FAST- Fixator Assisted Submuscular plating Technique-A simplified technique of submuscular plating in paediatric femur fractures.

The surgical management of paediatric femur fractures has evolved over the last few decades. Intramedullary stabilization with titanium elastic nail (TENS) is the preferred surgical management for length stable and mid diaphyseal femur fractures in children between 5-11 years of age. However, TENS is not preferred in length unstable fractures and in proximal or distal metaphyseal femur fractures due to higher incidence of angulation and shortening at fracture site. In such scenarios, submuscular plating has come up as an alternative surgical treatment modality which avoids these complications and provide good functional outcome. Many authors have suggested different surgical variations in techniques of submuscular plating for paediatric femur fracture. We have devised a technique of submuscular plating with help of external fixator (FAST) in paediatric femur fractures which minimises the surgical time and simplifies the procedure.

Greater trochanteric versus piriformis fossa entry nails for femur shaft fractures: Resolving the controversy.

BACKGROUND: Intramedullary nailing is the treatment of choice for shaft of femur fractures in adults. Antegrade nails involve entry through either piriformis fossa (PE) or greater trochanteric (GT) tip. The superiority of one entry point over the other is a matter of debate, and the present review was done to determine the same. RESEARCH QUESTION: Is GT entry for antegrade femur nailing superior to the PE for shaft femur fractures in adults? OBJECTIVE: The present systematic review was conducted to determine the superiority of one entry point over the other by comparing the outcome parameters like operative time, exposure to fluoroscopy, mal-unions, non unions, abductor weakness, varus malalignment and Harris Hip scores (HHS). METHODOLOGY: Three databases of PubMed, EMBASE and SCOPUS were searched for relevant articles that directly compared GT with PE for nailing in shaft femur fractures in adults. RESULTS: We analysed a total of 9 studies published between the years 2011-2017. There were 5 retrospective and 4 prospective studies, out of which 3 were randomised. The total number of patients was 256 in GT group and 460 in PE group. OUTCOMES: There was significant superiority of GT entry over PE on meta analysis; lesser operation time: standard mean difference (SMD): -21.01; lesser exposure to fluoroscopy : SMD: 36.36; lesser incidence of abductor weakness: Odd's ratio (OR): 14.35; better functional outcome (HHS): SMD -2.48. CONCLUSION: GT entry nails are superior to PE nails for treating shaft of femur fractures in adults. They have a shorter learning curve and better functional outcomes, however the rates of union are comparable in both.

Kuntscher's nail removal techniques: an illustrative walk-through its journey.

The use of Kuntscher nail for femur fracture dates back to World War 2. Since then, the technique of intramedullary nailing has evolved and the use of Kuntscher nail has become almost obsolete. The orthopaedic surgeons across the globe are facing a new challenge of removal of these Kuntscher nails due to different indications. Different but scattered English literature has been published describing the experiences and techniques of surgeon with K nail removal. Up till now, no systematic analysis has been performed evaluating the available literature. We have planned a systematic review to evaluate and explore the various indications and techniques of K nail removal.

Fast and slow myosin as markers of muscle regeneration in mangled extremities: a pilot study.

Mangled extremities were classically managed by amputation. But over the past few decades, with the advancement in surgical techniques, an increased number of limb salvages have been possible. As muscles usually get damaged in such grievous injuries, a thorough understanding of muscle regeneration may give a better insight into muscle healing in these injuries. Muscles are composed of slow and fast fibers which can be represented by slow and fast myosin, respectively. There are some animal studies which reported differential regeneration of slow and fast muscle fibers during muscle healing. We conducted this pilot study to find out whether the same holds true for muscle healing in mangled extremities also. This pilot study is designed in 15 patients with lower limb mangled extremities presenting to trauma center of PGIMER, Chandigarh, who were operated within 24 h of injury to see whether muscle healing in mangled extremities follows the same pattern. Biopsies were taken during initial surgery conducted within 24 h of injury and on the 7th day of injury when patient was posted again for secondary wound closure procedure or revision amputation. The biopsy samples were subjected to histopathological and immunohistochemistry examination using antibodies against fast and slow myosin. We found that the regenerating muscle fibers in the biopsy sample taken on the 7th day of injury showed only slow muscle fibers with the absence of fast muscle fibers when compared with the initial biopsy results showing differential regeneration of slow muscle fibers.

Role of PAX-7 as a tissue marker in mangled extremity: a pilot study.

The rising incidence of mangled extremity seen in modern trauma has lead to significant patient mortality. A lot of research is going on at microcellular level for a better understanding of tissue injury, repair and regeneration. PAX-7 is one such transcription factor, a marker of satellite stem cells in skeletal muscle. Though few studies have shown concrete evidence of increased expression of PAX-7 in the nearby injured zone in skeletal muscle post-injury, none has studied its expression in an event of mangled injury of limb in humans. We, hereby, attempted to identify whether PAX-7 expression of tissue near the zone of injury, after grievous trauma like mangled injury of extremities, actually increases, decreases or remains unaffected. A pilot study was conducted on 30 cases at a level 3 trauma centre; patients were segregated into two groups-group I with MESS score ≥ 7 and group II with score < 7. For group I patients, amputation was planned, and for group II, limb salvage surgery was planned. Skeletal muscle samples from three different zones (A, B and C) in group I, while pre- and post-debridement skeletal muscle samples in group II were sent for microscopic examination and IHC staining with PAX-7 antibody. A definite increase in PAX-7 expression, post-trauma near the zone of injury (Zone B and C in group I and post-debridement in group II), was noted. Increased expression of PAX-7 signifies increased recruitment of satellite stem cells near the injury zone, thereby reflecting the activation of skeletal muscle regeneration cascade. Hence, increased staining of PAX-7 in tissues could be a viable marker for identifying potential regeneration of skeletal muscle post-injury.

Assessment of dentinal damage during canal preparation using reciprocating and rotary files.

INTRODUCTION: The role of motion kinematics in creating dentinal damage during instrumentation is not very clear. The purpose of this study was to compare the formation of dentinal cracks with instruments working in continuous rotation and reciprocating motion. METHODS: One hundred twenty extracted human mandibular premolars were selected for the study. Thirty teeth served as controls, and the remaining 90 teeth were divided into 3 groups depending on the root canal preparation technique. Group 1 samples were treated with WaveOne primary files (Dentsply Maillefer, Ballaigues, Switzerland), group 2 samples with single F2 ProTaper (Dentsply Maillefer) working in reciprocating motion, and group 3 samples were prepared with sequential ProTaper (Dentsply Maillefer) until F2 working in continuous rotation motion. Roots were then sectioned at 3, 6, and 9 mm from the apex, and the cut surface was observed under a stereomicroscope for the presence of dentinal microcracks. RESULTS: The control group and WaveOne, single F2 ProTaper in reciprocating motion, and continuous ProTaper groups caused cracks in 0%, 15%, 26%, and 53% of samples, respectively. A statistically significant difference was found between 2 reciprocating file groups (WaveOne and single F2 ProTaper in reciprocating motion) and the continuous rotation group (ProTaper) (P < .05). However, no significant difference was found among the 2 reciprocating file groups (P > .05). CONCLUSIONS: Dentinal cracks are produced irrespective of motion kinematics. Within the limits of this study and the current literature, such incidence is less with instruments working in reciprocating motion compared with those working in continuous rotation.