ABSTRACT
Introduction: Hip fractures in the elderly have represented a major public health concern. Studies have shown that over 90% of the patients having these fractures are people of more than 50 years. These fractures have been classified according to their anatomical location into the neck of femur fracture, intertrochanteric fracture, and subtrochanteric fracture. The neck of femur fractures is associated with high mortality in the elderly compared to young adults. Surgical treatment is an established gold standard, with the option being osteosynthesis and hip replacement. Hemiarthroplasty is one of the gold-standard treatments chosen for the geriatric age group and has yielded universally acceptable results. Materials and Methods: The study evaluates the clinical, radiological, and functional outcomes of hip hemiarthroplasty in elderly with fracture neck of the femur Data of patients above 60 years who were operated on for fracture neck of the femur by bipolar hemiarthroplasty from May 2018 till December 2021were retrieved from the Medical Records Department of SCL Municipal General Hospital, affiliated to NHL Municipal medical college. The patients fitting the inclusion criteria were selected for the study. The sample size was calculated to be 43. Data were collected from the inpatient files, and then patients were asked to complete the questionnaire form during the final follow- up. All the patients were evaluated clinically and radiologically during the follow-up, and the functional outcome was assessed using the Harris Hip Score. Thirty-five patients had a domestic fall as the mode of injury. The lateral decubitus position of all patients was used during the operation that was performed using the Southern Moore approach. Forty patients received cemented femoral stems; the remaining three received press-fit ones. Results: The average age was calculated to be 71.86 years with the male-to-female ratio of 1: 1.15 with an average follow-up of 12.7 months. Eight patients had acetabular erosion at the end of 1 year. There was no femoral stem malalignment or aseptic loosening at the final follow-up. Nine patients had excellent Harris Hip scores, and five had fair scores. The remaining 29 patients had good Harris hip scores. Bipolar hemiarthroplasty has served us well in the study. Forty-one patients were able to get back to their preinjury functional level. Only one patient reported major pain in the hip at the final follow-up. In this study, there was no incidence of dislocation or revision surgeries. Conclusion: The present study modular bipolar hemiarthroplasty provides better pain relief with early mobilization and a good level of return to daily routine activities with minimal complications.
ABSTRACT
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.
ABSTRACT
Introduction: Lumbar spine pathology is major healthcare burden encountered in district and urban hospitals. Diagnostic imaging in these patients is not always indicated. Imaging is considered in those patients who show little or no improvement in their LBP after approximately six weeks of medical management with or without physical therapy, the current study was undertaken to assess the appropriateness of LBP imaging in primary care following the ACP guidelines. The inclusion criteria for the study were adult patients with persistent low back pain with orMethod: without radiculopathy post six weeks of medical management affecting their activity of daily living. And the exclusion criteria were spinal trauma , neurological impairment, bladder and bowel involvement, spinal malformations, history of malignancy presenting at the time of index visit. The study included total 115 patients. Out of 115 patients 87Result: [70%] patients showed abnormal finding on the radiographs. The most common abnormal finding was disco vertebral degeneration such as spondylosis (osteophyte formation) in 49.6%. Routine x-ray imaging in low backConclusion: pain patients is not always warranted. Moreover routine radiological imaging methods are not associated with meaningful clinical outcomes for the patients. Unnecessary imaging can lead to harmful radiation exposure of the patients and can further lead to additional medical expenditure and needless surgical intervention. Diagnostic radiological imaging should be used judicially.
ABSTRACT
Background : The most common major Paediatric injuries treated by Orthopaedic Surgeons are Femoral Shaft Fractures. Early reduction and hip spica are used to treat young children under five years old, whereas intramedullary interlocking nail is used to treat young teenagers over 15 years old. Objectives : To know prevalence of Femoral Fractures in paediatric age groups, to classify fracture type, mode of injury, course of healing and to evaluate the result of low cost-least invasive Ender抯 Nail Fixation in Paediatric patients in developing country. Materials and Methods : It is prospective study with 15 patients of 6-15 years age group with Femur Diaphyseal Fracture were treated with retrograde Ender抯 Nail in our Orthopaedic Department with minimum 6 months follow up. Fracture location was in the upper third of the femur in four cases (26.66%), mid shaft in nine (60%) and (13.34%) lower third in two. Results : All patients had union within an average of twelve weeks (8 to 16 weeks ). Skin irritation caused by a nail was found in one case. Twelve patients achieved excellent results, while three individuals good results, according to Flynn criteria. Conclusion : Enders nailing is recommended for Femoral Diaphyseal Fracture Fixation because it is safe, simple to apply and economical with a lower rate of complications.
ABSTRACT
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.