Average Time For Radiological Union Research Articles

Functional outcome of distal femur fractures managed by open reduction and internal fixation with locking compression plate

Background: Distal femur fractures are one of the most frequent fractures seen in high-velocity trauma, and they are associated with substantial morbidity if not treated properly. Stiffness, secondary arthritis, shortening, and disturbance in the activity of daily living can occur as a result of this fracture. Open reduction and internal fixation with locking compression plates (LCPs) is the preferred treatment. The anatomic contoured LCP for the distal femur has been found to provide one of the best outcomes in terms of anatomical reduction with joint congruity, soft-tissue healing, fracture union, and functional ability. This study was done to evaluate the functional outcome of distal femur fractures managed with LCP. Materials and Methods: Thirty patients with distal femur fractures were treated at our institute using LCP were analyzed for the outcome in terms of clinical, radiological union, and functional results. Results: Twenty-one patients were male and nine were female. The average age was 41.55 years with a range of 21–60 years. In 22 patients, cause of fracture was road traffic accidents and in eight were fall at various occasions. Twenty-one patients had right-side fractures. The average time for radiological union was 14.2 weeks. The average flexion of the knee was 107.16°. Functional outcome was assessed using Sanders' Functional Evolution Scale. The outcome was excellent in 30%, good in 40%, fair in 17%, and poor in 13%. Conclusion: Locking compression plating is an excellent internal fixation option for both extra- articular and intra-articular distal femur fractures, and it is particularly helpful in osteoporotic metaphyseal fractures.

Medial Malleolar Fracture Management—A Comparative Study of Radiological Outcome between Open Reduction Internal Fixation and Closed Reduction Percutaneous Fixation

Background Medial malleolus fracture is commonly seen nowadays in orthopaedic practice. There are different modalities of treatment based on fracture pattern and socioeconomic status. Undisplaced fracture can be managed by cast application. Various surgical modalities of treatment are available in treating medial malleolus fracture like tension band wiring, cancellous screw or cortical screw fixation, plate fixation, Kirschner wire, and suture anchors. The purpose of our study was to evaluate radiological outcome of medial malleolus fracture managed with open reduction internal fixation and closed reduction percutaneous fixation. Materials and Methods Our study included 67 patients who met inclusion criteria and were divided into two groups. Group 1 included 52 patients with medial malleolar fractures cases and were treated with open reduction and internal fixation either by cancellous screw fixation or tension band wiring. Other 15 patients in group 2 were treated by closed reduction and internal fixation with cannulated cancellous screw. All postoperative patients were evaluated at 1st month, 2nd month, 3rd month, 6th month, and 1 year. We evaluated patient clinically and radiological union of fractures. Results In our study out of 67 patients there was male preponderance and average age was 46.55 years. Right-side fractures were more compared with left-side fractures. Most common mode of injury was road traffic accident. Transverse fracture pattern was more in number in our study. Average union time in group 1 was 13.46 weeks and group 2 is 15.14 weeks. Fracture union was 96.15% in group 1 and in group 2 was 93.33%. Conclusion In our study, average radiological union time in patients treated with open reduction internal fixation was early compared with percutaneous fixation. This could be due to direct visualization of fracture site and good approximation of fracture fragments in open reduction internal fixation technique.

An Assessment of 3.5mm Reconstruction Plate Fixation in Olecranon Fractures

Background: Olecranon process is a large, curved eminence comprising of the proximal and posterior part of the ulna. It lies subcutaneously which makes it more vulnerable to injury. Due to intra-articular extension of fractures, anatomical reduction and early mobilization should be achieved in every case and usually managed surgically. Aims and Objectives: To access the results of reconstruction plate in fracture olecranon.Materials &Methods: This was a prospective study consisted of 25 cases of olecranon fractures which were managed by open reduction and internal fixation using 3.5mm reconstruction plate. Patients were followed up every month till 6 months. At each follow up visit clinical and radiological parameters were assessed: Final assessment was done at 6 months using the Mayo Elbow Performance Score.Result: According to the AO classification, Type A-1 – 7 cases, A-3 – 1case, B-1 – 13 cases, B-3 – 1 case, C-1 – 1 case, C-2 – 1 case, C-3 – 1 case. An adequate reduction was maintained in all fractured olecranon until union. Average radiological union time was 12 weeks in 72% cases, 15 weeks in 16% cases, 18 weeks in 8% cases and > 18 weeks in 4% cases. The results were graded as per the criteria laid by Rogers et al as excellent in 84% cases, good in 12% and unsatisfactory in 4% cases. 2 cases developed superficial infection and 1 deep infection and 1 delayed union.Conclusion: Open reduction and internal fixation of fracture of olecranon with 3.5mm reconstruction plate is based on sound biomechanical principle with a good functional outcome and a low incidence of complications.

Evaluation of functional outcome of distal tibial fractures managed with locking compression plate using minimally invasive plate osteosynthesis (MIPPO) technique

Background: Treatment of distal tibial fracture is challenging, because of precarious blood supply leading to poor healing. Various modality of surgical treatment such as closed intramedullary nailing, Open Reduction and internal fixation with conventional plate osteosynthesis and external fixation has been tried so far. But this modalities doesnot give better functional outcome and had high complication rate. The newer technique of distal tibia fractures fixation using MIPPO (minimally invasive percutaneous plate osteosynthesis), involves less soft tissue handling and minimal periosteal stripping resulting in low infection rate and faster healing. Aim of the Study: To evaluate clinical, functional and radiological outcomes after minimally invasive plate osteosynthesis using distal tibial locking compression plates. Materials and Methods: In this study, 30 patients with distal third tibial extra articular Metaphyseo diaphyseal fractures with or without associated fibula fractures were treated with MIPPO. The present prospective study was conducted in the department of Orthopaedics at Tripura Medical College, between August 2020 to July 2021. Results: All fractures had a good clinical and radiological union. The fractures were stabilized with MIPPO, at an average of 6.27 days post- trauma, with an average operative time of 66.25 minutes. Functional outcome evaluation was done using Olerud-Molander ankle score, at the end of 1 year. Average radiological union time of 17.6 weeks and there were one delayed union and one nonunion. None of the cases had implant failure or any significant deformity with good to excellent results in 86.66% cases. Conclusion: It is concluded that locking plate fixation by minimally invasive percutaneous plate osteosynthesis technique (MIPPO), is the most effective procedure for closed extra-atricular distal tibial Dia-metaphyseal fractures.

Prospective study on functional outcome of fracture shaft of femur (Winquest Hansen type 1, 2 and 3) treated with intramedullary interlocking nail

The management of femoral shaft fractures using intramedullary nailing is a popular method. The purpose of this study was to evaluate the functional outcome after antegrade intramedullary nailing of traumatic femoral shaft fractures. In a prospective study, patients with a femoral shaft fracture but no other injuries to the lower limbs or pelvis were included. A total of 40 patients met the inclusion criteria. All were operated by standard procedure of antegrade intramedullary interlocking nailing. Patients were reviewed at 1,3,6,12 months and we used KLAUSS & KLEMN CRITERIA and McNAIRS LOWER LIMB QUESTIONNARE for quantification of functional outcome. Mean age of such fractures was 24 years(+/- 5 years) majority being male and main mechanism of injury being RTA. There were 2 cases of fat embolism and 2 cases of superficial infection which healed by conservation method. Average time of radiological union was 12-24 weeks. There were no case of non-union but 1 case of delayed union for which dynamization was done.Final functional outcome came out to be good to excellent in all the patients.

Functional outcome of inter trochanteric fractures of femur in adults treated with short proximal femoral nails

Background & Aim: Intertrochanteric fractures in adults are common fractures & osteoporosis leads to significant complications associated with the fractures, prolonged immobilization, high morbidity & mortality. Hence the aim of the study was to see the effectiveness of Short Intramedullary Proximal Femoral Nail in these types of fractures. Material & Methods: In the current study total 30 patients were followed who presented at the tertiary level centre for Orthopaedics. Average age of the study group patients was 62 years. The patients selected between the duration total six months & were followed up for total 12 months. Patients regularly followed till radiological union & evaluated with harris hip score for functional outcome. The main focus given in the proper technical operative steps & strict guarded mobilization. Results: Partial weight bearing allowed in 20% of patients at 4 weeks post operatively & in 80% of patients after 4 weeks. Average radiological union time was 2.5 months.73.33% fractures unite in between 8-16 weeks duration. Three patients had some varus fracture union.One patient had upper screw cutout from the head & later on superior screw removed after union. One patient had avascular necrosis of head of the femur early changes (Ficat Arlet stage 1) at the end of 6 month. One patient has wound gaping with superficial skin & subcutaneous infection. One patient had nonunion implant failure & revision surgery performed.80% of patients had good to excellent harris hip score. Average operative time was 55 minutes.Conclusion: The short proximal femoral nail allows surgeon for easier insertion of the nail (only proximal reaming) & Minimal blood loss all leads to less complications. Good knowledge & application of proper surgical technique intraoperatively is important. Careful patient & fracture selection & early guarded vigilant mobilization are crucial factors for good management of intertrochanteric fractures.

Evaluation of functional outcome of distal femur fractures treated by closed reduction and internal fixation with retrograde femoral nail

Introduction: ‘Distal femoral fractures’ are defined as fractures up to 15 cms from distal femoral articular surface. Their traditional management comprised of skeletal traction, closed manipulation of fracture and external immobilization in the form of casts and cast bracings. These led to various complications. The trend of open reduction and internal fixation has become evident in the recent years, with a variety of implant options. This study aims to evaluate the functional outcome of 35 adult distal femur fractures treated with closed reduction and internal fixation with retrograde femoral nail. Materials and methods: 35 adults with distal femur fractures without neurovascular injury were considered for this study. After fixation, they were evaluated in regular follow-ups for functional outcome using Neer’s score and radiological union. Results: In our study, the average time for radiological union was 16.89 weeks. There were 3 patients with superficial infection. There were no varus collapse or implant failure. Functionally, 21 (60%) patients had excellent, 12 (34.29%) patients had good and 2 patients (5.71%) had fair results. There were no poor results. Conclusion: With the present study, we concluded that retrograde intramedullary supracondylar nail is a very good fixation system for distal third femoral fractures, particularly in extra-articular type fractures, due to minimal soft tissue dissection, preservation of fracture hematoma, reduced hospital stays, reduced infection rates and early mobilization.

Clinical and radiological evaluation of minimally invasive intramedullary fixation by titanium elastic nails in paediatric long bone fractures of lower limb: a prospective study

<p class="abstract"><strong>Background:</strong> Elastic stable intramedullary nailing for the treatment of paediatric femur and tibial diaphyseal fractures was introduced by Prevot and colleagues in 1979. It follows three-point fixation principle that provides internal support in presence of cortical contact and an intact soft-tissue envelope. This technique has many advantages, including better reduction, dynamic axial stabilization, shorter hospitalization with early rehabilitation and low complication rate.</p><p class="abstract"><strong>Methods:</strong> This is a prospective observational study done at Kauvery Medical Centre, Trichy between May 2017 to May 2018 consisting of 39 children between age 5 to 16 years with diaphyseal fractures of femur and tibia. The fractures were treated by closed reduction and internal fixation with titanium elastic intramedullary nailing. The patients were evaluated clinically and radiologically and followed for an average of 6 months. Outcome was assessed using transcutaneous electrical nerve stimulation (TENS) scoring system used by Flynn et al.<strong></strong></p><p class="abstract"><strong>Results:</strong> Our series consisted of 39 patients (22 cases with fracture shaft of femur and 17 cases with fracture shaft of tibia), 33 males and only 6 females. Average time for radiological union was 9.89 weeks. All patients had full range of hip and ankle motion and 2 (5.1%) patients had mild restriction in knee flexion at 12 weeks.</p><p class="abstract"><strong>Conclusions:</strong> Elastic stable intramedullary nailing is an ideal method for treatment of paediatric femoral and tibial diaphyseal fractures due to lower complication rate and good functional outcome in comparison to other methods of treatment.</p>

Outcome of distal tibia fractures managed with locking compression plate using MIPPO technique

Introduction: Treatment of distal tibial fracture with or without intra-articular involvement is challenging, for reasons like poor healing due to precarious blood supply. Various modality of surgical treatment such as closed intramedullary nailing, Open Reduction and internal fixation with conventional plate osteosynthesis and external fixation has been tried so far. But none of them have good functional outcome but had high complication rate. The newer technique of distal tibia fractures fixation using MIPPO (minimally invasive percutaneous plate osteosynthesis), involves less soft tissue handling and minimal periosteal stripping resulting in low infection rate and faster healing. Aim of the Study: To study the functional and radiological outcome of distal tibial fractures managed with MIPPO (minimally invasive percutaneous plate osteosynthesis), using locking plates and to look for complications in MIPPO. Materials and Methods: In this study, 55 patients with distal third tibial extra articular Metaphyseo-diaphyseal fractures with or without associated fibula fractures were treated with MIPPO. The present prospective study was conducted in the department of Orthopaedics at a tertiary care hospital, between September 2014 to September 2018, followed up for a period of 1 year.Results: All fractures had a good clinical and radiological union. The fractures were stabilized with MIPPO, at an average of 4.27 days post- trauma, with an average operative time of 76.5 minutes. Functional outcome evaluation was done using Olerud-Molander ankle score, at the end of 1 year. Average radiological union time of 19.6 weeks and there were one delayed union and one nonunion. None of the cases had implant failure or any significant deformity with good to excellent results in 88.5 % cases. Conclusion: From this study, it is concluded that Minimally invasive percutaneous plate osteosynthesis technique (MIPPO), using locking plate is the most effective procedure for closed extra-atricular distal tibial Dia-metaphyseal fractures.

A comparative study of both bone forearm fractures treated with intramedullary nailing vs plating in adults

Background: The aim of this paper was to study the diaphyseal fractures of radius and ulna treated with nail/plate in adults and to choose the best modality of treatment.Methods: From May 2017 to December 2018 in Department of Orthopaedics, Krishna institute of medical sciences, Karad, total of 30 patients of both bones forearm fractures were treated. 15 were treated with open reduction and internal fixation using DCP plating or 1/3rd tubular plate and 15 with intramedullary nailing with radius and ulna nail. 30 patients were available for the follow up. Follow up was done for one year. Functional results were assessed by using Anderson et al criteria.Results: The time required for surgery in plating group was 62 minutes, and 42 minutes for nailing group. Average time of radiological union for radius & ulna was 13 weeks in nailing group and 16 weeks in plating group. There was one case of radiological non union with ulna nailing and there was no other associated complications.Conclusion: We conclude that open reduction and internal fixation with plating is the gold standard procedure for the treatment of both bone forearm fractures in adults. Intramedullary nailing is a less attractive alternative compared to plating as the normal movements are hampered.

Effect of intramedullary nail compression amount on the union process of tibial shaft fracture and the evaluation of this effect with a different parameter.

This study aims to investigate the effects of different amounts of compression used in intramedullary nailing on the stress values of the fracture surface and time of the union process in tibia diaphysis fractures treated with intramedullary nails. Seventy patients (50 males, 20 females; mean age 34.0±10.7 years; range, 20 to 56 years) who had suffered from tibial shaft fractures between January 2007 and December 2015 were included in the study. Patients who had A2, A3, and B2 type fractures according to AO (Arbeitsgemeinschaft für Osteosynthesefragen) classification and those with closed fractures were included. The patients were divided into three groups. No compression was applied to Group A, dynamic compressive fixation intramedullary nailing was applied to Groups B and C. Amount of applied compression was 1 mm for Group B and 1.5 mm for Group C. Postoperative and follow-up radiographs of patients were evaluated according to Rust criteria, and functional results were evaluated according to Johner-Wrush criteria. Additionally, finite element analyses were performed separately for 1 mm and 1.5 mm compressions that were applied in Group B and C, respectively. The data were analyzed using a statistical software package. Clinical and radiological union was achieved in all patients. The average time of radiological union was 15.05±2.06 weeks in Group A, 12.48±1.42 weeks in Group B, and 11.64±1.63 weeks in Group C. The time of union for the group in which no compression was applied (Group A) was significantly longer than the other groups in which compression was applied (Group B and C) (p<0.001). Functional outcomes were 17 patients (85%) with excellent and three patients (15%) with good-moderate results in Group A, 23 (92%) excellent and two (8%) good-moderate in Group B, and 23 (92%) excellent and two patients (8%) with good-moderate results in Group C. In total, seven patients had knee pain. No infection was seen in any patient. Interlocking compression intramedullary nailing is a very effective treatment method for tibial shaft fractures. As the compression applied by the nail increases, the time of union shortens significantly.

Study of fractures treated with anatomical plates in lower limb

Introduction: It is a study of biological plating at various situations. Biological is a least contact plate designed for use in specific anatomical regions such as the proximal & distal femur, proximal & distal tibia. Minimal invasive plate osteo-synthesis by biological plate has the potential of becoming one of the main stays of fracture management in the years to come. Biological fixation principles advocate realigning by manipulation at a distance to the fracture site, leaving comminuted fragments out of the mechanical construct, preserving soft tissues with limited operative exposure. Materials and method: The study consists of 30 patients with fractures at different locations in the lower limb such as proximal femur, distal femur, proximal tibia and distal tibia. We have treated patients with anatomical plate for respective fracture in the bone. Clinical outcome and function results were evaluated by Harris Hip Score for proximal femur fracture, Knee Society score for distal femur and proximal tibia fracture, Olerud and Molander score for distal tibia fracture. Result: Out of the 30 patients included in the study, 18 cases were operated with open method and 12 patients were operated with closed method. Average radiological union time was 21.36 week. We have achieved 83.3% of excellent result. Conclusion: Anatomical plates are pre-contoured plate as per shape of the bone. Anatomical reduction is possible as well as length of the limb is maintained and axial alignment and rotational stability is provided. As plates have groove on inner surface so it preserves the periosteal blood supply which will help in faster healing of the bone. Anatomical plates are best proven option for the comminuted intra-articular fractures of the long bones.

Limited Open Reduction and Percutaneous Plate Osteosynthesis - Alternative Option to Minimally Invasive Plate Osteosynthesis in Management of Distal Tibia Fractures

The management of distal tibia fracture is challenging because of the limited soft tissue coverage and poor vascularity around the bone in that area. Minimally invasive percutaneous plate osteosynthesis is a novel technique in this regard but needs fluoroscopy. In unavailability of fluoroscopy or its technical malfunction, limited open reduction percutaneous plate osteosynthesis becomes useful. The aim of this study is to compare the outcomes of distal tibia fractures treated by LORPPO and MIPPO techniques in terms of duration of hospital stay, full weight bearing, union time and complications. Twenty-two cases of closed distal tibia fractures without articular involvement or comminution operated at Koshi Zonal Hospital, Nepal from March 2014 to May 2016 were included in this study. Total 11cases of which were treated by MIPPO whereas other 11 cases were treated by LORPPO. MIPPO technique was done only when the fluoroscopy was available. In MIPPO, the average age of the patients were 43.72 (range 23-65) years, hospital stay mean duration 8.45 (range 6-12) days, full weight-bearing walking was started in 11.27 (range 9-15) weeks and average radiological union time was 21.25 (range 18-28) weeks. In LORPPO, the mean age was 46.36 (range 25-70)years, hospital stay mean 11.81 (range 10-15) days, full weight bearing walking mean 10.63 (range 9-15) weeks and average radiological union time was 23.0 (range 19-27) weeks. The outcomes are comparatively similar for both the techniques. LORPPO could be an alternative to MIPPO in the management of distal tibia fractures.

Analysis of outcome of unstable intertrochanteric fractures treated by proximal femoral nail- A prospective and retrospective study

Background: An analytical study was conducted on the outcome of unstable Intertrochanteric fractures treated by conventional proximal femoral nailing in a prospective and retrospective method. Materials and methods: During our study period, 130 patients, both males and females, aged between 50 years and 100 years who were suffering from unstable intertrochanteric fracture and who were treated with Proximal femoral Nailing were included in the study. Both prospective and retrospective studies were conducted to evaluate clinical and functional outcome of 130 patients. Modified Harris Hip score was used to evaluate clinical and functional outcome. Radiological assessment with hip anteroposterior and lateral views were taken.quality of reduction, malialignments, screw cut outs, bony union and implant related complications were noted. Results: In our study majority of the cases about 60% were in the age group of 61 to 80 years among the study group of 50 to 100 years. Females were slightly more affected (52.35%) as compared to males (47.65%).Average time for radiological union was about 16 weeks. Among 130 of our patients 1 cased died on 3rd posteoperative day for reason unrelated to the surgery. So Harris Hip Score was calculated for 129 patients. We had 53.9% of excellent and 36.1% of good results which together accounted to about 90% of the cases Conclusion: Based on our experience and results we conclude that proximal femoral nailing is an excellent judicious and rational method of fixation for unstable intertrochanteric fractures in elderly patients.

Functional outcome in metacarpal fractures treated with Minifragment plating

There is trend on rise to use miniplates over the kirschner’s wire for treating the fractures of hand. The improved system of internal fixation by miniplates has many advantages. The aim of the study was to evaluate whether the newer stable fixation method i.e plating has any significant advantage. The study included a total of 20 cases with individuals ageing greater than 18 years. The patients excluded from the study were who had compound injury, severe osteoporosis and severe comorbid conditions in whom risk of anaesthetic complications were high. The average time for radiological union was 8.7 weeks. Stiffness was the most common associated complication in this study. 8 patients (40%) had shown excellent results; 9 patients (45%) had shown good results; 3 patients had shown fair results and none reported poor result. Plating is an excellent method of fixation in metacarpal fractures.

Treatment of proximal humerus fracture using proximal humerus locking plating

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Proximal humerus fractures are the most common upper extremity fractures in older patients. The aim of the present study was to evaluate the functional outcome and complications of proximal humeral locking plate used for healing proximal humerus fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This prospective study was conducted at the department of Orthopaedics, Sir T. Hospital, Bhavnagar, from June 2008 to March 2010, with 20 patients who suffered with complex proximal humerus fractures and underwent surgical treatment with proximal humerus locking plates. Functional outcome was assessed at the final follow up by using Constant Murley score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean age of the patients was 52 years. Male: female ratio was 1.5: 2. The most common mode if injury is low velocity trauma i.e. fall while walking or fall in bathroom seen in 13 patients. Average time for clinical union was 60 days, while average time for radiological union is 90 days taken in the study. Postoperative complications were seen in 2 patients. Delayed complications were seen in 10 cases. No patients had shown implant related complications. At the final follow up according to Constant Murley score, 36% patients had shown excellent results, 53% patients had shown good results and poor results were seen in 11% of cases.&lt;/p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our results show that good to excellent outcome can be achieved in treating proximal humerus fractures using locking plates in elderly patients. Early mobilization of the shoulder can be achieved without compromising fracture union.

Prospective Case Study of Outcome of Tibial Plateau Fractures Treated with Locking Condylar Plate.

Introduction: Tibial plateau injury involves the articular surface of the proximal tibia with diverse group of fractures that represent a wide spectrum of severity that challenge even the most experienced surgeons, but with the invent of modern diagnostic technology and the advent of locking plates, results appear to be improving over time.Method: The study was conducted on thirty patients admitted in the department of orthopaedics with diagnoses of tibial plateau fractures treated with Locking Condylar Plate. The patients were followed up for a minimum period of six months and clinico-radiological progression of fracture union with the functional outcome was studied using 100 point rating system devised by Delamarter et al.Result: Twenty-two patients showed excellent results while eight patients had good to fair and none with poor result. The average time for radiological union was 17.5 weeks.Conclusion: The results of the study concluded that while locking condylar plate seems to show excellent results in low energy tibial plateau fractures, it can probably be used to successfully treat patients with high energy fracture patterns without the need for additional medial stabilization.

Comparison between Accurate Anatomical Reduction and Unsuccessful Reduction with a Remaining Gap after Open Reduction and Plate Fixation of Midshaft Clavicle Fracture

Background: The purpose of this study is to compare the radiological and clinical outcomes after open reduction and plate fixation of midshaft clavicle fractures between patients who achieved successful anatomical reduction and those who had a remaining fracture gap even after open reduction and plate fixation, and were thus treated with additional demineralized bone matrix (DBM). Methods: This retrospective analysis was conducted on 56 consecutive patients who underwent open reduction and internal fixation using a locking compression plate for acute displaced midshaft clavicle fractures, and who underwent radiographic and clinical outcome evaluations at least 6 months postoperatively. The outcomes between those who achieved perfect anatomical reduction without remnant gap (n=32) and those who had a remaining fracture gap even after open reduction and plate fixation treated with additional DBM (n=24) were evaluated. Results: There were no differences in the use of lag screws or wiring and operation time (all p>0.05) between those with and without remnant gap. No difference in the average radiological union time and clinical outcomes (satisfaction and Constant score) was observed between the two groups (all p>0.05). However, significantly faster union time was observed for AO type A fracture compared with other types (p=0.012), and traffic accident showed association with worse clinical outcomes compared with other causes of injury. Conclusions: Surgical outcome of midshaft clavicle fracture was more affected by initial fracture type and event, and re-reduction and re-fixation of the fracture to obtain a perfect anatomical reduction spending time appears to be unnecessary if rigid fixation is achieved.

Treatment of Displaced Mid-Clavicle Fractures by Closed Titanium Elastic Nail

Introduction: Recently, intramedullary nailing for displaced middle third fractures of clavicle has received wide attention. Though open nailing has been widely described, closed nailing finds less mention. This paper therefore aims to study the outcome of closed titanium elastic nailing for displaced mid-clavicular fractures. Material and Methods: This was a prospective study of 34 patients with displaced middle third clavicle fracture who underwent closed intramedullary nailing with titanium elastic nail at a tertiary care centre. The operative time, length of incision, time for radiological union, pain and functional outcome after union were noted. Results: The mean operative time was 34.33 mins. The mean time of discharge was 2.25 days. The average time of radiological union was 10.23 weeks. All the patients achieved full, painless range of motion of the ipsilateral shoulder. The average Constant-Murley score at 12 months was 94.28 indicating excellent result. Conclusion: Closed titanium elastic nailing offers a safe and minimally invasive method of fixation for fractures of middle-third clavicle with excellent functional outcome.

English

BACKGROUND: Supracondylar fractures are one of the commonest fractures encountered in high velocity trauma which are associated with high morbidity and mortality.1 Isolated fracture can itself lead to complications such as ARDS and pulmonary embolism1. This necessitates early stabilization of fractures. Internal fixation is the choice of treatment in supracondylar fractures (AO type–A).2 Retrograde supracondylar nail has shown to give one of the best results in terms of recovery, fracture union, return to work and the functional outcome. METHODS: 20 patients with supracondylar fracture femur were studied (AO type-A). Supracondylar fractures femur were treated by closed or open reduction and internal fixation by Retrograde supracondylar nail inserted through inter-condylar notch between July 2012 to September 2014 at our institution. The patients were evaluated clinically and radiologically for outcomes. All patients were followed up for an average of 12 months. Outcome was assessed using NEER’S SCORE.3 RESULTS: Supracondylar femoral extra-articular fractures in 20 patients were treated in this study with retrograde intramedullary supracondylar nail after closed or open reduction. The AO-ASIF fracture classification was used. All extra-articular fractures were selected for study. Six were compound fractures according to the Gustilo-Anderson classification,4 the fracture was stabilized with the chosen system at an average of 6.9 days post-trauma, with an average operative time of 65. 9 minutes. In 15 cases closed reduction was possible while 5 required open reduction. Post-operatively all patients were shifted to continuous passive mobilization with early toe touch walking and gradually progressive weight bearing with appearance of clinical and radiological signs of union. Evaluation was done according to Neer’s rating system.3 65% excellent results were found. In the present study, road traffic accidents were observed to be the predominant cause of distal third femoral fractures in young patients. All fractures had a sound clinical and radiological union with an average radiological union time of 16.2 weeks and average full weight bearing time was 13.4 weeks. Average knee flexion was 108 degrees with an extensor lag of 4.15 degrees.