ABSTRACT
Background: Intertrochanteric fractures are one of the commonest fractures especially in the elderly with porotic bones. Our study was aimed to evaluate effectiveness of implant TSP in preventing above complication of DHS for unstable fracture I/T femur (i.e. Evan’s type III & V) measured in terms of fracture collapse, screw impaction, limb shortening &overall functional outcome. Methods: This prospective study was conducted in the Department of Orthopaedics, Traumatology, M G M Medical College & associated M. Y. Hospital, Indore from June 2008 to September 2010. 145 cases were registered in the study out of which 81 cases with unstable fracture intertrochanteric femur (type III & V of Evan`s) admitted and treated by internal fixation using TSP & DHS included. Preoperative assessment of fracture geometry was done using Evan’s classification. Intra operatively pattern of reduction achieved was seen on Antero-posterior and Lateral projections by image intensifier. Using TAD index assessment of Screw placement was done in postoperative period. Neck shaft angle measured on immediate post op x-ray with the help of Goniometer. During 1st follow up (2 weeks post op), 2nd follow up (4 weeks post op), 3rd follow up (3 months post op) and 4th follow up plain radiographs (true AP and true lateral hip with thigh) were obtained to look for signs of union and impaction. Functional results were evaluated after a period of 6 months postoperatively using new criteria devised from Harris hip score taking into consideration the needs of Indian patients (Modified Harris Hip Score). Results: Average screw impaction (Fracture collapse) was 15.8mm in DHS group & 6.5mm in TSP group. 20 patients (49%) out of 41 had screw impaction more than 15mm at 6 month of follow up, whereas only 1 patient (2.5%) out of 40 in TSP group. Average shortening in DHS group was 2.33cm & 1.42cm in TSP group. 25 (61%) out of 41 patients of DHS group had shortening more than 2cm whereas only 13 (32.5%) out of 40 patients in TSP group. In significant no. of patients excellent to good functional outcome (Harris Hip Score >60) was seen in TSP treated group. Average functional score was 76 in TSP group & 61.68 in DHS group. 28 patients (70%) out of 40 in TSP group had HHS >60 after 6 months of surgery, whereas only 17 patients (41.5%) out of 41 in DHS group. In type III fracture with TSP was having much better outcome than any other group. Conclusion:In unstable intertrochanteric fracture with lateral trochanteric wall fracture, reconstruction of lateral trochanteric wall & abductor mechanism using trochanter stabilizing plate helps in achieving anatomical reduction, imparts stability and prevents excessive sliding of screw & collapse, limb shortening. Thus it helps in achieving overall good functional outcome.
ABSTRACT
Background:Spinal dysraphism occurs due to failure of fusion of parts along dorsal aspect of midline structures lying along spinal axis from skin to vertebrae and spinal cord. Congenital spinal anomalies may be minimal and asymptomatic like spinal bifida occulta, or severe with marked neurological deficits like Arnold-Chiari malformation or caudal regression syndrome. Aim: To compare the results obtained from Ultrasonography and Magnetic Resonance Imaging in patients with spinal dysraphism. Methods: A total of 50 patients of age group new born to 06 months, who had signs of spinal dysraphism, were included. The patients were subjected to spinal USS and MR imaging after obtaining informed written consent from parents. All the images were reviewed by experienced radiologists who were blinded to the results of other investigative modalities. The findings of the MRI were compared with USS examination. Results: Out of 50 patients, 98 percent patient were detected to hydromyelia, 94 percent of tethering of cord, 92 percent of lumboacaral MMC and 88 percent cases were of Associated Arnold Chiari type II malformation (AC). Only 10% of patients had cervicothoracic meningomyelocele, diastematomyelia and intraspinal lipoma as their primary pathologies. Sensitivity and specificity of USS were 100 in diagnosing most of the spinal deformities. The mean time required for the MRI examination was 26.96 min; however in comparison ultrasonography took less mean time (10.62 min). Conclusion: Paediatric spinal dysraphism and associated malformations are accurately diagnosed on MRI scan. On the other hand, limited access to MR imaging together with high costs and the need for extensive preparation of the patients diminishes its suitability as a screening method for spinal dysraphism