Fracture stability, quality of bone and pitfalls in surgery versus complications of fixation in inter trochanteric fractures

This is a retrospective study of 65 cases [mean age 58.83 +/- 16.36 years] based upon radiological assessment of intertrochanteric fractures developing complications of fixation. Correlation is discussed between various complications and type of fracture, bone quality, reduction, type of instability and implant type, suitability and position. The tendency for deterioration of varus was significantly high in Evan's type 1c [68.18%] and 1d [75%] fractures with medical cortical deficit [78.38%]. The tendency for proximal cut out of implant was again significantly high in Evan type 1c [54.54%] and 1d [41.66%] fractures, varus reduction [46.62%], medical cortical deficit [51.36%] and suitable implants [51.62%] in unacceptable position [50%]. The tendency of medical migration of distal fragment was high in Evan's type 1d [54.15%] and type 2 [100%] fractures with reverse obliquity and compression hip screw [88.33%]. Tendency for penetration of femoral head was again high in Evan's type [2] fractures [36.36%] with reverse obliquity. Tendency for implant breakage/bending/loosening [15 cases] was high in Evan's type 1d [37.5%] and type 2 [27.27%] fractures, normal quality bone [52.94%] and implant placed in acceptable position [52%]. The difference was non significant for other factors and complications of fixation

Venous Trauma

This is a retrospective study conducted at Jinnah Postgraduate Medical Centre, Karachi from June 1994 to June 1997. Twenty three patients with thirty injured veins [on exploration] were included in this study. There were twenty male and three female victims with a mean age of 35.56 [ +/- 11.35] years. Firearm injuries [11] and road traffic accidents [6] were the predominant causes. Twenty one had combined arteriovenous injury. Twenty four veins were completely torn. Femoral and popliteal vessels were commonly injured. Twenty veins were ligated and ten were repaired. Those repaired were monitored post operatively with Doppler ultrasound. Four patients had subtotal amputation and sixteen had arterial insufficiency. Eight patients, [three deaths and five amputations] with eleven injured veins were not evaluated for final results. One patient out of five developed mild oedema with repaired veins and five out of ten with ligated veins. The difference in the rate and severity of postoperative oedema and wound healing between the two groups was not significant. We did not observe venous insufficiency during the follow-up period [three to eighteen months] in both groups