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ABSTRACT Objectives Our purpose was to evaluate the clinical results of PCL tibial avulsion fracture fixation performed with 4 mm cancellous screws using a dual posteromedial (PM) portal technique. Methods In a prospective study, we followed 12 patients submitted to PCL tibial insertion avulsion arthroscopic fixation using dual PM portals with cancellous screws from March 2014 to Jan 2020. The proximal higher PM portal served as an instrument portal and provided an optimal trajectory for arthroscopic screw fixation of larger PCL avulsion fractures. The lower PM portal was used as a viewing portal. Results Significant improvements were found between the preoperative and postoperative mean Lysholm scores at six months. The preoperative IKDC score mean of 10.13 increased to 89.3 at the end of six months. Minor adverse results with this technique were: grade I on posterior sag in five knees (41.6%), temporary stiffness in two cases (16.7 %), delayed union in one patient (8.3 %), and difficulty squatting at the end of six months in one patient (8.3%). Temporary extension lag was present in two individuals (16.7%), and fixed subtle flexion deficit of 3-5 degrees occurred in one individual (8.3 %). Conclusion The outcomes obtained with the proposed technique were similar to those obtained with open techniques, although mild flexion deficits and discreet posterior sag may be present in a significant number of cases. Level of Evidence II; Prospective Cohort Study.
RESUMO Objetivos O objetivo foi avaliar os resultados clínicos da fixação da fratura da avulsão tibial PCL realizada com parafusos esponjosos de 4 mm, utilizando uma técnica de portal postero-medial (PM) duplo. Métodos Em um estudo prospectivo, acompanhamos 12 pacientes submetidos à fixação da avulsão tibial de inserção PCL por via artroscópica utilizando portais duplos PM com parafusos esponjosos de março de 2014 a janeiro de 2020. O portal PM proximal superior serviu como um portal de instrumentos e forneceu uma trajetória ideal para a fixação artroscópica com parafusos de fixação de fraturas avulsas PCL maiores. O portal PM inferior foi usado como um portal de visualização. Resultados Foram encontradas melhorias significativas entre o pré-operatório e o pós-operatório, com pontuação média de Lysholm aos seis meses. A pontuação média do IKDC pré-operatório de 10,13 aumentou para 89,3 no final dos seis meses. Os resultados adversos menores com esta técnica foram: grau I na flacidez posterior de cinco joelhos (41,6%), rigidez temporária em dois casos (16,7%), união tardia em um paciente (8,3%) e dificuldade de agachamento ao final de seis meses em um paciente (8,3%). O atraso temporário da extensão estava presente em dois indivíduos (16,7%) e o déficit de flexão sutil fixo de 3-5 graus ocorreu em um indivíduo (8,3%). Conclusão Os resultados obtidos com a técnica proposta foram similares aos obtidos com técnicas abertas, embora déficits leves de flexão e discreta flacidez posterior possam estar presentes em um número significativo de casos. Nível de Evidência II; Estudo de Coorte Prospectivo.
ABSTRACT
Background: Isolated PCL avulsion fractures are uncommon. The road traffic accidents (RTA), sports injuries are common causes along with domestic trauma. Methods: We conducted a prospective study with sample size of 34 patients to evaluate the outcome of isolated PCL avulsion fractures treated with cancellous cannulated screws over washers. Results: Our study included 47.06% RTA, 26.47% sports trauma and 26.47% domestic injuries. Standard Burks schaffers approach was used in all 34 cases. Delayed union was found in 5.88 % beyond 16 weeks although none needed revision or reconstruction. The delayed union was obvious in patients with comminuted fractures, which were fixed with washers on screws along with pull through sutures. All the cases were evaluated using Lysholm, IKDC and objective PDT manual examination. Conclusion: The isolated PCL avulsion fractures treated with fixation have good Lysholm and IKDC scores, although objective laxity is present in significant number of cases without subjective disability. The isolated PCL injuries have good results if managed surgically.
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Background: Displaced proximal humerus fractures generally result in long-term functional disability. Recently, the advances in treatment for proximal humerus fracture have involved minimally invasive plating which offer minimal soft tissue damage and rapid and improved healing of the fracture. In recent literature, there has been a shift towards the deltoid splitting approach for the fixation of proximal humeral fractures due to the increased visualization of the posterior fragments as well as the less amount of soft tissue stripping. We used the deltoid splitting approach to evaluate the feasibility and outcomes as regards to axillary nerve injury, complications and functional deficits. Methods: Out of a total of 35 patients included in this study, 28 were male and 7 were female; with a mean age of 44 (range26 - 62yrs.). Results: In patients, the fracture of the proximal humerus was classified as type III; while 30 % (n=6) had type II fracture, according to Neer’s classification. Depending upon the fracture anatomy and the need for exposure, the skin incision was a continuous long incision in 7cases, with complete exploration of axillary nerve in the substance of deltoid; while in 13 cases, fixation was done using two separate skin windows. The mean follow up period was 26weeks (range 18-32 weeks). The average time to radiological union was14 weeks (range12-2 0 weeks). At final follow up, there were no cases of nonunion. There were 2 cases (10%) with varus malunion of the head fragment, and 1 case (5%) of acromial impingement. Axillary nerve palsy or deltoid dysfunction was not seen in any of the patients. The mean Constant- Murley score of shoulder function, at final follow up, was 78 (range 64-84). Graded according to the Constant shoulder score grading criteria, by calculating the difference of score between the involved shoulder and the uninvolved shoulder, 60% patients(n=12) had excellent, 35% (n=7) had good and 5% (n=1) had fair functional results. Conclusion: Thus deltoid splitting approach allows a feasible way to treat proximal humerus fractures with minimal axillary nerve injury, complications and functional deficits.
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Introduction: The cemented total hip athroplasty (THA) has been in existence for about three decades; however, objective outcome analysis of patients subjected to this procedure in India is lacking. At Joint Replacement Centre, Military Hospital (MH), Kirkee, Pune, Maharashtra, India, a large database of total hip arthroplasties exists. The cemented hip arthroplasties are being done regularly at MGM Medical College & Hospital, Kamothe. However, the functional results of cemented hips operated from 2003 to 2015 have been analyzed to assess the objective outcome. Materials and methods: A prospective and retrospective study of 100 cemented hips in 92 patients between 26 and 78 years of age was carried out. Sixty-one (74%) patients were in the age group of 50 to 70 years. The diagnosis of these patients was avascular necrosis: 40; rheumatoid arthritis: 15; ankylosing spondylitis: 8; osteoarthritis: 12; fracture neck femur: 16; and fracture femoral head: 1. In all patients, cemented THA using Indian Orthopedics (INOR) indigenous and Zimmer implants were done. Three types of implants were used, Charnley 22 mm head, 26 mm head using INOR modular system and collarless polished tapered Zimmer system. Eight cases had bilateral involvement. The cases were followed up for varying periods from 1 to 10 years. Results: The results were assessed by utilizing Charnley activity and pain score. There were 83% excellent, 8% good, 5% fair, and 4% poor results. Three cases required revision, two because of frank loosening, and one due to acetabular malpositioning. Charnley pain score improved from 2.2 preoperatively to 5.2 postoperatively (+ 28.3% change). Conclusion: The cemented THA is an excellent salvage procedure for advanced hip disorders resulting in pain and disability, especially in late age groups beyond 50 years.