Dynamization versus static antegrade intramedullary interlocking nail in femoral shaft fractures

Objective: to compare the primary dynamic interlocking technique with static interlocking method for femoral shaft fractures in terms of bony union

Study design: quasi experimental study

Place and Duration of study: department of Orthopaedic Surgery, Ziauddin University Hospital Karachi, from March 2012 to August 2013

Methodology: all patients with closed femoral shaft fractures were treated by closed reamed intramedullary [IM] interlocking nail. They were divided into two equal groups. Group I [Dynamization group] patients underwent primary dynamization and in Group II [Static group] patients the static nail was used. Both groups were divided into subgroups on the bases of post reduction intrafragmental gap less than or more than 3mm on x-ray.The surgical procedure and postoperative protocols were same for both the groups, with the exception of interlocking mode. The outcome was measured using Thorensen clinical criteria. Bony union, time of union, delayed union, nonunion, implant breakage and leg shortening were recorded

Results: a total of 64 patients were included, 32 in each group. Mean time of union was same in dynamic group and static group with post reduction intrafragmental fracture gap < 3mm. In the dynamic group with post reduction intrafragmental fracture gap=3mm, one case of nonunion was noted. In static group two cases of delayed union and one case of nonunion were noted in sub group with post reduction intrafragmental fracture gap=3mm

Conclusion: dynamization significantly shortened the mean time to union in femoral shaft fracture with intrafragmental gap =3mm, though it did not significantly affect the union rate of the femoral shaft fractures as compared to static close intramedullary interlocking nailing

Osteochondral grafting of knee joint using mosaicplasty

Focal cartilage defects of articular surface-traumatic and degenerative are difficult to treat, thus a variety of surgical techniques have been developed and reported for treatment of such defects. Procedures such as Priddies perforations, microfracture, abrasion chondroplasty have shown long-term results which are often less than adequate. One of the reasons is that all these techniques lead to the formation of fibrocartilage which has inferior mechanical properties as compared to the native hyaline cartilage. Mosaicplasty is a procedure which aims at replacing the lost articular cartilage with hyaline cartilage including underlying bone support, thus providing adequate stability to the cartilage and better cartilage/bone integration. A young man underwent this procedure for recalcitrant knee pain at our institution. At 2 years follow-up, his knee pain has significantly improved. We hereby present medium term results [2 years] of this first case report in local literature