Cases Of Superficial Infection Research Articles

Reoperation strategy of malunited tibial plateau fracture

Objective To explore the revision strategy of the malunited tibial plateau fracture and to analysis the main points of four common revision operations and the clinical effect. Methods From January 2012 to December 2016, 18 patients (5 males and 13 females) aged 35-60 years (average 49.7 years) underwent tibial plateau revision surgery in our hospital were collected. The time from the second revision operation to the first operation was 2-24 months (average 10.4 months). Our revision strategies were as follows: Firstly, to determine whether there is an infection or not. If there was infection, we changed the original internal fixation to external fixator to control infection. Secondly, todetermine whether the patient could suffer re-reduction and internal fixation. If the patient was older (>65 years old) or with severe local bone defect, total knee arthroplasty should be performed. Thirdly, patients were divided into four operation modes according to the tibial plateau fracture malunion type: 1. the original fracture line osteotomy; 2. the tibial tubercle + original fracture line osteotomy; 3. tibial metaphyseal window-rod reduction; 4. the osteotomy of fibula head and original fracture line osteotomy. Results All patients were followed up for 12-30 months (average 16.8 months), and the operation time was 120-300 min (average 185 min). 2 cases were infected before operation and the original internal fixation were removed to instead of external fixator;1 patient underwent total knee arthroplasty; 3 cases were treated with metaphyseal open window-rod reduction and internal fixation; 6 cases were operated with the original fracture line osteotomy and internal fixation; 4 cases were treated with tibial tubercle osteotomy+original fracture line osteotomy and internal fixation; 2 patients underwent fibular head osteotomy+ original fracture line osteotomy and internal fixation. All patients achieved bony union at the last follow-up. The healing time was 3-6 months (mean 3.6 months). The postoperative knee Rasmussen score was 19-29 (average 22.9), compared with average 14.4 points before operation (t=-10.169, P=0.001). The postoperative range of motion of knee joint was 60-110 degrees (mean 94.5 degrees), compared with average 55 degrees before operation (t=-5.773, P=0.001). The post-operative VAS pain score was average 1.1 points, compared with average 4.2 points before operation (t=8.960, P=0.001). Fracture reduction was excellent in 12 cases and good in 5 cases, with the excellent and good rate of 100%. 3 patients still had 2mm collapse on the articular surface, while 3 patients still had mild valgus (less than 5 degrees). There were 2 cases of superficial infection of the wound surface after operation. Conclusion It was difficult to revise the malunion of tibial plateau fracture and it was necessary to make a detailed operation plan before the operation. Satisfactory clinical effects could be obtained for the patients by correct revision strategy. The key to success was the proper revision strategy which was adopted according to the different characteristics of the tibial plateau fracture malunion of the patients. Key words: Tibial fracture; Intra-articular fractures; Osteotomy; Joint deformities, acquired; Reoperation

The preserving insertion point of the rectus abdominisPfannenstiel approach for the treatment of anterior pelvic ring fractures

Objective To compare the clinical efficacy of the preserving insertion point of the rectus abdominis-Pfannenstiel approach with traditional Pfannenstiel approach in the treatment of pelvic anterior ring injuries. Methods A retrospective analysis was performed on 43 cases with pelvic anterior ring injuries treated from September 2008 to February 2016. Among them, 20 cases were treated with the preserving insertion point of the rectus abdominis-Pfannenstiel approach (modified approach group) including 14 males and 6 females, aged 18-58 years, with an average age of 36.9 years. According to Tile classification of pelvic fractures, there were 8 cases of B1 type, 4 cases of B2 type, 2 cases of B3 type, 4 cases of C1 type and 2 cases of C2 type. And 23 cases were treated with traditional Pfannenstiel approach (traditional approach group, 16 cases of males and 7 cases of females, aged 19-59 years, with an average age of 36.8 years). Tile classification of pelvic fractures: 9 cases of B1, 4 cases of B2, 3 cases of B3, 4 cases of C1 and 3 cases of C2). The operative time, intraoperative blood loss, postoperative hospital stay, postoperative reduction, postoperative functional and complications were compared between the two groups. Results 43 patients were followed up for 12-40 months, with an average of 20.5 months. All fractures healed in 8-20 weeks, with an average time of 10 weeks. Duration of anterior approach: 119.0±18.3 min in the modified approach group and 93.7±17.8 min in the traditional approach group (t=4.597, P 0.05). Complications: 2 cases of internal fixation loosening and 2 cases of coital pain occurred in the modified approach group after surgery, with a complication rate of 20.0% (4/20). Postoperatively, 1 case of superficial infection, 1 case of pulmonary infection, 1 case of internal fixation loosening, 1 case of screw broken and 4 cases of coital pain occurred in the traditional approach group, with a complication rate of 34.8% (8/23). Conclusion Both approaches can achieve satisfactory results in the treatment of anterior pelvic ring injury. The preserving insertion point of the rectus abdominis-Pfannenstiel approach for the treatment of anterior pelvic ring injuries has the advantages of less bleeding, faster recovery and shorter hospitalization time. Key words: Pelvis; Fractures, bone; Fracture fixation, internal

Development and validation of a patient-reported outcome measurement in acute pancreatitis: the PAN-PROMISE study

To evaluate the early clinical and radiological results using the Bösch technique to treat hallux valgus.We reviewed retrospectively four patients with 6 feet undergoing the Bösch technique for mild and moderate hallux valgus from 2009 to 2012 with an average follow-up of 10.8 months. All patients complained of pain around the first metatarsophalangeal joint. They had cosmetic concerns, and difficulty in wearing shoes. At final follow-up patients were asked about the improvement of pain, cosmetic appearance of the foot, problems with wearing shoes, the ability to walk, and their satisfaction with the operation. Complications encountered were also recorded. The radiographic evaluation considered osteotomy site union, the hallux valgus angle, and the intermetatarsal angle.All patients complained of mild or no pain. They had a satisfactory cosmetic result, wore normal shoes without problems with no limitation of walking ability. They were satisfied with the procedure. One case of superficial infection was noticed. All osteotomies healed primarily within three months. The average hallux valgus angle improved from 32.7° preoperatively to 14.8° at final follow-up and the average intermetatarsal angle from 17.5° to 9.2°.The Bösch technique is a cost effective procedure that yields good clinical and radiological results while correcting mild and moderate symptomatic hallux valgus with reduced risk of surgery related complications.

Functional outcome of total hip replacement using a short stem implant

<p class="abstract"><strong>Background:</strong> Conventional cementless THA is associated with stress shielding of the proximal femur and thigh pain. Short femoral stem can conserve bone, reduce stress shielding in the femur and reduce thigh pain. The present study aims to describe the functional outcomes associated with short stem metaphyseal implant in THA in our department.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted in the Department of Orthopaedic Surgery, Indira Gandhi Medical College, Shimla among patients who needed THA for painful disabling hip. Modified Harris hip scores (HHS) were assessed for all patients pre-operatively and at their final follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> During the study period, a total of 20 patients were included in the study, 20% of them were females. The most common indication for THA was avascular necrosis head of femur with secondary osteomyelitis (n=14), of which 12 cases had excellent Hip Harris Score while two were in good category. Modified Harris hip score was excellent in patients where early partial and full weight bearing was started. Per-operatively, there was only one complication of fracture greater trochanter which was fixed with cerclage wire. In early post-operative period, two cases of superficial infection were noted and one case of varus malposition was present. In late post operative period, there were three cases of varus malposition and one case of deep infection as sinus.</p><p class="abstract"><strong>Conclusions:</strong> Total hip replacement with short anatomical metaphyseal loading stem improved the modified Harris Hip score significantly, with very few complications. Future multicentric studies are needed to evaluate the efficacy of short stem implants over a long follow up period.</p>

Application of modified direction-changeable lumbar Cage in transforaminal lumbar interbody fusion

To investigate the effectiveness of modified direction-changeable lumbar Cage in transforaminal lumbar interbody fusion (TLIF). A retrospective analysis was made of 161 patients with single segment L 4 or L 5 isthmic spondylolisthesis treated between January 2013 and December 2015. According to the implantation of Cage, they were divided into trial group (85 cases, modified direction-changeable lumbar Cage implanted in TLIF) and control group (76 cases, traditional nondirection-changeable Cage implanted in TLIF). There was no significant difference in the general data of gender, age, disease duration, slippage segment, and slippage grade between the two groups ( P>0.05). The intraoperative implantation time of Cage, Cage position adjustments times, fluoroscopy times during implantation of Cage, fluoroscopy exposure time, and total operation time were recorded and compared between the two groups. Visual analogue scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate the effectiveness of the patients before operation, and at 3, 6, and 12 months after operation, and the incidence of complications was recorded and analyzed. CT examinations were performed at 6 and 12 months after operation, and lumbar fusion was evaluated by Bridwell criteria. The intraoperative implantation time of Cage, Cage position adjustments times, fluoroscopy times during implantation of Cage, fluoroscopy exposure time, and total operation time in trial group were significant less than those in control group ( P<0.05). All the 161 patients were followed up 12-18 months (mean, 14.3 months). There was 1 case of dural sac tear in the trial group and 1 case of superficial infection in the control group; no complication such as dural tear and infection occurred in other patients. The fusion rate was 76.5% (64/85) in the trial group and 57.9% (44/76) in the control group at 6 months after operation, showing significant difference ( χ 2=6.44, P=0.02); at 12 months after operation, the fusion rate was 96.5% (82/85) in the trial group and 90.8% (69/76) in the control group (including 3 cases of Cage displacement and 4 cases of screw breakage), showing no significant difference in the fusion rate between the two groups ( χ 2=1.54, P=0.26). The VAS and ODI scores of the two groups decreased gradually at 3, 6, and 12 months after operation, and improved significantly when compared with those before operation ( P<0.05). There was no significant difference in VAS and ODI scores between the two groups before and after operation ( P>0.05). Both Cages can obtain the similar effectiveness. The modified direction-changeable lumbar Cage can significantly reduce the fluoroscopy times and radiation dose during TLIF, shorten the operation time, and effectively reduce the radiation exposure of patients and medical staff.

Telovelar approach versus transvermian approach in management of fourth ventricular tumors

BackgroundThe relationships of the fourth ventricle to the cerebellar surfaces and the fissures through which the fourth ventricle is approached surgically are among the most complex in the brain. The area in and around the fourth ventricle may be affected by a variety of neoplasms. Some are unique to the fourth ventricle; others are also found in different locations. The two most common surgical approaches to the fourth ventricle are the transvermian and the telovelar approaches.The aim of this studyThe aim of this study is to compare the results of telovelar and transvermian approaches in the management of fourth ventricular tumors with regard to clinical outcome and extent of tumor excision.Patients and methodsThis study includes 40 patients presented at Ain Shams University Hospital and Nasser Institute with the diagnosis of fourth ventriclular tumors in a 4-year period between 2011 and 2015. Surgical treatment was done in all cases in form of (1) a CSF diversion for hydrocephalic patients through insertion of V-P shunt or EVD. (2) Completely randomly choosing an approach, 20 patients were operated through the transvermian approach (50% of all patients) and 20 patients were operated through the telovelar approach. Patients were examined clinically, radiologically, and functionally using the Karnofsky performance scale at the postoperative period, every 3 months for the first year, and then 6 months thereafter.ResultsTotal excision of the tumor was achieved in 27 patients (67.5% of all patients) and 15 patients (75% of 20 patients operated via telovelar approach).There were 13 patients (32.5%) with different postoperative complications, 6 patients underwent telovelar approach,1 case of superficial infection, 3 cases of bulbar palsy (15% of patients operated via telovelar approach), and 3 cases of cerebellar mutism (15% of patients operated via transvermian approach and 7.5% of all patients).ConclusionThe telovelar approach can give better exposure to the fourth ventricle in craniocaudal direction and lateral direction without splitting of the vermis. For lesions in the upper half, the ventricletelovelar approach can be used but we have to shift to the transvermian approach for complete resection. The transvermian approach has a higher risk of postoperative cerebellar mutism syndrome particularly in children.

Locked intramedullary nailing using the sign nailing device.

Locked intramedullary nailing is the treatment of choice not only in diaphyseal fractures of long bone but also in most metaphyseal and periarticular fractures. In this study, we set out to present our experience with the Surgical Implant Generation Network (SIGN)] technique of locked intramedullary nailing in long bones that do not require the use of image intensifier, fracture table, and power reamers. This was a hospital-based prospective descriptive study involving 54 consecutive patients seen over a 2-year period. All closed fractures of the femur and tibia/fibula seen within the period under review were included in the study. The patients were followed up for a minimum of 12 months. Fracture union was recorded when there was absence of pain at fracture site and X-ray shows presence of bridging callus in two orthogonal views. Fifty seven fractures in 54 patients were managed in the period of the study. There were 46 [81%] femoral and 11 [19%] tibia/fibula fractures recorded in 47 [87%] males and 7 [13%] females with a male to female ratio of 6.7:1. Majority of the patients were within the 31--40 years age bracket (n = 25, 46%). All the fractures were as a result of motor vehicle accident. Thirty six (78%) of the femoral fractures were operated through the antegrade approach, whereas the rest (22%) were through the retrograde approach. Both proximal and distal locking were achieved in all cases. Fracture union was recorded in all but one case [98%]. Complications were observed in 8 cases, which included 5 cases of superficial infection, one case each of osteomyelitis, delayed union and nonunion. Locked intramedullary nailing using external jigs for screw placement as in the SIGN technique gives a good result and is recommended for use in the developing countries where image intensifiers are not readily available.

The Biotenodesis Screw and Endobutton Technique for Repair for Acute Distal Biceps Tendon Rupture

There were no re-ruptures, fractures or hardware-related complications. Overall 95% of patients (21/22) were satisfied and rated their experience as excellent or good. Mean time to return to work was 100 days (0-280) and mean time requiring pain relief was 23 days (1-56). 55% returned to sport at their pre-injury level. One case developed heterotopic calcification and there were 3 cases of superficial infection. Mean OES and Mayo scores statistically improved from 18 (6-37) to 43 (24-48) and from 48 (5-95) to 95 (80-100) respectively (p < 0.00001).

Application of meshy fascia encapsulating cancellous bone graft in repair of bone defect after limb fractures

To investigate the effectiveness of meshy fascia encapsulating cancellous bone graft in repair of bone defect after limb fractures. A clinical data of 21 cases of traumatic bone defect after limb fractures, who were treated with meshy fascia encapsulating cancellous bone graft between June 2011 and December 2016, was retrospectively analyzed. There were 13 males and 8 females, aged 14-64 years with an average of 40.1 years. The location of bone defect included humerus in 3 cases, radius in 5 cases, ulna in 4 cases, femur in 2 cases, and tibia in 7 cases. AO classification of primary fractures were type A in 2 cases, type B in 7 cases, and type C in 12 cases. There were 14 cases of open fracture, and 7 cases of closed fracture associated with bone defect. The time from injury to bone defect repair was 5-165 days (mean, 21.3 days). The length of bone defect was 2.5-6.5 cm with an average of 4.5 cm. The operation time was 86-130 minutes (mean, 101 minutes). The intraoperative blood loss was 185-647 mL (mean, 316 mL). One case of superficial infection and 2 cases of delayed healing of incision occurred after operation, and no neurovascular injury occurred. All the 21 patients were followed up 12-36 months (mean, 19 months). The clinical healing time was 2.5-7.0 months (mean, 5.4 months); no delayed healing and nonunion occurred, the bony healing rate was 100%. There was no deep infection, infection recurrence, broken of internal fixator, or refracture. At last follow-up, the grading of bony healing were all rated as excellent, and the functional recovery of the affected limb was excellent in 12 cases, good in 7 cases, and fair in 2 cases with an excellent and good rate of 90.5%. Meshy fascia encapsulating cancellous bone graft in repair of bone defect after limb fracture is characterized by easy to harvest fascia, simplicity of operation, no adverse reaction, lower cost, and satisfactory results.

Endoscopic Carpal Tunnel Release: Results and Complications in 126 cases

Objectives:To report the results and complications of a two portal endoscopic carpal tunnel release (ECTR) with the use of a clear tube for assessing the quality of decompression of the median nerve.Methods:Retrospective analysis of 126 consecutive cases (126 patients) where a two portal ECTR was performed. The demographic and physical examination data were obtained from the medical history. For evaluation, the preoperative and postoperative Quick DASH and the Boston Questionnaire were used and the complications were recorded.Results:The Quick DASH average was 33.7 preoperative (SD 11.05) and 6.8 postoperative (SD 6.44) P<0.001. The Boston Questionnaire´s median average was 1.24 (SD 0.26) for symptoms and 1.18 (SD 0.22) for function. We recorded seven minor complications (5.5%): two cases of transient hypoesthesia and a permanent one of the third web space, three cases of superficial infection, and one case of postoperative neuropathic pain. No major complications or reoperations were documented.Conclusion:Two portal ECTR with the use of a clear tube for assessing the quality of decompression is a safe, effective, predictable and reproducible technique for treatment of idiopathic carpal tunnel syndrome. The complication rate is low when performed by a trained surgeon

Minimally invasive plate osteosynthesis with locking compression plate for proximal and distal diametaphyseal tibial fracture

Background: The treatment of proximal and distal diametaphysealtibial fractures remains controversial. This study was performed to evaluate the results of Locking compression plate using MIPO technique in the management of proximal and distal diametaphysealtibial fracture.Aims and Objective: To analyse and observe the result of management of metaphyseal fractures of tibia with respect to operative technique, stability of fixation, union of fracture, post-operative range of motion and complication. Materials and Methods: The study was prospective study. Forty two patients who sustained fractures of proximal and distal dia-metaphyseal tibial fractures with or without articular involvement were included in the study and treated by employing the concept of Minimally invasive plate osteosynthesis during period of August 2015 to December 2017 and followed up at regular interval with minimum six months to thirty months. Intervention: Surgical reduction and fixation of fracture using proximal and distal anatomical locking compression plate followed by rehabilitation. Main outcome measure: Radiological outcome, perioperative and postoperative complication, postoperative alignment, range of motion.Results: All fractures got united with the average duration of 22.7 weeks for proximal metadiaphyseal tibia and 19.9 weeks for distal diametaphysealtibia. There were 3 delayed union cases which got united without any surgical intervention. Deep peroneal nerve palsy was seen in 2 cases with proximal tibia fracture treated with longer plate. 2 cases of superficial infection and one deep infection seen with proximal diametaphyseal fracture and 2 superficial infection with one case of wound dehiscence and implant prominent seen with distal diametaphyseal tibia fracture. No malalignment or angulation of more than 10 degree occurred in any plane for both proximal and distal diametaphyseal fractures.Conclusion: MIPO provides stable fixation with excellent union rate with minimal complication for both proximal and distal diametadiaphysealtibial fracture.Asian Journal of Medical Sciences Vol.9(6) 2018 76-83

Occurrence of closed diaphyseal fractures of tibia in adults

This study has been done to evaluate the results and complications of intramedullary interlocking nail for closed diaphyseal fracture of tibia in adults. 50 adult patients of fresh tibial shaft fractures treated surgically between December 2014 to march 2016. Among these 72% males and 28% females and RTA was the common cause of fractures and right side accounts for 60%. Surgery were performed with in 5 days average with interlocking intramedullary nail, trans tendinous approach was used in all 50 cases and reaming performed in all cases. All the fractures united with a union rate of 94%. Radiological union was possible in 12.2 weeks, average range of motion in knee joint flexion was 1350, full ankle motion observed in 90% patients. There were one case of mal union, two cases of superficial infection, twelve cases of knee pain, one case of implant failure, one case of shortening, one case of Nonunion and two cases of delayed union. Functional results according to criteria by Klemm and Borner, 92% of patients achieved good or excellent results, fair result obtained in one patient and one patient functional result was poor.

Surgical management of diaphyseal fractures of tibia with intramedullary interlocking nailing in adult patients

Background and Objectives: Fracture shaft of tibia are increasing due to high velocity trauma and industrialization. Not only are they common but often difficult to treat. Previously surgeons had to rely on non operative methods, ‘V’ nailing, ‘plates and Screws’ and external fixators but they had their known drawbacks like prolonged immobilization, infection, delayed union, nonunion, malunion and cumbersome for patients, with the introduction of intramedullary interlocking nail for tibial shaft fractures has overcome some of these complications and encourages the patients for early mobilization. This study has been done to evaluate the functional results and complications of intramedullary interlocking nail for tibial diaphyseal fractures of closed type. Methods: Fifty adult patients with fresh tibial shaft fractures were treated surgically with intramedullary interlocking nail between December 2014 to march 2016. Results: Among fifty patients treated with intramedullary interlocking nail, fractures united with a union rate of 94%. Two fractures showed delayed union, one fractures had non union and one fracture had malunion. One case had distal locking screws breakage. Two cases of superficial infection were noted. Seven patients had anterior knee pain, one case developed shortening of leg which was less than 1cm. Functional results were graded according to the criteria by Klemm and Borner. 92% of patients achieved good or excellent results, fair results were obtained in one patient and in one patient the functional results were poor. Conclusion: This study with fresh fractures of the tibia (closed type, transverse and short oblique) treated with intramedullary interlocking nailing is a safe and effective technique for management of closed tibial diaphyseal fractures with high union rates, low incidence of complication. Good functional results are achieved by careful preoperative planning and respecting the principles of intramedullary interlocking nailing technique.

Comparison of intramedullary nailing versus proximal locking plating in the management of closed extra-articular proximal tibial fracture

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; To compare the outcomes of closed reduction and expert tibial nailing (ETN) versus minimally invasive proximal tibial plating in treating proximal extraarticular tibial fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study included 30 cases of extraarticular proximal tibial shaft fractures. They were admitted to our department between March 2014 and June 2016 and treated respectively by closed reduction and ETN (group A, n=15) or minimally invasive proximal tibial plating (group B, n=15). To compare the therapeutic effects between two groups, the intraoperative condition, post-operative function, related complications and malalignment were investigated.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All the patients were successfully followed up till radiological union. The average union time for group A was 14.2 months and for group B was 16.7 months. 3 patients in group A developed delayed union and was treated with dynamization and ultimately lead to union whereas 1 patient developed non-union in group B. There were 3 cases of superficial infection in group B cured by antibiotics and repeated dressing change. Moreover, group A showed better result in terms of intraoperative blood loss, operation time, postoperative weight bearing time and fracture union time. Functional scores as calculated by the knee rating scale of the hospital for special surgery, 12 (80%) had excellent results in group A compared to 10 (66.66%) in group B which was not statistically significant.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Compared with plate and screw fixation, ETN fixation has the advantages of fewer complications, shorter operation time, being less invasive, earlier postoperative rehabilitation and weight bearing, quicker fracture union and better functional recovery, thus being an effective way to treat extra articular proximal tibial fractures.&lt;/p&gt;

A prospective study on functional outcome of distal tibia fractures treated with minimally invasive percutaneous plate osteosynthesis

Distal tibial fractures are very commonly encountered by orthopaedic surgeons. Fractures of distal tibia are among the most perplexing injuries. Distal tibial fractures are difficult to manage due to its poor blood supply and limited soft tissue. Soft tissue injury component is a major concern among these fractures and may result in serious complications and disability [1]. High energy motor vehicle accidents are the common cause [2]. 0.7% is the incidence of distal tibia fractures and it accounts to about 10-13% of all tibial fractures [3]. The aim of this study was to evaluate the functional outcome and to study major complications in KIM’s hospital. Materials and Methods: A prospective study which was carried out from October 2015 to September 2017 in Karnataka Institute of Medical Sciences, Hubbali, and Karnataka State, India. In this study period, cases of distal tibial fractures were treated by open reduction and internal fixation using MIPPO. All patients with age >18 years, closed fractures without intra-articular extension and Gustillo type 1 fractures were included. Pathological fractures and grade 2 and above were excluded. Results: In our series of 18 cases, there were 14 men and 4 women, with average age of 40.3 years. Sixteen (88.8%) cases were admitted due to RTA and with slight predominance of left side. All fractures healed with good functional outcome. Mean union time was 22.6 weeks. 14 cases showed good ankle function outcome and 3 showed fair ankle function outcome according to Merchant and Dietz criteria. There was 1 case of superficial infection, treated successfully with antibiotics. Conclusion: The strategy of biological osteosynthesis with a bridge plating is less invasive, with fewer soft tissue impingement and improved cosmoses and convenient for removal.

Pediatric humeral fracture fixed by a single retrograde titanium elastic nail

Introduction: Almost all pediatric humerus fractures are well managed with conservative treatment with higher percentage of union rate. However there are certain conditions where surgical intervention will be inevitable like humerus fracture associated with polytrauma compound fractures, those with head and unacceptable alignment. It is not only the stable fixation but also the alignment which is important and can be maintained even by a single pre-bent elastic or flexible intramedullary nailing. Methods: This was a retrospective study of 28 pediatric humeral fractures fixed with a single retrograde titanium elastic nail from 2012 to 2016. Time to unite the fracture along with other complications was noted. The functional outcomes were assessed according to Broberg and Morrey for elbow function and Disabilities of the Arm, Shoulder and Hand (DASH) score for shoulder function. Results: Average age of patients was 8.85 1.84 (range 6 to 12 years). Time to unite the fracture was 8.28 2.43 weeks (range 6 to 12 weeks). There were 1 case of malunion around 10 degrees, 1 case of nail migration, one case of superficial infection at the site of nail entry, one case of transient radial nerve palsy and one case of nail protrusion in our study. There were 24 (85.71%) cases of excellent and 4 (14.29%) cases of good results according to Broberg and Morrey functional scores. Conclusion: Fixation of pediatric humerus fractures with a single flexible nail reduces operative time, radiation exposure, cost of treatment, chances of iatrogenic supracondylar fracture and ulnar nerve injury without compromising the final outcomes.

Minimally invasive plate augmentation in the treatment of long-bone non-unions.

Exchange nailing is most acceptable for treating hypertrophic non-union of the long bones, requiring the removal of previously fixed implant. However, its main effect of mechanical stabilization is controversial in non-isthmal area. We hypothesized that minimally invasive plate augmentation over the non-union site may have a better option, without the need of bone grafting or removing pre-existing implants. Seventeen patients with hypertrophic non-union of the long bones between 2010 and 2014 on radiography who previously underwent intramedullary (IM) nailing or plate osteosynthesis for long-bone fractures were included. A locking compression plate was inserted with at least three mono- or bicortical screws at each proximal and distal segment. Broken or loosened interlocking screws of IM nail were simultaneously re-fixed. Fracture site exposure, pre-fixed implant removal, and bone grafting were not performed. We investigated whether union occurred and analyzed functional outcomes and complications. Eleven femoral and six tibial non-unions were prospectively included. In the pre-existing implants, 13 nails and 4 plates were found. All cases achieved union at a mean 22.7weeks. One case of superficial infection was managed with oral antibiotics. Deep infection or implant failure did not occur. Minimally invasive plate augmentation can achieve additional stability and promote healing of hypertrophic non-union of the long bones. When indicated, this technique is the least invasive alternative to exchange nailing and reduces surgical risks in the treatment of diaphyseal non-union.

Treatment of periprosthetic femoral fractures following hip arthroplasty utilizing locking compression plates

Objective To evaluate the clinical outcomes of periprosthetic femoral fractures (PFF) following hip arthroplasty utilizing locking compression plates (LCP) in regard to tips and tricks on the construction of LCP augmented with locking attachment plate (LAP) and titanium cables (TC). Methods A total of 41 cases of PFF follow hip arthroplasty (THA 3, Hemi-arthroplasty 2) between May 2008 to April 2016 have been retrospectively analyzed. There were 13 males and 28 females with an average age of 70.5±8.6 years, including 11 case of Unified Classification System (UCS) type IV.3B1.1, 21 cases of B2.1 and 9 cases of type C. All were closed fractures caused by simple fall in terms of low-energy injury. Surgical options depended on individual configuration of the fractures with the combination of LCP and LAP or TC. In respect of reduction techniques, minimally invasive plate osteosynthesis (MIPO) was used in 5 cases for type B1.1 and 8 cases for type C, Mini-open in 6 cases for type B1.1 and 1 case for type C. Posterolateral approach with open reduction internal fixation were selected for type B2.1. The patients were followed up periodically. Harris score, Mukundan criteria and complications were recorded. Results Five cases died of the comorbidities (heart failure 3, pulmonary infection 1, multiple organs failure 1) within 1 year postoperatively. The follow-up rate was 78.0% (32 out of 41 cases) and the average follow-up time was 41 months (ranging 11 to 71 months). No malunion, no reduction lost, no hardware failure, no hip dislocation and revision surgery following PFF care found. All cases showed the signs of fracture healing from 8 to 12 (average 10 weeks) postoperatively except 2 cases of delay union. The postoperative complications shown in 11 cases, including 2 cases of superficial infection of the wound, 6 cases of deep vein thrombosis (popliteal vein 2, intramural gastrocnemius vein 4) and 3 cases of the prosthetic loosening. Harris score at the latest follow-up were 91.5±2.1 for group B1.1, 77.5±4.2 for group B2.1 and 83.5±3.8 for group C. The LCP lengths were 248.9±24.3 mm, 258.6±25.2 mm, 280.4±24.0 mm for group B1.1, B2.1 and C respectively. The LCP length of group B1.1 was short than that of group C (P 0.05). Conclusion Utilizing LCP for PFF following hip arthroplasty can achieve satisfactory short and mid-term clinical outcomes with the prerequisites of precise and individualized preoperative planning. LCP augmented by LAP and TC is a reliable option with low complication rate. However, type C PFF needs longer plate with more screws at distal fragment and more titanium cables. Key words: Femur; Periprosthetic fractures; Arthroplasty, replacement, hip; Fracture fixation, internal

Comparative prospective study between medial and lateral distal tibial locking compression plates for distal third tibial fractures

PurposeTibial fracture is the most common long bone fracture. Distal third tibial fractures are challenging though open reduction and plating can result in anatomical reduction and rigid fixation. This paper aimed to evaluate and compare the results of medial and lateral locking compression plates for distal third tibial fractures. MethodsThis prospective clinical study involved 36 patients with distal tibial fractures admitted in Department of Orthopaedics, Sawai Mansingh Medical College & Affiliated Hospital, Jaipur, India, from June 2011 to May 2012, including 29 closed fractures and 7 open fractures at the mean age of 38.9 years. Thirty-six patients were divided equally into two groups based on treatment method, including medial plating group (18 patients) and lateral plating group (18 patients). They were followed up for at least 5 months after discharge. The functional outcomes were evaluated using Tenny and Wiss clinical assessment criteria. ResultsMalunion was found in 3 cases of medial plating group and in 1 case of lateral plating group. In the medial plating group, there were 5 cases of superficial infections, 1 deep infection, 1 nonunion and 3 wound dehiscence. In the lateral plating group, there was 1 case of superficial infections, 1 deep infection and 1 nonunion. In the lateral plating group, 4 patients reported feeling the plates and screws but none of them asked to remove the hardware. In the medial plating group, 9 patients reported symptomatic hardware problems and 7 asked to remove the hardware. The number of cases graded as excellent/good/fair was 1/8/7 in the medial plating group and 3/7/7 in the lateral plating group respectively. In the medial plating group, the final range of motion was 17.2° in ankle dorsiflexion and 30.7° in ankle plantar flexion. In the lateral plating group, the final range of motion was 19° in ankle dorsiflexion and 34.2° in ankle plantar flexion. ConclusionLateral plating of distal tibia is safe and feasible, which can provide biological fixation and prevent the soft tissue complications associated with medial plating.

Management of distal femur fractures with distal femur locking plate by MIPPO technique

Introduction: Distal femur fractures are a challenge to orthopaedic surgeons as full restoration of function is problematic and demands technical expertise. Rigid fixation, maintaining the alignment and length of the femur and early mobilisation is required to achieve good results. The study was conducted to know the outcome after fixation by distal femur locking plate by MIPPO technique. Materials and methods: A prospective study of 20 cases of distal femur fracture operated with distal femur locking plate using MIPPO technique was conducted at MVJMC & RH from June 2012 to June 2016. Patient followed up at 2, 4, 6 weeks and 3, 6, 9 months and has evaluated for fracture union, knee ROM and Knee Society Score at 6 months. Results: Total number of 20 patients with distal femur fracture was managed with distal femur locking compression plate by MIPPO technique. In all 20 patients fracture united with mean duration of 14.5 weeks. There were no cases of non-union. Mean Knee Range of Movements at 6 months was 1100 flexion and extension limitation of 100.Mean Knee Score was 87.6 and Mean Functional Score was 78. There were no cases of implant loosening or breakage. 1 case of superficial infection, no deep infection noted. Conclusion: With MIPPO technique using distal femur locking plate for distal femur fractures gives good results with rigid fixation, excellent union rates, good functional outcome and minimal complications