Functional Outcome of Intra–Articular Proximal Tibia Fractures (41C) Treated with Dual Plate Osteosynthesis

The fractures of proximal tibia particularly plateau fractures are more difficult to treat due to complexity of configuration and associated soft tissue injuries. AO 41C fractures are high energy fractures often accompanied by other injuries and complications, such as postoperative inflammation, wound problems and infections. Aim and objectives: functional outcome of intra-artcular proximal tibia fractures (41C) treated with dual plate osteosynthesis. Methods: The study will be conducted over a period of 19 months in department of Orthopaedics, BMCH.All cases attending OPD and emergency >18years of age with intra articular fracture proximal tibia (41C) will be assessed by clinically and radiologically .Clinically assessment will be done by Rasmussen’s score treated with open reduction internal fixation with dual plate osteosynthesis of intra-articular proximal tibia fractures , and those followed up at 2,6,10,14,20,24 weeks for any complications and morbidity. Results: The mean age among patients was 31.38+-11.37 years. The male: female ratio was 2.33.Among 10 patients; 2 had Diabetes Meliteus while 1 had hypertension. Mean duration of surgery from time of injury was 7.89 ±3.98 days. Mean hospital stay in patients was 18.16 ±3.69 days. Mean time for union in patients was 12.18±4.83 weeks. Radiographic results Rasmussen anatomic outcome (immediately postoperatively) was excellent in 6, good in 3, and fair in 1 patients. Conclusion: Dual plate osteosynthesis is the best , effective and simple procedure in treatment of complex inta-articular proximal tibia fractures (41C).

Clinical and Functional Outcome of Cemented Total Hip Replacement in Osteonecrosis of Head of Femur

Background: Osteonecrosis of the femoral head is one of the common causes of painful hip in more than 50yrs of age. At this age is associated with high functional demand. Osteonecrosis may have a devastating effect on the quality of life. The natural course of this disease is one of relentless progression with eventual collapse of the femoral head followed by secondary osteoarthritic changes in the hip. The management depends upon many factors including severity and location of necrotic lesion, patient factors and probability of collapse. Total hip replacement (THR) is needed in cases of collapse of femoral head, severe pain, osteoarthritis or destruction of hip joint. Moreover the factors like functional outcome after surgery implant longevity and need for revision surgeries must be considered while doing cemented total hip arthroplasty. In this context we conducted this prospective observational study to find out the clinical and functional outcomes of cemented THR in patients with of osteonecrosis of femoral head. Methods: The treatment period were january 2017 to june 2018 and sample size 20.we did our cemented total hip replacement through posterior approach (moore ) of hip and follow up was done at 4 ,6, 8 weeks and thereafter every 3 months. pre and post operative radiological and functional outcome has been compared. Results: In this study 18 patients (90%) had excellent results while 1 (5%) had good functional outcome and 1(5%) had poor outcome after cemented total hip replacement in osteonecrosis of femoral head. Conclusion: The mean HHS and number of patients with good to excellent result in our study..

Result of Internal Fixation and Posterior Muscle Pedicle Bone Grafting in Old Fracture Neck Femur

Background: Ten (10) cases of old fracture neck femur were treated by internal fixation and posterior muscle pedicle bone grafting of quadratus femoris and quadrate tubercle bone block. Methods: The treatment periodwere from January 2017 - June 2018 (approx18 months) at Burdwan Medical College Hospital. We did this procedure by open reduction and internal fixation by cannulated hip screws and muscle pedicle bone grafting. Follow up period was 1 to 1.5 years (average 14 months). Results: Evaluation parameter were union, non union collapse of neck, osteonecrosis of femoral head, pain, range of movement and functional activities and over all satisfaction of patient. The results of fracture healing rate was good (7), fair (2) and poor (1). The technique is simple, rewarding and easy access of fixation and muscle pedicle bone grafting. Conclusion: Bone graft was placed by making a gutter at fracture site and maintained by a screw or prolin suture.

A Study of Clinical Outcome of Precontoured Plate & Screw Fixation in Fracture Midshaft Clavicle

Background: This prospective study was done to evaluate the effectiveness of implants i.e., anatomical precontoured plate in treatment of displaced midshaft clavicular fractures. Methods: Thirty patients between 18 and 60 years of age wereincluded in this study. They were treated by fixation with anatomically precontoured plate and functional outcome was assessed.Clinical and radiological assessments were performed at regular intervals. Outcomes and complications of over 1.5 year of follow-up time were compared. Results: Range of motion was well maintained in all the patients. Constant score was excellent in 26 patients(87%) good in 2 patients(6.5%) and fair in 2 patients(6.5%).No patients had a poor result on constant scoring. The mean time to union was 5.8 months. Conclusion: In this prospective cohort study, primary open reduction and internal plate fixation of acute displaced midshaft clavicular fractures resulted in improved outcomes and a decreased rate of nonunion and symptomatic malunion.