Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 17 de 17
Filter
Add more filters










Publication year range
1.
Strategies Trauma Limb Reconstr ; 6(3): 155-8, 2011 Nov.
Article in English | MEDLINE | ID: mdl-21904844

ABSTRACT

To report a proximal femoral osteotomy with retention of bone ledges in a reciprocal position to increase bone contact and stability. The method was applied to 5 patients over a 3-year period. All patients had coxa vara. The average length gained was 1.5 cm, and the average neck shaft angle improvement was 30°. The Harris hip score improved from an average of 63 to 82. The reciprocal ledge osteotomy is technically less demanding and also allows conversion of normal shear forces around the upper femur to stabilizing forces. This method allows easier use of the DHS implant as potential rotation about the axis of the screw is negated by the ledges and the dynamic forces.

2.
J Child Orthop ; 3(6): 473-7, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19826852

ABSTRACT

PURPOSE: To determine the impact of a substantial delay in providing surgical treatment on the final outcome in transcervical femoral neck fractures in children. METHODS: Data on all pediatric patients with transcervical fractures of the femoral neck that were fixed by reduction and internal fixation after a delay of ≥7 days in our department between 2000 and 2008 were collected both retrospectively and prospectively. RESULTS: The medical records of 14 patients (15 fractures) were analyzed. The results after an average of 43 months of follow-up showed that the complication and avascular necrosis rates were higher in cases in which treatment had been delayed compared to those in comparable fractures that had been treated promptly after the event in other series. Nine of the 15 fractures had developed avascular necrosis at final follow-up. Overall, there were four excellent, three good, and eight poor results (based on the Ratliff criteria). CONCLUSIONS: Children whose transcervical fractures of the femoral neck were surgically treated after a delay of 1 week or longer had a high avascular necrosis rate and a relatively poor outcome. Reduction and internal fixation as the initial treatment should be implemented shortly after injury in order to enhance treatment outcome.

3.
Cases J ; 2: 7869, 2009 Jun 03.
Article in English | MEDLINE | ID: mdl-19830021

ABSTRACT

INTRODUCTION: High energy tibial plateau fractures along with calcaneal fractures individually produce several challenges for the orthopaedic surgeon. The principles of bony reconstruction include anatomic reduction and rigid internal fixation of intra-articular fractures and accurate restoration of the coronal, sagittal and transverse mechanical axes. Due to the tenuous nature of the soft tissue and devitalisation of the comminuted fragments with open reduction, external fixation of type 6 tibial plateau fractures is recommended. We report a case with ipsilateral high energy tibial plateau and calcaneal fractures both of which were managed with an ilizarov ring fixator. CASE PRESENTATION: A 55-year-old Kashmiri female presented to our department with an ipsilateral fracture of the tibial plateau and the calcaneum. Both were closed reduced and stabilized with an ilizarov ring fixator. CONCLUSION: The circular wire fixator provides a viable method to manage such fractures especially if they are co existent. This is especially true in situations where the soft tissue is compromised.

4.
Cases J ; 2: 8174, 2009 Jun 16.
Article in English | MEDLINE | ID: mdl-19830058

ABSTRACT

INTRODUCTION: Osteoporosis of the long bones challenges the orthopaedician in several ways. Amongst the difficulties encountered are the reduced bone mass, increased bone brittleness and medullary expansion, which must be factored in when deciding the type of surgical method to be used. One of the commoner complications of fixation of fractures in such bone is the occurrence of peri implant fractures with subsequent management requiring significant surgical acumen and judgment. CASE PRESENTATION: We report a case who sustained a supracondylar fracture of the femur, which was managed initially by a dynamic condylar screw assembly. The patient sustained a peri implant fracture during her rehabilitation, which was managed by the application of a longer side plate. 4 months postoperatively the patient sustained another peri implant fracture. Using a minimally invasive method we removed the screws from the plate and passed an intramedullary implant. The whole assembly was rotationally stabilized using an Ilizarov fixator. The union proceeded uneventfully. CONCLUSION: Use of such minimally invasive methods can be beneficial in such complicated situations.

5.
Chir Organi Mov ; 93(3): 149-53, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19711153

ABSTRACT

Penetrating injuries of the foot are a common presenting complaint in the emergency department. The residents of the underdeveloped world are especially prone to suffer such injuries as barefoot walking is still common. However, a relatively common injury that occurs in the shod feet is the "Nail-Slipper injury". A metal nail penetrates through the rubber sole of the footwear introducing the rubber piece into the soft tissue of the foot. As the nail is removed the piece remains behind often leading to delayed manifestations. This article describes the various delayed manifestations of this injury. A leading question for the antecedent injury of this kind should be asked from all patients with such presentations, especially in the urban setting.


Subject(s)
Foot Injuries/complications , Foot , Foreign Bodies/etiology , Wounds, Penetrating/complications , Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Time Factors
6.
Ortop Traumatol Rehabil ; 11(3): 264-70, 2009.
Article in English | MEDLINE | ID: mdl-19620744

ABSTRACT

BACKGROUND: The distal third of the tibia is unique in the sense that it has a minimal muscle cover and consequently the blood supply is easily compromised after a fracture in this area. Infected non union in this area provides a challenge to the orthopaedic surgeon. These difficulties are especially profound in the geriatric age group. MATERIAL AND METHODS: 12 cases with an infected non union of the distal third of the tibia were managed with acute docking over a distance of up to 2.5 cms. The age of these patients was more than 55 years. RESULTS: The average shortening at final follow up was 1.8 cms. The bone results were assessed according to the protocol laid down by the association for the study and application of the method of Ilizarov. Accordingly we had 3 excellent, 8 good and 1 fair result. The functional result was calculated as per the Ilizarov criteria [1]. On this basis we had 7 excellent, 4 good and 1 fair result. CONCLUSION: The acute docking modality is applicable to the distal tibia in such situations even in the geriatric population with predictable results.


Subject(s)
Bone Diseases, Infectious/therapy , Drainage/methods , Fractures, Ununited/complications , Tibial Fractures/complications , Aged , Bone Diseases, Infectious/etiology , Bone Diseases, Infectious/surgery , Female , Fractures, Ununited/surgery , Humans , Ilizarov Technique/adverse effects , Male , Middle Aged , Recovery of Function , Tibial Fractures/surgery , Treatment Outcome
7.
Ortop Traumatol Rehabil ; 11(1): 55-60, 2009.
Article in English | MEDLINE | ID: mdl-19259062

ABSTRACT

BACKGROUND: To assess the pattern of mass casualty incidents managed at our hospital over the last eight years, and evolve a differentiating classification based on this pattern. A combination of retrospective and prospective assessment was made. MATERIAL AND METHODS: All patients receiving injuries in mass casualty incidents and managed at our hospital. Patients with an injury severity score above 9. Management of injuries as per the trauma management protocol. Classification based on the data collected during the study and application of this classification to the subsequent mass casualty incidents to allow comparison between similar incidents in different settings. RESULTS: A classification system that mainly differentiates mass casualty incidents on the hospital basis, the criteria being: the time interval between the first information to first reception, and the percentage of admission above the maximum normal intake. CONCLUSIONS: The Barzullah classification system is the first attempt at developing a hospital based differentiation in mass casualty incidents. It provides a valid and easy method of comparing such incidents between hospitals and perhaps a basis for developing protocol for mass disaster management.


Subject(s)
Critical Care/organization & administration , Disaster Planning/organization & administration , Emergency Service, Hospital/statistics & numerical data , Mass Casualty Incidents/classification , Triage/statistics & numerical data , Wounds and Injuries/classification , Diagnosis, Differential , Efficiency, Organizational , Female , Humans , Injury Severity Score , Israel/epidemiology , Male , Mass Casualty Incidents/statistics & numerical data , Surgery Department, Hospital/statistics & numerical data , Wounds and Injuries/diagnosis , Wounds and Injuries/epidemiology
8.
J Orthop Surg (Hong Kong) ; 17(3): 313-6, 2009 Dec.
Article in English | MEDLINE | ID: mdl-20065371

ABSTRACT

PURPOSE: To describe a technique that preserves anterior and posterior alternate ledges in a closing wedge osteotomy. METHODS: Five patients aged 14 to 19 years underwent a closing wedge osteotomy for genu valgum in 8 limbs using a reciprocating ledge technique. A unicortical wedge of bone was removed, with the anterior and posterior cortices spared. The anterior cortex at the proximal level and the posterior cortex at the distal level were cut through. With a wobbling action, the osteotomy site was rotated, and the distal fragment externally rotated. Manual force was applied to close the osteotomy site ensuring overlapping of the reciprocal ledges. The distal fragment was translated laterally to prevent club deformity. The osteotomy site was held with one or 2 staples. Stability was tested by flexion and extension of knee. RESULTS: All 8 limbs attained bone union within 12 weeks, and full range of motion within a mean of 13 (range, 12-15) weeks. The mean correction of the tibiofemoral angle was 13 degrees. At a mean follow-up of 12 months, all patients were pain-free and none developed club deformity. CONCLUSION: Sparing reciprocal ledges in a closing wedge osteotomy for genu valgum may increase stability in the flexion-extension axis, enable early range-of-motion exercises, and facilitate early bone union.


Subject(s)
Genu Valgum/surgery , Osteotomy/methods , Adolescent , Female , Humans , Male , Surgical Stapling , Treatment Outcome , Young Adult
9.
Strategies Trauma Limb Reconstr ; 3(3): 119-22, 2008 Dec.
Article in English | MEDLINE | ID: mdl-19039648

ABSTRACT

One of the recommended methods for the management of displaced unstable proximal humeral fractures is the unilateral external fixator. In polytrauma cases this method may be especially useful for the stabilisation of these fractures. However, problems may arise if the fracture is fixed in a malaligned or distracted position. Conversion of the treatment concept to other modalities is difficult because of the problem of pin tract infection. The Ilizarov apparatus provides an useful method in such situations, as it allows distraction, translation and compression without the need for further anaesthesia and additional fixation.

10.
Injury ; 39(8): 947-51, 2008 Aug.
Article in English | MEDLINE | ID: mdl-18589419

ABSTRACT

Polytrauma cases in mass disasters present several challenges to the orthopaedic surgeon. Delayed referral, multisystem involvement and the requirement to manage coexisting injuries by interhospital transfer often make infection an inevitable risk. 28 patients with polytrauma were studied after being referred after being recovered from the debris of their homes in the Kashmir earthquake. All patients were referred more than 24h after sustaining their injuries. The lower limb fractures were fixed by external fixators in all these cases before interhospital transfer for the management of their co existing injuries. Return referral to the orthopaedic facility occurred after an average of 25 days. All cases were converted to Ilizarov fixation. The results bear out the fact that the Ilizarov method may be well suited for conversion osteosynthesis of lower limb fractures in polytrauma cases.


Subject(s)
External Fixators/standards , Femoral Fractures/surgery , Ilizarov Technique/standards , Tibial Fractures/surgery , Adult , Earthquakes , Female , Femoral Fractures/diagnostic imaging , Humans , India , Injury Severity Score , Male , Multiple Trauma/surgery , Postoperative Complications/prevention & control , Radiography , Retrospective Studies , Tibial Fractures/diagnostic imaging , Time Factors
11.
Strategies Trauma Limb Reconstr ; 3(2): 93-6, 2008 Sep.
Article in English | MEDLINE | ID: mdl-18551253

ABSTRACT

The management of perilunate dislocations diagnosed later than three months continue to elicit debate with literature being scarce. We report a 22-year-old male with transscaphoid perilunate dislocation who reported to our hospital 8 months after sustaining the injury. Open reduction was done along with bone grafting. Five years after the surgery the patient is symptom-free with an excellent range of motion.

12.
J Trauma Manag Outcomes ; 2: 2, 2008 Jan 29.
Article in English | MEDLINE | ID: mdl-18271951

ABSTRACT

BACKGROUND: Management of orthopaedic injuries in polytrauma cases continues to challenge the orthopaedic traumatologist. Mass disasters compound this challenge further due to delayed referral. Recently there has been increasing evidence showing that damage control surgery has advantages that are absent in the early total care modality. We studied the damage control modality in the management of polytrauma cases with orthopaedic injuries who had been referred to our hospital after more than 24 hours of sustaining their injuries in an earthquake. This study was conducted on 51 cases after reviewing their records and complete management one year after the trauma. RESULTS: At one year, out of the 62 fractures, 3 were still under treatment, while the others had united. As per the radiological and functional scoring there were 20 excellent, 29 good, 5 fair and 5 poor results. In spite of the delayed referral there was no mortality. CONCLUSION: In situations of delayed referral in areas where composite trauma centers do not exist the damage control modality provides an acceptable method of treatment in the management of polytrauma cases.

15.
Injury ; 39(2): 249-55, 2008 Feb.
Article in English | MEDLINE | ID: mdl-18093590

ABSTRACT

Interaction between humans and wild animals has increased in recent times, because of overlap of habitats. A proportion of this interaction is violent. Most of the literature describing the injuries sustained by humans in such contact pertains to the involvement of soft tissues. Trauma to bones and joints is only witnessed when larger animals attack humans. We studied the pattern of orthopaedic injuries over a period of 2 years in a series of 32 cases presenting to our hospital with a history of being attacked by the Asian black bear (Ursus thibetanus). This paper also documents the complications and challenges involved in managing these injuries. We suggest that orthopaedic traumatologists need to be prepared to deal with such cases in areas where interaction between humans and large wild animals is manifest.


Subject(s)
Ursidae , Wounds and Injuries/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Animals , Behavior, Animal , Child , Exophthalmos , Facial Injuries/epidemiology , Facial Injuries/surgery , Female , Fracture Fixation/statistics & numerical data , Fractures, Bone/epidemiology , Fractures, Bone/surgery , Humans , India/epidemiology , Male , Middle Aged , Multiple Trauma/epidemiology , Multiple Trauma/surgery , Plastic Surgery Procedures/statistics & numerical data , Time Factors , Wounds and Injuries/epidemiology , Wounds and Injuries/etiology
16.
J Orthop Traumatol ; 9(2): 97-9, 2008 Jun.
Article in English | MEDLINE | ID: mdl-19384623

ABSTRACT

Fracture of the femoral neck continues to be a vexing clinical and therapeutic challenge for the orthopedic surgeon. The fracture has a propensity for non-union and avascular necrosis. It is a challenge for the orthopedic surgeon to decide when to intervene in a case with non-union where the implant continues to be in place. We present a case with persistent clinical and radiological non-union signs where the fracture eventually united after 32 months. The case bolsters the view that a continued conservative regime might entail good results in such situations.

17.
Int Orthop ; 32(4): 559-66, 2008 Aug.
Article in English | MEDLINE | ID: mdl-17387474

ABSTRACT

The Ilizarov method has been studied extensively in the management of non-union of long bones. In most cases this involves filling of defects present primarily or after débridement by bone transport. Acute docking over gaps longer than 2 cm has not been adequately studied, however. The purpose of this paper is to report the efficacy of acute peg in hole docking as a bone graft-sparing modality in the management of infected non-union of long bones.


Subject(s)
Arm Injuries/surgery , Fractures, Ununited/surgery , Ilizarov Technique , Leg Injuries/surgery , Wound Infection/surgery , Adolescent , Adult , Aged , Arm Injuries/diagnostic imaging , Female , Fractures, Ununited/diagnostic imaging , Humans , Leg Injuries/diagnostic imaging , Male , Middle Aged , Postoperative Complications , Radiography , Treatment Outcome , Wound Infection/diagnostic imaging
SELECTION OF CITATIONS
SEARCH DETAIL
...