ABSTRACT
Introduction: Congenital trigger thumb is an uncommon anomaly of children. Its management is controversial, ranging fromobservation to extensive release.Aim: The aim of the study was to study the functional outcome of surgical management of the congenital trigger thumb in children.Materials and Methods: In this prospective study, 26 thumbs (21 pediatrics) underwent surgical release of the trigger thumb.Surgery was performed under general anesthesia with a tourniquet.Results: The prospective study demonstrated that pre-operative range of motion (ROM) averaged 36° loss of extension (range,0°–90°; standard deviation [SD], 22°); and post-operative ROM averaged 1° loss of extension (range, 0°–30°; SD, 7°) at 3 yearsfollow-up. There were no secondary surgeries. The children were being followed up for 3 years. All of them are found to havea good functional outcome and free of any complications until follow-up for 3 years.Conclusion: Congenital trigger thumb is a rare anomaly which is noticed by the parents around the age of 1½ years. Asconservative treatment invariably failed to give good results, all children are managed surgically with better cosmetic andfunctional results.
ABSTRACT
introduction: Clubfoot and its management have been the topic of keen interest to the orthopedics field ever since timeimmemorial and many techniques in the successful management of these have been advocated till date. This study discussesone such technique of management in children with Joshi’s external stabilization system (JESS) fixator.Aim: This study aims to evaluate the role of JESS in the management of neglected, resistant and relapsed congenital talipesequinovarus (CTEV), in the age group of 1–6 years.Materials and Methods: A total of 20 feet in 20 children underwent JESS fixation surgery at the Department of Orthopaedics,Government Rajaji Hospital, Madurai Medical College, from October 2015 to September 2018.Results: Four patients had excellent results, 12 patients had good results with an average score of 78, three patients had fairresults, and poor results in one patient. The average pre-operative Pirani score was 4.5 and post-operative score of 0.93 withP < 0.001 which was statistically significant. The average pre-operative Dimeglio score was 12 (Stage III) which statisticallyimproved post-operative (P < 0.001) to 5 (Stage 1).Conclusion: By controlled differential distraction using JESS apparatus, a painless, Pliable, plantigrade. The perfect sized andcosmetically acceptable foot has been obtained even in children 1 year–6 years. Controlled differential distraction using JESSfixator has got a definite role in the management of relapsed and neglected CTEV and it does not prevent the foot from beingtreated surgically at a later date if needed.
ABSTRACT
Background: Dorsolumbar fractures are unstable mostly which requires surgical spinal stabilization to maintain anatomicalreduction and stability and also to promote early bony fusion and mobilization. Posterior short-segment pedicle screw fixation isusually done for burst fractures. Even though early clinical results of this surgery are usually satisfactory, a high failure rate andprogressive kyphosis remain a concern. To overcome this, in addition to short-segment fixation, the pedicle screw is insertedat the fracture site. Long-segment fixation is usually done for fracture dislocations.Materials and Methods: A total of 25 patients with dorsolumbar spinal injuries admitted in Government Rajaji Hospital andMadurai Medical College were selected for the study and followed for a period of 24 months. Of these, four patients were lostfollow–up, and hence, 21 cases were included in the study and followed for a period of 2 years.Results: A total of 25 patients were selected for the study. Our results showed good to excellent in long segment, 72.7% of thepatients were good (eight cases), and in short segment, 70% of the cases were good (seven cases). In long segment, 27.7%of the patients were fair (three cases), and in short segment, 30% of the cases were fair (three cases). In our study, the meanof Oswestry Disability Index in long segment is 32.31 and mean in short segment is 31.99. In our study, only one patient hadrod breakage, but the patient had no pain and no neurological deficit, and functional outcome is good.Conclusion: We conclude that short-segment fixation with index vertebra fixation provides as good results as long-segmentfixation with reduction in cost and time of surgery in the treatment of thoracolumbar spinal injuries.
ABSTRACT
Introduction: Most complex tibial plateau fractures are a result of the high-energy injury. Resulting comminution makesinterpreting of fracture patterns difficult. Fully understanding these fractures is the basis for successful treatment.Aim: The aim of this study was to analyze the functional and radiological outcome of column-specific fixation of tibial plateaufracture.Materials and Methods: This was a prospective cohort study; 10 patients with tibial plateau fractures with displaced complextibial plateau fractures operated at Government Rajaji Hospital, Madurai, were included in this study. The follow-up period was36 months. The fractures were evaluated by computed tomography using Lu three-column concepts and managed with lowprofile locking plate system as per column-specific fixation. Follow-up analysis was made using Modified Rasmussen’s Clinicaland Radiological Criteria.Results: In our study, 70% of the patients were in active productive age group (30–50 years). 90% of the patients were male.30% of single-column fractures (LUO) (Schatzker type IV 10% and Hohl and Moore Type I coronal split fracture 20%), 30% oftwo-column fracture (LUO) (Schatzker Type IV 20% and Type V 10%), and 40% of three-column fractures (LUO) (SchatzkerType V 40%) were included. In this study, 40% of patients had an excellent outcome, 50% of patients had a good outcome,10% of patients had poor clinical, and 10% had fair radiological outcome. One patient developed wound necrosis, for whichflap cover is done and eventually patient developed deep infection for whom implant removal was done after 6 months.Conclusion: Three-column fixation is a new fixation concept in treating complex tibial plateau fractures, especially useful formultiplanar fractures involving posterior column with excellent functional outcome.