Functional Outcome of Paediatric Diaphyseal Fractures of Femur Treated with Closed Reduction and Multiple K Wire Fixation.

Background: Diaphyseal fracture of the femur in children is one of the common causes of paediatric morbidity. These fractures in children above the age of five years, depending upon the fracture personality, can usually be managed satisfactorily using different intramedullary implants, including Kirchner wires, Rush nail, as well as extramedullary implants using various combinations of plates and screws. Each of these methods of fracture fixation has its own merits and demerits. The current study is aimed at assessing the efficacy of internal fixation of these fractures using closed reduction and percutaneous ‘K’ wire fixation. Methods: Twenty six (n=26) children with a mean age of 7.2 years (range 5-14 years) were treated using closed reduction and multiple percutaneous K wire fixation under image intensifier. The minimum follow up period was twelve months. The final clinical and radiological assessment of patient was done at the end of one year. Three patients (n=3) were lost to final follow-up and were excluded from the final statistical calculations. Results: Twenty one fractures (n=21) united at an average time interval of 4.1 months (range 3- 6.5 months). Two patients had delayed union and one had malunion. Superficial wound infections were seen in two (8.7%) patients. Impingement of bent k wires was felt by another two (8.7%) patients. Stiffness of the knee joint was seen in three patients (13%) during follow-up. Out of three (n=3) patients with knee stiffness two responded well to vigorous physiotherapy programme, while one (n=1) patient had limited knee range of motion even at the final follow-up. Malunion was seen in one (n=1) patient. Conclusion: Closed reduction and percutaneous K wire fixation is a safe, economical, technically non-demanding and highly efficacious technique for the treatment of paediatric femoral diaphyseal fractures.

Two Staged Surgery for Gap Non-Union of Patella Fracture: A Good Alternative.

Gap Nonunion of patella fractures are rare conditions whose treatment is challenging for surgeons. Strict protocol for such fracture gap nonunion of patella is not well documented in the literature. The decision in treatment of these conditions is based on many factors such as functional demands of the patient, factors leading to nonunion, and presence of an intact extensor mechanism of the knee. We present a case of neglected gap nonunion of a transverse fracture of patella treated at 5 months after injury with a two stage reconstruction procedure.

Outcome of Discectomy by Fenestration Technique in Prolapsed Lumbar Intervertebral Disc.

Background: Prolapsed disc is the major cause of low backache with radiculopathy. Many different techniques, from extensive laminectomy to minimal invasive endoscopic surgeries have been described with aim to minimize the possibility of damage to other structures. Methods: Twenty patients with clinical symptoms and signs prolapsed disc having radiological confirmation by MRI were subjected to disc excision by fenestration technique. Results: The follow-up analysis as per Modified Mac Nab’s Criteria showed excellent results in 15 patients, good in 4 patients and fair in 1. Conclusion: Discectomy by fenestration offers sufficient and adequate exposure for lumbar disc excision. Advantages over conventional discectomy are smaller incision, lesser morbidity, shorter convalescence, early return to work and comparable overall results. It can even be performed in peripheral centers where recent microscopic and endoscopic facilities are not available.