Constant Scoring Research Articles

EVALUATION OF RESULTS OF PROXIMAL HUMERUS FRACTURE TREATED BY PHILOS PLATTING

Purpose: To assess the functional outcome of proximal humerus fracture treated with Proximal Humerus Internal Locking osteosynthesis (PHILOS) plating. Methods: Functional outcomes of 30 patients aged 30 to 75 (mean 57) years who underwent Philos plate xation for proximal humeral fractures were evaluated after taking informed consent about the study. Indications for surgery were 2-part, 3-part or 4-part closed proximal humeral fractures with angulation of more than 45 degrees or displacement of more than 1 cm. All patients satisfying the inclusion criteria were operated and followed up for 6 months .Functional outcomes and shoulder range of movement were assessed based on the Constant scoring system and was done at 6 months postoperatively. Result: Patients were followed up for 6 months. All fractures healed satisfactorily. No wound infections, vascular injuries, avascular necrosis, or loss of xation ensued. One patients with axillary nerve palsy recovered spontaneously within 3 months. Functional outcome was excellent in 11 patients, good in 15, and moderate in 4. The mean Constant score was 83(range 40–100). Conclusion: Proximal humerus fractures treated by Open Reduction and Internal Fixation by Philos plate have good functional results with low complication rates.

Evaluation of outcome of surgically treated displaced clavicle fractures

Clavicle fracture is the most frequent trauma of the scapular girdle, and involves the midshaft in 4 out of 5 cases. Non-displaced clavicle fractures of whatever location are usually managed non-operatively. Rare open fractures or fractures associated with neurovascular complications are usually managed surgically. High-energy trauma (floating shoulder, shoulder impaction, multiple trauma) may be managed surgically, on a case-by-case basis [1, 2]. This was a prospective study where 50 patients attending Outpatient, casualty and patients admitted with clavicle fractures from January to December 2018 were studied. Totally 50 patients underwent open reduction and plate fixation from January to December 2018 were followed up for a period of 6 months from the date of admission and analyzed both clinically using Constant Murley scoring system and radiologically with serial radiographs. Clavicle fractures were more common on the right side; about 60% of the patients and 40% of patients had fracture on the left side. The majority of trauma was due to road traffic accidents which constituted to 80%, while fall constituted the rest 20%. Of the 50 clavicle fractures, 40 cases in this study are simple fractures and 6 cases are comminuted fracture and 4 cases was segmental clavicle fracture. All patients were followed up on a regular basis and serial X rays were taken. Union was defined as complete cortical bridging between the distal and proximal fragments. All fractures achieved union as determined by the surgeon after radiographic evaluation. The patients with simple displaced fractures united in 9 weeks while in cases of comminuted fracture with butterfly fragment required 13 weeks and segmental fracture required 15 weeks. There were no instances of nonunion.

English

BACKGROUND Fracture clavicle is one of the most common conservatively treated fractures. Conservative management showed lesser rates of non-union and satisfactory results for fracture clavicle initially. Recent studies showed that the functional outcome following conservative management was not as optimal as it was thought to be. With changing injury patterns, increased incidence of high velocity trauma and increased functional demands of the modern patients which led to thorough evaluation of the functional outcomes following conservative management of fracture clavicle, the outcome was not optimal. Recent studies showed increased rate of non-union among conservatively managed cases compared to those which were fixed internally. Some found residual deficits among patients treated conservatively. We wanted to study the functional outcome and complications following internal fixation of clavicle fractures by using plating techniques. METHODS This prospective study was done in Department of Orthopaedics, Andhra Medical College, Visakhapatnam. We studied functional outcome of 30 fractures of clavicle which were fixed using plating technique during the period October 2016 - October 2018. Thirty patients (n = 30) were treated with plating technique using precontoured locking plates and recon plates. The fractures in this study were middle third clavicle fractures which were divided into two types based on the classification of Robinson. Type 2 Robinson clavicle fracture implies that it is a middle third clavicular fracture, which is further divided based on fracture morphology. 2b1: Displaced simple or wedge comminuted fractures 2b2: Segmental comminuted fractures. In this study, superior plating was done. The implants used were precontoured LCP and recon plates. Functional outcome was assessed using Constant Murley scoring and Quick Dash score at 10 weeks. The follow up period was for 1 year - October 2016 to October 2018. RESULTS The average time of union for the fractures treated with plating technique in our study was around 10.2 weeks. The mean Constant Murley score of our study was 91. Eighteen out of 30 patients had excellent outcomes. One patient had fair outcome due to stiffness of the shoulder. 10 patients had good result. The average DASH score of the patients was about 9.8. CONCLUSIONS Treatment of fracture middle third of clavicle using plating technique provides good functional outcome and faster recovery with minimal complications. KEYWORDS Clavicle A02.835.232.087.227, Wounds and Injuries C26, Postoperative Complications C23.550.767

A prospective study to know the outcome of midclavicular fractures treated with reconstruction / anatomical plate

Background: Clavicle fractures are the most common injures occurring due to trivial fall on an outstretched hand, RTA or associated with poytrauma. Most of these fractures are treated in conservative methods by using clavicular braces and figure of 8 bandages which resulted in high rates of non/mal union and functional diasability. The aim of the present study is to show the surgical management of midclavicular fracture with open reduction internal fixation (ORIF) with Recon/Anatomical PlatesMethods: The present study includes a total of 30 patients with mid-clavicular fractures operated with orif with recon/anatomical plates at mahavir institute of medical sciences and general hospital, vikarabad. Results: In a total of 30 patients operated with ORIF were 20 male and 10 were female patients. 22 cases had right clavicle fracture and 8 patients had left clavicle fracture.85% of patients’ sustained injury due to trivial fall, and 15%RTA. All patients were admitted in emergency department and treated. According to Constant Murley scoring system excellent results were seen in 20 patients, good in 6 patients and fair in 2 patients and poor in 2 patients. Conclusions: Mid-clavicular fractures treated with ORIF with plates showed excellent functional outcome, early mobilization, no pain and resume to his/her regular duties, when compared to conservative methods.

Functional outcome of conservative versus surgical management in mid shaft clavicle fractures at tertiary care centre

Aim of the study: To evaluate the functional outcome of locking compression plate fixation and figure of eight clavicle brace in the treatment of displaced middle 1/3rd clavicle fracture.Materials and Methods: In our Prospective Study, we included 36 patients, both male and female patients with displaced middle-third clavicle fracture (Robinson type 2B1). Patients were randomly divided into two groups, based on treatment modalities as a conservative group and surgical management group, with 18 patients in each group. All patients will be followed up every week for 2 weeks after treatment, and then every 6 weeks, 3 months, 6 months and 1 year. Functional outcome were assessed with the help of Constant and Murley scoring system. Result: In our study, we found that the functional outcome of surgical patients was significantly improved. At the end of 12 months, in surgical group excellent and good outcome was achieved in 12 patients (75%) whereas in conservative group excellent and good outcome was obtained only in 3 patients (18%). The complications seen in the surgical group were 2 cases each of infection implant failure and four cases of nonunion in the conservative group. Conclusion: In this study, we observed that patients who were treated by surgical treatment with locking compression plating had a better functional outcome in terms of early range of movements and less shoulder stiffness and therefore early return to work when compared to the conservative group.

Comparison of the Posterior and Anterolateral Surgical Approaches in the Treatment of Humeral Mid-Shaft Fractures: A Retrospective Study.

BackgroundThe aim of this study was to retrospectively assess and compare the functional outcomes and complications following anterolateral versus posterior surgical approaches for the treatment of mid-shaft fractures of the humerus.Material/MethodsThis study included 107 patients treated for mid-shaft fractures between May 2015 and July 2018. Demographic and surgical data were collected for each patient. During follow-up visits, radiographs were acquired and evaluated. The clinical outcomes of the involved joints were assessed by the Constant scoring system, range of motion (ROM), and the Mayo Elbow Performance Scoring system at the 12-month follow-up.ResultsThe posterior approach was performed in 57 patients with type A fractures (group I, n=28) and type B or C fractures (group III, n=29). The anterolateral approach was performed in 50 patients with type A fractures (group II, n=32) and type B or C fractures (group IV, n=18). There were no significant differences between group I and group II nor between group III and group IV with respect to patient demographic data, surgical data, Constant score, ROM, or Mayo Elbow Performance score. A significant difference in the total complication rate was observed between group I and II.ConclusionsThe anterolateral approach showed an advantage over the posterior approach for treating simple humeral mid-shaft fractures. However, this advantage was not observed in treating comminuted fractures.

Study of surgical management of fracture of proximal humerus by PHILOS plate and screws

<p class="abstract"><strong>Background:</strong> Proximal humerus fracture accounts for about 5% of all fractures in recent advances proximal humerus fractures are often managed operatively with PHILOS plate which provides greater angular stability and study was aimed at to assess functional outcome of PHILOS plate fixation in proximal humerus fractures.</p><p class="abstract"><strong>Methods:</strong> Prospective study of 31 cases of proximal humerus fractures admitted and operated in Kempegowda Institute of Medical Sciences Hospital November 2017 to May 2019 of which 4 patients died due to medical comorbidities so 27 patients were studied. Follow-up of these patients was done at 6 weeks, 12 weeks and 24 weeks with functional evaluation was done using Constant and Murley (CM) scoring and disabilities of the arm, shoulder and hand (DASH) scoring.<strong></strong></p><p class="abstract"><strong>Results:</strong> CM scoring and DASH scoring was applied to analyze the functional outcome among the cases. Most of the patients had excellent outcome (52%) followed by good (26%), fair (8%) and poor (15%) outcome according to CM scoring and according to DASH scoring 20.21 was mean score and mean CM score was 77.62. Complications observed were impingement in 1 patient, avascular necrosis in 2 patient and non union in 1 case.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that the use of PHILOS plate for the fixation of proximal humerus fractures is a good device as it provides rigid fixation and early mobilisation and prevented complications. Precontoured locking plates work on the principle of angular stability, divergent screws, less disruption of vascularity and less chances of plate failure.</p>

Results of surgical management of displaced or complex proximal humeral fractures with proximal Humerus internal locking system: A prospective study of 55 cases

Background: The optimal treatment of proximal humeral fractures remains always challenging and controversial. The purpose of this prospective study was to evaluate the functional outcome of proximal humerus internal locking system (PHILOS) plate fixation for displaced or complex proximal humeral fractures and to establish the influencing factors of an unfavourable outcome. Materials and Methods: After obtaining approval from institutional ethics committee, 55 patients with the displaced proximal humeral fractures were managed by open reduction and PHILOS plate fixation through delto-pectoral approach and as per standard protocol. The results of follow-ups were analysed radiologically and clinically, using the “Constant and Murley scoring system” at once in a month for first three months, once in three months for next six months and once in six months thereafter upto 2 years post-operatively. Results: In the present study, out of 55 patients, clinical results were excellent in 50.9%, good in 21.8%, fair in 16.4% and poor in 10.9% patients. Radiological union was achieved in all patients, including two cases of mal-union and one case of delayed union. Post- traumatic frozen shoulder (7 cases), secondary arthritis (5 cases), secondary screw penetration (3 cases), and AVN humeral head (3 cases) were the main complications observed in this study during 2 years of follow-ups, which were treated accordingly. Conclusion: Pre-contoured PHILOS plate preserves shape of humeral head, provides angular stability, facilitates to restore the medial column and prevent secondary varus collapse in severe comminuted and osteoporotic proximal humeral fractures. With proper patient selection, PHILOS plate provides favourable clinical and radiological outcome with acceptable complication rates.

Proximal Humerus Fractures Managed With Joshi External Stabilizing System

Proximal humerus fractures account for 4% to 5% of all fractures. These fractures have been conventionally treated either conservatively in a shoulder immobilizer or by open reduction and internal fixation with a locking plate. Conservative treatment often leads to a stiff shoulder, and operative management requires extensive soft tissue dissection. In this study, we have chosen a middle path for treating proximal humerus fractures in the form of closed reduction and Joshi external stabilizing system (JESS) with early mobilization, thus overcoming the problem of shoulder stiffness associated with conservative management and excessive soft tissue dissection associated with the open procedure. We conducted a study on 25 patients with proximal humerus fractures with Neer types 2 and 3 fractures. The mean age was 49.6 years with a female preponderance of 64%. JESS was applied after closed reduction in all cases. Mobilization was started on days 1 or 2 of surgery. All patients were followed up at 2, 4, 6, and 8 weeks and at 6 months after surgery. All cases were evaluated functionally using the constant shoulder scoring system. In our study, the mean constant shoulder score was 75.7 at 6 months. All fractures united in 6 to 8 weeks. In our study, we had 2 cases of pin-tract infection and 1 case of shoulder stiffness. The JESS fixator is a good modality of treatment for Neer types 2 and 3 proximal humerus fractures, facilitating early mobilization without compromising on fracture stability and union rates.

Functional outcome for the acromioclavicular joint disruption with or without lateral end clavicle fractures treated with hook plate

BACKGROUND: Acromioclavicular (AC) joint dislocation is most frequently encountered in contact sports and is far more common in males. Grade-III AC dislocation involves complete loss of contact between the clavicle and acromion secondary to the total disruption of both the AC and coracoclavicular ligaments, with loss of vertical and horizontal stability, respectively. The use of hook plate on open reduction and internal fixation of the AC joint dislocation had a little adverse effect on shoulder function and is an effective method for the treatment of AC joint dislocation. Hence, this retrospective study was carried out to assess the clinical and functional outcome of AC joint injuries treated with hook plate. AIM: The aim of this study is to assess and document the clinical and functional outcome of AC joint dislocation with or without lateral end clavicle fracture treated with hook plate. MATERIALS AND METHODS: This retrospective study of patients with Rockwood Type III AC joint disruption (dislocation) who were treated in our hospital. During the period from July 2013 to July 2018, a total of 33 patients with Type III AC joint disruption with or without associated lateral end clavicle fractures were included in this study, with 26 males and 7 females. The functional outcome was assessed using the CONSTANT scoring system during follow-up after hook plate fixation at 4 weeks, 3 months, 6 months, and 12 months. RESULTS: Thirty three patients with AC joint disruption were participated in the study after meeting the inclusion and exclusion criteria. There were 26 males (78.8%) and 7 females (21.2%) with a mean age of 44.7 years, eight patients had an associated lateral end clavicle fracture. All the patients were fixed with hook plate were followed up for a period of 1 year postoperatively. The mean Constant score improved progressively from a preoperative score of 44.5 to postoperative score of 68.3 at 4 weeks, 77.9 at 3 months, 89.4 at 6 months, and 93.3 at 12 months. CONCLUSIONS: In the current study, we conclude that the surgical and functional outcomes after AC joint stabilization with or without lateral end clavicle fractures using hook plate fixation yield satisfactory results. The hook plate also provides good horizontal, rotational, and vertical stability. Furthermore, the maintenance of reduction by the hook plate was significantly superior compared to the other modes of treatment. The hook plate also facilitates early mobilization and prevents stiffness of the shoulder joint.

Evaluation of Functional Outcome of Management of Proximal Humerus Fractures by Different Treatment Modalities

Introduction: Proximal humerus fractures account for 4-5% of all fractures and could be managed both conservatively and surgically. As much as 85% minimally or non-displaced fractures can be managed conservatively. In spite of early union and exercise programme by conservative treatment, the problem of shoulder stiffness is common. To overcome stiffness, early mobilisation is mandatory which is not possible in conservative treatment before three weeks. Therefore, surgical intervention is needed for early mobilisation and early return of function. Aim: To compare the functional outcome between the four common methods of managing proximal humerus fractures namely locking plate, Joshi External Stabilisation System (JESS), percutaneous K-wire fixation and conservative method. Materials and Methods: Patients with proximal humerus fracture above 18 years of age between August 2011 to August 2013 were included in the study. The study population was divided into four groups viz., Group A, B, C, D depending on the mode of treatment by locking plate, external fixator, K-wire fixation and conservative method of treatment, respectively. The patients were followed-up at 3 weeks, 6 weeks, 12 weeks, 18 weeks and thereafter every 6 weeks’ interval till 9 months. After union, cases were evaluated radiologically and clinically for functional results by using the Swanson Shoulder Score and Constant Scoring System (Modified). Results: At the end of the study there were 17 patients in the Group ‘A’, 7 patients in the Group ‘B’, 7 patients in the Group ‘C’ and 11 patients in Group ‘D’. At 9 months of follow-up according to modified constant shoulder score the percentage of excellent score in group A was maximum. Group B and Group D had maximum number of good scores. The mean constant shoulder score increased in all groups at 9 months of follow-up as compared to 3 months of follow-up except in group D. Similarly, according to Swanson’s shoulder score, group A had the maximum number of excellent scores. Conclusion: From the above study it can be concluded locking plates are an excellent modality of treatment of proximal humerus fractures with excellent union rate and early mobilisation.

Use of proximal humerus internal locking system plate in proximal humerus fractures and its relation with the functional outcome

<p class="abstract"><strong>Background:</strong> Proximal humerus fractures are the fractures occurs at or proximal to the surgical neck of the humerus, which accounts for 7% of all fractures and 80% of all humeral fractures. Now a days most of these fractures are managed with internal fixation because of better availability of anatomical plates. The aim was to assess the functional outcome and complications of proximal humerus fractures treated with proximal humerus internal locking system (PHILOS).</p><p class="abstract"><strong>Methods:</strong> This is a prospective study of 30 patients with two, three, and four parts proximal humerus fractures treated with proximal humerus internal locking sysyem from 2016 to 2018 with 25 to 80 years of age in a tertiary care hospital. Functional outcome is assessed by using constant murley shoulder scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> Functional outcome as per constant score, 10 patients (33%) got excellent outcome, 06 patients (20%) got very good outcome, 07 patients got (23%) good outcome, 05 patients got (17%) fair outcome and 02 patients got (07%) poor outcome. Complications observed were superficial infections, implant failure and axillary nerve neuropraxia.</p><p class="abstract"><strong>Conclusions:</strong> Open reduction and internal fixation by using PHILOS is the ideal method in treating displaced proximal humerus fractures mainly in two and three part proximal humerus fractures which provides stable fixation and less complications.</p>

Prospective study of internal fixation of clavicle fractures by various methods

Background: Fractures of the clavicle have been traditionally treated non-operatively. Although many methods of closed reduction have been described, it is recognized that reduction is practically impossible to maintain and a certain amount of deformity and disability is expected in adults. More recent data based on detailed classification of fractures, suggest that the incidence of nonunion in displaced comminuted clavicular fractures in adults is between 10 and 15%. All fractures with initial shortening of >2cm resulted in nonunion. According to Rowe a nonunion rate of 0.8-1% is seen in conservatively managed patients Materials and Methods: This is prospective study and was carried out from September 2016 to September 2018 at Orthopedics Department in Maharajah’s Institute of Medical Sciences. During this period 30 patients of clavicle fractures were treated surgically. All the patients were evaluated functionally (constant murley scoring) and radiologically for union with a follow up period of 12monthsResults: Majority of the patients were with middle third clavicle fracture i.e. 26 (87%) patients. road traffic accidents were the most common mode of injury with males 18 (60%) predominant and left side(60%) being the commonest side involved in this study. Majority of the cases were operated less than 10 days. Radiological union observed in 8-12 weeks in 29 (97%) cases, 26 (86%) cases had excellent functional outcome at final follow up.Conclusion: This study concluded that primary open reduction and internal fixation with plate and screws for displaced middle third clavicle fractures provides a more rigid fixation and does not require immobilization for longer periods. It helps in getting back to daily activities and early mobilization.

Results of modified JESS augmentation for fracture proximal humerus stabilized with percutaneous K-wires

Background: Proximal Humeral fractures are defined as fractures occurring at or proximal to surgical neck of Humerus1. Various methods are used for treating such conditions with mixed results. Closed reduction & percutaneous pinning with JESS augmentation with interconnecting double frames have been described for such fractures with satisfactory results. We aim to modify the same by mounting the JESS in a single frame with biplanar configuration review our results. Material and Methods: Total 15 patients with proximal humeral fractures were treated from 2016 to 2017 by fixation with JESS & K-wires. There were 10 (62.5%) males and 5 (37.5%) females, with a mean age of 57.5 years. Road traffic accident (RTA) was the most common mode of injury in patients less than 60 years old (4 out of 7), while fall on the ground was the most common cause in fractures in elderly patients (age>60 years, i.e. 6 out of 8). Displaced (more than 45° of angulation or >1cm of displacement) 2 and 3 part fractures and patients of age >20 years were included in the study. The fixator was removed when there was clinical (subsidence of pain) and radiological signs of union (bridging callus in 3 out of 4 cortices). Shoulder function was assessed using Constant scoring system. Result: 100 % union seen with duration ranging from 6weeks to 8 weeks followed by JESS removal. According to Constant score 3 cases (20%) showed excellent result, 9 cases (60%) showed good result, 2 cases (13.3%) showed fair result & 1 case(6.7%) showed poor result which may be due to noncompliance in physiotherapy & early pin loosening. Conclusion: External fixation with JESS & K-wires is an alternative cost effective option to treat Neer’s 2 & 3 part fractures, enables early mobilization & achieves safe healing with less soft tissue dissection. Keywords: Proximal humerus fractures, External fixator, JESS.

Study of proximal humerus fractures treated with proximal humerus interlocking system (Philos) plating

Introduction: Proximal humerus fractures are common and debilitating injuries, especially in elderly as osteoporosis and deforming forces of muscle attached. Wide range of treatment modalities ranging from conservative management to shoulder arthroplasty. In our study we have evaluated proximal humerus interlocking osteosynthesis (PHILOS) plate in displaced and comminuted fracture due to its rigid construction, angular stability and early post- operative rehabilitation. Objective of Study: The objective of study 1) To evaluate and analyze the functional outcomes of PHILOS plate for displaced fractures of proximal humerus 2) To improve stability in osteoporotic humeral bone 3) To preserve the biological integrity of the humeral head and to secure an anatomical reduction with multiple locking screws with angular stability 4) To study the complication rates of PHILOS plating in proximal humerus fractures Methodology: A prospective study of treatment of proximal humerus fractures treated with PHILOS plate was carried out at our institute, at the Department of Orthopaedics, S.S.G. Hospital Vadodara from June 2017 to august 2018, where after applying exclusion and inclusion criterion, 20 patients of proximal humerus fractures were included in our study. Fractures were classified as per NEER’S classification. Assessment of union, movements at shoulder, constant score and complications were done during regular follow-up of 5 month. The functional outcome was measured using Constant and Murley Shoulder Scoring System. Results: In present study, after clinical and radiological assessment after 5 months follow-up, mean Constant and Murley score of 84.85 was achieved.9 patients (45%) had excellent result with score more than 90 and 7 (35%) patients had good result with score more than 80, 2 patients (10%) had fair result with score more than 70. 2(10%) patients had poor results with score less than 70 may be due to with medial cortical comminution and osteoporosis in which malreduction and shoulder stiffness are most frequent complication. Conclusions: The divergent and convergent orientation of the locking screws of PHILOS plate provides stable biological fixation with high union rate to use for treatment of fractures of the proximal humerus in Neer’s 2-part, 3-part, and 4-part with better functional and radiological outcome especially in osteoporotic bone due to low complication and early postoperative mobilization. Potential minimal complication can be prevented by advanced surgical skill and expertise and rotator cuff tying.

Clinico-radiological outcome of fracture middle 3rd clavicle treated non-operatively and with plate osteosynthesis: A comparative study

Background: Clavicle fractures are common injuries, accounting for 2.8% of all fractures. Fractures of the middle third account for approximately 80% of all clavicular fractures. Displaced middle 3rd clavicle fractures are typical and are generally treated non-operatively. Non-operative treatment of these fractures with axial shortening is correlated with a non union rate of 13 – 18% and a delayed union rate of 25%. Intractable pain, neurological complications and loss of shoulder function have been noted. Prompt fixation of these clavicle fractures charter increased patient comfort, and early shoulder mobility. We have taken up this study to analyse the results of plate fixation and non-operative treatment for middle third clavicle fractures in terms of time to union, functional improvement and complications.Objectives: To compare results of plate fixation of middle third clavicle fractures with those managed nonoperatively in terms of radiological union and functional outcome.Materials and Methods: This is a prospective comparative study. The duration of study period is 2 years. Cases satisfying the inclusion criteria and who had received treatment either nonoperatively or in the form of plate fixation at Chettinad Hospital and Research Institute based on the patient’s informed decision during the period of Jun 2013 to Feb 2015 were included in the study. Patients were then followed up for a period of up to 9 months (3, 6 & 9 months) and evaluated clinically with Constant and Murley scoring system and with radiographs.Results: There was significant improvement in the rate of fracture union and functional scores in the operated group compared to the nonoperative treatment group.Conclusions: In this prospective study, plate fixation of middle third clavicular fractures resulted in earlier functional recovery and lower complication compared with nonoperative treatment.

Evaluation and comparison of the complications of internal fixation by TENS method and plate and screws method for clavicle fracture

Background: Fractures of clavicle are common injuries with incidence of 2.6% of all fractures and 44% of all shoulder injuries. Better operative technique; improve metallurgy and availability of image intensifiers made the operative techniques as a method of first choice by more and more surgeons. So the study was conducted to evaluate and compare the complications of these two methods of fixation. Methodology: The study was conducted on 62 patients with fracture of clavicle. Selected patients were treated by, closed/open reduction & internal fixation by TENS and Group II by open reduction & internal fixation by plate& screws. Patients were followed periodically at 2weeks, 6 weeks, 3, 6, 12 months, 18 months and 24 months. Results were evaluated by Constant scoring system given by Murley (1987). Results: Overall plate had more intra op and post op complications like more blood loss, more operative time, superficial infections, deep infections, implant protuberance, ugly scar, difficult implant removal than TENS fixation. In this study nonunion was equal in both TENS and plate fixation groups. Conclusion: In our study no significant difference was found in function and nonunion rate in both the groups but major complications and union time are more in plate fixation group than TENS group so, TENS fixation is the preferred treatment of choice for fracture middle 1/3rd clavicle.

To evaluate functional outcome of proximal humerus interlocking osteosynthesis (PHILOS) plating by constant & murley scoring system for treatment of displaced proximal humerus fractures

To evaluate functional outcome of proximal humerus interlocking osteosynthesis (PHILOS) plating by constant & murley scoring system for treatment of displaced proximal humerus fractures

Evaluation of the results of locking compression plate for the treatment of non-united humeral shaft fracture augmented with autogenous cancellous bone graft

A fracture bone usually heals by the formation of new bone at the fracture site. Occasionally, only fibrous tissue is formed, when this happens both surgeon & patient are disappointed. The bone is a specialized form of connective tissue may account for its ability to heal by the formation of new bone. The humerus is a long bone connecting two important joints of upper limb- which has wide range of movement having very little bony stability in shoulder joint and distal elbow joint which is a uni axial hinge joint. This prospective study of "treatment of nonunion of humeral shaft fracture by locking plate and screws augmented with autogenous cancellous bone grafting" was carried out during the period of 1st December 2011 to 31th May 2013 at National Institute of Traumatology and Orthopeadic Rehabilitation (NITOR) Dhaka, Bangladesh. Sample size will be calculated by using following statistics = 384. Purposive sampling (non-randomized) according to availability of the patients and strictly considering the inclusion and exclusion criteria. Data will be collected with a pre-tested structured questionnaire containing history, clinical examination, laboratory investigations, pre-operative, per-operative, postoperative follow up findings and complications. 16 Patients were selected by using non randomized sampling method. The age ranges from 28-60 years. The mean age of occurrence was 38.19 (+10.04) years. Motor vehicle accident was the commonest cause of fracture found in 81.25% cases. Second most common cause was fall from height (12.50%). Right side involvement was more (62.50%). Among the affected people serTce holders and shopkeepers were commonest (25% each), next were businessmen and farmers (18.75% each). The mean union time was 16.38 (+2.78) weeks. Postoperative complications were noticed such as wound infection (6.25%) and shoulder pain (6.25%). There was no complication (81.25%). Functional outcome of this treatment was analyzed by Constant and Murley scoring (1999). Excellent functional outcome was found in 5 (31.25%) cases, good in 9 (56.25%) cases, fair in 1 (6.25%) case and poor in 1 (6.25%) case. Regarding the final outcome satisfactory result was found in 14 (87.50%) cases and unsatisfactory result in 2 (12.50%) cases. Based on the results shown above it is concluded that "treatment of nonunion of humeral shaft fracture by locking plate and screws augmented with autogenous cancellous bone grafting" is an effective modality of treatment for the nonunion of humeral shaft fracture and is especially recommended in osteoporotic bones and elderly patients with compromised bone quality.

The outcome of proximal humeral locking plates in the management of three and four part proximal humeral fractures in special cohort of young patients in high velocity trauma.

Locking plate fixation provides satisfactory outcome following proximal humerus fractures. None of the previous studies selectively evaluate the outcome in young patients. This study evaluates outcome of locking plate system in the treatment of acute three- and four-part fractures in young patients. In this prospective study we included all patients who were less than 60 years, involved in high velocity trauma, had proximal humerus comminuted three part and four part fractures and were operated using locking plate at our centre, between August 2011 to August 2015. All the patients were followed up regularly. Assessment was done clinically using Constant and Murley scoring system and radiologically using signs of healing in the form of callus formation and cortical continuity. Twenty-five eligible patients were operated during the study period. All patients were involved in motor vehicle collision. Average age of our patients was 41.2. The average duration of follow-up was 18.2 months(8 months to 27 months). 24 out of 25 fractures united clinically and radiologically at three months' follow-up. Average Constant and Murley score at final follow-up was 78.52. The results were excellent to good in 15 patients, fair in five patients and poor in five patients. Overall complication rate was 24%. Majority of them (20%) were restriction of movements of shoulders. None of our patients needed reoperation. Locking plate system, in three part and four part proximal humerus fractures in young patients, provides secure and stable fracture fixation for early mobilization. Early results with locking plate system were promising in younger patients. In these patients, locking plate system has definite role to preserve the humeral head and there by maintain the functional activity level.