Short versus long proximal femoral nail in the management of intertrochanteric fractures - a comparative study.

INTRODUCTION: Intertrochanteric fractures are those that occur in the region spanning from the extracapsular basilar neck region to the region along the lesser trochanter proximal to the development of medullary canal. Low-energy falls account for 90% of fractures in people over the age of 50, with females having a higher prevalence. Intertrochanteric fractures in children and teenagers are caused by high-energy trauma. The aim of this study was to compare the functional and radiological outcomes as well as complications of intertrochanteric fractures treated with long proximal femoral nail (PFN) versus short proximal femoral nails. METHODS: The study was a clinical randomized prospective comparative study which included 30 (2 groups of 15 patients each, being treated with short and long PFNs respectively) skeletally mature patients with fresh (less than 3 weeks old) intertrochanteric fractures of femur AO/OTA 31-A1, AO/OTA 31-A2 or AO/OTA 31-A3 as per AO/OTA classification. Harris Hip score was used to compare the functional outcomes. RESULTS: The average age of patients in short PFN group (Group A) was 62.1 ± 15.77 years and in long PFN group (Group B), it was 54.1 ± 10.8 years. Male-female ratio in the study was 1.7:1. AO31A2 of AO fracture classification was the most common type of fracture in both the groups. The mean injury to surgery interval in Group A was 9.6 ± 4.45 days and in Group B, it was 6 ± 4.12 days. The mean operative duration in Group A was 68.6 ± 6.62 minutes and in Group B, it was 78.6 ± 7.35 minutes. The average time of union in Group A was 15.69 ± 2.72 weeks while that of Group B was 15.77 ± 2.05 weeks. The average Harris Hip score at final follow up in Group A was 81.0 ± 11.62 and in Group B, it was 80.3 ± 10.83. There was 1 case of implant failure in each group, which were re-operated. One case of screw back-out in Group A led to a varus collapse and had to be reoperated. One case of non-union was reported in Group B. One case of superficial wound infection was reported in each group. CONCLUSION: The Proximal Femur Nail can be used as an efficient implant to manage per trochanteric fractures regardless of the length of the implant. However, the mean operative time was found to be lower when a short nail is used.

Cemented unipolar or modular bipolar hemiarthroplasty for femoral neck fractures in elderly patients - which is better?

INTRODUCTION: Hemiarthroplasty is considered to be the treatment of choice for femoral neck fractures in elderly, however there is no consensus to support the choice between unipolar or bipolar hemiarthroplasty. Several studies found that patients with bipolar hemiarthroplasty had a better outcome of pain, a higher rate of return to the pre-injury state, and a greater range of hip motion. Some studies have demonstrated equal hip functional outcome between unipolar and bipolar hemiarthroplasty, but unipolar hemiarthroplasty was favoured due to its lower cost. The purpose of this study was to compare the functional and radiological outcome of cemented unipolar vs modular bipolar hemiarthroplasty in displaced femoral neck fracture in elderly patient population. METHODS: It is a prospective randomized study, with 44 patients in each group. Elderly Patients (>60 years of age) with traumatic displaced femoral neck fractures were included in the study. Cemented unipolar or modular bipolar hemiarthroplasty was performed in the respective patient groups using posterior or anterolateral approach. Functional outcome evaluation was done by Harris Hip Score and radiological outcome evaluation was done for acetabular erosion. The data was entered in MS EXCEL spread sheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 20.0 (IBM, Chicago). RESULTS: The mean age in the unipolar and bipolar group was 67.2 and 66.1 years respectively. The average follow-up period was 20.1 and 22.3 months in the unipolar and bipolar group respectively. Mean operating time was significantly more in the modular bipolar group (78.3 minutes) compared to the unipolar group (67.3 minutes). Two patients (4.5%) had acetabular erosion in each group. Mean Harris Hip score at 3 months follow-up was significantly higher (p value <0.05) in bipolar group (75.8±4.2) than the unipolar group (77.7±2.9). However, subsequent follow-ups at 6 months (80.9±2.8, 82.0±2.5, p value >0.05) 12 months (83.1±2.2, 83.2±1.2, p value >0.05) and 24 months (85.5±2.4, 85.2±2.8, p value >0.05) did not show any significant difference between the two groups. The incidence of general complications was 34% in bipolar and 20.4% in unipolar hemiarthroplasty group. CONCLUSION: Functional outcome in terms of Harris Hip Score are better in the bipolar group at 3 months follow up but there was no significant difference in the functional outcome between the two groups at 6, 12 and 24 months follow up. The operative time for unipolar is lower and statistically significant compared to bipolar hemiarthroplasty of the hip.

Prediction of quadruple hamstring graft diameter for anterior cruciate ligament reconstruction by anthropometric measurements.

BACKGROUND: The literature is scanty regarding the anthropometric predictors on the diameter of quadruple hamstring graft obtained in anterior cruciate ligament (ACL) reconstruction in Indian population. Minimum diameter of the graft for ACL reconstruction should be >7 mm to preclude failure. The objective of this study was to assess the prediction of the hamstring graft diameter by several anthropometric parameters including age, thigh circumference, weight, height and body mass index (BMI). MATERIALS AND METHODS: 46 consecutive patients who had undergone ACL reconstruction by the same surgeon using quadruple hamstring grafts were evaluated. The age, thigh circumference of the normal side, height, weight and BMI were recorded preoperatively and Pearson correlation was done using these parameters with graft diameter measured intraoperatively. Regression analysis in a stepwise manner was undertaken to assess the influence of individual anthropometric parameters on the graft diameter. RESULTS: There were 44 males and 2 females. Mean age was 29.4 years, mean height was 172.6 cm, mean weight was 70.9 kg, mean BMI was 23.8 kg/m(2), mean thigh circumference was 47.1 cm and mean graft diameter was 7.9 mm. There was a positive correlation individually between the thigh circumference and graft diameter obtained (r = 0.8, P < 0.01, n = 46), and between the height and graft diameter (r = 0.8, P < 0.01, n = 46). On the regression analysis thigh circumference and height were found to be significant predictors of graft diameter giving the following equation: Graft diameter (mm) = 0. 079 height (cm) +0.068 thigh circumference (cm) -9.031. CONCLUSION: Preoperatively using the above equation if graft diameter came out to be <7 mm then alternate options of graft material must be kept in mind in order to prevent failure.

Management of congenital talipes equinovarus by Ponseti technique: a clinical study.

The purpose of this study was to evaluate the early results of treatment of idiopathic congenital talipes equinovarus (CTEV) by the Ponseti method and compare the results with those of other manipulation techniques and surgical treatment reported in the literature. A total of 100 patients with 156 clubfeet (80 males, 20 females), were treated for idiopathic CTEV by the Ponseti method. The average age at presentation was 4.5 months. Scoring of each foot was done according to the Pirani score. Photographs showing the deformity and podograms were taken to have an objective record against which the results were compared. The mean total Pirani score at the start of treatment was 4.26 and mean foot print angle (FPA) was 14.2 degrees. Post correction, there was a significant difference (P < .001, z = 18.638) in the mean FPA. There was also a statistically significant difference between the pre- and postcorrection Pirani scores (P < .001, z = 55.427). In 95% of the patients correction of the deformity was achieved. The Ponseti technique is based on sound understanding of the pathoanatomy of clubfoot. The good results obtained by the Ponseti technique show that posteromedial soft tissue release may no longer be required for most cases of idiopathic CTEV.