CLINICAL AND FUNCTIONAL OUTCOME OF PROXIMAL HUMERAL FRACTURE FIXATION WITH RUSHNAIL AND K WIRE FIXATOR VS PHILOS PLATING : A STUDY OF 30 CASES

Introduction- Aim- Proximal humerus fractures represent one of the most common fracture type in upper extremity. this study aimed to see clinical and functional outcome of proximal humeral fracture fixation with Rushnail and K-wire fixator vs PHILOS plating. A prospective study was conducted over 6 months of a tot Material And Method- al of 30 patients with proximal humerus fracture. Patients were divided into two groups by randomized controlled trial .Group 1 included 15 patients who were treated with closed reduction and Rushnail with percutaneous k wire fixation. Group 2 included 15 patients who were treated with ORIF with PHILOS plate .All these 30 patients were followed up for mean duration of 6 months. Mean neer s Results- core at final follow up was 90 in group 1 patients while it was 80 in group 2 patients As per the Neers scoring system. Mean neer score at final follow up was 90 in group 1 patients while it was 82 in group 2 patients. As per the Neers scoring system; 8 patients (54%) in group1 had excellent results, 7 patients(46%) had satisfactory Results. For Group 2 ,as per Neers scoring system 6 patients (40%)had excellent results,7 patients (47%) had satisfactory results,2 patients (13%) had unsatisfactory result with poor outcome. In conclusion it was found that Rushnail wit Conclusion- h K- wires fixation for proximal humerus fractures type II and type III (Neer's) gives superior results than proximal humerus interlocking system (PHILOS).

COMPARATIVE STUDY BETWEEN FIBULA PLATING VERSUS INTRAMEDULLARY K-WIRE WITH MEDIAL MALLEOLAR SCREW IN FIXATION IN BIMALLEOLAR FRACTURES OF ANKLE

Background: Pott's fracture is eponym of bimalleolar fracture, which account for one fourth of patients of ankle injury, it is more common in women, people over 60 years of age. There has been an increase in the prevalence of one such fracture over the last two decades both in the young, active patients and in the elderly. Objectives: The aim of this study was to compare the clinical and functional results of patients with bimalleolar fractures treated with semi tubular / reconstruction plating or intra medullary k-wire in fibula along with medial malleolar screw. Material And Method: This was a prospective randomized comparative study carried out using fibula plating and intramedullary k wire for fixation of lateral malleolus fracture and malleolar screw fixation for fracture medial malleolus among 60 patients admitted in S.M.S Hospital, Jaipur during the study period of April 2018 to December 2019. Informed consent was taken and functional assessment of patient was done at 1, 3 and 6 months after discharge according to the Modified ankle score of Olerud Molander. Results: The quantitative data was presented as mean and standard deviation and were compared by student's t-test. Probability was considered to be significant if less than 0.05. There was a significant differences (P=0.008 & P=0.001) in both the groups on the basis of mean duration of partial weight bearing (weeks) and initiation of full weight bearing (weeks). There was a significant difference in both the groups on the basis OMAscore at 1, 3 and 6 months. Conclusion: The final functional outcome was compared by Modified Olerud & Molander Score. 24 (80%) cases in fibula plating group had excellent to good results whereas, 15 (50%) cases in intramedullary k wire group had excellent to good results (P=0.010). In conclusion, cases managed by Fibula Platting had better functional outcome as compared to those treated by Intramedullary K Wire group.

Novel cross-locking intramedullary nails for olecranon: a finite element analysis and specimen experiments / 中华创伤骨科杂志

Objective:To determine the mechanical properties of our self-designed novel cross-locking intramedullary nails and the impact of number of conical locking nails on the fixation through a finite element analysis and specimen experiments.Methods:Mimics 19.0 and SolidWorks 2014 were used to create transverse fracture models of the olecranon which were subjected to fixation with respectively K-wire tension band (KTB) and our self-designed novel cross-locking intramedullary nails (NIN). The strengths of KTB and NIN fixation were analyzed by Ansys. Fifteen human ulna specimens were used to construct a transverse fracture model of the olecranon; an Instron E10000 mechanical testing machine was used to determine mechanical properties in fixation respectively with KTB, one NIN (NIN-1) and 3 NINs (NIN-3).Results:In the finite element analysis, in simulation of the forearm flexed at 45° under a 100 N load, the deformation of the fracture surface of the olecranon in fixation with KTB, NIN-1 and NIN-3 was respectively 0.131 mm, 0.123 mm and 0.121 mm. In the specimen experiments, in simulation of the forearm flexed at 45°, the maximum failure loads for fixation with KTB, NIN-1 and NIN-3 were (313.38±27.68) N, (528.56±53.58) N and (871.04±94.95) N, respectively, showing significant differences among the 3 groups ( P<0.05). The maximum failure load for NIN-3 fixation was significantly greater than that for KTB or NIN-1 fixation, and the maximum failure load for NIN-1 fixation was significantly greater than that for KTB fixation ( P<0.05). Conclusions:Compared with KTB fixation, NIN fixation is more convenient in operation and has better mechanical properties. NIN-3 fixation has the best mechanical properties.

Correção de fratura Salter-Harris tipo I em porquinho-da-índia (Cavia porcellus) - relato de caso / [Correction of Salter-Harris type 1 fracture in guinea pig (Cavia porcellus) - case report]

Um filhote de porquinho-da-índia (Cavia porcellus) foi recebido para atendimento após histórico de ataque por cão. Na avaliação física, observou-se edema, dor e crepitação em membro pélvico direito, sugestivo de fratura. Na avaliação radiográfica, confirmou-se fratura Salter-Harris tipo I em epífise distal da tíbia. A resolução cirúrgica escolhida foi a associação de pino transarticular e coaptação externa com tala de Altman. O paciente teve acompanhamento radiográfico semanal e obteve alta médica no 35o dia de pós-cirúrgico, quando se observou consolidação com completo remodelamento ósseo.(AU)

A guinea pig (Cavia porcellus) cub presented edema, pain, and crepitus in the right pelvic limb after being attacked by a dog. Radiographic examination revealed Salter-Harris type 1 fracture on the distal region of the tibia. The surgery technique to correct the fracture involved an association of transarticular pinning and external coaptation with Altman splint. After surgery, radiographs of the patient were performed weekly and on the 35th post-surgery day, the bone was completely remodeled and healed, and the animal was dismissed.(AU)

Surgical Treatment of Pediatric Intra-Articular Proximal Phalangeal Head Fracture of the Big Toe

PURPOSE: Pediatric intra-articularproximal phalangeal head fractures of the big toe are very rare and few studies on this have been published. The purpose of this study is to present the diagnostic approach and surgical management of these extremely rare fractures, which might be easily underestimated or misdiagnosed.MATERIALS AND METHODS: The study retrospectively reviewed all the patients who were diagnosed as intra-articular proximal phalangeal head fracture of the big toe and who underwent surgical intervention in our institution. The size of the bony fragment and hallux valgus interphalangeus angle were measured on the preoperative X-rays. The size and rotation of the osteochondral fragment, the presence of avascular necrosis, ligamentous injury and soft tissue entrapment were assessed on the preoperative magnetic resonance images (MRIs). The radiologic and functional evaluation were performed at 1 year postoperatively.RESULTS: The average size of the bony fragments measured on the X-rays was 4.1 mm in width and 2.3 mm in length. Two cases showed hallux valgus interphalangeus. Preoperative MRI was performed in four cases and the average size of any osteochondral lesion was 5.3 mm in width, 3.9 mm in length, and 4.7 mm in height. Rotation of the osteochondral fragment was observed in one patient, and soft tissue entrapment was noted in two patients. Postoperatively, successful bony union was achieved in all the patients and the average time to union was 74.4 days.CONCLUSION: Intra-articular proximal phalangeal head fractures of the big toe are very rare and often neglected due to incomplete ossification in the pediatric population. It is important to suspect the presence of this intra-articular fracture and to appropriately implement further evaluation. Nonunion of chronic cases as well as acute fractures can be successfully treated through open reduction and internal fixation using multiple K-wires.

Migrated K Wire Into Popliteal Fossa From Tension Band Wiring Of Patella: A Case Report

Despite being extensively used, k wires have their own set of complications, with loosening and eakage of these wires being the most significant one of them. We report a case of patella fracture treated with tension band wiring (TBW). After achieving fracture union, patient was lost to follow up. He reported four years later with a oken k–wire which had migrated posteriorly into the popliteal fossa and had to be removed as it was causing symptoms to the patient. We recommend following certain steps to prevent the occurrence of such a complication: following AO principles of fracture fixation, encouraging hardware removal after union of fracture wherever possible, close clinical and radiological follow up to detect the movement, eakage and migration of wires at the earliest and removal of migrated wires on priority basis, irrespective of patient being symptomatic or asymptomatic.

Adhesions as an Uncommon Complication of K-Wiring in Paediatric Phalangeal Fractures

@#Paediatric hand fractures are common and prompt management is mandatory to achieve a good functional outcome. However many fail to realize that treating a fracture does not only involve bones but the soft tissues, as well. K-wiring itself can be difficult with multiple attempts inadvertently injuring the flexor or extensor tendons and resulting in adhesions. We highlight this possible complication of K-wiring which we believe is under reported due to the perception that K-wiring is a simple procedure. We present a case of a 9-year-old child, who sustained a closed displaced fracture of the base of the proximal phalanx (Salter Harris type 2) of the left index finger. He underwent percutaneous K-wiring but was complicated with severe adhesions of the flexor digitorum profundus (FDP) and flexor digitorum superficialis tendons (FDS). He was unable to flex the proximal and distal interphalangeal joints of the affected finger. We subsequently performed tendon adhesiolysis twice together with A2 pulley reconstruction, to restore movement of the finger. K-wiring of the fingers are not just simple bony procedures but also involve soft tissue components which can be prone to adhesions

Functional Assessment Following Treatment of Acromioclavicular Joint Dislocation by Screw and Tension Band Wiring

Background: The acromioclavicular (AC) joint is commonly involved in traumatic injuries in male athletic population. Treatment of acute complete AC dislocation is controversial in literature. Both conservative and surgical treatment has been reported with similar results. Methods: We report a prospective study of 17 patients of Acromioclavicular dislocations (Type III) managed with screw and tension band wiring and were followed up for a period of 3 years. Repair of Coracoclavicular Ligament was performed if found completely torn. Results: Patients were assessed on basis of pain relief, tenderness, functional ability, range of motion at shoulder and cosmosis. Conclusion:Fixation with screw and Tension band wiring is a simple, easy, less time consuming surgical technique allowing faster rehabilitation in young and adult active patients to achieve a stable, pain free shoulder with no serious intra-operative or post-operative complications.

Supplementary Technique for Unstable Clavicle Shaft Fractures: Interfragmentary Wiring and Temporary Axial K-Wire Pinning

BACKGROUND: Treatment of unstable clavicle fractures remains a challenge for orthopedic surgeons, but the evolution of treatment strategies has allowed for reliable results with minimal complications. Although several surgical options exist, open reduction with plating remains the treatment of choice for clavicle fractures. The purpose of this study is to determine an easy way to achieve successful preplating reduction while minimizing surrounding soft tissue damage during treatment of midshaft fractures of the clavicle. METHODS: A retrospective study included all consecutive adult patients operated on by a single surgeon for acute displaced clavicular midshaft fracture between January 2010 and October 2014. Hybrid technique with interfragmentary cerclage wiring, temporary axial K-wire pinning, or their combination was used in all patients. The demographic data and clinical outcomes, including operation time, union time, restoration of anatomy, shoulder functional score, and complications were evaluated. RESULTS: There were 54 male and 19 female patients, with an average age of 39.3 years (range, 18 to 77 years) for males and 58.3 years (range, 39 to 77 years) for females. They were followed up for 24 months (range, 12 to 44 months). All patients had reliable bone union after surgery using interfragmentary cerclage wiring and temporary axial K-wire fixation; fracture union was obtained at an average of 11.7 weeks (range, 8 to 21 weeks) postoperatively. Additionally, there was no postoperative loss of fracture reduction or plate loosening. At the final follow-up, all patients had regained excellent functional outcomes. CONCLUSIONS: The cognizant effort to achieve anatomic reduction without surrounding soft tissue insult before definitive plating allows excellent radiologic and functional outcomes. Interfragmentary cerclage wiring and temporary axial K-wire pinning can overcome difficulties associated with unstable clavicle fractures to allow proper fracture reduction. In this article, we introduce a concise technique for achieving the desired outcomes reliably and efficiently when treating unstable clavicle midshaft fractures.

Anatomical Locking Plate with Additional K-wire Fixation for Distal Clavicle Fracture

BACKGROUND: Neer type II distal clavicle fractures have the drawback of coracoclavicular instability and insufficient distal bony fragment, thereby making it difficult to achieve adequate fixation. Although various surgical treatments have been described for Neer type II fracture, the optimal treatment remains controversial. This study reports the clinical results and usefulness of anatomical locking plate with additional K-wire fixation. METHODS: A totally of 21 patients with type II distal clavicle fracture were included in the study. The surgical procedure reduced the fracture temporarily; it included insertion of one or two K-wire from the lateral margin of the distal fragment to the proximal fragment through the fracture site, followed by application and fixation of the locking plate. The bony union and migration of K-wire was evaluated in the follow-up radiography. The coracoclavicular distance and acromioclavicular joint arthrosis were assessed at the final follow-up. The Constant Score (CS) and Korean Shoulder Score (KSS) were evaluated for clinical scoring. RESULTS: Bone union was achieved in all cases. At the final follow-up, coracoclavicular distance of the injured shoulder was increased, as compared to the intact shoulder (p=0.002), with no accompanying clinical symptoms. No K-wire migration was observed. At the final follow-up, K-wire irritation was observed in two cases and acromioclavicular arthrosis in one case, with no other adverse effects. Pain visual analogue scale, CS, and KSS were improved in all cases. CONCLUSIONS: The method of anatomical locking plate with additional K-wire fixation could be useful in achieving beneficial clinical results.

Cable Pin System versus K-wire Tension Band Fixation for Patella Fractures in Chinese Han Population: A Meta-analysis / 华中科技大学学报（医学）（英德文版）

This meta-analysis compared the therapeutic effect of cable pin system (CPS) with K-wire tension band (KTB) in the treatment of patella fractures among Chinese Han population.The databases of PubMed,Cochrane library,China National Knowledge Infrastructure (CNKI),Chinese WanFang and Chinese VIP were searched for studies on CPS versus KTB in the treatment of patella fractures among Chinese Han population.Literatures were screened according to the inclusion and exclusion criteria.The quality of the studies was assessed,and meta-analysis was performed using the Cochrane Collaboration's REVMAN 5.3 software.A total of 932 patients from 15 studies were included in this meta-analysis (426 fractures treated with CPS and 506 fractures treated with KTB).There were significant differences in duration of hospital stay [mean difference (MD)=-1.07;95％ confidence interval (CI):-1.71 to-0.43],fracture healing time (MD=-l.23;95％ CI:-1.68 to-0.77),flexion degree of knee joint at 6th month after operation (MD=14.82;95％ CI:10.93 to 18.71),incidence of postoperative complication [risk ratio (RR)=0.16;95％ CI:0.09 to 0.27] and excellent-good rate of B(o)stman score (RR=1.09;95％ CI:1.03 to 1.16) between the CPS group and KTB group,while no significant difference was found in operative time between the two groups (MD=-4.52;95％ CI:-11.70 to 2.67).For the treatment of patella tractures among Chinese Han population,limited evidence suggests that the CPS is more suitable than the KTB when considering the hospital stay,fracture healing time,flexion degree of knee at 6th month after operation,incidence of postoperative complication and excellent-good rate of B(o)stman joint score.Due to the limitation of high quality evidence and sample size,more large-scale randomized controlled trials are needed to validate the findings in the future.

Anatomical Locking Plate with Additional K-wire Fixation for Distal Clavicle Fracture

BACKGROUND: Neer type II distal clavicle fractures have the drawback of coracoclavicular instability and insufficient distal bony fragment, thereby making it difficult to achieve adequate fixation. Although various surgical treatments have been described for Neer type II fracture, the optimal treatment remains controversial. This study reports the clinical results and usefulness of anatomical locking plate with additional K-wire fixation. METHODS: A totally of 21 patients with type II distal clavicle fracture were included in the study. The surgical procedure reduced the fracture temporarily; it included insertion of one or two K-wire from the lateral margin of the distal fragment to the proximal fragment through the fracture site, followed by application and fixation of the locking plate. The bony union and migration of K-wire was evaluated in the follow-up radiography. The coracoclavicular distance and acromioclavicular joint arthrosis were assessed at the final follow-up. The Constant Score (CS) and Korean Shoulder Score (KSS) were evaluated for clinical scoring. RESULTS: Bone union was achieved in all cases. At the final follow-up, coracoclavicular distance of the injured shoulder was increased, as compared to the intact shoulder (p=0.002), with no accompanying clinical symptoms. No K-wire migration was observed. At the final follow-up, K-wire irritation was observed in two cases and acromioclavicular arthrosis in one case, with no other adverse effects. Pain visual analogue scale, CS, and KSS were improved in all cases. CONCLUSIONS: The method of anatomical locking plate with additional K-wire fixation could be useful in achieving beneficial clinical results.

Comparison of Intramedullary K-Wire Nailing versus Plate for Fixation in Metacarpal Midshaft Fracture / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare the clinical and radiological results of patients with metacarpal midshaft fracture following surgery using either intramedullary K-wire nailing or internal fixation of plates. MATERIALS AND METHODS: This study was conducted with 39 metacarpal midshaft fracture patients between October 2008 and September 2012. Of these 39 patients, 15 patients underwent intramedullary K-wire nailing and 24 patients underwent internal fixation of metal plates. We analyzed bone union time and final posterior angulation radiologically and the range of motion, grip power, and quick-disabilities of the arm, shoulder and hand (DASH) scores, visual analogue scale (VAS) score clinically. RESULTS: Bone union was observed in all cases and bone union times were not significantly different between the two surgical methods. The final follow-up radiographs showed statistically significant differences in posterior angulation, which was 14°, on average, among the patients who underwent intramedullary K-wire nailing and 5°, on average, among the patients who underwent internal fixation of plates. No significant differences were found for the range of joint motion, power, and quick-DASH scores and VAS score were not significantly different between the two groups. CONCLUSION: Intramedullary K-wire nailing showed significant differences in posterior angulations, but both intramedullary K-wire nailing and internal fixation of plates produced good clinical outcomes in the treatment of metacarpal midshaft fracture. Therefore both techniques are considered good treatment methods.

Designing of a new drilling guide for K-wire in Tension-band wiring of patellar fractures and its experi-mental study / 实用医学杂志

Objective To develop a newly designed guide and evaluate its clinic application prospect in treatment of patella fracture. Methods In our mechanical experiment, we carried out the tensile test of the two generation drilling guides by biomechanics machine and then analyzed the difference in their deformation. In the corpse experiment , we transversed fractures at the equator of the patella obtained from 10 fresh cadaver speci-mens. They were divided into 2 groups randomly: a test group and a control group. The second-generation of the aiming guide was used for the test group but not for the control group during the experiment. Then we evaluated its clinic application in the treatment of patella fracture. Results In the mechanical experiment, the displace-ment of the first generation guide was significantly larger than that of the newly one. The accuracy in the place-ment of k-wires by the second generation guide was significantly higher than by the first generation guide (P <0.05). Conclusions The drilling guide is reasonable in design and convenient in use. Moreover, it can improve the accuracy and quality of insertion of tension-band wiring of patellar fractures. The second-generation one is better and thus it is worth clinically spreading.

Prospective study of treatment of extraarticular fractures of distal end radius by cross K wire fixation and cast immobilisation and its comparison with Kapandji’s method of intrafocal pinning anatomically and functionally.

Background: Distal radius fractures account for 17% of all fractures in adults. The fracture of the lower end of radius crushes the mechanical foundation of man’s most elegant tool, the hand. No other fracture has a greater potential to devastate hand function. Extra-articular fractures (type A in the AO classification) require avoidance of malunion with angulation and shortening. Malalignment results in limitation of movement, changes in load distribution, midcarpal instability and an increased risk of osteoarthritis of the radiocarpal joint. Aims and objectives: Treatment of extraarticular fractures of distal end radius by cross K wire fixation and cast immobilisation and its comparison with Kapandji’s method of intrafocal pinning anatomically and functionally. Methods: Total 50 cases were included in the study. First 25 cases were treated by Kapandji’s method and next 25 cases were treated by cross K wire fixation and all cases were given below elbow cast after internal fixation. Patients were followed up at regular intervals and Anatomical and functional outcomes were evaluated in all the patients. Results: In our study anatomical end results were satisfactory in 96% and unsatisfactory in 4% of the subjects treated with cross K wire fixation and 72% and 28% in cases treated by Kapandji’s method whereas Functional end results were excellent in 28% cases, good in 68% cases, fair in 4% case and poor in 0% cases treated with cross k wire fixation and 12%, 60%, 24% and 4% in cases treated by Kapandji’s method. Conclusion: Cross K wire method proved to be better than Kapandji’s method of intrafocal K wire fixation both functionally and anatomically.

Operative Treatment of Displaced Medial Epicondyle Fractures Using K-Wires Cross-Fixation / 대한정형외과학회잡지

PURPOSE: The aim of this study was to investigate the clinical and radiological outcomes following reduction of displaced medial humeral epicondyle fracture with a K-wire cross-fixation. MATERIALS AND METHODS: Seventeen patients (mean age, 12.7 years; 12 boys and 5 girls) who underwent cross-fixation using K-wires in displaced medial epicondyle fracture, regardless of dislocation, were included. Surgical outcomes were estimated using the Elbow Assessment Score of the Japanese Orthopaedic Association. Statistical significance between the elbow assessment score and age, fracture type, dislocation, displacement width, and size difference between bilateral medial epicondyles was estimated 6 weeks after surgery. RESULTS: The mean elbow assessment score among the patients was 98 points (range, 94-100 points). Displaced medial epicondyle fractures were radiologically classified according to 3 groups: minimally displaced (2 cases), entrapped (9 cases), and associated with dislocation (6 cases). The mean displacement width of the fracture fragment was 11.6 mm. At 6 weeks postoperatively, the medial length of the distal humerus (28.6 mm) was greater compared to that of the contralateral side (28.1 mm). Displacement of the fracture fragment was statistically related to the elbow assessment score (p=0.011). The other assessed values did not show statistical meaning. CONCLUSION: Open reduction of the displaced medial humeral epicondyle fracture using K-wire cross-fixation in children and adolescents showed favorable clinical results with no instability or elbow complications.

Treatment for Concurrent Ipsilateral Femoral Neck and Shaft Fractures Using Reconstruction Nail with Temporary K-Wires

PURPOSE: The purpose of this study is to evaluate the results of operative treatment using a reconstruction nail after temporary K-wire fixation of the femoral neck for ipsilateral femoral neck and shaft fractures. MATERIALS AND METHODS: A total of 11 cases were treated, which were followed-up for more than two years, between August 2007 and July 2012. The average age was 51 years (29-69 years) and men were dominant counting eight cases. All cases were operated with a reconstruction nail after temporary K-wire fixation of the femoral neck. Bone union periods, alignment, etc. were evaluated by radiological methods and accompanying damage and complications were also investigated. Functional evaluation was performed in accordance with Friedman and Wyman criteria at the last follow-up. RESULTS: The average time for union of the femoral shaft was 22.5 weeks (12-32 weeks), and femoral neck was 13.1 weeks (8-20 weeks). There was no nonunion, and four femoral shaft fractures resulted in delayed union. There was one case of leg length discrepancy more than 2 cm long, but malalignment of more than 10 degrees was not observed. Avascular necrosis of the femoral head did not occur. Functional results were good in eight cases, fair in two cases, and poor in one case. CONCLUSION: Treatment with reconstruction nailing after temporary K-wire fixation of the femoral neck is thought to be a good method which prevents neck displacement and has low complication rates.

Clinical study of minimally invasive percutaneous crossover K-wire fixation of scaphoid fractures under C-arm / 国际外科学杂志

Objective To observe the clinical efficacy of minimally invasive percutaneous K-wire crossover fixation treating scaphoid fractures under C-arm.Methods From March 2011 to May 2014,20 patients with fresh scaphoid fractures had postoperative regular outpatient follow-up.Evaluation indicators included Cooney wrist scoring system,X-ray assessment of fracture healing,questionnaire survey of patient's subjective satisfaction at the final follow-up.Results All patients were followed up for 4 to 18 months,the mean follow-up time being 10 months.Postoperative X-ray showed all cases achieved bony union within 8 to 12 weeks,an average of 9.2 weeks.The questionaire resuits of patient's subjective satisfaction showed that general feeling of treatment in 2 cases,relatively satisfied in 2 cases,greatly satisfied in remaining 16 patients at the final follow-up.According to the postoperative Cooney wrist score,excellent in 8 cases,good in 10 cases,fair in 2 cases,the overall satisfactory rate was 90.2％.There were not pin tract infection,nonunion,malunion,avascular necrosis of scaphoid and other complications.2 cases showed that wrist pain during weight-bearing activities and weather getting cold,minor limitations of wrist function and degree of activity,grip strength slightly worse than the contralateral.Conclusions Minimally invasive percutaneous K-wire crossover fixation under C-arm combined with postoperative plaster external fixation properly can attain good clinical results in the treating of scaphoid fractures and worthy of further promotion.

A Study of Supracondylar Fractures of Humerus in Children by Open Reduction and Internal Fixation with Kirschner Wires.

Background: Supracondylar fractures of humerus is the commonest injury, constitutes about 65.4% of all fractures about the elbow in children. Displaced supracondylar fracture of humerus demand great respect and challenging one to treat, since it requires accurate anatomical reduction and internal fixation to prevent complications. So, in this study, we reported the results of open reduction and internal fixation with K-wires in the displaced (Gartland’s type III) supracondylar fracture humerus in children. Material and Methods: Thirty cases of displaced (Gartland’s type III) supracondylar fractures treated by open reduction and internal fixation with K-wires were studied between September 2011 to August 2013 at our institution and followed for an average of 24 months. Results: We came across 36 male patients and 14 female patients. Majority of the cases (38) were due to high energy trauma of road traffic accidents involving relatively younger patients. At the end of 5 months, all except four patients could mobilize independently without any aid. We did not come across complications like fracture of femur and failure of fixation and no reoperations were required. Conclusions: Open reduction and internal fixation with K-wires is the most commonly accepted treatment of displaced supracondylar fracture humerus in children when done at appropriate time. It gives more stable fixation, better anatomical reduction with negligible complication.

A clinical study of management of proximal humeral fractures in adults.

Background: Fractures of the proximal humerus are one of the commonest fractures encountered by an orthopaedician. The incidence of this fracture has significantly increased perhaps due to the increased vehicular traffic and mechanized life. The approach towards the management of these fractures types of fractures has changed during the course of period. Since the appropriate treatment and results associated with each modality of treatment for these fractures is not defined this study was undertaken. Methods: This longitudinal study was done on 150 cases of proximal humerus fractures which were managed by both conservative and surgically. Initial preoperative clinical and radiological assessment was done and appropriate mode of treatment of given depending upon type of fracture according Neer’s classification. Follow up of patient was done both clinically and radiologically at 2nd, 6th and 8th weeks and assessed for any complications. Final assessment was done according to Neer`s shoulder scoring criteria. Results: The 90 cases were treated conservatively and 60 surgically. Maximum follow up was 9 months and minimum 4 month with an average follow- up of 6.67 months. Our series showed excellent result in 70 cases (46.6%), satisfactory in 65 cases (43.3%) and fair in 15 cases (10%). Conclusion: Undisplaced fractures of the proximal humerus can be managed conservatively and non-displaced tuberosity fractures, if managed conservatively, give good results. Displaced two or three part fractures in young patients need anatomical reduction with internal fixation. Conservative treatment of four part fractures, four part fracture dislocation and anatomical neck fractures gives poor results and so primary hemiarthroplasty is indicated. There is direct relationship between displaced proximal humeral fractures between fracture severity i.e. greater displacement, communition, and crushing and the eventual results that is more than the initial insult, worse the prognosis. Rehabilitation is the key to success.