Radiological and functional outcome of PFN A2 in treatment of intertrochanteric fractures in elderly patients

Introduction: Intertrochanteric fracture is one of the most common fracture seen in elderly age group. Intramedullary fixation achieves stable fixation. This study was done to find out outcomes with PFNA2, with an objective of finding significance of various radiological parameters. Methods: Forty-three patients were included who underwent closed reduction and PFNA2 fixation. They were followed up at 1month, 3months, 6months and 1 year postoperatively and tip apex distance, Cleveland index, parkers ratio, nail protrusion height, and neck shaft angle were calculated. Statistical correlation of each parameter with complications such as helical blade cut out and back out was derived. Results: Tip apex distance and Cleveland index was found to influence the position of screw and thereby the final outcome. No statistical correlation was derived between Parkers ratio, neck shaft angle and nail protrusion height with the complications. Functional outcome as calculated by Harris hip score was found to be satisfactory in most of the patients. There was only negligible mean loss of functional outcome postoperatively as calculated with parkers mobility score Conclusion: PFNA2 confirms to be stable fixation for both stable and unstable intertrochanteric fracture with fewer complication and good functional outcome in short period of time.

Introducción: La fractura intertrocantérica es una de las fracturas más comunes observadas en el grupo de edad avanzada. La fijación intramedular logra una fijación estable. Este estudio se realizó para conocer los resultados con PFNA2, con el objetivo de encontrar significación de varios parámetros radiológicos. Métodos: Se incluyeron 43 pacientes sometidos a reducción cerrada y fijación PFN A2. Se realizó un seguimiento a 1 mes, 3 meses, 6 meses y 1 año después de la operación y se calculó la distancia del vértice de la punta, el índice de Cleveland, la proporción de Parker, la altura de la protuberancia del clavo y el ángulo del eje del cuello. Se derivó la correlación estadística de cada parámetro con complicaciones como el corte de la hoja helicoidal y el retroceso. Resultados: Se encontró que la distancia del vértice de la punta y el índice de Cleveland influyen en la posición del tornillo y, por lo tanto, en el resultado final. No se obtuvo correlación estadística entre la proporción de Parkers, el ángulo del eje del cuello y la altura de la protuberancia del clavo con las complicaciones. Se encontró que el resultado funcional calculado por el puntaje de cadera de Harris fue satisfactorio en la mayoría de los pacientes. Solo hubo una pérdida media insignificante de resultado funcional después de la operación, según se calcula con la puntuación de movilidad de Parker. Conclusión: PFN A2 confirma ser una fijación estable para las fracturas intertrocantéricas estables e inestables con menos complicaciones y buen resultado funcional en corto período de tiempo.

Radiological Outcomes of Distal Radius Fractures Managed with 2.7mm Volar Locking Plate Fixation-A Retrospective Analysis.

INTRODUCTION: Distal radius fractures accounts for around 15% of all fractures diagnosed and treated in the emergency rooms. These fractures usually result secondary to high velocity injury such as a motor vehicle accident or fall on an out stretched hand. In the elderly, it is a common fragility fracture. Volar Locking Compression Plates (LCP) is effective devices for fixation of the distal radius fractures. There is a lacuna with regard to literature on the 2.7 mm volar LCP and the current study retrospectively assesses the postoperative radiological outcomes. AIM: To measure the radiological outcomes in patients with displaced distal radius fractures managed with 2.7 mm volar LCP fixation using Sarmiento's Modification of Lindstorm Criteria. MATERIALS AND METHODS: A retrospective study was conducted in the Department of Orthopaedic Surgery at Kasturba Medical College Allied Hospitals, Mangalore from May 2014 to July 2016. All displaced distal radius fractures of skeletally mature patients who underwent volar locking plate fixation between May 2014 to July 2016 and follow up with X-rays at six weeks and three months were included as part of the study. The study comprised of 20 patients and fractures were classified using the AO and Melone's classification systems. The radiological outcome was scored based on Sarmiento's Modification of Lindstorm Criteria. RESULTS: Post operative check X-rays were analysed at immediate post operative, six weeks and three months. The mean immediate post operative radial shortening, decrease in radial deviation and loss of palmar tilt were 4.08±2.23, 5.91±4.01and 4.11±3.29 respectively. The corresponding values at last follow up were 4.71±2.31, 7.9±5.13 and 4.91±3.32 respectively. No statistically significant difference (p=0.930;874;716) in radial shortening, decrease in palmar angulation and loss of radial deviation was seen till the final follow up. Sarmiento's Modification of Lindstorm Criteria showed a good radiological outcome in 60% followed by fair in 25% and excellent in 15%. CONCLUSION: Use of 2.7 mm volar LCP showed good to excellent post operative radiological outcomes in majority of the cases. The fracture reduction achieved in the immediate post operative period is maintained throughout the follow up duration.

Minimally Invasive Plate Osteosynthesis with Locking Plates for Distal Tibia Fractures.

INTRODUCTION: Distal tibia fractures are challenging injuries with multiple fixation options. Minimal invasive plating for distal tibia fracture is becoming more popular with documented good outcomes. AIM: To evaluate the functional and radiological results of fixation of distal tibia fractures with locking plates with Minimally Invasive Plate Osteosynthesis (MIPO) technique. MATERIALS AND METHODS: Fifty fractures of distal tibia without Intra-articular extension were operated with locking compression plating with MIPO technique. They were followed up at regular intervals. Functional and radiological results were evaluated at the end on one year. RESULTS: The fractures united in 48 (96%) patients with 2 (4%) cases of delayed union which took 30 weeks of time. Postoperatively, 2 patients developed superficial skin infection, 2 patients developed deep infection and 3 patients developed ankle stiffness due to loss of postoperative protocol and 4 patients had implant failure in form of screw breakage. Good amount of range of mobility of ankle joint was present in almost all patients. CONCLUSION: MIPO with locking plates for distal tibia fractures is associated with good functional outcomes and is an effective treatment for distal tibia fractures. Although, a larger sample of patients and longer follow up are required to fully evaluate this method of treatment, we strongly encourage its consideration in the treatment of such complex fractures.

Study of Adverse Effect Profile of Parenteral Zoledronic Acid in Female Patients with Osteoporosis.

INTRODUCTION: Osteoporosis is still a under recognized entity in the population. Osteoporosis-related fractures can be prevented if people at risk can be screened, diagnosed and treated early. Bisphosphonates remain the mainstay of osteoporosis treatment as they have multimodal action. Oral bisphosphonate therapy has, significant gastrointestinal side effects leading to noncompliance. Of late parenteral Zoledronic Acid is being used as once or twice yearly infusion for the treatment of osteoporosis. AIM: Our article studies the side effect profile and tolerability of parenteral Zoledronic Acid, one of the most potent bisphosphonate used in clinical practice in patients with osteoporosis. MATERIALS AND METHODS: This study was done in KMC hospitals where 49 patients diagnosed with osteoporosis were included for the study. After obtaining a written informed consent each patient received one infusion of 5 mg Zoledronic Acid as per standard treatment protocol. Patient was monitored for clinical improvement and development of any adverse effects. CONCLUSION: In our study all subjects reported significant pain relief after infusion of Zoledronic Acid. Zoledronic Acid had very few serious adverse effects that can be prevented through pre-infusion screening, maintaining good hydration and careful patient monitoring. In our population the patients only experienced mild symptoms of pyrexia, arthralgia myalgia and influenza like symptoms which resolved with symptomatic treatment.

Ligamentous Reconstruction of Traumatic Dislocation of Thumb Carpometacarpal Joint: Case Report and Review of Literature.

INTRODUCTION: Thumb carpometacarpal dislocation is a rare injury with many treatment options described in literature. CASE DESCRIPTION: A 47-year-old male patient presented to hospital with an isolated dorsal dislocation of the thumb carpometacarpal joint. Closed reduction of the dislocation could be easily done but joint was grossly unstable and redislocated. Repair of ruptured dorsoradial ligament and joint capsule was done with immobilization for 6 weeks. At 2-years follow-up evaluation, the patient was pain free and returned to his previous level of activity. No restriction of carpometacarpal movements or residual instability was noticed. Radiographic examination showed normal joint congruity and no signs of osteoarthritis. CONCLUSION: Capsuloligamentous repair can be considered the treatment of choice in thumb carpometacarpal dislocations with instability after closed reduction.