Cancellous Screw Fixation Research Articles

An unusual Ogden type V tibial tubercle avulsion fracture: a case report and literature review

BackgroundOgden type V tibial tubercle avulsion fracture is an unusual type of physial injury. Thus, little is known about its mechanism of injury and treatment. The type of osteosynthesis is variable and depends on the experience of the surgeon. We commonly used cancellous screws fixation combined with tension band wiring for displaced fracture of the anterior tibial tuberosity.Case presentationThe present manuscript describes a case of a Han nationality 13-year-old boy who presented with severe pain of the left knee, which began after landing following a high jump. He had no significant past medical history apart from a high body mass index of 30.3. Radiographs revealed that he had an unusual Ogden type V tibial tubercle avulsion fracture. He was treated by open reduction and combined fixation with cannulated screws and tension-band wiring. After 3 months, the fracture healed without any complications or knee symptoms with full range of motion. He underwent reoperation for symptomatic hardware, which was removed at 5 months after initial surgery, and returned to his prior level of sporting activity at 1 year follow-up.ConclusionOur case suggests that excellent functional outcome could be achievable by open reduction with the combination of internal fixation and tension-band wiring for Ogden type V tibial tubercle avulsion fracture. This type of osteosynthesis could not only achieve anatomical reduction and stable fixation for such fractures, but also avoid further damage to the proximal tibial epiphysis, which prevents serious complications, such difference in leg length.

Analysis of Calcaneal Avulsion Fractures Treated Surgically and Nonsurgically: A Retrospective Multicenter Study.

Calcaneal avulsion fractures (CAvFs) at the Achilles tendon insertion are among the more challenging fractures to treat. Although rare, they often require reoperation. The optimal treatment, including nonsurgical procedures and better implants for surgical procedures in the treatment of CAvFs, remains to be established. Therefore, our study aimed to (1) perform a descriptive evaluation of CAvFs, including cases managed nonsurgically, and (2) assess surgical procedures, including the incidence of complications and reoperation for surgically treated CAvFs. In this multicenter retrospective study, we collected data of patients with CAvFs treated at 9 hospitals from 2012 to 2022. We performed a descriptive study of CAvFs and compared postoperative complications and reoperation rates for multiple surgical techniques and implants. The size of the bone fragments was quantified. The data of 70 patients with CAvFs were analyzed; 20 patients were treated nonsurgically, and 50 were treated surgically. The mean age of patients was 68.5 years; 67% of the patients were female. Nineteen percent of the patients had diabetes, and 19% had osteoporosis. The incidence of postoperative complications was 30%, with infection in 14%, necrosis in 26%, and loss of reduction in 18%. The reoperation rate was 22%. Surgical techniques with use of cannulated cancellous screws were performed in 80% of the surgical cases. Cannulated cancellous screw (CCS) fixation alone resulted in a reoperation rate of 35%, whereas additional augmentation, including washers with CCS fixation, resulted in a reoperation rate of 10%. CCS fixation was successfully performed, although suture anchors were used in some cases with smaller fragments. CAvFs occurred more frequently in older women and had a high rate of postoperative complications. A combination of CCS with augmentation was more effective at reducing postoperative complications than CCS fixation alone, even when the bone fragment size was small. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Comparison of femoral neck shortening after femoral neck system and cannulated cancellous screw fixation for displaced femoral neck fractures in young adults

BackgroundThe purpose of this study was to compare the outcomes of femoral neck shortening between the femoral neck system (FNS) and the cannulated cancellous screws (CCS) for displaced femoral neck fractures in young adults Patients and methodsIn this retrospective analysis, 225 patients aged 18–65 years with displaced femoral neck fracture were divided into two groups according to internal fixation: 135 patients in the FNS group and 90 patients in the CCS group. The length of hospital stay, duration of surgery, intraoperative blood loss, quality of reduction, extent of femoral neck shortening, incidence of femoral neck shortening, femoral neck shortening at each follow-up visit, Harris hip score (HHS), reoperation, and complications were compared between the two groups. ResultsThe median follow-up time was 28.2 (26.0, 31.2) months in the FNS group and 30.2 (26.3, 34.7) months in the CCS group. The follow-up time, age, sex distribution, body mass index (BMI), mechanism of injury, injured side, length of hospital stay, time from injury to surgery, and fracture classification were similar between the groups. Duration of surgery was longer in the FNS group (65.0 (55.0, 87.0) min versus 55.0 (50.0, 65.0) min, P<0.001); intraoperative blood loss was greater in the FNS group (50.0 (20.0, 60.0) ml versus 20.0 (10.0, 35.0) ml, P<0.001). Femoral neck shortening was 2.4 (1.0, 4.5) mm in the FNS group versus 0.6 (0.0, 2.6) mm in the CCS group at 1 month postoperatively (P<0.001); 3.7 (1.8, 6.4) mm in the FNS group versus 1.2 (0.6, 3.8) mm in the CCS group at 3 months (P<0.001); 4.1(2.4, 7.7) mm in the FNS group versus 2.3 (1.1, 4.4) mm in the CCS group at 6 months (P<0.001); 4.2 (2.6, 7.7) mm in the FNS group versus 2.6 (1.3, 4.6) mm in the CCS group at 12 months (P<0.001); and 4.5 (2.8, 8.0) mm in the FNS group versus 2.8 (1.5, 4.8) mm in the CCS group at 18 months (P<0.001). The two groups showed no significant differences in HHS, reoperation, and reduction quality. ConclusionCompared to CCS, FNS is deficient in preventing femoral neck shortening. Future research should focus on improving FNS in terms of preventing femoral neck shortening.

Dynamic Locking Plate versus Multiple Cancellous Screws for the Fixation of Intracapsular Femoral Neck Fractures: Long-Term Results and Quality-Of-Life Assessment Based on Patient-Reported Outcome Measures.

The purpose of this study was to compare the long-term clinical outcomes and quality-of-life measures for two fixation methods in the setting of displaced femoral neck fractures. The two groups included fixation with multiple cancellous screws (group 1) and telescopic femoral neck screws and a small locking plate device (Targon FN) (group 2). Patients underwent reduction and internal fixation with either multiple cancellous screws or the Targon FN device from March 2000 to January 2012. Failure endpoints included nonunion, osteonecrosis of the femoral head, and revision surgery. Patient-reported outcome measures included chronic pain, ability to ambulate, and the use of ambulation assistive devices. Statistical analysis demonstrated a statistically significant lower rate of non-union and overall complication in the Targon FN group (p value < 0.001 and p value = 0.005, respectively). Logistic regression analysis showed that operative fixation with the Targon FN device decreased the odds ratio for overall complication by a factor of 0.34 (p = 0.02). There were no statistically significant differences between groups 1 and 2 in patient-reported outcomes (chronic pain (p = 0.21), ability to ambulate (p = 0.07), and the use of an ambulation assistive device (p = 0.07)). When compared to traditional cancellous screw fixation of femoral neck fractures, the Targon FN device has significantly lower complication rates and equivalent patient-reported outcomes.

Novel approach of plate assisted buttressing in Hoffa fracture

PurposeHoffa fracture is a femoral condyle fracture in the coronal plane. The lateral condyle is more commonly involved. The diagnosis is often difficult to detect with routine radiographs. Conservative management in this type of fracture resulted in nonunion, malunion, and other complications, such as stiff knee. Therefore, surgical management is mandatory in displaced fractures. Previous studies suggest only application of cancellous screw fixation, but these are not enough to counter vertical shear stress. Therefore, this study will evaluate the clinical outcomes of open reduction and internal fixation of Letenneur type I Hoffa fracture using cancellous screws with posterior buttressing plate. MethodThis was a prospective cohort study conducted from March 2017 to July 2022 in orthopaedics department of tertiary care center after approval of institutional ethical committee. The study included 36 patients with Letenneur type I fractures treated by open reduction and internal fixation using posterior buttress plate and cancellous screws. Radiographs and clinical outcomes, range of movement (ROM), bone union, and knee society score (KSS) of patients were assessed at the end of 4 and 12 months in the follow-ups. All statistical analysis was done using Epi info version 7.2.1.0. ResultsIn the 36 patients with Letenneur type I fracture, the majority belong to younger age group between 25 and 54 years with 22 males and 14 females. The modes of injury were road traffic accidents in 25 patients and fall from height in 11 patients. The right knee was involved in 21 cases and left was involved in 15 cases. Lateral condyle involvement was seen in 27 cases and medial condyle in 9 cases. All 36 patients with Letenneur type I Hoffa fracture were evaluated 4 months after surgical intervention. The notable improvements were observed in terms of ROM 120.4° ± 5.0° and KSS 85.0 ± 4.2. At the 12-month follow-up, considerably better outcomes were maintained regarding ROM 128.1° ± 5.2° and KSS 89.3 ± 4.8 with p < 0.05 which was statistically significant. At the final follow-up, all patients had routine fracture healing with a union time of (3.2 ± 3.4) months. ConclusionsFixation of Letenneur type I Hoffa fracture with cancellous screws and posterior buttress plate is effective, reliable and capable of providing adequate stability. Buttress plate assisted fixation is a valuable enhancement of the conventional technique of lag screw fixation of Hoffa fractures.

The outcome of cannulated cancellous screw fixation for treatment of base of fifth metatarsal fractures

Background: The fracture of the base of the fifth metatarsal is one of the common fractures that occur in 5th decade of life in the foot. Stable fixation with the cannulated cancellous screw provided early healing and patients can return to their work early. Aims and Objectives: The aim of the study is to find the functional outcome of closed reduction and internal fixation with cannulated cancellous screw fixation for the displaced base of fifth metatarsal fractures, to evaluate the clinical and radiological union of fifth metatarsal fractures, and to study the complications of treatment of fifth metatarsal fractures. Materials and Methods: This prospective study was conducted in the Department of Orthopaedics Manipal teaching hospital Pokhara, Nepal, from February 2022 to January 2023. A total of 35 patients with the fractured fifth metatarsal base were included in the study. The patient was kept in a supine position with a pillow under the knee so that the knee was flexed to 90° and the foot was plantigrade. A cannulated cancellous screw of the appropriate size was inserted along with a washer to fix the fracture. Results: There were a total of 35 patients with the base of 5th metatarsal fractures. The mean age of the patient was 36.94±8.04 years, with males 22 (62.9%) and females 13 (37.1%). The left side commonly involves 22 (62.9%). The history twisting injury is the most common mode of injury. All patients had a union of fracture by 7.09±1.07 weeks ranging from 6 to 9 weeks. There were no cases of sural nerve injuries in our study. Conclusion: The base of fifth metatarsal fractures is commonly seen in athletes and patients around 40 years of age. Closed reduction under image guidance and stable fixation with cannulated cancellous screw fixation provides early healing of fractures. Patients can return to work early.

SOFT TISSUE COMPLICATIONS IN THE EARLY POSTOPERATIVE PERIOD AFTER OSTEOSYNTHESIS OF CALCANEU

Introduction. The complex anatomy and biomechanics of the calcaneal bone is an important component in stability of a lower extremity. According to the literature, calcaneus fractures occur in 2% of all skeletal bone fractures. The vast majority of such fractures (almost 75%) are intra-articular injuries resulting from high-energy trauma. The absolute majority of studies show the indisputable advantage of surgical tactics for the treatment of intra-articular fractures of the calcaneal bone in a remote period. Conservative treatment of displaced fractures, in turn, is considered as an alternative in cases where there are absolute contraindications to surgical treatment. An analysis of reliable sources demonstrates better long-term functional results in patients treated by applying minimally invasive techniques. To date, the question of the relationship between the choice of surgical treatment method and early postoperative complications from soft tissues remains not fully resolved. The purpose of this work is to analyze soft tissue complications in the early postoperative period after calcaneus osteosynthesis and to determine the relationship between the frequency of such complications and various methods of surgical treatment. Materials and methods. The treatment outcomes of 42 patients with displaced calcaneal fractures (47 fractures) were analyzed. Patients were divided into 3 groups depending on the surgical techniques used in the treatment: open direct reduction through an extended L-shaped approach followed by fixation with a plate, minimally invasive open reduction through access to the subtalar sinus followed by the fixation with a calcaneal mini-plate, closed reduction with transcutaneous cancellous screw fixation. Results. The main soft-tissue complications in the early postoperative period after calcaneus osteosynthesis among patients of different groups were recorded, and the relationship between the frequency of such complications and various methods of surgical treatment was established. Conclusion. The use of minimally invasive methods of surgical treatment for displaced calcaneus fracture prevents a number of early postoperative complications in soft tissues, promotes wound healing and prevents the development of secondary infectious complications.

Evaluation of functional and radiological outcome of transverse cancellous lag screw fixation technique in pauwels type 3 fracture neck of femur

The study was conducted to evaluate the outcomes of transverse cancellous lag screw (TCLS) fixation in pauwels type 3 fracture neck of femur (NOF). 29 patients with pauwels type 3 fracture neck of femur were operated with transverse cancellous lag screws. Functional outcome was evaluated using Harris hip score while RUSH score was used to evaluate radiological outcome. The follow up period was 6 months. Quantitative variables were compared using unpaired t- test/Mann- Whitney test. Qualitative variables were compared using Chi-Square test /Fisher’s exact test. Pearson correlation coefficient/Spearman rank correlation coefficient was used to find out the correlation between quantitative variables. A p value of &amp;#60;0.05 was considered statistically significant. Mean Harris hip score was 84.86 with excellent outcomes in 44.82% of patients. Mean RUSH score was 26.55 at the end of 6 month follow up. The mean time to union was 4 months and the union rate was 93.10%. Over all TCLS fixation technique had good results in our study. This construction not only improves the compression pressure across the fracture site, also offer a multi-plane structure to lock the fracture ends. The addition of the transverse lag screw (inserted perpendicularly to the fracture line) allows optimum control of shear forces in the fracture ends. The transverse screw also provides rigid cortical support by transferring the bending moments from the femoral head and neck to the enhanced posterior lateral cortical support, which harmonized the function of the calcar femorale.

A COMPARATIVE STUDY OF USING DYNAMIC HIP SCREW VS MULTIPLE CANCELLOUS SCREW FIXATION IN FRACTURE NECK OF FEMUR IN YOUNGADULTS

Introduction: Incidence of fracture of neck of femur is increasing in young adults. Dynamic Hip Screw with a derotation screw or CC screw is used in operation to reduce and stabilize femoral neck fractures. the commonest complications of intracapsular fractures of neck femur are non-union and avascular necrosis. Material And Methods: The study included 40 patients with history of trauma and diagnosed with fracture neck of femur. After thorough evaluation of patient , Pre-operative radiograph of pelvis with both hips were taken. Routine preoperative profile was done in each patient, along with pre-anesthetic check-up. Follow-up X-rays were taken at each follow-up, which were scheduled at 6 weeks, 3 months, 6 months and at 12 months. Functional and radiological outcome were assessed by scoring Modified Harris Hip Score Observation And Results At 12 months: The mean Harris Hip Score in Group 1 was 84.69 ± 4.51 and in Group 2 it was 90.68 ± 2.54. The mean Harris Hip score at 12 months was significantly higher in Group 2 as compared to Group 1 (P=0.001). Conclusion: When it came to treating fractures of the neck of the femur in young adults, our research found that dynamic hip screw fixation performed better than cancellous screw fixation. In terms of functional outcome, the dynamic hip screw had a higher Harris Hip Score and a lower rate of avascular necrosis. Based on the findings of this study, we recommend using a dynamic hip screw rather than a cancellous screw to fix a fracture of the neck of the femur. We recommend larger studies because there is a lack of research comparing these two fixation modalities.

Biplane double supported screw fixation in femoral neck fractures using percutaneous approach

Introduction: Fracture neck of femur has always presented a great challenge to the Orthopaedic surgeons. Results depend upon adequacy of reduction and stable fixation. Fixation with cannulated cancellous screws is usually adequate for femoral neck fractures. The aim of the study was to analyze the results of treatment of fracture neck of femur with cannulated cancellous screw fixation using BDSF method.Materials and Methods: This prospective study was carried out in the postgraduate Department of Orthopaedics, Govt. Bone and Joint Hospital, an associated hospital of Govt. Medical College Srinagar from 2019-2021. A total of 25 patients who presented in the department with femoral neck fractures and qualified the inclusion criteria were included in the study.Results: Among 25 patients 12 (48%) patients achieved excellent results, 8 (32%) patients achieved good results, 3 (12%) patients achieved fair results and 2 (8%) patients achieved poor results. 80% of the patients achieved either excellent or good result.Conclusion: BDSF is a novel method of fixation of femoral neck fractures, associated with higher axial fixation strength and union rate compared to conventional fixation methods. It employs bi-plane positioning of three cannulated screws placed at steeper angles to the diaphyseal axis.

A prospective study of functional outcome of posterior tibial spine chip fractures treated with screw fixation

Aim: To study the functional outcome of posterior tibial spine fractures treated with threaded Cannulated cancellous Screw fixation. Materials and Methods: This is a prospective study of Posterior Tibial Spine Avulsion fractures in the age group 15-60 years admitted in Government Medical College, Kota, during the period from August 2020 to December 2022. The cases were classified under Modified Meyers and Mckeever classification. Patients with associated vascular Injury and skeletally immature and age group more than 60 years were excluded. Through Burks and Schaffer approach, avulsion fractures of Posterior Tibial Spine were fixed with 4mm partially threaded Cannulated cancellous Screw. Discussion: In our study, the mean age group of the patient was 33 years with a male preponderance. Road traffic accidents and accidental fall were the commonest mode of injury and the mean operating time was 43.5 minutes. Post operatively the knee flexion was around 120 degrees in average. And 15 patients had excellent outcome with Lysholm knee scoring scale and 5 had good outcome with no patients with fair or poor outcome. Results: Open reduction and internal fixation of Posterior Tibial Spine avulsion fractures through Burks and Schaffer approach had yielded excellent results in our study. A displaced avulsion fracture of Posterior Cruciate Ligament with more than 10 mm posterior tibial translation should be reduced and fixed in order to stabilise the joint and to prevent non-union.

A Comparative Study of Dynamic Hip Screw Versus Multiple Cannulated Compression Screw Fixation in Undisplaced Intracapsular Neck of Femur Fractures.

Background Femoral neck fractures are common injuries. Although many studies have compared two-hole dynamic hip screw (DHS) versus multiple cannulated cancellous screw (CCS) fixation for undisplaced intracapsular fractured neck of femurs (NOF), there is no consensus on which surgical technique results in better outcomes. The aim of our study was to compare DHS and CCS for undisplaced NOFs. The primary outcomes were reoperation and mortality rates at one year postoperatively. Methodology A retrospective analysis was performed involving all patients who underwent fixation with DHS/CCS for an undisplaced intracapsular NOF at our hospital between January 2016 and December 2020. All patients had a minimum follow-up time greater than one year. All patients underwent a standardised NOF protocol. Patients either underwent DHS or CCS fixation according to surgeon preference, and there was no randomisation to either group. Results A total of 41 patients underwent fixation with DHS compared to 32 who underwent CCS. The reoperation rate at one year was 9.8% in the DHS group compared to 6.3% in the CCS group. This difference was not statistically significant (p = 0.588). The one-year mortality rate was similar between groups at 22.0% and 21.9% in the DHS group and the CCS group, respectively (p = 0.994). Registrar-level surgeons performed 80.5% of DHScompared to 59.4% of CCS, and consultant surgeons performed 4.9% of DHS compared to 25% of CCS. Conclusions There was no significant difference in revision rates or complications seen between CCS and DHS. A significantly higher percentage of CCS fixations were performed by consultant-grade surgeons at our hospital compared to DHS. This study provides further data on the choice of fixation method for intracapsular fractures. It also reports on the grade of the operating surgeon at our unit, which may be a factor in the quality of fixation and ultimately reoperation rates.

A CLINICAL STUDY OF AO CANNULATED CANCELLOUS SCREWS FIXATION FOR GARDEN’S TYPE I AND TYPE II FRACTURE NECK OF FEMUR IN YOUNG ADULTS

Objectives: The objectives of this study were to study the functional outcome of surgically managed type I and II fracture neck of the femur by AO cannulated cancellous screws in young adults. Methods: A prospective study of 20 cases of type I and II Garden’s fracture neck of femur in young adults managed surgically by AO cannulated cancellous screws fixation in Chigateri Government Hospital and Bapuji Hospital, between September 2014 and September 2016 satisfying the inclusion and exclusion criteria which were studied. The functional outcome was evaluated using the Modified Harris hip scoring system. Results: In our study, we achieved 85% excellent results, 10% good, and 5% fair results. We had 95% satisfactory results in terms of the functional outcome. The results were comparable to other studies. Conclusion: Intracapsular fracture neck of femur in young adults treated surgically by closed reduction and 6.5 mm AO cannulated cancellous screw fixation gave excellent to good functional outcome in 95%. Hence, this would be the best procedure for intracapsular fracture neck of the femur, and this is going to stay for an extended period in orthopedic practice.

Clinical outcome of arthroscopic suture versus screw fixation in tibial avulsion of the anterior cruciate ligament in skeletally mature patients

BackgroundTibial eminence fracture is an intra-articular fracture of bony attachment of ACL. The displaced fragment could hinder the mobility of the knee and may lead joint instabilty; therefore, requires fixation. Arthroscopic suture and screw fixation are the widely used surgical modalities for eminence fractures of the tibia. Past studies have not yet depicted the superiority of one method over the other. Through this cohort study, comparison of the clinical and functional outcomes of these two surgical methods was done. MethodsA prospective, randomized, interventional study was conducted from December 2019 to January 2022 for comparing the clinical outcome of arthroscopic pull through suture fixation and arthroscopic antegrade cancellous screw fixation in skeletally mature individuals. Ninety patients (45 in each group) were randomly assigned and treated with the above two methods. A comprehensive clinical analysis was done after nine months of surgery for assessment of functional outcome, ligament laxity, range of motion, and complications if any. Results65.55% of anterior tibial eminence fractures were caused by road traffic accidents followed by sports injuries (28.88%). The postoperative mean subjective IKDC score in the suture group was 91.36 and for the screw fixation group was 85.71 (p = 0.001). After nine months of surgery, the mean LKS was 91.96 in patients treated with suture fixation and 86.00 in patients treated with screw fixation (p = 0.001). Pivot shift grading was grade 3 in one patient of the suture group and in three patients of the screw group (p = 0.319). Seven patients who had screw fixation required re-surgery for removal of the implant; however, no such complication was seen in the suture fixation group. ConclusionArthroscopic pull-through suture fixation of tibial avulsion of ACL in skeletally mature patients seems to be a superior intervention over arthroscopic screw fixation with the benefits of better clinical and functional outcomes and decreased chances of re-surgery.

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.

Is Percutaneous Screw Fixation with 6.5 mm Cannulated Cancellous Screws a Viable Option in Pelvic Ring Fractures?

Background Historically, internal fixation in pelvic ring fractures has been proven to be better in outcome than both external fixation and conservative management. In an attempt to overcome the morbidity of extensile surgical approaches, percutaneous fixation of the pelvis has been receiving increasing attention. The aim of the study was to assess the functional outcome in patients with pelvic ring fractures treated with percutaneous screw fixation. Methods The study included 12 patients of pelvic ring fracture admitted at NSCB medical college, Jabalpur (Madhya Pradesh) from December 2019 to October 2021, all treated percutaneously with cannulated cancellous screw fixation. Four patients had Tiles type C1 injury, 4 patients with type C2, 2 with type B1 and 2 with type A2 injury. Functional assessment was done using the Majeed Scoring system at preoperative, at 3 weeks, 6 weeks, and 3 months postoperatively. Results Functional outcome score at 3-month follow-up was poor in 8% patients, fair in 8% patients, good in 33.3% patients, and excellent in 50% patients. Pain was the most frequent complaint on follow-up. Conclusion Fixation of acute pelvic ring injuries with 6.5 mm cc screws using percutaneous technique offers favorable functional outcome and can be performed in hemodynamically unstable patients.

Percutaneous screw fixation for trapezium fracture

&lt;p class="abstract"&gt;Isolated trapezial fracture is a rare diagnosis which can lead to long term symptoms if missed. We reported a case of vertical intra-articular displaced trapezial fracture treated with percutaneous cancellous screw fixation with good functional outcome.&lt;/p&gt;

Outcome of Isolated PCL Tibial Avulsion Fractures Treated with Cannulated Cancellous Screw Fixation

Background: The posterior cruciate ligament (PCL) presents commonly as avulsion fractures from the tibial attachment site. Isolated tears of the PCL can be caused by a fall on the flexed knee or dashboard injury in road traffic accident. Such a mechanism (the upper tibia driven posteriorly with the knee flexed) may produce PCL disruption as the only clinically detectable instability. For the PCL avulsion fractures fixation, there are various methods available like closed reduction and internal fixation (CRIF), open reduction and internal fixation (ORIF), and arthroscopic fixation. This study was performed to assess the result of PCL avulsion fracture managed with ORIF with cannulated cancellous screw.&#x0D; Methods: We performed ORIF using cannulated cancellous screws with the posterior approach in 11 patients with isolated PCL tibial avulsion injuries. The minimum follow-up period was 6 months. The results were assessed radiologically and clinically. The spectrum of outcomes following PCL tibial avulsion fracture were measure using the Lysholm knee scoring system and range of motion (ROM) of the knee joint.&#x0D; Results: 63.6, 27.3, and 9.1 percent of the cases had excellent, good, and moderate fracture healing, respectively.&#x0D; Conclusion: PCL tibial avulsion fractures managed with open reduction with cannulated cancellous screw fixation yields good functional outcome with less complications.

Strategies in the management of femoral fractures in post-polio limb a retrospective analysis of 10 patients with 3-year follow-up

Background: Out of 10–20 million people in the world with post-polio sequelae, around 6.5 million of them are in India. Due to its eradication, survivors have lived through their life and crossed 40–50 years of age. Falls and subsequent fractures are common in these patients, which are difficult to manage and cause considerable morbidity. We conducted this study to analyze the various strategies used in the management of fractures in a post-polio limb. Methods: This is a retrospective study analyzing a total of 10 adult patients with post-polio sequelae complicating the fractured limb, which was managed with varied treatment options such as locking compression plate, dynamic hip screw, and hemiarthroplasty. The functional status of the patient was evaluated with Vignos grade of disability. Results: All the patients (mean age of 34 ±12 years ) were treated with extramedullary internal fixation devices such as locking compression plating in 6 patients, dynamic hip screw fixation in 1 patient, cancellous screw fixation in 2 patients, and total hip replacement in one patient. Of the 10 cases, 8 were fresh fractures, and 2 presented with a failed fixation for repeated fracture sustained later on. The mean follow-up period was 37.8 ±16.4 months. Bony union was attained at a mean duration of 3.5 ±1.4 months in all the patients undergoing fracture fixation. None of the included had secondary implant failure or other complications. Conclusion: Patients with limbs involving post-polio sequelae are more prone to fractures and are difficult to manage using the standard treatment protocols. Extramedullary internal fixation device provides effective stability for bony union and optimal functional results without major complications in these small, deformed, osteoporotic, and hypo-vascularized femurs.

Cannulated cancellous screw fixation for the management of sustentaculum tali fracture: A case report.

IntroductionAn isolated sustentaculum tali fracture is a rare manifestation of orthopaedic injury involving the supporting bone of the middle calcaneal facet. Globally, the incidence is estimated to be less than 1% of all calcaneus fractures.Presentation of caseWe reported a 42-year-old man with persistent ankle pain and instability on the right foot following a week after a motorcycle accident. The Computed tomography evaluation showed an avulsion of the medial sustentaculum tali on the right calcaneus bone. An open reduction and internal fixation procedure was performed using two cannulated cancellous screws applied across the lateral wall through the sustentaculum bone medially. The subjective postoperative evaluation showed that the patient responded well and gradually returned to daily routine activities without pain and instability.Discussion and conclusionSurgical approach using the cannulated cancellous screw to establish a firm fixation of sustentaculum tali fracture fragment into calcaneus bone and to prevent pathological movement.