Average Union Time Research Articles

Eklem dışı distal tibia kırıklarının tedavisinde minimal invazif plaklı osteosentez ile intramedüller çivilemenin karşılaştırılması

Aim: Our study’s aim was to investigate the effectiveness of minimal invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMN) in extraarticular distal tibia fractures and to compare the outcomes of these two treatment methods.
 Materials and Methods: Between January 2008 and January 2015, 59 patients had extraarticular distal tibia fracture and treated with MIPO or IMN were evaluated retrospectively. Postoperative x-rays were evaluated for fracture consolidation and angular deformities. For the functional evaluations of the patients Olerud-Molender Ankle Scoring (OMAS) method was used and ankle joint range of motion was measured by goniometer.
 Results: At the last visit, all the fractures consolidated. Average union time was 16.1weeks (range, 12-24 weeks) in MIPO group and 15.5 weeks (range 10-24 weeks) in IMN group, respectively (p = 0.254). The mean OMAS scores were 67.5 (range 40–90) and 63 (range 30-90) in the IMN and MIPO groups, respectively (p= 0.12). The mean operation time was 95(range 45-115) minutes in IMN group and 75(range 40-100) minutes in MIPO group (p= 0.04). The mean operative radiation exposure times were 30(range 8-143) and 17 (range 5-65) seconds in IMN and MIPO groups, respectively (p= 0.03). Angular deformities were found in IMN group at 7 (23%) patients and in MIPO group at 5 (17%) patients, respectively. Soft tissue problems were seen in more patients in MIPO group.
 Conclusion: In conclusion, IMN and MIPO can be used safely in the treatment of distal tibial metaphyseal fractures. While IMN caused more angular deformity and more union delay, patients treated with MIPO had poorer functional results and more soft tissue problems.

Locking Compression Plate as an External Fixator for the Treatment of Tibia Infected Bone Defects.

This study was designed to observe the medium-term efficacy of an induced membrane technique combined with a locking compression plate as an external fixator for the treatment of tibia infected bone defects. Patients with a tibial infection were admitted to our department between January 2013 and November 2014. All patients were treated with the induced membrane technique. In the first stage, polymethyl methacrylate (PMMA) cement was implanted in the defects after debridement and then fixed with a locking compression plate (LCP) as an external fixator. In the second stage, bone grafts were implanted to rebuild the defects. The external plates were replaced with nails in 57 patients (internal group), and the remaining 30 patients were not exchanged with fixation (external group). The infection control rate, bone union rate, and complications of the two groups were compared. Eighty-seven patients were enrolled in this study, and all patients had a minimum follow-up of 5 years (average 62.8 months) after grafting. Eighty-three patients (95.4%) achieved bone union, and the average union time was 6.77 months. Five patients (5.7%) experienced recurrence of infection. Complications included pin tract infection, fixation loosening, deformity connection, and limitation of joint range of motion (ROM). No significant differences in the infection control rate or bone defect union rate were noted between the two groups. The overall rate of complications in the external group was 50%, which was greater than that noted in the internal group (21.1%). Locking compression plates are external fixators with smaller sizes that are easier to operate than conventional annular fixators or assembled external fixators. The use of locking compression plates in combination with the induced membrane technique in the treatment of tibia infected bone defects can achieve good clinical efficacy after medium-term follow-up.

A prospective study to evaluate functional results of PHILOS locking plate system in management of proximal humerus fractures in adults

<p class="abstract"><strong>Background:</strong> Various management options are available for management of proximal humerus fractures where PHILOS plating is one of them. But data available in literature on its use and efficacy in management of all types of proximal humerus fractures is still dicey. So, we through our study attempted to grow our knowledge regarding its functional results, complication rates, etc. for use in coming future.</p><p class="abstract"><strong>Methods:</strong> 30 patients with proximal humerus fractures classified on the basis of Neer’s classification were included in study who were operated from 2018 to 2020 at our institute. These patients were operated by PHILOS locking plate system with either delto-pectoral or trans-deltoid approach and they are followed up at regular intervals to assess them clinicoradiologicallly and functionally by Neer’s criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study we found maximum incidence of these fracture between age group of 40-80 years (66.66%) with male to female ratio of 2:1 with 19 patients having left sided and 11 patients having right sided proximal humerus fracture. Complications were found in 11 patients (36.67%). Functional evaluation was carried out using Neer’s criteria at final follow up which came to excellent results in 3, satisfactory in 18, unsatisfactory in 7 and failure in 2 patients. Average time of fracture union was 12.62 weeks.</p><p class="abstract"><strong>Conclusions:</strong> PHILOS locking plate system serves good purpose in management of fractures of proximal humerus but requires trained faculty to do this operation who has detailed knowledge about shoulder anatomy and mechanism of injury to reduce complications associated with this type of modality.</p>

Study of distal tibial extra-articular fractures fixed with locking compression plate using MIPO technique

Background: Fractures of distal tibial metaphysis present a management challenge because of their inherent instability, scarcity of soft tissue, subcutaneous nature and poor vascularity of bone. MIPO techniques are advantageous because of limited soft tissue strapping, maintenance of the osteogenic fracture haematoma without interrupting vascular supply to the individual fracture fragments. Materials and Methods: This is a study of 20 patients of closed extra articular distal tibial fractures treated with anatomical LCP applied on antero-medial surface of lower end tibia with MIPO technique. Age was ranging from 20 to 60 yrs. 14 male and 6 female patients were there. 7 patients were having fibula fracture at same level of tibia fracture, they were fixed with DCP/ 1/3 tubular plate before fixing tibia. Results: AO/OTA type 43 A1 fractures were there in 15 patients. 4 pts. were having 43 A2 and one pt. was having 43 A3 type fracture. Average operation time was 80 mins. Average union time was 18.5 weeks. One pt. was having delayed union, one having superficial skin infection, one having 6* varus angulation and one having malleolar skin irritation. No pts. required second surgery of bone grafting. No implant failure. Conclusion: MIPO with LCP is a reliable and effective method of treatment for the distal tibial extra-articular fractures, preserving most of the osseous vascularity and fracture haematoma and thus providing a more biological repair. Using indirect reduction technique and small incision is technically demanding. Keywords: Anatomical LCP, Distal tibial fractures, MIPO.

Comparative study of Ender’s nailing and PFN in subtrochanteric fractures of femur in adults

Background: The incidence of proximal femoral fractures are markedly increasing because of increasing life expectancy and motor vehicle accidents. Subtrochanteric fractures of femur pose a great problem because of diversity of fracture patterns and difficulty in attaining anatomical reduction and also it is high stress region, having less vascularity. Intramedullary fixation devices like PFN is technically demanding and many times it needs open reduction of fractures. Favourable mechanics is attained by flexible intramedullary nailing like Ender’s nailing. Materials and Methods: This is a comparative study of 40 cases of subtrochanteric fractures of femur, out of which 20 treated with Ender’s nailing and other 20 treated with PFN. All were closed fractures. Age was ranging from 20 to 70 years. In our study patients distribution according to Frank- Seinsheimer classification was as follows… Type I – Nil, II A – 1 pt., II B – 6 pts., II C – 1 pt., III A – 11 pts., III B – 6 pts., IV – 7 pts., V – 8 pts. In PFN open reduction was done in 5 pts., while in Ender’s nailing all pts. were managed by close reduction. Results: Average union time was 18 weeks in PFN, while 15 weeks in Ender’s nailing. Reoperation due to implant breakage and/or Z-effect was required in two cases in PFN. Shortening upto 1 cm. seen in 2 pts. in PFN, while in Ender’s nailing upto 1 cm. in 6 pts. and from 1 to 2 cm in 2 pts. Conclusion: In obese pts. Ender’s nailing is easy, while PFN is more technically demanding. Union is earlier in Ender’s nailing v/s PFN. PFN is more stable implant. Excellent or good results are seen in 15 out of 20 pts. in PFN, while 18 out of 20 pts. in Ender’s nailing. Keywords: Ender’s nailing, PFN, Subtrochanteric, Femur.

English

BACKGROUND Femoral shaft fractures result from high energy trauma and maybe associated with life threatening conditions. Typical in younger people is associated with polytrauma. Though intramedullary nailing (IMN) is the gold standard option of treatment, external fixation (EF) can also be used temporarily or definitively, in such cases. The aim of this study was to compare the functional outcome of these two procedures. METHODS This prospective comparative study was conducted at our centre over a period of 6 years. Age, sex of the patients, laterality, type of fracture with mean follow up, union time, and complications such as delayed union, angular deformities, and limb length discrepancies were tabulated and compared. RESULTS There were more cases of open fractures in the EF group compared to IMN group. In the IMN group the average surgery duration was 95.76 minutes and it was 69.4 minutes in the EF group. The average time for bone union was 25.66 weeks in IMF group and 28.22 weeks in EF group. Complication rate was higher in EF group with 11 complications (7 major & 4 minor) compared to IMN group with only 6 cases presenting with complications (3 each of major & minor). CONCLUSIONS Though IMN is the gold standard in treatment of femoral shaft fractures, EF in polytrauma is an alternative method for definitive fracture stabilization, with minimal additional operative trauma and an acceptable complication rate. KEYWORDS Femoral Shaft Fractures, Intramedullary Nailing, External Fixation, Polytrauma, Definitive Treatment

Locally developed external fixators as definitive treatment of open tibia diaphyseal fractures: a clinical prospective study conducted in Ivory Coast.

This study sought to evaluate the effectiveness of locally developed external fixators (LDEF) as definitive treatment for open tibia diaphyseal fractures (OTDF) in Ivory Coast. Gustilo I, II, and IIIA OTDFs of patients admitted within 24hours of injury were prospectively included and treated with LDEF. The rates of union, mal-union, septic complications, as well as the functional results were assessed, in addition to the LDEF construct's integrity. Predictive factors of failure or poor results were assessed. Overall, 40 OTDF patients were admitted within 24hours of injury. Gustilo I, II, and IIIA fractures were observed in three, 13, and 24 patients, respectively. Uneventful fracture healing was obtained in 29 cases, with an average union time of 8.47months. Mal-union and non-union were registered in three and four cases, respectively. Pin-track infection (PTI) was observed in 13 cases and deep infection in seven. Infection resolved in all patients except four, who developed chronic osteomyelitis. None of the non-unions were associated with an infection. The overall functional result was satisfactory in 32 patients. PTI was the only predictive factor for chronic infection. Biplanar frames, when compared to monoplanar constructs, were associated with a significantly improved functional outcome. LDEF improved significantly the OTDF management, as it provided better stability and superior fracture healing rates than what is observed with the standard of care in the same environment. PTI remains an essential problem but with, hopefully, limited negative consequences.

Flight Crash During COVID-19: Lessons Learnt.

PurposeThe survival rate of a Flight crash is quite low and this makes the Calicut incident unique. Management of flight crash victims is itself a herculean task and during COVID-19 pandemic it poses another challenge to the treating team since all the patients are under quarantine and the treatment protocols are not well defined.MethodsOn 7/8/2020 at around 7.41 pm, Air India Express aircraft from Dubai to Calicut, while landing on the runway lost its control and skidded off the runway and broke into three parts. We report a detailed analysis of orthopaedic injury patterns and difficulties encountered in the management of these patients with full personal protective equipment (PPE) kit during COVID-19 pandemic.Results47 patients from the crash site were brought to our hospital and 38 of them were admitted under the orthopaedic department. 74 doctors and 76 trained nurses along with 58 supporting staff were involved in the management of the mass casualty during that night. Most of the patients suffered injuries to lower extremity and spine which included 11 femur, 13 tibial and 12 spine fractures. Average union time was around 3 months for fractures. Delayed union of fracture femur, avascular necrosis of talus and nonunion of 5th metatarsal base fracture were the reported complications. Surgical site infection was observed in two patients.ConclusionTrauma management team should be prepared to manage difficulties encountered during identification, communication, and treatment of the disaster victims during this COVID-19 era.

A study to evaluate the functional and radiological outcome of proximal femoral nail Anti rotation 2 in inter trochanteric fractures of femur

Introduction: Fractures around the trochanteric area of the femur are among the most frequent fractures encountered in orthopaedics, especially in geriatric population and increasing life expectancy has resulted in increase in these type of fractures. Aim: The aim of this study was to analyze the functional and radiological outcome of patients treated with PFN A-II. Methods: Patients presenting with unstable intertrochanteric femur fracture (AO classification) and Singh’s index ≤ 3 were included. The study included 70 patients (30 males and 40 females), at our institution during the period of July 2019 to December 2020. Clinical outcome was measured in terms of procedure time, clinical function at each follow-up and mortality. Radiographic evaluation was measured by quality of reduction, Cleveland Index, tip-apex distance (TAD), and time for the union. Complications including delayed union, non-union, screw backing out , screw cut through into the joint, infection, osteonecrosis of the femoral head, and implant breakage were also investigated. Results: All the 70 patients included in the study were treated with PFN A-2. The average age of the patients included was 74.4 years . The TAD was more than 25mm in 8 patients. 11 patients has sub optimal position of the implant as per cleveland index. Outcome was excellent in 45, good in 15, fair in 7,poor in 3, and this is based on modified Harris hip score with the minimum follow-up period being 6 months. The difference between the neck shaft angle of the operated side when compared with the un-injured side is more than 10 * in 11 patients. The average union time was 5.6 weeks, average modified Harris hip score was 86.5. Conclusion: The result of our study shows that PFNA2 is an excellent device for osteosynthesis as it can be easily inserted. Moreover, it provides stable fixation in the osteoporotic patients , which allows early full weight bearing mobilization of the patient.

Study of results of extra articular distal tibial fracture treated with locking plate by minimally invasive percutaneous plate osteosynthesis

Introduction: Distal tibial fractures present a challenge due to subcutaneous location of tibia and precarious blood supply of distal leg. MIPO (Minimal invasive plating osteosynthesis) has evolved as a newer concept to treat distal tibial fractures with minimal articular comminution and minimal soft tissue damage. Methodology: This study was carried out at Department of Orthopaedics, Tertiary care Hospital. 45 patients with distal tibia fractures were identified of which 42 patients were enrolled in the study based on the inclusion and exclusion criteria. With 2 patients being lost to follow-up during the course of study before completing at least 6 months of follow-up, we had 40 patients remaining to study. Results: 37(92.5%) fractures were united between 10-14 weeks. Average time of union was 12 weeks. Majority of patients 20 (50%) had 50-70 degree of plantar flexion at final follow-up while 8 patients (20%) had

The functional and radiological outcome of open reduction and internal fixation of comminuted intra-articular distal humerus fracture with bi-columnar plating technique in adults

Recent studies have emphasised the importance of surgical approach, anatomical reconstruction, rigid fixation and early rehabilitation for good outcome. Hence the present study was planned to evaluate the outcome of surgical treatment of comminuted intra-articular distal humerus fractures fixed with bi-columnar plating technique. All the fractures were fixed using the AO bi-columnar plating techniques with distal humerus locking plates or reconstruction plates, fifteen cases via olecranon osteotomy approach and seven fractures fixed by triceps reflecting anconeus pedicle (TRAP) approach. Physiotherapy was started from 1st post-op day with unprotected ROM exercises were allowed by 3rd week. Patients were followed up at 6 weeks, 3 months, 6 months interval. Clinical outcome was assessed using MEPI (Mayo Elbow Performance Index) score and radiologically assessed for reduction, alignment, fracture union, post traumatic arthritis, and heterotopic ossification. The mean MEPI score was 90.45 points (range, 0 to 100 points), indicating mild impairment. Radiological union was achieved in 18.18% of patients at one and half month intervals whereas 81.82% of patients had radiological union during third month with average time for union being 10.9 weeks. We conclude that open reduction internal fixation of comminuted intra-articular fractures of the distal humerus with bi-columnar plating technique is an effective procedure with an excellent outcome in 54.5%, good outcome in 27.3% and fair outcome in 18.2% of patients in most age groups according to MEPI scoring. Patients have a high level of satisfaction and the majority return to their previous level of activity.

Technique of minimally invasive plating in mid clavicular fractures and its results

Aim: In this study we wanted to study the technique and pitfalls in minimally invasive plate osteosynthesis technique for displaced midshaft clavicular fractures (DMCFs) and assess its outcome.Materials and Methods: The proposed study is a prospective non randomized control study on the management and treatment of clavicle fractures centered in K.R Hospital attached to the Government Medical College and research institute, Mysore during the term between January 2019 to December 2019.A Total of 31 Cases of Patients underwent internal fixation by MIPO using Pre-contoured locking compression plate. Patients were functionally assessed at the end of follow up period as per the CONSTANT MURLEY Shoulder outcome scoring system.Results: Out of 31 patients, 87.1% of patients were below the age of 40years in our study with Males (87.1%) and Females (12.9%). Most of the patients were operated within 3 days and Right sided fractures were more common than left sided (54.8% vs 45.2%).Average time of union was 13 weeks. Most of the cases did not have any complications except for hypertrophic scar in 2 patients, implant prominence in 3 patients, superficial infection in 1 patient.Conclusion: Closed biological fixation using MIPO technique with locking Pre-contoured plate can preserve the blood supply of the fracture site and minimize soft-tissue related complications. Although it needs surgical expertise and proper technique for better results. MIPO technique with locking reconstruction plate is a feasible and worthwhile alternative for DMCFs.

APPRAISAL OF CLINICAL OUTCOME OF BIPLANE DOUBLE SUPPORTED SCREW FIXATIONS (BDSF) FOR FEMORAL NECK FRACTURES

Background: Over the years, primary hip arthroplasty has become a popular choice of management modality for intracapsular fracture neck of femur in geriatric hip. Although the complication of nonunion and avascular necrosis (AVN) is nullied by arthroplasty, the probability of re-operation and high surgical stress is substantially high as compare to osteosynthesis. The aim of this study was to determine the clinical outcome of biplane double supported screw xation (BDSF) for femoral neck fracture. Material And Methods: A total of 37 patients (15 males, 22 females) with a mean age of 75.97 years underwent BDSF for femoral neck fracture and were followed up for a period of 10-12 months. They were assessed on the basis of improvement in Harris Hip Score (HHS) and Garden Index. Results: After BDSF the union was achieved in 89.18% (33) patients.The mean HHS was 91.027 points and a garden index of 161-170 was achieved in 56.76% (21) patients at one year of follow up. The majority of patients had good to excellent functional outcomes. The average time of clinico-radiological union was 9.3 weeks. BDSF method used in femoral neck fracture Conclusion: xation has given very good results in this study. Though anatomical reduction is crucial, BDSF method ensures reliable xation, early rehabilitation and good functional outcome especially in elderly

Surgical outcome of proximal tibial fractures treated with locking compression plate: A prospective study

Background: The knee joint is one of the major weight bearing joints in the lower extremity. Generally, these injuries fall into two broad categories, high energy fractures and low energy fractures. Fractures of the proximal tibia are the result of high energy injuries and because of lack of soft tissue coverage in this region. The majority of tibial plateau fractures are secondary to high speed velocity accidents and fall from height. Fractures result from direct axial compression usually with a valgus or varus moment and indirect shear forces. Materials and Methods: The study was conducted between the period of November 2017 to April 2019 includes at Department of Orthopaedics, Bowring hospital,Bangalore.20 patients with diagnosis of proximal tibial fractures were treated with locking compression plate. All Schatzker’s classification type 1-6 proximal tibial fractures in adults aged 18 years and above of either sex were included in the study. All patients were followed up. With each follow up, clinical and radiological examinations were performed at 6 weeks, 3 months and 6 months. Results: The study included 20 patients, 18 males and 2 female aged from 21-80 years with mean age of 40.02 years. The average time for fracture union in our series was 15.52 weeks. In present study, knee stiffness was observed in 2 patients. Our study yielded excellent to good results in 80% of cases. Conclusion: Displaced tibial plateau fractures are best managed operatively. Optimal knee function is achieved by accurate anatomical reduction and secure fixation followed by early mobilization to attain functional arc of motion. For minimally-displaced fractures with minimal bone defects percutaneous fixation suffices, whereas for comminuted fractures, open reduction and internal fixation is mandatory. In our study, we found that proximal tibial locking plate provides complete union and early mobilization to attain better functional outcome.

Operative management of closed tibial plateau fracture treated with posteriomedial plate with inclusion or exclusion of anteriolateral plate

The proximal tibia is involved in body weight transmission though the knee joint and leg, it plays a vital role in the knee joint function and stability. Fractures of proximal tibia have historically been difficult to treat because of its subcutaneous location of the anteromedial surface of the tibia. Severe bone and soft tissue injuries are not infrequent and there is high incidence of open fractures compared to other long bones. This study was a prospective study done on 20 consenting cases of closed tibial plateau fractures who were admitted with posteriomedial plate with inclusion or exclusion of anteriolateral and have come for follow up during the study period chosen based on the inclusion and exclusion criteria. In our study Average time for union of fracture was 18 weeks (range from 16-24 weeks). In our study two patients developed knee stiffness One patient with knee joint stiffness is due to lack of postoperative mobilization .Second patient developed knee stiffness due to patella fracture treated with TBW and physiotherapy and regain 900 of flexion.

Treatment of posterolateral tibial plateau fractures with a rotational support plate and special pressurizer: technical note and retrospective case series

BackgroundIn tibial plateau fractures, the posterolateral segment of the tibia plateau is frequently affected and challenging to treat. Although there are many surgical approaches and fixation methods for the treatment of these fractures, all of these methods have limitations. We designed a new rotational support plate (RSP) and a special pressurizer that can fix the fracture directly via the anterolateral approach. This method is advantageous because it leads to little trauma, involves a simple operation, and has a reliable fixation effect. This study details the technique of treating these fractures with the RSP and special pressurizer and provides the outcomes.MethodsFrom May 2016 to January 2019, the data of 12 patients with posterolateral tibial plateau fractures treated with the RSP and special pressurizer in our hospital were retrospectively analyzed. Postoperative rehabilitation was advised, knee X-rays were taken at follow-ups, and fracture healing, complications, and knee range of motion were assessed. The Hospital for Special Surgery (HSS) knee score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to evaluate knee function at the last follow-up.ResultsThe average follow-up time of all patients was 16.5 months (range, 12–25 months). The average bony union time was 3.2 months (range, 3–4.5 months). At the last follow-up, the average knee range of motion was 138° (range, 107–145°). The average HSS score was 91 (range, 64–98). The average KOOS Symptoms score was 90 (range, 75–96). The average KOOS Pain score was 91 (range, 72–97). The average KOOS ADL score was 91 (range, 74–97). The average KOOS sport/recreation score was 83 (range, 70–90). The average KOOS QOL score was 88 (range, 69–93). Skin necrosis, incision infections, and fixation failure did not occur during the follow-up period.ConclusionsWith our newly designed RSP and special pressurizer, posterolateral tibial plateau fractures can be easily and effectively reduced and fixed through the anterolateral approach, which serves as a novel treatment for posterolateral tibial plateau fractures.

Importance of firm isthmic fixation in high-energy induced subtrochanteric fracture of the femur: retrospective observational study in a level I trauma center.

This study aimed to report the surgical outcomes in patients with high-energy induced subtrochanteric fracture and determine the risk factors for nonunion using statistical analysis. This study evaluated 88 patients with high-energy induced subtrochanteric fractures who underwent surgeries with indirect reduction technique and intramedullary nailing between March 2015 and December 2020. Outcome measures, including union time and nonunion incidence, were assessed by radiologic evaluation. Multiple logistic regression analyses were performed to identify the risk factors for nonunion, using age, sex, injury severity score, body mass index, preoperative mobility score, implant, and isthmic fixation as covariates. Five nonunions and two delayed unions were identified. The average union time was 17.4weeks. Multiple logistic regression analyses showed that poor isthmic fixation was the only risk factor for nonunion (odds ratio 15.294, 95% confidence interval 1.603-145.894, P value 0.018). Out of five nonunion cases, four were confirmed as hypertrophic, and one was confirmed as atrophic. Although surgical treatment using an indirect reduction technique and intramedullary nailing showed good outcomes, hypertrophic nonunion due to distal instability could occur if a firm fixation at the level of the isthmus cannot be achieved. Level III, retrospective cohort study.

Minimally invasive internal fixation for unstable pelvic ring fractures: a retrospective study of 27 cases

BackgroundThis study aimed to evaluate the radiographic and clinical outcomes of anterior subcutaneous internal fixation (INFIX) with or without posterior fixation for the treatment of unstable pelvic fractures.MethodsIntraoperative blood loss, operation time, and duration of hospital stay were recorded, and fracture union and postoperative complications were evaluated. The fracture reduction quality was evaluated using the Matta score, pelvic deformity index (PDI), and pubic symphyseal width (PSW). In addition, the functional recovery and general quality of life were evaluated using the Majeed score and the 12-Item Short-Form Survey (SF-12), respectively. Furthermore, sacral nerve injury was evaluated using the Gibbons classification.ResultsTwenty-seven patients (14 males and 13 females) with an average age of 37.4 years were followed up for a mean of 22 months. The average operation time, median intraoperative blood loss, and average duration of hospital stay were 129 ± 47 min, 100 mL, and 22 ± 13 days, respectively. All patients achieved bony union with an average union time of 13.3 weeks. Furthermore, the average PDI and PSW were 0.07 ± 0.04 vs. 0.04 ± 0.03 (P = 0.009) and 1.15 ± 1.36 vs. 0.54 ± 0.17 (P = 0.048) before and after the operation, respectively. In 78% of the patients, the Matta or Majeed scores were excellent or good. The SF-12 physical and mental health scores were 45.1 ± 10.2 and 53.2 ± 6.3, respectively. Furthermore, one superficial surgical site infection, one loosening of INFIX, one lateral femoral cutaneous nerve irritation, one femoral nerve injury, and two implant discomforts due to the bar were noted. Among five patients with sacral nerve injuries, four were asymptomatic, and one just had paresthesia at the last follow-up.ConclusionINFIX with or without sacroiliac screws can achieve satisfactory radiographic and functional outcomes in the treatment of unstable pelvic ring fractures.Trial registrationChiCTR2000038812. Registered 04 October 2020. Retrospectively registered.

COMPARATIVE STUDY ABOUT THE OUTCOME OF COMMINUTED FRACTURE SHAFT TIBIA FIXED WITH INTERLOCKING NAIL AND BIOLOGICAL PLATING

Incidence of tibial diaphyseal fractures (26 per 100,000 persons per year in an average population) is the highest among long bone fractures. Now-a-days closed reduction with intramedullary interlocking nailing is generally accepted by surgeons to be the most popular method for fixation of tibial fractures in adults. To compare the outcome of fixation of comminuted tibial fractures following minimally invasive plating and nailing. It is prospective study of adult patients admitted to orthopedic department of Sohag university hospitals suffering from comminuted fracture Shaft tibia. The study will be approved by Scientific and Ethical committees at Sohag Faculty of Medicine. An informed written consent will be obtained from all participants. This study is being done on 30 patients of comminuted fracture shaft tibia. The average follow up time was thirty- three weeks (range from 19 to 54 weeks). The average time of union in all our 30 patients was about 13 weeks (range from 8 to 16 weeks). Three of the thirty patients had post operative fracture angulation was less than 5 degrees in the coronal and sagittal planes and one patient had post operative valgus angulation of about 5 degrees. As regard intraoperative exposure to radiation it was less in cases of biological plating There was two patients infected and they required removal of the nail and plates and treated by external fixation they represent about 10% of patients. Out of the 30 fractures managed by this method 24 fractures showed uncomplicated healing within a reasonable period of time. The complication rate was considered minimal. Only one case of non-union, two cases of delayed infection and 4 patients of malunion in valgus or varus malalignment, however we passed through a learning curve during performing this study, with most of the complications occurring in the early cases. So MIPO could attain satisfactory results in uncomminuted tibia shaft fractures, and locked intramedullary nailing is more appropriate in comminuted fractures.

A prospective study of functional outcome of intracapsular femoral neck fractures with delayed presentation in young adults

Objectives: To assess the functional and radiological outcome of intracapsular femoral neck fractures with delayed presentation in young adults treated with cannulated cancellous screws. Methods: A prospective study included 21 patients with intracapsular neck of femur fractures who presented after 24 hours of injury but within 3 weeks of injury for which closed reduction and fixation was done with cannulated cancellous screws in Sanjay Gandhi Institute of trauma and orthopedics, Bangalore from May 2018 to December 2019. Patients were followed up at 6 weeks, 3 months, 6 months and 12 months. Clinical outcome was assessed using Modified Harris hip score and radiological assessment was done using x rays. Results: In our study we analysed the following parameters especially age, fracture type according to Garden and Pauwel, time of presentation, timing of surgery. In our study we found that patients with Pauwels type 3 (23.81%) and Gardens type 4 (42.86%) had low hip scores compared to others. 85% patients were pain free, 80% had good mobility post surgery. Incidence of non union was 2 out of 21 cases. The Modified Harris Hip Score evaluated at maximum follow-up of our patients averaged 90.13 with the maximum score being 96 and the minimum score being 67.8. Overall, 10 patients (47.62%) achieved excellent result, 6 patients (28.57%) achieved good result, 3 patients (14.29%) achieved fair result and 2 patients (9.48%) achieved poor result. 76.19% of the patients achieved either excellent or good results. According to radiographic evaluation AP view xray of pelvis with hip in 15 degree internal rotation, radiological parameters such as fracture union, non union changes, avascular necrosis of head, arthritic changes in the joint were analysed. Fracture union was seen in 19 patients (90.48%) and non union in 2 patients (9.52%). AVN changes were seen in 3 patients (14.29%). Average time of union was less than 3 months in 8 patients (44.4%), 3 to 4 months in 5 patients (27.7%), 4to 5 months in 4 patients (22.2%) and in one patient (5.55%) union achieved at 6 months.Conclusion: We conclude that canulated cancellous screw fixation is a viable option of treatment for fractures of intracapsular neck of femur in young adults with delayed presentation, showing excellent to good functional outcome and early radiological union with minimal complications.