Posterior malleolus fracture fixation in ankle injuries: A clinical study

Introduction: Posterior Malleolar fractures are relatively rare and a part of complex ankle injuries. Trimalleolar fractures affect the stability of the weight-bearing ankle joint. Management of posterior malleolar fractures is a challenge. Aims: This study aimed to examine the radiological and clinical outcomes of the management of posterior malleolar fractures in adults. Settings and Design: This is an original research retrospective study Materials and Methods: Eleven patients underwent fixation of ankle fractures with fixation of posterior malleolus as needed using screws or plates. Surgical outcomes were examined in follow-up with an average follow-up of 21 months using the American Orthopedic Foot and Ankle Score (AOFAS) score and with radiological correlation at each follow-up. Results: In our series, 27% of patients had 44B type injury and 73% of patients had 44C type injury as per AO/ OTA classification. The average AOFAS score was 90.45 for the series and the score for patients treated with direct reduction of the fragment was better than for those treated with indirect reduction. The average score for patients managed with screws was better than for those treated with plates in our series. 82% of patients showed excellent to good outcomes with one patient having an infection and one patient having moderate to severe pain. Conclusion: Anatomical reduction of posterior malleolar fragment leads to better long-term functional outcomes and a stable ankle joint with early mobilization.

Study of prevalence and operative results of fracture shaft femur in adults

Background: Being the principal weight bearing of the lower limb, fractures related to the femur pose a threat to humans and affect the overall quality of life. Conservative management is no longer preferred, and stable internal fixation is the modality of treatment these days. Aims and Objectives: The aim of this article is to study the operative outcomes of fixation of fracture shaft femur in terms of union, stability, functional outcomes, and complications. Materials and Methods: This study is a retrospective study of 35 patients with proximal, mid-shaft, and extra- articular distal shaft femur fractures admitted to Smt. SCL Municipal Hospital for 3 years from May 2019 to May 2022. Results: The results showed improvement in all the functional and radiological outcomes. More than 70% of the patients achieved greater than 125° of knee flexion. The radiological union of fractures was 4.4 months in our study. According to Neer’s score, 33 patients scored excellent to satisfactory. Conclusion: Internal fixation of fractures in the femoral shaft is an absolute must and has gained widespread acceptance as implants and technology have improved. The rationale for internal fixation is that it restores anatomical alignment and allows early mobilization of the patient and limb.

Percutaneous fixation of Calcaneum fractures.

Introduction : Displaced intra-articular calcaneum fractures require reduction and internal fixation for favourable long term results. Open procedures are more prone to complications regarding wound healing. Percutaneous fixation offers a middle pathway in treating simpler variety of displaced calcaneal fractures. Material and Methods : Over a two year period 22 cases of Essex-Lopresti tongue type displaced calcaneum fractures were treated using percutaneous screw fixation following closed reduction techniques were reviewed. Clinical outcome was evaluated by standardized physical examination using AOFAS ankle & hindfoot scores and radiographs of both injured and uninjured feet for comparative purposes. Results : Fall from height was the commonest cause of injury. The average time from injury to operation was 2 days. All patients went on to complete union. There was significant improvement of the Bohler and Gissane angles following reduction as well as maintenance of heel height and breadth. The mean AOFAS score was 84 indicating a good result. There was loss of reduction as evaluated on x-rays in follow-up in14 % patients. The rate of infection was 9% and rate of implant removal was 5%. No cases of peroneal tendon dysfunction were found. Conclusion : For simple displaced intra-articular Essex-Lopresti tongue type fractures of the calcaneum percutaneous fixation techniques give reliable good results without significant complications.