ABSTRACT
Background: The anterior cervical decimpression and fusion (ACDF) surgery was first described by Smith and Robinson and Cloward RB in the 1950s. This procedure has since become the standard for treating degenerative cervical disc disease. Material & Methods: This Prospective Quasi-Experimental Study was conducted at the department of National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) and Dhaka Medical College Hospital, Bangladesh. The study was conducted during the period of 06 May 2019 to 05 May 2020 and 24 Patients were included by non-randomized purposive sampling according to the availability of the patient and strictly considering the inclusion and exclusion criteria. The analysis was done by SPSS 20.0 for windows software. Results: The age range of patients was 32 to 68 years, with a mean age of 51.67 (±11.15) and male-female ratio was 11:1. Occupation of the subjects demonstrates that service holder comprised the main bulk 8 (33.3%). Other occupants were farmer 6 (25.0%), businessman 4 (16.7%), driver 2 (8.3%), house wife 2 (8.3%) & manual labour 2 (8.3%). 4 (16.7%) patients had per-operative hemorrhage. There were no dural injuries or recurrent laryngeal nerve palsy. It was observed that 4 (16.7%) patients developed dysphagia, 2 (8.3%) patient had infection and 6 (25%) patients had neck pain. There was no temporay hoarseness or respiratory problems. Conclusion: The study shows that the anterior cervical decompression and interbody fusion by stand-alone anchored spacer are relatively easy, safe and an effective procedure for patients with cervical degenerative disc disease with good neurological and radiological outcome. It provides immediate stability to the affected area, reduces the risk of graft extrusion, avoids the need for extended post-operative external immobilization, and significantly shortens the rehabilitation period.
ABSTRACT
Background: Proximal Femoral Nail (PFN) is a surgical technique used to treat unstable intertrochanteric fractures, which are fractures that occur in the upper portion of the thigh bone (femur). The procedure involves using a nail-like device that is inserted into the femur and secured in place with screws to stabilize the fracture and promote healing. It is a commonly used treatment option for this type of fracture and can lead to good outcomes in most cases. The aim of the study was to observe the outcome of Unstable Intertrochanteric fracture by Proximal Femoral Nail (PFN). Material & Methods: This prospective observational study was conducted at the Department of Orthopedics, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh. The study duration was 2 years, from July 2017 to June 2019. A total of 34 cases were included in the study sing purposive sampling (non-randomized) according to availability of the patients and considering inclusion and exclusion criteria. Results: The participants’ age range was 16-90, with a mean of 56.91 ± 17.76. Most (35.29%) were 61-75 years old. 61.76% were female and 38.24% were male. 50% were housewives, 14.71% ex-service holders, 14.71% service holders, 11.76% businessmen, 5.88% students, and 2.94% farmers. The leading cause of injury was falls on slippery ground (55.88%), followed by motor vehicle injuries (44.12%). 70.59% of injuries occurred on the right side and 29.41% on the left. 76% had Kyle Type III fractures, 24% had type IV. 85.29% had open reduction, 14.71% had closed reduction. The mean duration of injury to operation was 15.59 days and the mean hospital stay was 19.15 days. 70.59% had no complications and 55.88% reported no pain at last follow-up. 58.82% had a good Harris hip score and 58.82% had excellent outcomes by final follow-up. Conclusion: The majority of patients in this study were in the 61-75 age range and female, with the most common cause of injury being falls on slippery ground. The most common fracture type was Kyle type IV, with a major portion of cases requiring open reduction. The rate of complications was relatively low, and the functional outcomes were acceptable and comparable to other studies. The duration of injury to operation and hospital stay were slightly longer than other studies, likely due to the busy nature of the study location. Overall, the Proximal Femoral Nail is a safe and effective treatment option for unstable proximal femoral fractures.
ABSTRACT
Background: Intertrochanteric fractures are one of the most disabling injuries, most commonly observed among the elderly, and shows a challenging problem for orthopedic surgeons. Nowadays, intertrochanteric fractures are being treated with different extramedullary and intramedullary devices. Among them, intramedullary fixations show the best outcome, and are widely used for different treatment of unstable intertrochanteric fractures (type 31A2, 31A3). A new device designed by AO/ASIF, the Proximal Femoral Nail Anti-Rotation (PFNA) represents a unique intramedullary nail system for improved management, with decrease in the number of complications. Material & Methods: This prospective hospital based clinical trial was conducted at the Department of Orthopaedic Surgery, Chittagong Medical College Hospital, Chattogram, Bangladesh. The study duration was 2 years, from January 2018 to December 2019. During this period, a total of 48 patients who were admitted in the study place with unstable intertrochanteric fracture of femur were included in the study. Patients were followed up for 24 weeks, and overall outcome was measured using Kyle’s Criteria. Results: 48 patients were treated for unstable intertrochanteric fractures. The majority were between 50-80 years old (62.5%), with a mean age of 58.38. Gender distribution was even, with 50% male and 50% female. 75% of fractures were caused by a fall from height and 25% by a road traffic accident. 68.75% of fractures were type 31A3 and 31.25% were type 31A2. 68.75% of patients did not have comorbidities. The mean time interval for fixation was 12.6 days, and the majority of operations lasted between 45-90 minutes. 87.5% had a closed reduction and 12.5% had an open reduction. 64.58% of patients had radiation time between 2.5-3.3 minutes. At 2 weeks follow-up, 21.28% had poor functional outcome, 78.72% had fair functional outcome, and none had good or excellent outcomes. At 6 months follow-up, 2.17% had poor outcomes, 8.70% had fair outcomes, 34.78% had good outcomes, and 54.35% had excellent outcomes. 16.67% of patients experienced complications such as infection, varus, delayed union, and lateral migration. Conclusion: Most patients achieved good to excellent functional outcomes after treatment, with minimal complications.