ABSTRACT
Background: Management of tibial plateau fractures remains challenging because of their number, variety and associated soft tissue injuries that further augment their complexity. proper management of the initial injury aims to obtain a stable, painless, mobile joint and to prevent the development of osteoarthritis. Anatomical restoration of articular surface and stable fixation are essential to achieve this goal. This study highlights the operative reduction and internal fixation of tibial plateau fractures and compare the results of fixation with only cannulated cancellous screws and plates. Methods: Institution based randomized, prospective, retrospective and observational study comprising of 30 patients attending Orthopaedics emergency or O.P.D. of age group 25-65 years with closed tibial plateau fractures. The outcome of treatment is assessed clinico-radiologically. Results: In our study we obtained overall excellent (76.2% cases) to good functional results (23.8% cases) by operative treatment with plate osteosynthesis for Tibial plateau fractures. All the patients treated with only cannulated cancellous screws had excellent functional outcome. Conclusion:The operative management of Tibial plateau fractures has definite advantages over conservative management. Percutaneous or open fixation using cannulated cancellous screws gives excellent functional results. But it is not suitable for severely depressed or comminuted fractures. Percutaneous and minimally invasive plate fixation method is more biological, requires less surgical time, less hospital stay, has minimum complications and has a good functional outcome. There is no ideal implant for these fractures, however, soft tissue handling is very important during surgery.
ABSTRACT
Background: ISpondylolisthesis is defined as anterior or posterior slipping of one segment of the spine on the next lower segment. The mainstay of surgical treatment for adult patients with low-grade acquired spondylolytic spondylolisthesis is fusion, with or without decompression. Objectives: To study the safety, efficacy and functional outcome of surgical management of lumbo-sacral spondylolisthesis with pedicle screw fixation, and free bone grafting, and its associated complications. Methods: 10 adult patients with lumbosacral spondylolisthesis treated by instrumented posterior spinal fusion with free iliac chips bone graft and their followup with functional and radiological parameters. Results: Following operation 5 patients(50%) having excellent results & 2 patients(20%) have good results. Conclusion:Instrumented posterior fusion with free graft is a good option for symptomatic lumbosacral spondylolisthesis and also has added advantages of correction of olisthesis, three column stabilization and early mobilization.
ABSTRACT
Background: Osteoarthritis is now considered to be primarily a disease of cartilage in which intrinsic biomechanical and mechanical alterations lead to its breakdown. Increasing failure of conservative treatment lead surgeons to explore the operative arena. High Tibial Osteotomy (HTO) is a satisfactory surgical method in knees with unicompartmental osteoarthritis and angular deformity. Objectives: To manage medial uni-compartment osteoarthritis of knee with medial open wedge or lateral closing wedge osteotomy and to compare between the two. Methods: HTO of 20 adult patients with medial compartment osteoarthritis or medial bicompartment osteoarthritis with genu varum deformity and their followup with functional and radiological parameters. Results: Following operation 12 patients having excellent results & 8 patients (40%) having good results. 19(95%) patients were satisfied. Conclusion: There is no significant statistical difference between the patients undergoing medial open wedge and lateral close wedge high tibial osteotomy except for medial joint space. Medial Open Wedge is technically easy with fewer risks, hence preferred over lateral close wedge.