Cannulated Cancellous Screw Research Articles

The Functional and Radiological Outcome of Hoffa's Fracture Treated With Cannulated Cancellous Screws.

Introduction: Distal femur AO type 33 B fractures consist of partial articular fractures subdivided into three types namely sagittal lateral condyle fracture, medial condyle fracture, and coronal split fracture. Coronal plane fractures of the distal femur are less frequent compared to sagittal plane fractures and are known as Hoffa fractures. The mechanism of injury is usually a direct anteroposterior force to the flexed and abducted knee for lateral condylar fractures and a direct impact on the medial side of the knee in flexion for a medial condylar fracture. Various approaches like lateral parapatellar for lateral condylar Hoffa's fixation, with or without posterior approach for open reduction of Hoffa's fracture with screw or buttress plate fixation, medial parapatellar approach for medial condylar Hoffa's fracture screw fixation are used.Materials and Methods: This study was conducted at R L Jalappa Hospital and Research Center attached to Sri Devaraj Urs Medical College, Kolar, India, from June 2017 to May 2020 with 17 patients as a sample size.Results: Seventeen patients with Hoffa's fracture were treated with cannulated cancellous screws with lag effect including 12 males and five females with a mean age of 31.1 years. The range of motion ranged from 120 to 135 degrees of flexion with a mean of 125.2 degrees. Three patients had extensor lag ranging from 5 to 10 degrees with an average of 6.3 degrees. Neer scores were excellent in 11, good in four, and fair in two patients. The average fracture union time for the lateral condyle was 16.4 months and for the medial condyle, it was 16.7 months.Conclusion: Restoration of articular anatomy and its congruence is of paramount importance for better surgical outcomes. Closed or open reduction and stable fixation with anteroposterior cannulated cancellous screws are essential. A good post-operative rehabilitation program is required for better outcomes.

A prospective observational study of functional outcome of pott’s fracture managed with operative modalities

Introduction: The movement around the ankle joint is very important because of the cultural practices, which involve squatting and sitting cross-legged. Bimalleolar Pott’s fractures are very common in ankle joint injuries because of the increased incidence of road traffic accidents and industrial trauma. Accurate reduction of fractures around the ankle joint is important for a painless ankle joint. AIM: To study the functional outcome of surgically managed closed bimalleolar fractures of the ankle in adults; to evaluate the restoration of the anatomy of malleoli and ankle perfectly by operative treatment with internal fixation; to assess the union of fractures after surgical management; and to achieve stable fixation and early mobilization of the ankle. Materials and Methods: We have evaluated clinical, radiological and functional outcomes of 50 patients treated with different treatment modalities, which include - tension band wiring (TBW), Kirschner (K)-wire, malleolar screw (MS) and cannulated cancellous screws (CCS) for medial malleolus fracture and rush nail, one-third tubular plate, fibular locking plate for lateral malleolus fracture. Results: The present study of 50 patients with ankle fractures treated by open reduction and internal fixation. Excellent results were achieved in 27 (54%) patients, good in 14 (28%), Fair in 5 (10%) and Poor in 4 (8%) patients. The patient with poor results had mild pain with activities of daily living, diminution in the abilities to run and to do work, the reduced motion of the ankle and narrowing of joint space.Conclusion: Closed treatment is often inadequate for restoring the proper biomechanics and anatomical structure of an injured ankle joint, internal fixation is an excellent method. Treating malleolar fractures with the use of anatomic fixation and open reduction was found to be very effective.

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.
 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.
 Results: 63.6, 27.3, and 9.1 percent of the cases had excellent, good, and moderate fracture healing, respectively.
 Conclusion: PCL tibial avulsion fractures managed with open reduction with cannulated cancellous screw fixation yields good functional outcome with less complications.

Operative outcomes of Lisfranc’s fracture dislocation

Lisfranc joint injury is uncommon and can fail to notice at the initial assessment and treatment. Once ignored, late reduction is difficult and requires extensive dissection. Lisfranc joint injuries are known to result in unctional loss and chronic pain due to residual ligamentous instability, deformity, and/or arthritis; osteoporosis may also occur due to antalgic gait without weight bearing.This recognition is important, as most of the injuries are either misdiagnosed or overlooked, such as in patients suffering from polytraumatic injuries, possibly becoming a permanent source of pain after the major fractures have healed.A prospective study to be conducted at the Department of Orthopaedic Surgery, Vijayanagar Institute of Medical Sciences, Ballari from 2018 to 2020. This study consists of 30 cases of Lisfranc’s Fracture Dislocation treated operatively by Cannulated Cancellous Screws and K wires (Kirschner Wires). The cases were selected according to inclusion and exclusion criteria. The functional outcome was evaluated using AOFAS score.In our study, we achieved Excellent in 10% of the cases. Good outcome in 73.33% of cases, Fair outcome in 13.3% of the cases and no patient had poor outcome in our study. Average AOFAS (American Orthopaedic Foot and Ankle Score) being 76.5.It can be concluded from the present study that operative management with CC (Cannulated Cancellous Screws) Screws and K Wires is an effective means of treatment based on biomechanical principle with good functional outcome and minimum complication.

Comparison of dual plating with single lateral locking plate supplemented with two medial cannulated cancellous screws for AO type C tibial plateau fractures—An experience from central India

Background: Type C tibial plateau fractures are complex injuries, and an ideal method for their treatment is still controversial. In the present study, we discuss the outcomes of Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C tibial plateau fractures treated with dual locking plating and single lateral locking plate supplemented with two medial cannulated cancellous (CC) screws. Materials and Methods: This prospective study included 34 patients of AO type C tibial plateau fractures divided into two groups. Dual locking plating and single lateral locking plate supplemented with two medial CC screws were the treatment methods in group 1 and groups II, respectively. The patients were evaluated using the Rasmussen clinical grading system at 1 and 2 years postoperatively. Results: The range of motion (ROM) was observed as 121.0° ± 1.9° and 126.3° ± 2.6° in group II, whereas in group I, ROM was 112.5° ± 3.1° and 120° ± 1.5° at 1 and 2 years, respectively. Pain, walking capacity, and final outcome were significantly better in group II at 1 and 2 years postoperatively. No significant difference was observed in two groups in terms of radiological results. Conclusion: Lateral locking plate supplemented with two medial CC screws proves to be a better method to treat AO type C tibial plateau fractures in adults, with minimal complications.

Outcomes of Displaced, Comminuted, Intracapsular Neck Femur Fracture in Young Adults Managed with Three Screw Inverted Triangle Versus Four Screw Diamond Configuration: A Comparative Pilot Study.

Three cannulated cancellous screws (CCS) inverted triangle configuration is considered to be the gold standard for management of displaced intracapsular neck femur (ICNF) fractures in young adults. However, some authors have recommended four CCS in diamond configuration in the presence of comminution. However, there are no comparative studies to assess the superiority of one over the other. Therefore, the aim of the present study was to compare the radiological and functional outcomes of displaced, comminuted, ICNF fracture in young adults managed with three screw inverted triangle versus four screw diamond configuration CCS fixation. Twenty-three patients (group I) with displaced comminuted ICNF fractures were managed with three CCS fixation in inverted triangle fashion between October 2014 and October 2015 and were followed up for a mean duration of 33.5months (range 25-38months). Twenty-five patients (group II) with the same inclusion and exclusion criteria were managed with four CCS in diamond configuration between October 2013 and October 2014 and followed up for a mean duration of 33.3months (range 25-38months). Radiological outcomes of these patients were compared in terms of union rates and avascular necrosis, while functional outcome was measured by Harris Hip Score (HHS) at a minimum of 24 months. Nineteen patients of group I and 20 patients of group II were available for final follow-up. Mean union time in group I was 15weeks (12-24weeks), while in group II, it was 14weeks (12-24weeks). There was total of four (4/19) cases of non-union in group I, while it was two (2/20) cases in group II. One patient (1/19) developed avascular necrosis in group I, while two (2/20) developed the same in group II. In group I, the mean HHS was 87.3 (range 84-94) points, while in group II, mean HHS was 93.5 (range 78-96) points. There is no difference in the clinical and radiological outcomes following three screw inverted triangle or four screw diamond configuration CCS fixation of displaced comminuted ICNF fracture in young adults. Thus, we conclude that both three screw inverted triangle or four screw diamond configuration CCS fixation are effective treatment modalities for fracture neck femur with comminution and in the absence of larger studies and long-term follow-up the superiority of one over the other cannot be recommended.

Dynamic Hip Screw versus Cannulated Cancellous Screw in Pauwels Type II or Type III Femoral Neck Fracture: A Systematic Review and Meta-Analysis.

Vertically oriented femoral neck fractures (FNFs) are known to be especially unstable FNFs, and they have a higher associated risk of failure. The dynamic hip screw (DHS) technique and the cannulated cancellous screw (CCS) technique are the two main fixation techniques used in the treatment of FNFs. However, no large clinical study has compared the DHS and CCS techniques in patients with high-shear-angle FNFs. MEDLINE, Embase, Cochrane Library, and Web of Science were systematically searched for studies that compared the DHS and CCS techniques for the treatment of Pauwels type II or type III FNF. Pooled analysis was performed to identify differences between the DHS and CCS techniques in Pauwels type II or type III FNF, with a focus on postoperative complications such as fracture nonunion and osteonecrosis of the femoral head (ONFH). We included five studies with a total of 252 patients. The DHS technique was used in 96 patients (DHS group), and the CCS technique was used in 156 patients (CCS group). The pooled analysis revealed that the nonunion rate in the CCS group was significantly higher than that in the DHS group (OR = 0.32; 95% CI, 0.11–0.96; p = 0.04, I2 = 0%), but there was no difference in the incidence of ONFH between the groups (OR = 0.98; 95% CI, 0.20–4.73; p = 0.98, I2 = 53%). For vertically oriented FNFs, the DHS technique is more favorable and has a lower risk of fracture nonunion than the CCS technique.

Percutaneous cannulated cancellous screw fixation v/s open reduction and internal fixation with plating for intra-articular calcaneal fractures

Introduction: The calcaneus is the largest tarsal bone and the most commonly fractured. Calcaneal fractures account for about 2% of all fractures, with 75 percent of these being intra-articular. Anatomic restoration in intra-articular calcaneal fractures was not always associated with a positive outcome in terms of quality of life, hence the best treatment option is still up for debate. Open reduction and internal fixation (ORIF) is considered an exemplary modality for treating calcaneal fractures. Soft tissue complications after ORIF procedures, on the other hand, have been reported to be as high as 30%. Scholars have advocated external fixation, percutaneous cannulated cancellous screw fixation, and Schanz pin assisted reduction and fixation as minimally invasive methods to reduce postoperative problems. In the present study, we aim to study the outcome of intra-articular calcaneum fractures treated with percutaneous cannulated cancellous screws V/S open reduction internal fixation with calcaneum plates. Materials and Methods: 22 patients with intra-articular calcaneum fracture (with displacement > 2mm) were recruited for the study after taking informed written consent. Patients were divided randomly into 2 groups; Group A were treated with minimally invasive percutaneous cannulated cancellous (CC) screw fixation. While patients in Group B were treated with open reduction internal fixation (ORIF) with plating. The study was a randomized controlled trial conducted at Krishna Institute of Medical Sciences, Karad during the period of May-2020 to May-2021. Pre-operative and post-operative Bohler’s angles were calculated using PACS, functional outcome was assessed at 6 months post-operatively using AOFAS score and post operative pain was assessed using VAS score. Results: The present study indicated no significant difference in the post-operative maintenance of Bohler’s angle when operated by either of the techniques. But, functional outcome in terms of AOFAS score when assessed at the end of 6 months indicated an excellent and good outcome in patients operated with cannulated cancellous screws as compared to patients operated with ORIF with calcaneum plating. Post operative complications were reported significantly high in group of patients operated with ORIF with plating as compared to percutaneous CC screw group patients. Conclusion: Percutaneous minimally invasive fixation using cannulated cancellous screws are better choice than ORIF with calcaneum plating due to lesser post operative pain and soft tissue complications, better functional outcome in terms of AOFAS score and lesser implant related soft tissue complications.

Clinical Status and Complications in Children Treated by Cannulated Cancellous Screw for Femoral Neck Fracture

Background: Cannulated screw fixation (CSF) is a widely used surgical procedure for the management of fractures of the neck of femur. Although the frequencies of such occurrence are not so high among children in every year surgeons use this fixation methods in treating children in a good number. We have very few research-based data regarding the outcomes and complications in children treated by cannulated cancellous screw for femoral neck fracture. Aim of the study: The aim of the present study was to assess the outcomes and complications in children treated by cannulated cancellous screw for femoral neck fracture. Methods: This prospective observational study was conducted in the Rahat Anwar Hospital, Rayal City Hospital, Arif Memorial Hospital, Barisal and in the Orthopedics surgery department of Sher-e-Bangla Medical College (SBMC) Hospital, Barisal, Bangladesh during the period from January 2016 to December 2020. In total 27 children with femoral neck fracture selected for cannulated screw fixation were enrolled as the study subjects. Only cases with displaced intracapsular hip fractures (Garden type 3–4) were included, Data were processed, analyzed and disseminated by MS Word and SPSS programs as per need. Results: In this study finally the mean (±SD) length of follow-up period was 22.13 ± 3.77 months. As post-operative status, according to the mean Garden’s alignment index, anteroposterior and lateral scores were 167.86 ± 5.12 and 172.14 ± 6.13 degree respectively. Postoperative mean Harris Hip Scores at 6 weeks, 3 months, 6 months and 1 year after surgery were found 58.77 ± 4.45, 79.06 ± 3.65, 89.61 ± 5.66 and 93.27 ± 5.81 respectively. At the post-operative period, the mean vertical femoral neck shortening was found 5.11 ± 1.88 mm and the mean horizontal femoral neck shortening was found 5.06 ± 1.79 mm. In this study, as complications non-union and avascular necrosis were found in 1 and 2 patients respectively. Besides these, for 1 patient, 2nd time ........

Surgical fixation of posterior cruciate ligament avulsion fracture from tibial attachment using cannulated cancellous screw: a clinical, radiological and functional outcome evaluation

<p class="abstract"><strong>Background:</strong> PCL (posterior cruciate ligament) is the main posterior stabilizer of the knee and plays a role in central axis controlling and imparting rotational stability to the knee. Injury to PCL presents commonly with avulsion fractures from its tibial attachment. An avulsion fracture of the PCL, if not surgically fixed, may lead to secondary changes in the knee joint. The aim of the study was to evaluate the clinical and functional results in patients with PCL tibial avulsion fractures treated by CC (cannulated cancellous) screw fixation.</p><p class="abstract"><strong>Methods:</strong> This was a prospective study conducted at a tertiary care government hospital in Kolkata, between December 2018 to July 2020 on patients who underwent CC screw fixation for post-traumatic PCL avulsion fracture from tibial site. All patients were followed up for 9 months. Lysholm knee score was used to assess the functional outcomes of the patients.<strong></strong></p><p class="abstract"><strong>Results:</strong> In a total of 10 patients, 9 (90%) patients showed excellent and 1 (10%) patient had good result during the final follow-up. 80% patients did not develop any complications. At the end of 9 months, the mean Lysholm score was 95.6. 8 (80%) patients achieved almost full knee ROM post-operatively by the end of final follow-up.</p><p class="abstract"><strong>Conclusions:</strong> Surgical fixation using CC screws is a simple, easy, safe and reproducible method without requiring significant expertise for achieving good stability in PCL tibial site avulsion fractures, where early intervention prevents significant late disability as it provides an excellent clinical, functional and radiographic outcome along with good joint function.</p><p> </p>

Management of displaced patella fracture with modified tension band wiring and percutaneous cannulated screws-a dilemma

<p class="abstract"><strong>Background:</strong> Displaced patella fracture has seen various surgical management methods in the past among which tension band wiring (TBW) and less invasive percutaneous cannulated cancellous (CC) screw fixation are mostly preferred and debated on which is better option. The study has been designed to compare the functional outcome and various parameters of both the methods.</p><p class="abstract"><strong>Methods:</strong> The study was conducted as prospective clinical study in 30 skeletally mature patients with x-ray evidence of patella fracture fulfilling inclusion and exclusion criteria, out of which 15 were done tension band wiring and rest percutaneous cancellous screw and outcome graded as excellent, good, fair and poor based on Lysholm knee score.<strong></strong></p><p class="abstract"><strong>Results:</strong> The comparison of the mean values of the Lysholm score in patients operated with patella TBW (92.47) were better than with percutaneous CC screw fixation (88.93). Patella TBW was responsible for all the cases of infection 2 (6.67%) and delayed non-union 1 (3.33%). Whereas stiff was nearly equal in both the techniques. The comparison of the mean values of the knee flexion in patients operated by using percutaneous CC screw (107.27) was better than patella TBW (105.67).</p><p class="abstract"><strong>Conclusions:</strong> Patients managed with CC screw fixation technique achieved better knee function, especially in the early postoperative period. The reported advantages of the percutaneous fixation technique include avoidance of extended incisions, preservation of the blood supply to the patella, and the possibility of a simpler removal of all hardware in the clinical setting. These results suggest that the percutaneous CC screw technique may be a superior alternative to conventional modified tension band wiring.</p>

Dynamic locking plate vs. cannulated cancellous screw for displaced intracapsular hip fracture: A comparative study

IntroductionThere is no consensus regarding the optimal device for displaced intracapsular hip fractures. This retrospective study compared two techniques (1) cannulated cancellous screw (CCS), and (2) Targon Femoral Neck (TFN) plate. Materials and methodsData regarding gender, operational data, complications, pain, Quality of life and function scores were retrieved. Results103 patients were included, 42 were treated using CCS, compared to 61 treated using TFN. Operative time shorter for CCS (p = 0.019). Complication rates were not different (p > 0.05). ConclusionAs CCS method take shorter operating time and reduced costs, CCS should be used for the treatment of displaced ICHF.

Clinical analysis of internal fixation femoral neck fractures with two or three cannulated screws

Introduction/Objective. Angular stability and dynamic fixation are key factors to successful healing of femoral neck fractures. The objective was to evaluate the efficacy of internal fixation of femoral neck fractures with two parallel self-tapping antirotation screws (SAF) compared to standard, three cannulated cancellous screws (CCS) fixation. Methods. In total 100 fractures were retrospectively analyzed, divided in two groups in which two SAF screws were used in parallel (n = 50) or three standard screws in an inverted triangle configuration (n = 50). The groups were compared with operation time, time of consolidation, femoral neck shortening, Harris hip score and reoperation rates. Results. SAF parallel fixation group of patients achieved consolidation rate of 86% compared to 74% in CCS fixation group, without statistically significant difference between the examined groups (p > 0,05). Dynamization of implants was significantly positively correlated with the fracture healing time in both examined groups (SAF: r = 0.324, p = 0.025; CCS: r = 0.572, p = 0.001), with significantly shorter healing time in SAF patients ? on average 15 weeks (15.02 ? 1.44) in relation to the CCS group of patients ? 19 weeks (19.81 ? 2.94) (?2/z = 7.048, p < 0.001). There was no statistically significant difference in the Harris hip score and reoperation rate among the study groups (?2 = 2.44, p = 0.487; ?2 = 0.500, p = 0.696). Conclusion. Our results suggested that dual parallel fixation is simpler, less invasive and it demands less performance time. It is not inferior to fixation with three screws, from the point of biomechanics, possible complications, healing and functional recovery.

Cannulated Cancellous Screw Fixation for the Management of a Rare Isolated Sustentaculum Tali Fracture: A Case Report

An isolated sustentaculum tali fracture is a rare manifestation of orthopedic injury involving the supporting bone of the middle calcaneal facet. Globally, the incidence is estimated to be less than 1% of all calcaneus fractures. We 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. Informed Patient Consent: The patient has already been assigned for informed consent and agreed to the publication of the case and clinical images for medical education purposes. Funding: None Conflict of Interests: None

Free fibular graft augmentation in delayed fixation of fracture neck of femur in young adults

Introduction: This clinical study was conducted to assess the long-term follow-up results of using free fibular graft to augment fracture fixation with cannulated cancellous screw (CCS) or dynamic hip screw (DHS) as a treatment option for femoral neck fractures in young adults who presented after 24 h of injury but within 3 weeks. Methodology: A prospective study was conducted on the patients of femoral neck fractures managed with multiple cancellous screws or DHS with fibular graft. Patients aged between 15 and 50 years and having Garden Type III or IV fracture with duration of injury >3 weeks were included in the study. They were assessed for radiological outcome and functional outcome using modified Harris hip score. Results: Twenty-two cases were operated between day 2 and day 21 after sustaining injury. The mean time of union was 3.4 months. Nineteen fractures united uneventfully. Two fractures went in for nonunion and one developed avascular necrosis (AVN) of the femoral head. According to Harris hip score, 14 patients scored “excellent,” three patients scored “good,” three scored “fair,” and “poor” score was recorded in two patients. Conclusions: Delay in surgery as a contributing factor for the development of complications in fracture neck of femur cannot be ruled out with the present literature available. Using a free fibular graft as an adjunct to implant construct helps in reducing the rates of nonunion and AVN. However, this cannot be a substitute for proper surgical precision that is required in the treatment of fracture neck of femur. Further prospective studies involving large sample size are required.

Cannulated cancellous screws versus dynamic hip screw in femoral neck fractures: a comparison in productive age group at tertiary care hospital of North India

<p class="abstract"><strong>Background:</strong> Since intracapsular fracture neck femur was recognized by Ambrose Pare almost 4 centuries back, the management of intracapsular neck femur fracture has undergone many changes. The multitude of various implants designed and techniques available for its treatment themselves indicate the inadequacy of the various methods of treatment. Objective was to compare cannulated cancellous screws (CCS) versus dynamic hip screw (DHS) in femoral neck fractures in productive age group.</p><p class="abstract"><strong>Methods:</strong> This observational study with both prospective and retrospective data analysis of patients operated by different surgeons in same hospital setup has been conducted from March, 2018 to February, 2020 at the department of Orthopedics, Government Medical College (GMC), Jammu. 105 cases satisfying the inclusion criteria admitted in GMC Jammu were included clinically and radiologically. Total number of patients included in the study was 97 patients as 8 patients were lost to follow-up. Functional outcome was evaluated by using Harris hip scoring.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study 8 CCS cases were lost to follow up. Total 97 of cases were followed up till one year both radiologically and clinically after a given time intervals and final assessment done on the basis of Harris hip score. Among 97 cases 71 were males most of them in age group of 41-45 years and 26 were females with 46-50 years age group predominance. 47.42% fractures were classified as type III in garden’s staging. </p><p class="abstract"><strong>Conclusions:</strong> DHS is a better implant than CCS in hands of doctors who lack of expertise and precision i.e. required for CCS in fracture neck femur in young adult patients.</p>

Fixation of Closed Transverse Patella Fracture with Cannulated Cancellous Screws and Anterior Tension Band Wiring- A Prospective Study

Patella fractures accounts for 1% of all skeletal injuries. Patella fractures usually need to be treated with accurate reduction and fixation to obtain optimal knee function. Improper reduction of the articular fragments leads to complications like arthritis and quadriceps dysfunction. Tension band wiring and pasting are commonly performed fixation methods. Tension band wiring with K-wires is associated with wire prominence and soft tissue irritation. Cannulated cancellous screw fixation of the fracture and tension band wiring through the cannulated screws avoid the complication of wire migration and breakage. In our study, we fixed these fractures with cannulated cancellous screws and tension band. This is a prospective study done in SRMC from 2012-2017. A total of 17 Patients with transverse patella fracture are taken into a study, 4mm cannulated cancellous screws with 18 mm stainless steel wire is used for anterior tension band wiring. Extensor retinaculum closure is done for all these patients. All patients had excellent knee function, according to KSS. There was no case of implant prominence or soft issue irritation in any of these patients. One patient had extensor lag. Cannulated cancellous screw with anterior tension band wiring is a reliable, effective and reproducible technique in treating transverse patella fractures.

PIT2 Descriptive Analysis of Complications, Length of STAY (LOS) and Costs of Surgical Fixation for Femoral Neck Fracture (FNF) in JAPAN

An increase in the incidence of FNF in Japan, most of which will require surgical treatment, would add significant burden to the healthcare system. This study describes patient characteristics, complications, LOS and healthcare expenditures associated with FNF surgical fixation in Japan. Patients ≥18 years old with a primary diagnosis of FNF receiving surgical fixation between 2008-2017 were identified using the Medical Data Vision Co. Ltd. database. Surgical fixations of interest included Cannulated Cancellous Screws (CCS), Dynamic Hips Screw (DHS), Hook Pin (HP) or Hook Pin with plate (HPL). Baseline characteristics, complications, readmissions, implant revisions, LOS and healthcare expenditures were extracted. Descriptive statistics were calculated to assess these endpoints. 8,044 patients (mean age 77.0±12.9; 76.2% female) met inclusion criteria. FNF fixation with HP (45.8%) was most common, followed by CCS (34.1%), DHS (11.4%) and HPL (8.7%). The most frequent inpatient complication was blood loss requiring transfusion (7.9% CCS, 21.2% DHS, 7.4% HP and 8.2% HPL). Median (IQR; day) LOS from surgery was CCS 21 (15, 34); DHS 28 (18, 48); HP 24 (16, 39); HPL 22 (16, 35.5). The median (IQR) inpatient healthcare expenditures were ¥1,171,759 (928,632, 1,703,036) for CCS, ¥1,600,066 (1,219,870, 2,525,716) for DHS, ¥1,505,947 (1,206,093, 2,132,549) for HP and ¥1,636,166 (1,384,697, 2,337,470) for HPL. 12-month follow-up period, readmission (6.6% in CCS, 3.7% in DHS, 6.3% in HP, 5.6% in HPL) and revision rates (2.7% in CCS, 1.5% in DHS, 2.7% in HP, 4.0% in HPL) were observed by fixation type. This study highlighted shorter LOS with less invasive fixation approaches (CSS, HP and HPL) and lower incidence of readmission & revision for DHS patients in a sample of FNF patients. Future research on patient factors and fixation methods that influence healthcare resource utilization in FNF treatment is necessary to address the burden in Japan.

In vitro biomechanical comparison of various implants in Pauwels type 3 fracture neck femur

<p class="abstract"><strong>Background:</strong> The objective of this study was to find out the correlation among type of implant, type of fracture and quality of bone in a cadaveric model of unstable fracture neck of femur (Pauwels type 3) fixed with either; proximal femoral nail (PFN), dynamic hip screw (DHS), dynamic hip screw with an anti-rotation screw (DHS and ARS) or cannulated cancellous screws (CCS).</p><p class="abstract"><strong>Methods:</strong> This study was conducted on 24 cadaveric bones (6 in each group) in which unstable fracture neck of femur (Pauwels type 3) were created and fractures in each group were fixed with different implants after creating a comparable group using DEXA scan. These were tested on a cyclic physiological loading machine at 2 cycles per second with a load of 200kg. The test was observed for 10,000 loading cycles or till failure whichever occurred earlier. Subsidence was measured and analyzed.<strong></strong></p><p class="abstract"><strong>Results:</strong> Five specimens in the PFN group, 3 specimens in the DHS and ARS and DHS group completed 10,000 cycles while all the specimens in CCS group failed before 10000 cycles. Mean subsidence of the PFN group was significantly lower than the other groups.</p><p class="abstract"><strong>Conclusions:</strong> PFN constructs were stronger than the other constructs. However, these data must be interpreted as strictly biomechanical, representing only part of the scenario at work in vivo. Nonetheless, the significant findings of increased strength of fixation over the DHS, DHS with ARS and CCS certainly appear to support the use of PFN clinically.</p><p class="abstract"> </p>

Efficacy of proximal femoral nail augmentation in unstable intertrochanteric fracture

<p class="abstract"><strong><span lang="EN-US">Background: </span></strong><span lang="EN-US">To assess the short term functional and radiological outcome of unstable intertrochanteric fracture fixation using proximal femoral nail with augmentation using Cannulated Cancellous (CC) screw or Stainless Steel (SS) wiring.</span></p><p class="abstract"><strong><span lang="EN-US">Methods: </span></strong><span lang="EN-US">A prospective study was conducted with 20 cases of unstable intertrochanteric femoral fractures from May 2017 to March 2019. Six females and fourteen male patients in the age group between 40 and 80 years were included in this study. There were 8 cases of AO31A2 and 12 cases of AO31 A3. Fracture were fixed by proximal femoral nail with augmentation by an additional CC screw or encirclage with SS wires to strengthen the lateral trochanteric wall.</span></p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong><span lang="EN-US">Fracture union was achieved in all cases with a mean period of 15.4 weeks. Patients were followed up for a period of 6 months. At the end of follow up the Modified Harris Hip Score was found to be more than 90 % in 16 cases.</span></p><p class="abstract"><strong><span lang="EN-US">Conclusion:</span></strong><span lang="EN-US"> Augmentation of proximal femoral nail in unstable intertrochanteric fracture with additional screw or cerclage wire increases the efficacy and stability of construct, aiding union and expedition of time to union.</span></p>