Close Reduction Research Articles

Magnetic resonance imaging follow-up can screen for soft tissue changes and evaluate the short-term prognosis of patients with developmental dysplasia of the hip after closed reduction

BackgroundMagnetic resonance imaging (MRI) can show the architecture of the hip joint clearly and has been increasingly used in developmental dysplasia of the hip (DDH) confirmation and follow-up. In this study, MRI was used to observe changes in the hip joints before and after closed reduction (CR) and to explore risk factors of residual acetabular dysplasia (RAD).MethodsThis is a prospective analysis of unilateral DDH patients with CR and spica cast in our hospital from October 2012 to July 2018. MRI and pelvic plain radiography were performed before and after CR. The labro-chondral complex (LCC) of the hip was divided into four types on MRI images. The variation in the thickening rate of the ligamentum teres, transverse ligaments, and pulvinar during MRI follow-up was analyzed, and the difference in cartilaginous acetabular head index was evaluated. The “complete relocation” rate of the femoral head was analyzed when the cast was changed for the last time, and the necrotic rate of the femoral head was evaluated after 18 months or more after CR. Lastly, the risk factors of RAD were analyzed.ResultsA total of 63 patients with DDH and CR were included. The LCC was everted before CR and inverted after CR, and the ligamentum teres, transverse ligaments, and pulvinar were hypertrophic before and after CR, and then gradually returned to normal shape. The cartilaginous acetabular head index gradually increased to normal values. Complete relocation was observed in 58.7% of femoral heads, while 8.6% had necrosis. The abnormalities in LCC was related to RAD (OR: 4.35, P = 0.03), and the rate of type 3 LCC in the RAD group was higher. However, the IHDI classification (P = 0.09); the “complete relocation” of femoral heads (P = 0.61); and hypertrophy of the ligamentum teres (P = 1.00), transverse ligaments (P = 1.00), and pulvinar (P = 1.00) were not related to RAD.ConclusionsIn this study, MRI can observe the variations of the abnormal soft tissue structures of the diseased hips after CR and spica casting, and can evaluate which hips will have RAD after CR. Therefore, we can utilize MRI in DDH patients appropriately.

Management of early and late presenting tibial stress fracture with advanced osteoarthritis of the knee: A dilemma among arthroplasty surgeons in developing countries

BackgroundSingle-stage total knee arthroplasty (TKA) with long-stem is a viable option to treat proximal tibial stress fracture in advance knee osteoarthritis. However, in patients with old mal-united or non-united tibial fractures, treatment becomes complicated. Therefore, our aim in this study was to monitor clinical and radiological outcome in patients presenting early or late managed by single-stage long-stem TKA. MethodsThis retrospective study included 24 consecutive patients; all were female. Patients with recent and mobile stress fracture (Group A) were treated with close reduction and long-stem tibial component. However, in patients with old, sclerotic or mal-united fractures (Group B), open reduction, partial fibulectomy and plating with bone grafting was also performed. Outcome was monitored by tibiofemoral angle, functional Knee Society score and time taken for union. ResultsThe mean age of patients was 62.34 years. There were 13 patients in Group A and 11 in Group B. The mean follow up was 42.79 months (range, 18–72 months). Knee Society score improved from 29.83 ± 6.10 to 91.57 ± 4.89 in Group A and from 27.21 ± 3.32 to 89.87 ± 3.89 in Group B. Tibiofemoral angle improved from 20.57 ± 3.00° to 0.80 ± 0.46° in 21 varus knees, whereas it improved from 22.33 ± 4.61° to 0.83 ± 0.28° in three valgus knees. Iatrogenic perforation of tibial cortex occurred in one case. Union of stress fracture was achieved in all cases with a mean duration of 4.70 months. ConclusionExcellent results were obtained in both groups but were slightly lower in patients presenting late, therefore all efforts must be made to treat such cases as early as possible.

COMPARATIVE STUDY OF FUNCTIONAL OUTCOME OF OLECRANON FRACTURE TREATED WITH TENSION BAND WIRING AND CANNULATED COMPRESSIVE SCRE

Olecranon fractures are one of the most commonly seen orthopaedic injuries in the emergency room. There are various types of management including non-operative, TBW using k wire, TBW using Cancellous screw, plating, intramedullary screw xation, olecranon excision (1). Our study is to compare functional outcome of two operative methods namely TBW and intramedullary CCS xation. 25 patients were retrospectively analysed and divided into two groups. Group A (n=13) patients were treated by TBW and group B (n=12) by CCS. All the cases were followed up and the results were analysed by using a Mayo Elbow Performance Index. The mean operation time in group Awas 46.63 minutes and 35.40 minutes in group B .The mean fracture union time in group A was 15.62 weeks (range 8–24 weeks), and 14.24 weeks in group B. Excellent results were achieved with 6.5mm CCS in 8(66.6%) patients while with TBW K wire 7(53.8%) patients, good results were achieved with 6.5mm CCS with Washer in 3(25%) patients while with TBW K wire 4(30.7%) patients fair results were achieved 6.5mm CCS in 1(8.33%) patients while with TBWK wire 2(15.38%) patients. The technique of close reduction and internal xation with CCS is as effective as open reduction and internal xation with T

Nerve Grafting for Chronic PIN Palsy Due to Radiocapitellar Joint Entrapment 2 Years Following Closed Reduction of a Pediatric Monteggia Fracture-Dislocation: A Case Report With 1-Year Follow-up

This article describes the first case of successful nerve grafting for posterior interosseous nerve (PIN) palsy secondary to radiocapitellar joint entrapment 2 years following closed reduction (CR) of a pediatric Monteggia fracture-dislocation (MFD). Patient notes were examined. The literature was reviewed to determine whether similar cases or techniques had been reported. A 5-year-old girl presented with a PIN palsy 2 years following CR of an MFD, demonstrating Medical Research Council (MRC) grade 4 wrist and MRC grade 2 finger and thumb extension. Nerve exploration at 27 months revealed a PIN crushed in the radiocapitellar joint with a proximal neuroma-in-continuity and no response to electrical stimulation. Neurolysis and lateral antebrachial cutaneous nerve cable grafting were performed. The decision to pursue nerve grafting was based on the intraoperative appearance of an atrophic PIN with no response to stimulation, but with minimal muscle atrophy, short distance to target muscles, and pediatric patient with extended reinnervation timeline. Full recovery (MRC grade 5 wrist extension and MRC grade 4+ finger and thumb extension) was achieved at 1-year follow-up. We present the first case of successful nerve grafting for PIN palsy secondary to radiocapitellar joint entrapment 2 years following CR of a type III MFD. Even with significant treatment delay, nerve reconstruction should be considered in the pediatric population.

Closed Reduction for Developmental Hip Dysplasia in Lately Diagnosed Walking Age Children

Aim: The aim of the study was to assess the success and possible complications of closed reduction (CR) treatment of developmental hip dysplasia (DHD) in late-diagnosed children and explores its relation to the acetabular index (AI) measurement prior to treatment. Patients and Methods: Twenty-three consecutive patients with dislocated hips, 16 unilateral and 7 bilateral (30 hips), were retrospectively included in the study. They were admitted to the specialist pediatric orthopedic unit of the University Hospital (Tripoli Medical Center) in Tripoli, Libya. There were 21 females and 2 males with an average age at diagnosis of 17 months (range from 14 to 31 months). Their average follow-up period was 3 years (2–5 years), and none of them received treatment prior to diagnosis. All patients received prior inpatient skin traction for at least 2 weeks followed by CR with soft tissue release (adductor tenotomy), hip spica applied and maintained for an average of 3 months. Patients who had a failure of reduction or resubluxation at follow-up went for open reduction and a reconstruction procedure. Results: CR was successful in 27 hips (90%), failed in 3 (10%) other, the average age of the successful reduction group was 20.5 months, while that of the open reduction group, it was 23 months (P = 0.25). The average AI of the CR group was 39.0°, while that of the open reduction group, it was 42.7° (P = 0.15); 6.7% of patients with an AI of <40° had a failure of CR, while 16.7% of an AI of >40° had a failure of CR of the hip (P = 0.46). No complications of treatment were recorded at follow-up. Conclusion: Staged CR of DHD in older children in the hands of experienced specialists is still a valid means of their treatment, especially in developing countries with limited resources. There is a relatively higher failure rate of CR, the older the child is and the higher the AI.

Surgical Management of Supracondylar Fractures of the Humerus in Children by Closed Reduction and Percutaneous Pinning with Kirschnner Wires-A Cross-sectional Study

Introduction: Supracondylar Humerus Fracture (SCHF) is frequently encountered in paediatric age group and constitutes nearly three fourth of all upper extremity fractures. Most commonly used technique for surgical treatment in the displaced SCHF in children is closed reduction and stabilisation with percutaneous pins. Aim: To find out the outcome and safety of percutaneous pinning techniques in terms of functional and radiological outcome and to note the associated complications with this method of fixation. Materials and Methods: This was a cross-sectional study, conducted on patients admitted to Department of Orthopaedics, Hassan Institute of Medical Sciences, Hassan, between January 2017 to December 2019. Thirty paediatric cases were retrospectively reviewed. These were admitted with a supracondylar fracture and had reported to the hospital over a three-year period. All fractures were treated with closed reduction and fixation with percutaneus K-wire followed by immobilisation in above elbow slab for three weeks. K-wires were removed at three weeks and mobilisation with physiotherapy was advised. Outcome was measured by Flynn’s Criteria. The results were analyzed as per appropriate descriptive statistical tests. Results: The mean age of the patients was 7.4 years (range 3-15years). Males outnumbered females. Total 22 (73.3%) patients had left-sided fracture and 8 (26.6%) had fracture on right side. Fracture union was seen in all the patients at a mean interval of 4.2 weeks (range 3-5 weeks), in a follow up of 12 weeks. Most (90%) of the injuries were the result of trauma, including fall. 70% of the fractures were Gartland Type III supracondylar fracture. Cross K- wire fixation was done in 21 patients and lateral-only pin in 9 patients. Among the 21 patients, who had type III fracture, 4 of them were fixed with 2 Lateral K- wire pinning and 17 of them with crossed K-wire pinning configuration. The commonest post-operative complication observed was a superficial pin tract infection, seen in 4 (13.3%) patients. Outcome according to the Flynn’s criteria 25 patients (83.3%) had excellent result, 3 (10%) patients had good result, 1 (3.3%) had fair result and 1 (3.3%) patient had poor functional result. Conclusion: The present study concludes that close reduction and percutaneous k-wire pinning techniques give a favorable outcome in displaced supracondylar fractures of the humerus in children, without any serious complications.

Functional outcome of intra-articular fracture of distal end of radius treated by open reduction and internal fixation with locking distal radius system

Background: There is alays been a dilemma in the treatment of intra-articular distal radius fracture (DRF). Close reduction and cast application gives satisfactory result in extra-articular Distal Radial Fractures but there is alays been debate beteen open and close reduction in the intra-articular fracture. Hence, this study is to evaluate effectiveness of open reduction and internal fixation of intra-articular Distal Radial Fractures. Materials and Methods: This prospective observational study as carried out in the department of orthopedics, All India Institute of Medical Sciences, Patna, from August 2016 to March 2019. The patient ere included ho qualified the inclusion criteria. The included patient ere treated by open reduction and internal fixation ith distal radius plate. The outcome as assessed in term of anatomical variables (radial dorsal tilt, length, and angle), residual deformity, and subjective result evaluation using Sarmiento's modification of Lind Storm criteria. The complication if any as also noted. Results: This study included 30 cases of intra-articular DRF, 12 fractures of AO type B, and 18 fractures of AO type C. Anatomically, 24 patients (80%) had excellent restoration of anatomy, 4 patients (13%) had good restoration and 2 had fair (7%) restoration of anatomy. 93% of patients had excellent to good alignment of fragments and good reduction could not be achieved in 7% of patients resulting in fair or poor results. Functionally, 22 patients (73%) had excellent, 5 good (17%), and 3 patients had fair (10%) restoration of functions. Conclusion: Open reduction and internal fixation ith volar plate and scres fixation gives satisfactory (good to excellent) result in intra-articular Distal Radial Fractures.

Adult Traumatic Eight Days Old Anterior Dislocation of the Hip with Ipsilateral Fracture Upper Third Shaft Femur: An Atypical Case Report

Introduction: Anterior or posterior dislocation of hip are usually associated with fracture head of femur but dislocations associated with femoral neck, trochanter and shaft are very rare and among this anterior dislocation of hip with ipsilateral fracture of shaft femur is an extremely rare injury. We reported a case of anterior dislocation of hip associated with ipsilateral fracture shaft femur upper third in adult male. Case presentation: A 25 yrs male, low socioeconomic status was brought to our emergency department was conscious but unable to mobilize his right lower limb and external rotation deformity was present with some shortening. No neurovascular compromise and was found fracture shaft femur along with anterior dislocation of right hip on x-ray and treated by close reduction of femoral head and internal fixation of fracture shaft femur by intramedullary nail. Conclusion: Early diagnosis of hip dislocation is essential to prevent avascular necrosis of femur head in future. We concluded that there is no need of open reduction for anterior hip dislocation in every such case. Close reduction of anterior dislocation of hip followed by femur interlocking for femoral shaft fracture is good option for management for such type of injuries. Keywords: Hip dislocation, Close reduction, Avascular necrosis, Fracture dislocation

Results of flexible nails for fixation of tibial diaphysis fractures in children

Background: Fracture tibia is one of the most common fractures in the pediatric age group. It accounts about 15% of cases. In majority of cases, close reduction and plaster application is the mainstay of treatment. Objectives: The objective was to assess the outcome of flexible nails in the treatment of tibial diaphysis fractures in children and to evaluate the results regarding the union rate and complications including limb length discrepancy, angular deformities, and pain. Materials and Methods: This prospective descriptive case–control study which included 30 children with 30 unilateral tibial diaphysis fractures in which the physis were open, all were closed, and open (type 1 and type 2) fractures, and with displaced transverse, short oblique, and spiral fractures, in which the trial of close reduction was failed. All patients are admitted and operated at West Erbil Emergency Hospital. Alignment of fractures, any infection, delayed union, nonunion, limb length discrepancy, motion of knee joint, time of complete union, and skin irritation were assessed with minimum follow-up period of 6 months. Results: In the current study, the complete union was achieved in 9–11 weeks in 20 (66.7%) patients, while in 6 (20%) patients, achieved in 12 weeks, and in 4 (13.3) patients, achieved in 13–16 weeks that were regarded as a delayed union. In 6 (20%) patients, there were nail protrusion and skin irritation, no shortening more than 0.5 cm was recorded, shortening <0.5 cm recorded in 12 (40%) patients, and no lengthening was recorded. In 3 (10%) patients, the angulations in coronal and sagittal views were 5°–10°. There was no case of nonunion. Conclusion: Elastic nails are an effective way for the treatment of the pediatric tibial diaphysis fractures. It is a simple and easy method but with radiation risk, although elastic nails have complications, all are avoidable and minor that will be managed with minimal intervention.

Volar Locking Plate Fixation Versus Closed Reduction for Distal Radial Fractures in Adults: A Systematic Review and Meta-Analysis.

Distal radial fractures in adults are common, representing a substantial burden to patients and health systems. The 2 main treatments are closed reduction and cast immobilization (CR) and volar locking plate (VLP) fixation. Our primary aim was to determine if VLP fixation leads to better patient-reported pain and function at 12 months compared with CR. We searched systematically for randomized controlled trials (RCTs) comparing outcomes of VLP fixation with CR for the treatment of distal radial fractures in adults. The Cochrane Collaboration risk-of-bias tool was used to assess the methodological quality of each study. Meta-analyses of patient-reported outcomes, clinical outcomes, and complications were performed. Key findings were assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A total of 8 RCTs (810 participants) were eligible for inclusion. Based on moderate-certainty evidence, no clinically important differences in patient-reported pain and function were found: although the mean difference (MD) in the Disabilities of the Arm, Shoulder and Hand (DASH) score at 12 months was 4.1 points (95% confidence interval [CI], 1.2 to 7.0 points) in favor of VLP fixation, this was well below the minimum clinically important difference of 10 points. There was low-certainty evidence that VLP fixation led to better Patient-Rated Wrist Evaluation (PRWE) scores at 12 months (MD, 6.9 points; 95% CI, -0.6 to 14.3 points) and better DASH scores at 24 months (MD, 8.9 points; 95% CI, 5.8 to 12.1 points) but again, these differences were not clinically important. There was very low or low-certainty evidence that VLP fixation provided better long-term radiographic outcomes, including palmar tilt (MD, 6.5°; 95% CI, 2.8° to 10.1°), radial inclination (MD, 3.4°; 95% CI, 2.5° to 4.3°), and ulnar variance (MD, 0.7 mm; 95% CI, -0.8 to 2.1 mm). There were no clinically important differences between treatments with respect to patient-reported pain and function at 12 months post-treatment, even though VLP fixation resulted in better fracture alignment than CR. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Atypical Fracture of Axis With False Localising Sign

Introduction: Injuries of upper cervical spine many times associated with false localizing signs as a neurological deficit means there is a no clinic-radiological correlation. Purpose of this case report is to diagnose rare clinical presentation due to injury of pyramidal tract decussating at lower medulla. Method and Materials: A 21 years old male patient presented with traumatic quadriplegia (Frankel-A). Primary treatment was given along with immobilization of neck with collar. Routine X-ray of cervical spine was taken. X-ray was showing shear fracture of C 2 vertebra with intact dens. Crucified tong was inserted. Methyl Prednisolon injection in proper dose within 8 hours was given. (NASCIS II) CT SCAN was done to know exact fracture geometry. It was showing a fracture of C2 body in an oblique plane shearing off in one piece with the dens tilted towards right side and with subluxation of C1-C2 articular process on left side. Clinically patient improved in 24 hours in form of 4/5 power grade in all limbs except left upper limb. Left upper limb shoulder and elbow muscle power was grade 2/5 and o/5 in hand. Bladder/bowel was improved. Even though there was a weakness of left upper limb, but reflexes were preserved remarkably (Cruciate paralysis as a false localizing sign). Considering atypical unstable fracture, open indirect reduction of C-1-2 done from posteriorly and stabilization done with apofix clamps after fusion between C1-C2 posterior arches. Result: Patient had Frankel grade-A on admission. At three months follow up patient had almost full neurological recovery except finger grip power grade was 4/5. On final follow up at 12 months, neurology improved to Frankel grade-E. He had no neck pain with mild restriction of rotation. X-ray of cervical spine in flexion-extension shows stability and fusion of C1-C2 posterior elements. Conclusion: Atypical clinical presentation like cruciate paralysis as a false localizing sign should be kept in mind while dealing with fracture of upper cervical spine. As this fracture has good prognosis, proper treatment is needed. If close reduction is not achieved then open reduction and stabilization with fusion will provide early mobilization and faster neurological recovery. Keywords: Fracture; Axis; Cruciate; Paralysis.

Dorsally displaced distal radius fractures: introduction of Pacetti's line as radiological measurement to predict dorsal fracture displacement.

Background and aim of the work:In the best of our knowledge there is not yet in the literature a measurement able to assess post reduction stability of distal radius fractures. Aim: to study the relationship between our newly introduced Pacetti’s line, anatomical reduction of DRFs and post-reduction stability of fractures.Methods:Retrospective observational study. Patients/Participants: 230 patients (122men, 108women) who sustained a dorsally displaced distal radius fracture. Close reduction procedures attempted; below elbow cast applied. Follow-up: Pacetti’s line used on true AP and lateral view xrays after reduction and casting (T0) and at 7-14 days (T1-T2). Main Outcome Measurements: Assessment and prediction of early displacement of DRFs.19Results:The Pacetti’s line intersected the lunate bone in 162 cases (70.4%) after anatomical reduction, of which 20.4% (N=33) lost anatomical reduction. Cramer’s V test: significant relationship between transition of Pacetti’s line through the semilunar bone and stability of anatomical reduction at T0 follow-up (p<0.001, Cramer’s value=0.83). The Pacetti’s line intersected the lunate bone in 119 cases (51.7%) at 7-14 days follow-up. None of patients lost anatomical reduction. Cramer’s V test: significant relationship between transition of Pacetti’s line through the semilunar bone and stability anatomical reduction at T1 and T2 follow-up (p<0.001, Cramer’s value=0.73).Conclusions:We strongly recommend the use of the Pacetti’s line as it seems to provide reliable prediction of further fracture displacement and consequently of definitive management. The Pacetti’s line seems to represent a very useful tool providing simple, feasible, efficient and reliable information on DRFs characteristics and natural course.

The role of Close Reduction Intra Maxillary Fixation management of comminuted mandibular fractures in the Iraq War compared to the Open Reduction Internal Fixation under Special Criteria's

The role of Close Reduction Intra Maxillary Fixation management of comminuted mandibular fractures in the Iraq War compared to the Open Reduction Internal Fixation under Special Criteria's

Outcome of Distal radius fracture managed by MIPO - A case series

Introduction: Various treatment options for management of distal radius fracture include close reduction and application of cast, K wire fixation, external fixator application and open reduction and plating. The current study is aimed to assess the outcome of distal end radius fracture managed by minimally invasive plate osteosynthesis by evaluation of clinical results, radiological features and functional outcome. Materials and Methods: This was a prospective study conducted in Orthopedics department of SGRRIMHS, Dehradun 80 patients were enrolled. Evaluation was done on the basis of clinico- radiological and functional assessment. The parameters were measured preoperatively and on 4, 12 and 24 weeks. Chi square test was used to compare proportions and T-test was used to compare means of groups. P-value

Treatment Outcome of Métaizeau Technique of Intramedullary Pinning in Pediatric Displaced Radial Neck Fracture

Introduction: Displaced radial neck fracture in children when poorly managed results in deformity of elbow and incapacitates patient’s daily activities due to compromised forearm motion, hence they require careful attention. Aims: The aim of this study is to assess the outcome of Métaizeau Technique in displaced radial neck fracture in Children. Methods: This hospital based study evaluated the treatment outcome of 35 patients with an average age of 9.34 years (range, 6 – 14 years), who presented with displaced radial neck fracture; and were treated by Métaizeau technique of intramedullary pinning by Kirschners (K) wire at Nepalgunj Medical College, Kohalpur from April 2017 to January 2020. Only Judet’s type 3 and 4 fractures were included in this study. Close reduction was attempted in all cases. All patients were followed up for an average of 8.4 months (range, 6-12 months). Functional outcome was assessed as per Métaizeau functional score. Results: All fractures united at an average of 3.77 0.84 months (meanSD). Twenty seven patients had type 3 fracture and remaining 8 had type 4a fracture. Twenty five (92.5%) patients with type 3 fracture exhibited excellent results; while three patients (37.5%) with type 4a fracture had excellent outcome. Closed reduction produced excellent outcome in all patients while 80.95% patients with percutaneous reduction had excellent result. Conclusion: Outcome depends on initial fracture type and mode of reduction. Closed reduction should be preferred over an open reduction in order to achieve superior outcome.

Profile of neglected supracondylar humeral fractures in prof. dr. soeharso orthopaedic hospital surakarta, indonesia (january 2018 - december 2018)

Introduction: The supracondylar humeral (SCH) fracture is a fracture that occurs in the distal part of the humeral bone at the level of the condyle, which passes through the olecranon fossa. SCH fracture is the most common fracture in the elbow of children and is usually treated in an emergency setting, whether using close reduction or open reduction, and percutaneous pining. However, the treatment often delayed for various reasons. Object: This study was to analyze the profile of patients with neglected SCH fractures in Prof. Dr. R Soeharso Orthopaedic Hospital, Surakarta, Indonesia in 2018. Materials and Method: We retrospectively reviewed the hospital medical records of all admitted patients with neglected SCH fractures from January 2018 to December 2018 in Prof. Dr. Soeharso Orthopaedic Hospital Surakarta. Results: Eight patients with neglected SCH fractures, 7 males (87%) and 1 female (13%). Seven patients were children and one patient was a young adult. Four cases were extension type and 4 cases were flexion type. In cases of deformities: 5 cases (62%) were varus deformity, 2 cases (25%) were valgus, and 1 case (13%) was s-shape deformity. We did open reduction and inserted k-wires in all patients, 62% (n=5) was lateral approach, 25% (n=2) was posterior approach, and 13% (n=1) was medial approach. The average time the patients seek the treatment was 3.875 weeks, varies starting from 2 weeks - 7 weeks. We compared ROM of the elbow before and after surgery, and found that surgery was able to improve ROM in patients with neglected SCH fractures. However, in some patients, the post-operative ROM cannot be optimal.

Comparative study of the clinical and radiological outcome of subtrochanteric fracture femur fixed by dynamic condylar screw (DCS) and long proximal femur nail (PFN)

Background: Subtrochanteric fractures are included among those injuries caused by severe high energy trauma in the younger population. However, in the older population, this particular hip injury is caused by trivial fall and osteoporotic bones in the elderly population. It is difficult to treat these kinds of fractures easily. In order to avoid major complication such as mortality, the early surgical treatment regime is required to be followed. Aim: To compare and study the clinical and radiological outcome of subtrochanteric fracture femur fixed by Dynamic Condylar Screw (DCS) and Long Proximal Femur Nail (PFN) Materials and Methods: Total of 30 patients was included in the study. Simple randomization technique was employed to categorized patients for either PFN treatment or DCS treatment. Fifteen patients out of 30 were treated using PFN, and the remaining 15 were treated using DCS using close reduction. The study period was from July 2017 to June 2019. All the patients with subtrochanteric femur fractures within two weeks of injury were included for the study. Patients’ follow-up was done at 6-weeks, 3-months, and 6 months. Results: The highest number of patients, i.e. 40%, was aged between 51 and 60 years with the mean age of 58.231.26 years. The number of male patients (66.66%) was higher as compared to female patients. The mode of treatment for 50% of patients was PFN while it was DCS for the remaining 50% of the patients. The highest number of patients, i.e., 50% had Type III femur fracture. The patients treated using PFN showed improved functional outcome as compared to the patients treated using DCS. The patients were able to bear full weight within five weeks of surgery. The mean union time for patients treated with PFN was 16 weeks, while the mean union time in patients treated with DCS was 19 weeks. Also, the mean Harris Hip Score for patients treated with PFN was 90 and for the patients treated with DCS was 85. Conclusion: In light of the above resul

Outcomes of Percutaneous Pinning Technique in the Management of Two-Part and Three-Part Proximal Humerus Fracture in Adults

Background: Proximal humerus fractures represent 4-5% of over-all fractures. In patients above 40 years of age, it accounts for 75% of all humerus fractures. Fractures of the proximal end of the humerus oftentimes represent a management dilemma with the multiple surgical options available to deal with them. Objective: To evaluate the functional and radiographic outcomes of the percutaneous pinning techniques in the management of two-part and three-part proximal humerus fracture. Patients and Methods: A case series of 25 patients, functional outcome was determined by ASES and Constant scores and multiple radiographic views were taken to assess the fracture union, mal-union, and the presence of avascular necrosis. Results: ASES score of the whole group was 87.27 while the mean Constant score was 79.04. Only 16% of the entire group developed varus malunion (defined by Neck-Shaft-Angle &lt;=120degrees). Moreover, 16% of the whole group developed OA of the glenohumeral joint. Conclusion: This study supports that the percutaneous close reduction and pinning technique is an effective and reliable surgical technique in the management of closed two-part and three-part proximal humerus fractures in adults. Appropriate preoperative planning is important to achieve a successful surgical result, and regular postoperative follow-up and rehabilitation are essential to get an optimum functional outcome. Keywords: Proximal humerus fracture, percutaneous pinning, upper extremity surgery, trauma surgery, Clinical outcomes, Percutaneous fracture fixation

Comparative study between close reduction internal fixation and open reduction internal fixation in lower fibula with medial mallolus fracture

Comparative study between close reduction internal fixation and open reduction internal fixation in lower fibula with medial mallolus fracture - IJOS- Print ISSN No: - 2395-1354 Online ISSN No:- 2395-1362 Article DOI No:- 10.18231/j.ijos.2020.055, Indian Journal of Orthopaedics Surgery-Indian J Orthop Surg

Efficacy of closed reduction for developmental dysplasia of the hip: midterm outcomes and risk factors associated with treatment failure and avascular necrosis

BackgroundThe purpose of this study was to evaluate the efficacy of closed reduction (CR) in the treatment of developmental dysplasia of the hip (DDH) and to investigate risk factors associated with CR failure and avascular necrosis (AVN) occurrence in follow-ups.MethodsThe study retrospectively included 110 patients and 138 hips with DDH diagnosis that underwent closed reduction between February 2012 and November 2015 in our single tertiary medical institution. The failure rate of CR and the underlying risk factors were evaluated. Meanwhile, the incidence of AVN and the related risk factors among the successful CR cases were assessed.ResultsThe overall failure rate of DDH treated by CR in the present study was 31.16% (43/138). Risk factors for the CR failure were older age at the time of CR (≥ 18.35 month), large medical interval before CR (≥ 35.35 mm), and severer dislocation of the affected hip (IDHI grades III and IV). The incidence of AVN was 8.33% (6/72) in patients with successful CR at the last follow-up. No significant risk factors had been established in the present study that associated with the AVN occurrence.ConclusionsFor the treatment of DDH with CR, patients with younger age might achieve better outcomes; early diagnosis and early treatment might be the key point in the DDH treatment.