Orange city tapping nail: An innovative implant for humeral diaphyseal fractures.

BACKGROUND: We have conducted this study to evaluate the effectiveness of Orange City tapping nail in humeral diaphyseal fractures in terms of radiological union, shoulder function and complications. It's a pilot study with the new implant "Orange City tapping nail" developed at our institute. MATERIALS AND METHODS: Thirty patients with humeral diaphyseal fractures were treated with Orange City tapping nail through antegrade nailing procedure. The cases were followed up prospectively for a period of minimum six months. Outcome of the procedure were assessed according to American Shoulder and Elbow Surgeons (ASES) score, radiological union, complications and secondary procedures required. RESULTS: Twenty eight (93.33%) fractures united with an average consolidation time of 15.75 weeks. Two patients had nonunion. Functional outcome was excellent to good in 24 (80%) patients. One (3.33%) case had infection with Orange City tapping nail. CONCLUSION: Results of Orange City tapping nail were excellent to good for humeral diaphyseal fractures in terms of union, shoulder function and complications. It is a safe, easy and reliable method for the treatment of humeral diaphyseal fractures. Postoperative shoulder stiffness and impingement depends on operative technique and postoperative rehabilitation. We need a larger comparative study with conventional antegrade nail to evaluate the effectiveness of the implant.

Simultaneous Bilateral Distal Femur and Tibia Periprosthetic Fractures after Total Knee Arthroplasty: A Rare Case Report.

INTRODUCTION: Incidence of periprosthetic fractures is increasing with the rising number of total knee arthroplasties performed every year. The management of such fractures is challenging due to multiple factors. We reported a rare case with simultaneous bilateral distal femur and tibia periprosthetic fractures managed with open reduction and internal fixation (ORIF) and healed uneventfully. CASE REPORT: A 64-year-old female came with simultaneous bilateral distal femur (Bilateral Type IIB Rorabeck) and tibia (Bilateral Type IIIB Felix) periprosthetic fractures following road traffic accident. All fractures were managed with ORIF using locking plates. Bony union achieved in 4thpost-operative month without any complication. DISCUSSION: Management of such fractures can be challenging for orthopedic surgeons due to elderly patients with osteoporotic bone and poor healing potential. This injury is not reported in the literature previously and is quite challenging. At 1-year follow-up, the patient is walking comfortably without support and knee flexion range from 0 to 110° on both sides. CONCLUSION: The presentation of such injuries will be increasing in future, and we should be prepared to overcome this challenge. We have managed this case with basic principles of orthopedics, and it healed without any complication.

Bilateral Anterior Column Acetabulum Fracture following Road Traffic Accident: A Rare Presentation.

INTRODUCTION: Bilateral anterior column acetabulum fractures in literature have been reported due to osteoporosis and seizure disorders. Very few cases have been reported after road traffic accident (RTA) and that too in a young patient without osteoporosis. We present a similar case in a young patient following a high-velocity injury managed with open reduction and internal fixation (ORIF). CASE REPORT: A 28-year-old male presented with bilateral anterior column acetabulum fracture following RTA. The patient was initially admitted to emergency and stabilized hemodynamically. He was operated later with ORIF on both sides using ilioinguinal approach. At 1-year follow-up, the patient is able to walk, squat, and do routine activities without pain and fracture healed uneventfully. DISCUSSION: Acetabulum fractures are known for their complex nature and difficulty in management. We have seen this challenging case of bilateral anterior column acetabulum fracture following RTA, which has not been reported earlier and managed with open reduction and internal fixation with excellent results. CONCLUSION: This is among the few reported cases of bilateral anterior column acetabulum fracture due to high-velocity injury following RTA. The pattern of injury clarifies the complexity of acetabular fractures and challenges associated with treating these injuries. Such injuries will be more common in future due to increasing incidence of high-velocity trauma.