A comparative study on the use of ultra-low dose computed tomography scans with conventional computed tomography scans for the evaluation of proximal tibia intra-articular fractures.

Purpose: A rise in the need of preoperative CT assessment of proximal tibial intra-articular fractures has given rise to an increased load of radiation exposure. This comparative study aims at assessing the efficacy of low dose CT scan by collating images of tibial plateau fractures produced by low dose CT scan with that of conventional dose CT scan. Furthermore, the study aims at computing the comprehensive reduction in the effective dosage of radiation when low dose CT scan is employed for assessing these fractures. Methods: The study comprise of 23 cases of proximal tibial intra-articular fractures (confirmed by initial radiographs). Low-dose CT scan of the injured limb was preceded by conventional dose CT scan for generating images that were assessed and reported independently by five (single blinded) radiologists (using Schatzker's CT based classification). Quantification of fracture was done to compare them statistically. Results: A sensitivity of 93.94 % and positive predictive value of 93.92 % was observed on comparing images from low dose and conventional dose CT scan. An effective reduction of 89.81 % in overall dosage of radiation exposure was observed. Conclusion: Near equal quality images were generated by low dose CT scan as compared to conventional dose CT scan, thereby demonstrating its non-inferiority with an effective reduction of 89.81 % in overall dosage of radiation exposure.

Comparative study of the efficacy of gentamicin-coated intramedullary interlocking nail versus regular intramedullary interlocking nail in Gustilo type I and II open tibia fractures.

PURPOSE: Open tibia fracture is prone to infection, consequently causing significant morbidity and increasing the hospital stay, occupational loss and onset of chronic osteomyelitis. Intramedullary nailing is one choice for treating tibia shaft fractures. To improve the delivery of antibiotics at the tissue-implant interface, many methods have been proposed as a part of prophylaxis against infection. This study was conducted to study the role of gentamicin-impregnated intramedullary interlocking (IMIL) nail in the prevention of infection in Gustilo type I and II open tibia fractures and to compare the results with regular intramedullary nail. METHODS: The study included 28 patients with open tibia fractures (Gustilo type 1 or type 2); of them 14 underwent regular IMIL nailing and the other 14 were treated with gentamicin-coated nailing. Randomization was done by alternate allocation of the patients. Follow-up was done postoperatively (day 1), 1 week, 6 weeks, and 6 months for bone union, erythrocyte sedimentation rate (ESR), hemoglobin and C-reactive protein (CRP). Statistical significance was tested using unpaired t-test. A p value less than 0.05 was considered significant. RESULTS: There were 4 cases of infection in controls (regular IMIL nail) and no infection among patients treated with gentamicin-coated nail during the follow up (X2 = 4.66, p = 0.031). At 6 months postoperatively, CRP (p = 0.031), ESR (p = 0.046) and hemoglobin level (p = 0.016) showed significant difference between two groups. The bone healing rate was better with gentamicin-coated nail in comparison to regular IMIL nail at 6 months follow-up (p = 0.016). CONCLUSION: Gentamicin-coated IMIL nail has a positive role in preventing infection in Gustilo type I and II open tibia fractures.

New technique of imaging and treatment of pediatric supracondylar humeral fracture without moving the injured limb.

The management of closed, displaced supracondylar fracture of humerus in children can be divided into 3 stages. In stage 1 closed reduction is achieved whose acceptability is confirmed, on table, in stage 2 using an image intensifier. This reduction is maintained in stage 3 by immobilization in slab/cast or by percutaneous Kirschner wire fixation. Although enough literature for proper technique in stage 1 and stage 3 are available, there are certain practical problems encountered in the equally important stage 2, which needs a closer look. Most of the C-arm compatible tables have their metallic base toward the head end of the table with metal bar on the sides for additional attachments. These interfere with the rotation of the image intensifier and also with the quality of the image obtained. As a result, to obtain lateral image many surgeons rotate the fractured upper limb instead of the C arm. This practice is unacceptable, as rotating the fractured limb cannot only add to the injury but it can also cause loss of reduction. Similarly, many surgeons strongly condemn using the image intensifier as an operating table. We are proposing a new surgeon and anesthetist friendly method of positioning the patient in which both anteroposterior and lateral views can be obtained without moving the fractured upper limb. In addition, if required the surgeon can proceed to open reduction without the need to reposition or re drape the patient.