ABSTRACT
PURPOSE: Roof arc angle (RAA) is determined by measuring angle between a vertical line drawn from center of the acetabulum towards the acetabular dome and a second line drawn from center of acetabulum to the fracture through the acetabulum. Joel and Matta demonstrated that when roof arc angle was less than 45° on Pelvic AP and Judet's views, the fracture line is considered to be passing through the weight-bearing dome and require surgical fixation. The main purpose of the study is to calculate patient-specific angle and width for the better evaluation and management of acetabular fractures. METHODS: Radiographs of normal hips were retrieved from electronic data and parameters were calculated. Two observers calculated the parameters at two different intervals. Pearson correlation formula was used to find a correlation between groups. RESULTS: Fifty radiographs of 28 patients were reviewed. The mean age of patients was 75.58 years ±13.28. The radius of the acetabulum, the radiographic measurement of sector width for 45° angulation at the roof, and the mathematical calculation for roof arc for 45° angle had significant positive correlation for both observers at two different occasions. CONCLUSIONS: The measured roof arc width ranges from a minimum of 16.20 mm-31.50 mm and the calculated arc width for a 45-degree angle varies from a minimum of 15 mm-25.56 mm. These values are higher than the described values of 10 mm equals to 45 degrees. Hence, the values measured in this study should be considered for decision making in the management of acetabular fractures.
ABSTRACT
Pseudotumors are not uncommon complications after total hip arthroplasty (THA) and may occur due to differences in bearing surfaces of the head and the liner ranging from soft to hard articulation. The most common causes of pseudotumors are foreign-body reaction, hypersensitivity and wear debris. The spectrum of pseudotumor presentation following THA varies greatly-from completely asymptomatic to clear implant failure. We report a case of pseudo-tumor formation with acetabular cup aseptic loosening after revision ceramic-on-metal hip arthroplasty. The patient described herein underwent pseudotumor excision and re-revision complex arthroplasty using a trabecular metal shell and buttress with ceramic-on-polyethylene THA. Surgeons should be aware of the possibility of a pseudotumor when dealing with revisions to help prevent rapid progression of cup loosening and implant failure, and should intervene early to avoid complex arthroplasty procedures.
ABSTRACT
INTRODUCTION: Closed reduction of supracondylar humerus fractures with K-wires has become the standard line of management with different opinions regarding the technique that is utilized. AIM: To compare the functional and radiological outcomes of lateral and cross pinning technique in supracondylar fractures of humerus in children. MATERIALS AND METHODS: A prospective study with 57 cases of displaced fracture supracondylar humerus, treated by lateral (Group A n=28) and cross pinning (Group B n=29), was conducted between May 2013 and May 2015. Independent sample student's t-test was done to assess the parameters like age, follow-up and duration of surgery. The results were expressed as mean with standard deviation and p<0.05 was considered as statistically significant. RESULTS: As per the Gartland classification system, 46 (80.7%) patients had Type IIIA and 11 (19.2%) patients had Type IIIB fracture. The average surgical time was 28.3±1.6 minutes in Group A and 30±3.6 minutes in Group B (p=0.02). About, 3.5% patients in Group A had pin loosening. As per the Flynn criteria, 78.6% in Group A and 79.3% in Group B had excellent results. CONCLUSION: No significant difference in terms of functional and radiological outcome was observed between both the techniques. Thus, both the techniques have equal results.
ABSTRACT
INTRODUCTION: Treatment of proximal humerus fractures always holds a dilemma for the treating surgeon. AIM: To assess the functional outcome of proximal humerus fractures treated with Proximal Humerus Internal Locking System (PHILOS) plating. MATERIAL AND METHODS: Fifty three consecutive patients were treated with PHILOS plating between August 2013 and August 2014. The inclusion criteria were skeletally matured patients with closed fracture proximal humerus with displacement >1 cm and varus angulation of >450. Severely comminuted fractures, open fractures and valgus impacted fractures were excluded from the study. The outcome was assessed using Neer's scoring system. RESULTS: The average age was 54.3±5.8 years. As per the Neers classification system, there were 6 (11.32%) 1-part, 19 (35.85%) 2-part, 17 (32.085) and 11 (20.75%) 3 and 4-part fracture respectively. Average surgical duration was 94±10.2 minutes. Radiological union was seen at 12±4.6 weeks. There were 2 (3.77%) cases of varus collapse. Three (5.66%) cases had screw back out, which was later revised and had a favourable outcome. As per the Neer's scoring system, 7 (13.21%) cases had excellent results, 37 (69.81%) had satisfactory, 6 (11.32%) had unsatisfactory while 3 (05.66%) cases had poor outcomes. CONCLUSION: PHILOS plating has a good functional outcome. However, proper patient selection, thorough knowledge of the anatomy and biomechanical principles are the pre-requisites for a successful surgery.
