Femoral neck fracture; outcome of unipolar hemiarthoplasty in elderly patients

Objective of this study determines the outcome of unipolar hemiarthoplasty in elderly patients with femoral neck fracture at Liaquat University Hospital Hyderabad/ Jamshoro. Total 50 elderly patients were included in the study with femoral neck fracture and all the cases were selected from accident, emergency and OPD. All the patients with the history of pregnancy, those patients who were unfit for anesthesia, malignancy, neurological deficits of lower extremity, rheumatoid arthritis and Parkinson's disease regarding with systemically disease were excluded from the study. All the patients under went surgical hemiarthoplasty treatment with Austin moor-femoral head prosthesia. In the last all postoperative complications, functional outcome and mortality were noted on proforma. Total 50 patients were included in the study. Mean age of this study was mean +/- SD 64.98 +/- 4.13. Females were found in majority with male/ female ratio 1:1.27. Post operative pain was noted in the 50% of the cases and out of them severe pain was noted only in 4% of the cases. Superficial infection was seen in 4% of the cases and deep infection was not found in the cases and death was occurred in 10% of the patients. On the outcome, excellent results were found in the 44.44% of the study participants, good and fair results were seen in 26.66% and 20% respectively, while poor results were seen in 8.88% of the patients. It is concluded that unipolar hemiarthoplasty is of the reliable procedure by use of Austin-moor femoral head prosthesia for the treatment of femoral neck fracture in elderly

Outcome of early management of club foot by ponseti technique

The Objective of this study is to assess the anatomical correction, cosmetic and functional outcome of the Ponseti method in idiopathic congenital Talipes Equino Varus [CTEV]. Experimental and case series study. The study was carried out in the Department of Orthopaedic Surgery and Traumatology [DOST] Liaquat University of Medical and Health Sciences Jamshoro for a period of two years from 21-01-2009 to 20-01-2011. This study was contains 50 cases of congenital talipes equino varus "CTEV". In this study all the case were selected with age of one year from the birth with congenital "talipes Equino Varus". All the cases with Acquired "Talipes Equino Varus", atypical foot, "talipes Equino Varus' with Arthrogryposis Multiplex Congenital, "talipes Equino Varus previously treated by method other than ponseti technique were excluded from the study. Total 50 cases of congenital Telipase Equine, Varus [CTEV] having 77 feet were analyzed in this study with [male female ratio 1:7]. Out of 50 cases, 27 [54.0%, n = 50] had bilateral [54 feet] deformities and 23 [46.0%, n = 50] cases were unilateral deformities. Severity was assessed according to Pirani Scoring system. 48 [62.0%] had severe foot deformity while 29[37.60%, n = 77] patients had moderate foot deformity. Out of 77 feet, rocker bottom foot deformity developed in 03[18%] feet, increased stiffness of ligaments and joints occurred in 1[1.2%, n 77] foot while vascular complications like skin ulceration and necrosis was observed in 1[1.2%, n =77] feet. At the end of 2 to 3 years follow-up period, in 72 [94.0%, n = 77] patients congenital clubfoot deformities were corrected successfully by using Ponseti method while 05 [6.0%, n = 77] patients were not fully corrected due to other complications. The Ponseti method is a fast, safe and effective treatment for congenital idiopathic clubfoot and radically decreases the need for extensive corrective surgery

DCP with intramedullary interlocking nails; compare the outcome in closed diaphyseal humeral shaft fracture with type A1-2, A2-2 and A3

The objectives of the study are to compare the outcome of dynamic compression plates with intramedullary nails in closed diaphyseal humeral shaft fracture with type A1-2, A2-2 and A3. Comparative study. Study was carried out at the Orthopaedics Unit-I, Liaquat University Hospital Hyderabad / Jamshoro, from March 2007 to Feb 2009. Study consisted of 40 patients of diagnosed cases of closed diaphyseal humeral shaft fracture with type A1-2, A2-2 and A3. Patients were divided in two groups. Group A for dynamic compression plates and group B for intramedullary nails. Detailed Clinical examination of the patient was done and recorded in proforma. Systemic review was also done to see any major or minor head injury. All patients underwent for base line investigation. In Inclusion criteria; patients with type A1-2, A2-2 and A3-2 closed diaphyseal humeral shaft fracture, bilateral fractures, associated with minor head injuries, age between 20-40 years and fracture not more than two weeks old. In Exclusion criteria ; Open fracture, associated with severe chest or abdominal injuries, pathological fractures and malunited fractures with neurological deficit. Follow up of all these patients was done .1st four visit after every week, then alternet week upto 3rd month then monthly upto 6 month to assess any complication. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software version 16.0. In both groups male were 35[87.5%] and female 5[12.5%] with male: Female Ratio of 7:1. There was wide variation of age ranging from a minimum of 20 year to 40 year in both group. The mean age was 29.78+3.5 years. The most common cause of fracture shaft of humerus was road traffic accident [RTA]. There were 23[57.5%] patients who sustained fractures of the humerus following road traffic accidents. Eight [20%] cases had fractures shaft of humerus after fall from height and 9 [22.5%] cases had fractures shaft after assault. The Fracture pattern was Oblique in 22[55%] cases, Transverse in 12[30%] and Spiral in 6[15%]. Severity of post operative pain in both groups was recorded. Mild pain was felt in 10[50%] patients of DCP group and 6 [30%] patients of IMN group, Moderate pain was seen in 7[35%] patients of DCP group and 10 [50%] patients of IMN group, severe pain was described by 3[15%] patients in DCP group and 4 [20%] patients in IMN group. The complications seen in this study were Infection [1[5%] patients in DCP VS 0[0%] patients in IMN group], Iatrogenic palsy of radial nerve [1[5%] patients in DCP VS 0 [0%] patients in IMN group], Non union [1[5%] patients in DCP VS 1 [5%] patients in IMN group],Severe impingement [0[0%] patients in DCP VS 3 [15%] patients in IMN group], Adhesive capsulitis [0[0%] patients in DCP VS 2 [10%] patients in IMN group]. However minimal loss of fixation in 1 [5%] cases and late fracture occurred in one case 5%. The duration of hospital stay varied from 1 to 20 days. It was longer about -10-20 days in 12[60%] of DCP patients as compared to IMN cases where majority 11[55%] were discharged within 1 to 10 days. The mean hospital stay in DCP group was 15 days and IMN group was 13.5 days. Dynamic compression plate is a safe and effective procedure for treatment of humeral shaft fractures. With low threshold of complications it has significant advantages over intramedullary nails procedure revealed with earlier mobilization, minimum hospitalization and fast recovery towards normal life

Subtrochanteric femoral fractures treated by fixation with dynamic dondylar screw system

Objective: The purpose of this study was to evaluate the results of dynamic condylar screw system in the management of subtrochanteric femoral fractures, regarding union time, implant failure rate; infection rate and functional out come

Study Design: A prospective case series

Place and duration of study: This study was carried at the department of Orthopedic Surgery and Traumatology Liaquat university of Medical and Health, sciences Jamshoro, during January 2008 to December 2009

Material and Methods: Total 52 consecutive patients with subtrochanteric fracture were studied .Four patients were lost during follow-up and total 48 patients were finally assessed. The inclusion criteria was closed subtrochanteric fractures in adults of both gender aged 20 years or above; pathological fractures and open fractures were excluded from the study. After fixation of fractures with dynamic condylar screw system patients were followed -up for 6-12 months, the mean follow up period was 8 months. Results of treatment were assessed by the Radford criteria

Results: Among 48 studied cases, males were 29[60.42%] and female 19[39.58%]. Most common mode of injury was road traffic accidents in 32 patients [66.66%] and 16 patients had fall. All the patients underwent operative treatment by fixation of DCS. Autogenous bone graft was done in 07 patients. The union rate in this series was [93.5%]. Implant failure was observed in 03[6.25%] patients, 03 [6.25%] patients developed varus deformity and infection occurred in 02 [4.66 %]. According to criteria of Radford, we achieved good to excellent results in 81 % cases, fair in 6 [12.5 %] patients, poor in 03[6.25%0] patients

Conclusion: We conclude that subtrochanteric fractures need open reduction and internal fixation to avoid complications like implant failure, nonunion, infection, and mal-union. In our circumstances we achieve good results by the use of dynamic condylar screw

Evaluation of risk of lag screw cut out in unstable intertrochanteric fractures

Object: To evaluate the risk of lag screw cut out in unstable intertrochanteric fractures

Material and Methods: This study was conducted in the Department of Orthopedic Surgery and Traumatology [DOST] Liaquat University of Medical and Health sciences Jamshoro from January 2006 to December 2009. Unstable intertrochanteric fractures type A2 and A3 of AO classification fixed with DHS in stable [anatomic and wayn county] reduction, were included in study. All patients were assessed on six months follow up x-rays for cut out failure in different positions for placement of screw in femoral head. For placement of screw, femoral head was divided in 9 columns/zones on antero-posterior and lateral plane x-rays

Results: Out of total 66 study subjects 45 [68.1%] were males and 21 [31.8%] were females, 56 [84.8%] were of A2 and 10 [15.2%] of A3 type. Mean age was 65.41 years. Forty [60.6%] patients were fixed in anatomical reduction and 26 [39.3%] in wayn county reduction. The screw placement was 24 [36.3%] in central -central, 9 [13.6%] in central -inferior, 17 [25.7%] in posteriorinferior and 16 [24.2%] in remaining off central [unsatisfactory] zones. The cut out was in 2 patients [8.3%] in central-central , 0% in central inferior position , 3 patients [17.6%] in posterior inferior and 4 patients [25%] in remaining off central zones [all cut out were in superior zones of femoral head]

Conclusion: We conclude that placement of lag screw in inferior on AP and central on lateral view in femoral head gives excellent results after achieving stable reduction, having maximum bone to plow for cut out. But it is difficult and time consuming so if it is aimed in lower half on AP and central on lateral view in femoral head it will give better results