for the treatment of carpal tunnel syndrome in pregnancy. MATERIAL AND METHOD: Twenty-four pregnant volunteers who suffered from carpal tunnel syndrome occurring in the third trimester of their pregnancies were injected with 4 mg of dexamethasone acetate combined with 1% lidocaine into the carpal tunnels. The volunteers filled the Boston symptom severity questionnaire and were examined by Phalen's test, Semmes-Weinstein monofilament test, grip strength, and pinch strength before injection, one month after injection, and one month after delivery. RESULTS: There was significant improvement of symptoms, grip strength and pinch strength of the injected hand compared with the opposite side at one month after injection (p < 0.01). However, after delivery, the symptoms of carpal tunnel syndrome improved on both the injected and opposite hands. CONCLUSION: Carpal tunnel syndrome in pregnancy is generally resolved after delivery and, therefore, should be treated conservatively. The patient with severe symptoms can be treated with dexamethasone injection in the third trimester with good results.

An estimation of grip strength during puberty.

OBJECTIVE: Find the correlation of grip strength in puberty with chronological age, height, weight, and percentage of body fat. MATERIAL AND METHOD: One thousand one hundred and five volunteer students between 11 and 14 years of age in Central Thailand participated in the study. The body weight and height were measured with standard balance and stadiometer The percentage of body fat was measured with Near Infrared interactance device. The grip strength was measured with Digital Handgrip Dynamometer The results were statistically analyzed by multiple linear regression. RESULTS: It was found that grip strength has a significant correlation with age, height, and weight but not with percentage of body fat. The prediction of grip strength in puberty can be estimated with the following equations: a) For boys, Grip strength (kg) = -59.797 + 2.493 Age (yr) + 0.308 Height (cm) + 0.147 Weight (kg), and b) For girls, Grip strength (kg) = -32.887 + 0.926 Age (yr) + 0.236 Height (cm) + 0.155 Weight (kg). CONCLUSION: The predictive value of an age, height, and weight equation is more precise than that of solely chronological age.

Comminuted Rolando's fractures: treatment with modified wrist external fixator and transmetacarpal pinning.

BACKGROUND: For comminuted Rolando's fracture, external fixation with early mobilization is the treatment of choice however, there is controversy in this treatment. Low-profile or mini external fixator can be used, but expense and availability of this kind of implant in Thailand has resulted in using various techniques of surgery. The purpose of this retrospective study was to present the authors' alternative technique with modified implants and the outcome in the management of comminuted Rolando's fracture. MATERIAL AND METHOD: The patients with comminuted Rolando's fracture were treated by using external fixation across the wrist (mostly by locally-made implants) between the radius and the first metacarpal and transmetacarpal K-wire fixation from the first to the second metacarpal. RESULTS: Between 1999 and 2005, six patients with a mean age of 25 years (range, 19-33 years) were studied The average follow-up period was four months. Satisfactory reductions were achieved in all fractures. The average operation time was 27.5 minutes. All closed fractures united within six weeks and had satisfactory results, which was normal range of motion of thumbs and wrists and with no complications. Only one opened fracture caused by a gun shot injury was healed in eight weeks and had a mild degree of reflex sympathetic dystrophy. CONCLUSION: Closed reduction and external fixation with modified wrist external fixator and transmetacarpal pinning is simple, safe, fast, and effective for the treatment of comminuted Rolando's fractures.