Dynamic hip screw [DHS] evaluation of stable and unstable intertrochanteric fracture of femur fixed

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

Diaphyseal femoral fractures; treatment by close v/s open intramedullary interlocking nail

To assess the best results of diaphyseal femoral fractures treated by closed intramedullary interlocking nail and open intramedullary interlocking nail. Cross sectional. Jan 2009 to Jan 2011. LUH Jamshoro / Hyderabad. Total 40 fractures of shaft of femur in 40 patients were treated with IMILN. All patients have same post operative follow up. Early range of motion exercises of hip and knee joint was started, pain management and 3rd generation cephalosporin intravenous antibiotics given for 5 days followed by oral antibiotics. Patients discharged as early as possible when patient's condition allowed and removal of stitches after two weeks. Patient's assessment regarding wound condition, range of movement of proximal and distal joints and fractures assessment radiologically and clinically was done every month. Majority of the cases were with the age groups of 37.5% between 21-30 years. RTA was found most common 70% of the cases. According to the AO classification oblique fractures were found most common 45%. On the assessment of final results in both close and open methods, 5% infection found in close method and 7.5% infection were in open method, less union time was found in closed group, deformity was equally found in both groups and heeling time was also less found in closed group. It is concluded that closed intramedullary interlocking nailing method is the best procedure with excellent union for the femoral fracture

Functional outcome of open diaphyseal tibial fracture treated by A.O fixation VS N.A fixation

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

Outcome of the closed diaphyseal humeral fracture treated with dynamic compression plate

To determine the treatment outcome of the closed diaphyseal humeral fracture treated with dynamic compression plate at Liaquat university hospital Hyderabad. Total 30 patients having displaced diaphyseal humeral fracture were included in the study. All the patients having fracture of less than 10 days and between the ages 15 - 45 years were selected. All the patients selected after counseling and diagnosed as a case of closed diaphyseal humeral shaft fracture on the basis of clinical examination and X-rays. In this study dynamic compression plates [DCP] were used for stabilization of humeral shaft fracture as assessed by pre operative workup, operative findings and outcomes were recorded with postoperative complications. To avoid the radial nerve palsy it is isolated during operative procedure. Present study was comprises of 30 patients with humeral fracture with the mean age of 30.29 +/- 8.92 years and male/ female ratio of 7:3. On the radiological findings most common type of fracture was oblique in 54%. From the complications, postoperative pain was found in 6.6% of the cases along with postoperative Infections in 10%. 90% fractures united while 10% fractures found with non union. Excellent result were seen in 60% of the cases, while 30% cases were noted with satisfied results and very poor results were found in 10% of the cases. It is concluded that DCP is the good option for the fixation of diaphyseal humerus fracture. Radial nerve palsy is less likely if isolated during operation

DCP with intramedullary interlocking nails; compare the outcome in closed diaphyseal humeral shaft fracture with type A1-2, A2-2 and A3

The objectives of the study are to compare the outcome of dynamic compression plates with intramedullary nails in closed diaphyseal humeral shaft fracture with type A1-2, A2-2 and A3. Comparative study. Study was carried out at the Orthopaedics Unit-I, Liaquat University Hospital Hyderabad / Jamshoro, from March 2007 to Feb 2009. Study consisted of 40 patients of diagnosed cases of closed diaphyseal humeral shaft fracture with type A1-2, A2-2 and A3. Patients were divided in two groups. Group A for dynamic compression plates and group B for intramedullary nails. Detailed Clinical examination of the patient was done and recorded in proforma. Systemic review was also done to see any major or minor head injury. All patients underwent for base line investigation. In Inclusion criteria; patients with type A1-2, A2-2 and A3-2 closed diaphyseal humeral shaft fracture, bilateral fractures, associated with minor head injuries, age between 20-40 years and fracture not more than two weeks old. In Exclusion criteria ; Open fracture, associated with severe chest or abdominal injuries, pathological fractures and malunited fractures with neurological deficit. Follow up of all these patients was done .1st four visit after every week, then alternet week upto 3rd month then monthly upto 6 month to assess any complication. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software version 16.0. In both groups male were 35[87.5%] and female 5[12.5%] with male: Female Ratio of 7:1. There was wide variation of age ranging from a minimum of 20 year to 40 year in both group. The mean age was 29.78+3.5 years. The most common cause of fracture shaft of humerus was road traffic accident [RTA]. There were 23[57.5%] patients who sustained fractures of the humerus following road traffic accidents. Eight [20%] cases had fractures shaft of humerus after fall from height and 9 [22.5%] cases had fractures shaft after assault. The Fracture pattern was Oblique in 22[55%] cases, Transverse in 12[30%] and Spiral in 6[15%]. Severity of post operative pain in both groups was recorded. Mild pain was felt in 10[50%] patients of DCP group and 6 [30%] patients of IMN group, Moderate pain was seen in 7[35%] patients of DCP group and 10 [50%] patients of IMN group, severe pain was described by 3[15%] patients in DCP group and 4 [20%] patients in IMN group. The complications seen in this study were Infection [1[5%] patients in DCP VS 0[0%] patients in IMN group], Iatrogenic palsy of radial nerve [1[5%] patients in DCP VS 0 [0%] patients in IMN group], Non union [1[5%] patients in DCP VS 1 [5%] patients in IMN group],Severe impingement [0[0%] patients in DCP VS 3 [15%] patients in IMN group], Adhesive capsulitis [0[0%] patients in DCP VS 2 [10%] patients in IMN group]. However minimal loss of fixation in 1 [5%] cases and late fracture occurred in one case 5%. The duration of hospital stay varied from 1 to 20 days. It was longer about -10-20 days in 12[60%] of DCP patients as compared to IMN cases where majority 11[55%] were discharged within 1 to 10 days. The mean hospital stay in DCP group was 15 days and IMN group was 13.5 days. Dynamic compression plate is a safe and effective procedure for treatment of humeral shaft fractures. With low threshold of complications it has significant advantages over intramedullary nails procedure revealed with earlier mobilization, minimum hospitalization and fast recovery towards normal life