Early Fixation Research Articles

Prediction of internal fixation failure of femoral trochanteric fracture by external wall morphology

To investigate the relationship between the shape of the lateral wall and the early failure of internal fixation in the fracture of the femoral trochanteric region(FFT). Total 295 patients with femoral trochanteric fracture underwent internal fixation from January 2015 to January 2020 were selected. The patients were divided into two groups according to whether there was early internal fixation failure after surgery, 19 patients in the failure group and 276 patients in the normal group. Gender, affected side, age, AO classification, body mass index(BMI), preoperative hemoglobin, X-ray measurement of lower lateral wall thickness, preoperative internal diseases, intraoperative blood loss, postoperative tip apex distance(TAD), postoperative neck shaft angle, operation time and other data were compared between two groups. The shape of the lateral wall was compared between two groups, and the correlation between the shape of the lateral wall and the early internal fixation failure of femoral trochanteric fracture was analyzed. All patients were followed up for more than 1 year. There was no significant difference between two groups in terms of intraoperative blood loss, operation time, postoperative TAD, and postoperative neck shaft angle(P>0.05). At the latest follow-up, the visual anaglue scale (VAS) of the failure group was higher than that of the normal group(P<0.01), and the Harris score of the failure group was lower than that of normal group(P<0.05). The receiver operator characteristic (ROC) curve between shape of lateral wall and failure of early internal fixation of femoral trochanteric fracture was drawn. The critical value of the midpoint lateral wall thickness was 16.5 mm, and the area under the ROC curve was 0.845;The critical value of average sidewall thickness was 16.5 mm, and the area under ROC curve was 0.838;The critical value of the axial area of the sidewall was 7.5 mm, and the area under the ROC curve was 0.826. The shape of the lateral femoral wall measured by CT could be used as a predictive factor for the early failure of internal fixation of femoral trochanteric fractures. For patients at risk, more reasonable surgical plans and postoperative preventive measures should be developed.

Study on outcomes of fractures of distal femur

Introduction- Open distal femur fractures are rare, complex injuries which occur in polytrauma patients and are complicated by bone loss, contamination, compromised soft tissues and poor host condition. The study intends to evaluate patients treated for open fractures of distal end of the femur using the staged protocol of early external fixation with debridement followed by definitive fixation with an anatomical locking plate and bone grafting at a later stage. Method- The study included a group of 20 patients of open distal femur fractures who were operated with temporary external fixator and later on converted to definitive fixation with condylar locking plate with bone grafting. These patients were operated with our staged protocol and clinical outcome was evaluated using the functional evaluation scoring system by Sander’s et al and Knee Society Scoring. Out of these 20 patients, 1 was lost to follow up at 3 months and 2 others were lost to follow up at 6 months. These 3 were excluded from our study. Results- Fracture union was seen in all 17 patients. The average time to union was 22.65+3.3 weeks. Two patients were complicated with infection and delayed union.

Radial nerve transection after ballistic humeral shaft fractures: A retrospective cohort study

IntroductionRadial nerve palsy following fracture of the humeral shaft is common. However, the incidence of nerve transection in the setting of ballistic trauma is unknown. The purpose of this study was to estimate the incidence of radial nerve transection after ballistic fracture of the humerus. MethodsPatients presenting to an urban, level-1 trauma center with a ballistic fracture of the humeral shaft were retrospectively reviewed. Patient demographics, clinical exam on presentation, and operative data were reviewed to determine the incidence of radial nerve palsy on initial examination, the incidence of operative treatment, the incidence of how frequently the nerve was directly visualized, and the incidence of radial nerve transection. ResultsOne-hundred and thirteen ballistic humeral shaft fractures were identified. Of these, 30 (26.5%) patients had a complete radial nerve palsy on exam. Of patients with a radial nerve palsy, on exam 20 were taken to the operating room and the nerve was visualized in 17 of those cases. There 2 were partially lacerated nerves and 12 nerves were completely transected. Thus, in patients with a complete nerve deficit on examination who underwent operative treatment with nerve exploration, the rate of nerve transection was 70.6%. The lower bound rate of nerve transection for all patients with radial nerve palsy (assuming all unexplored nerves were intact) was 40.0%. ConclusionThe rate of nerve transection in patients with humerus shaft fractures with associated radial nerve palsies is likely higher than the rate of nerve transection in similar injuries caused by blunt mechanisms. The authors recommend early exploration and fixation of these injuries.

Fixation of Proximal Third Humeral Shaft Fractures in Older Patients.

Humeral shaft fractures occur frequently in older patients. The more proximal end of the shaft is prone to non-union when compared with more distal fractures. We provide an overview of several key features of this significant patient group. Our institutional fracture database was searched for all cases of proximal third humeral shaft fractures in patients over 60years of age. Retrospective evaluation of patient demographics, management, length of stay and incidence of non-union was performed. 75 patients (61 female) were analysed. 33 patients were 'frail' (Clinical Frailty Scores of >4). Non-union occurred in 19 of 45 non-surgically treated fractures and in 1 of 37 cases treated surgically. Mean length of stay was 5.9days (non-operative) and 6.6days (operative). Proximal extension into the humeral head is common. Non-surgical management of proximal third humeral shaft fractures is associated with an increased risk of non-union. We detail an operative technique and case example supporting early fixation of displaced proximal third humeral shaft fractures in older patients that can be utilized for both primary and delayed fixation. In view of the significant association of non-union a well-constructed prospective cohort study with outcome assessment would be of value to further characterize this emerging injury population.Level of Evidence: Level IV, retrospective case series.

SURGICAL RIB FRACTURE FIXATION IN THE NORTH OF SCOTLAND: EARLY OPERATIVE INTERVENTION IMPROVES OUTCOMES

This study aimed to assess the outcomes of patients with complex rib fractures undergoing operative or non-operative management at our center over a six-year time period.Retrospective analysis was performed to identify all patients with complex rib fractures at our center from May 2016 to September 2022. Outcome measures included mechanical ventilation, tracheostomy, pneumonia, and mortality at one year.388 patients with complex rib fractures were identified. 37 (10%) patients fulfilled criteria for surgical management and underwent rib fracture fixation; 351 patients were managed non-operatively with anaesthetic block or analgesia alone. The fixation group had a significantly higher proportion of patients with flail chest (30 (81%) vs 94 (27%), p&lt;0.001) and were significantly more likely to require ICU admission (30 (81%) vs. 16 (5%), p&lt;0.001) than the non-operative group. At one year follow-up, no significant differences were seen for mortality between these groups (1 (3%) vs. 27 (7%), p=0.276).Of the surgical management group, those that underwent fixation &lt;72 hours post injury were significantly less likely to develop pneumonia than those who were delayed &gt;72 hours (2 (18%) vs 15 (58%), p=0.038), with downward trends noted for ICU length of stay (6 vs 10 days, p=0.140) and duration of mechanical ventilation (5 vs 8 days, p=0.177); no significant differences were seen for tracheostomy (3 vs. 5, p=0.588) or mortality (0 vs 1, p=0.856).Surgical fixation of complex rib fractures improves outcomes in selected patient groups. Early surgical fixation led to reduced rates of pneumonia and may improve other outcome measures.

Early Reduction of the Posterior Column: A Surgical Technique in AO/OTA C3 Tibial Pilon Fractures

Staged treatment for pilon fractures is widely accepted. It remains to be discussed how to reduce and fix posterior column fractures while avoiding clinical complications. We provided a staged treatment protocol with detailed surgical techniques for closed AO Foundation/Orthopaedic Trauma Association (AO/OTA) C3 tibial pilon fractures with fibular fractures. In the first stage, the internal fixation of the fibula and distal tibial posterior column is accompanied by an external fixator. After swelling, the medial and anterior columns were fixed via the posteromedial approach in the second stage. We advocate early reduction and fixation of the posterior column and lateral column. The right timing of surgery can ensure well-reduced articular surface and alignment while minimizing soft tissue complications.

Pre-Peritoneal Pelvic Pack with External Fixator Versus Pelvic Pack Alone for Hemodynamically Unstable Patients with Pelvic Fracture; A Historical Cohort Study

Purpose: Pelvic fracture is one of the most common cause of death in traumatic patients. It is due to high-energy trauma and approximately 80% of patients who develop severe hemorrhagic shock after a high-energy trauma die in the early stages. Unstable hemodynamic state due to pelvic fracture needs early fixation which supposed as a part of the resuscitation. This study was designed to compare the outcome, morbidity and complications of treatment with pre-peritoneal pelvic pack with external fixator against pelvic pack alone in traumatic pelvic fracture and unstable hemodynamic patients. Methods: In a retrospective case control study, patients with pelvic fracture and unstable hemodynamic state who referred to emergency and surgery department of Shahid Rajaei Hospital, Shiraz, Iran from august 2018 to august 2019 were enrolled by census manner. In the control group, 25 patients treated just by a pre-peritoneal pack (PPP group), while in the case group, pre-peritoneal pack and external fixator was done as the procedure to control bleeding (PPP Plus fixator group) in 22 individuals. All study procedures and data gathering was approved by the committee of ethics in Baghiatollah University of medical sciences. Two groups were compared for presence of thromboembolism, hospital stay, infection, BUN, creatinine, rate of blood transfusion and mortality. Results: Mean age of participants were 34.48±13.79 in pelvic pack group, while it was reported 32.36±16.29 in PPP plus external fixator ones. Mean of Injury Severity Score (ISS) (13) was measured 23.12±9.85 in Pelvic Pack group, while it was calculated 19.22±8.09 in PPP plus external fixator group. Acute kidney injury was reported in 6 (24%) individuals of PPP group, while its rate in PPP plus fixator group was 40.9%. Mortality rate was reported 32% and 4.5 % in control and case groups, respectively. There was a significant difference between groups (P-Value = 0.017, LR=6.42). VTE was reported 12% and 4.5 % in PPP group and PPP plus fixator ones, respectively. Conclusion: It was concluded that using external fixation with PPP can be a useful method for treatment of pelvic fractures with unstable hemodynamic situations. It is recommended to use biomarkers like lactate or others to determine the situation of patients as precise as possible.

Rib Plating Outcomes in Elderly Trauma Patients With Multiple Rib Fractures: A Community Hospital Experience.

Rib fractures in the elderly are one of the most common injuries in trauma patients admitted to the hospital, accounting for over 350,000 patients annually in the United States. Rib plating has been shown to be most beneficial among certain populations. Early surgical intervention is important to utilize approaches that limit the use of pain medications. This is a retrospective data analysis to determine the efficacy of rib plating in elderly trauma patients with rib fractures. A total of 253 patients were seen with rib fractures, 63% were male and 37% were female. The mean age is 64 ± 18.5years. Of these patients analyzed, 76% had an associated comorbid condition. A majority of patients (95%) presented to the emergency department (ED) with mild GCS range (13-15). Moderate GCS range (9-12) was 4%, and 3% of patients were with severe GCS (3-8.) The mean ISS was 10. The overall mortality rate was 4.5%. Patients were divided into 2 groups: group I consisted of patients who received open reduction and fixation of the fractured ribs, and group II was patients managed conservatively without surgery. Statistical analyses using Student's t-test and Chi-square test were performed. Institutional Review Board approval was obtained for this study. Rib plating in elderly trauma patients with multiple rib fractures has shown to be beneficial in terms of mortality. Furthermore, geriatric patients with comorbidities will benefit from early open reduction and fixation of rib fractures, though a larger study is needed to establish clearer criteria for rib plating.

Radiological and Long-Term Functional Outcomes of Displaced Distal Clavicle Fractures.

To investigate radiological and long-term functional outcomes in modified Neer 2a, 2b, and 5 distal clavicle fractures. Retrospective cohort study. A single university teaching hospital. One hundred fifteen patients sustaining displaced distal clavicle fractures between January 01, 2010 and December 12, 2017. Operative versus nonoperative management. Radiographs were reviewed for fracture management and union. A customised questionnaire consisting of QuickDASH (Disabilities of the Arm, Shoulder and Hand), work, sports/performing arts, global satisfaction, and complication modules was used to determine functional outcome. One hundred fifteen patients were included [mean age of 49 (18-89) years]. Thirty-three (29%) underwent early fixation (<6 weeks from injury) and were younger (37 vs. 53 years, P < 0.0001). Radiographs were available for 96 patients. Nonunion rate was 55% (53/96), and majority had undergone initial nonoperative management (49 vs. 4, P < 0.00001). Eleven patients with symptomatic nonunion were deemed appropriate for delayed fixation with all cases uniting. Of the operatively managed patients, 27% (12/44) underwent metalwork removal. There were no differences in functional outcome between operative versus nonoperative and union versus nonunion patient groups at a mean follow-up of 79 months ( P > 0.05). Functional outcome and patient satisfaction at long-term follow-up were similar regardless of operative fixation or radiological union. Nonunion in displaced distal clavicle fractures seemed to cause minimal functional deficit in most elderly sedentary individuals, or the outcome measures were not sensitive enough to capture these differences. An individualized approach should be adopted, with less active, comorbid, and elderly patients counseled regarding the minimal functional improvement of surgery and risk of reoperation. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Early total care or damage control orthopaedics for major fractures ? Results of propensity score matching for early definitive versus early temporary fixation based on data from the trauma registry of the German Trauma Society (TraumaRegister DGU®)

PurposeDamage control orthopaedics (DCO) und early total care (ETC) are well-established strategies for managing severely injured patients. There is no definitive evidence of the superiority of DCO over ETC in polytrauma patients. We conducted this study to assess the probability of a polytraumatised patient undergoing DCO. In addition, the effect of DCO on complications and mortality was investigated.MethodsWe analysed data from 12,569 patients with severe trauma (Injury Severity Score ≥ 16) who were enrolled in the trauma registry of the German Trauma Society (TraumaRegister DGU®) from 2009 to 2016 and had undergone surgery for extremity or pelvic fractures. These patients were allocated to a DCO or an ETC group. We used the propensity score to identify factors supporting the use of DCO. For a comparison of mortality rates, the groups were stratified and matched on the propensity score.ResultsWe identified relevant differences between DCO and ETC. DCO was considerably more often associated with packed red blood cell (pRBC) transfusions (33.9% vs. 13.4%), catecholamine therapy (14.1% vs. 6.8%), lower extremity injuries (72.4% vs. 53.5%), unstable pelvic fractures (41.0% vs. 25.9%), penetrating injuries (2.8% vs. 1.5%), and shock (20.5% vs. 10.8%) and unconsciousness (23.7% vs. 16.3%) on admission. Based on the propensity score, patients with penetrating trauma, pRBC transfusions, unstable pelvic fractures, and lower extremity injuries were more likely to undergo DCO. A benefit of DCO such as reduced complications or reduced mortality was not detected.ConclusionWe could identify some parameters of polytrauma patients used in the trauma registry (Traumaregister DGU®), which led more likely to a DCO therapy. The propensity score did not demonstrate the superiority of DCO over ETC in terms of outcome or complications. It did not appear to adequately adjust for the variables used here. Definitive evidence for or against the use of DCO remains unavailable.

Comparative study of vacuum-assisted closure therapy versus vacuum-assisted closure therapy supplemented with vitamin C in compound wound healing

Background: It is imperative for early and precise management of the compound wound for preventing further complication and delaying definitive management. As we all know superiority of vacuum assisted closure (VAC) therapy in wound management over any other method, but adding vitamin C has been shown to accelerate wound healing, reducing hospital stay, and cost of management and prevention of delaying definitive management of wound due to some conspicuous property of vitamin C that serve as superior adjuvant in wound healing. Methods: A case series of 40 patients who have been inflicted with compound wounds with most following road traffic accidents. We then categorised patients and tried to observe any difference in rate of satisfactorily healing of wound with 20 patients put on VAC therapy alone and other 20 patients put on VAC therapy supplemented with vit C. Results: Patients who were undergoing VAC dressing and supplemented with vitamin C, not only portrayed a better result of wound healing but also reduced the amount of vacuum dressing sittings. Conclusions: It was observed that, in general, patients who were undergoing VAC dressing and supplemented with vitamin C, not only portrayed a better result of wound healing but also reduced amount of vacuum dressing sittings, improved rate of granulation tissue, reduced hospital stay, early definitive fixation of associated fracture and skin grafting and showed superior outcomes in terms of better tissue recovery.

Clinical effects of early debridement, internal fixation, and Masquelet technique for childhood chronic haematogenous osteomyelitis of long bones

BackgroundChildhood chronic haematogenous osteomyelitis (CCHOM) is a severe condition in paediatric patients. The optimal timing of debridement and the subsequent method of bone reconstruction in CCHOM patients remain controversial. The purpose of this study was to assess the treatment efficacy of Masquelet technique with early debridement and internal fixation in CCHOM of long bones.MethodsBetween January 2016 and January 2021, a total of 21 patients (18 males, 3 females) with CCHOM of long bone were included. The mean age was 10.4 years (range, 2–18 years). All cases were treated by a two-stage surgical protocol of Masquelet technique. In the first stage, aggressive debridement, sequestrectomy, and inducing membrane by bone cement spacer were performed after definite diagnosis. In the second stage, cement spacer was removed, and autologous and allogeneic bone was grafted. Internal fixation was used for the first and/or second stage depending on stability requirements. The patients’ clinical and imaging results were retrospectively analysed.ResultsThe mean follow-up was 31.7 months (range, 21–61 months). None of the patients experienced recurrence of infection. Radiographic bone union time was 4.3 months (range, 2.5–11 months). Five cases underwent re-operation due to complications such as bone resorption or refracture. By the last follow-up visit, bones had healed and all of the patients had resumed daily living and sports activities.ConclusionThe Masquelet technique with early debridement and internal fixation is a viable surgical method for the management of large long bone defects of CCHOM patients.

Our Clinical and Radiological Results in the Treatment of Bone Transport with Ilizarov External Fixator in Patients with Segmental Tibial Defects. Is Depression Associated with Poor Outcomes?

Abstract Objective: The aim of this study was to evaluate the clinical and radiological results of patients who underwent bone transport with Ilizarov external fixator in the treatment of tibial defects due to traumatic causes, and to investigate the factors that have a positive or negative effect on the results. Patients and Methods: From a total of 30 patients with tibial segment loss due to traumatic causes treated with bone transport with an Ilizarov external fixator between 2013 and 2020 in the Department of Orthopedics and Traumatology of the Faculty, 25 with adequate examinations and follow up were included in this study and were evaluated retrospectively. The patients were grouped according to the etiology of bone loss, demographic characteristics, Paley’s pseudoarthrosis classification and Solomin’s long bone defect classification. The results were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) outcome criteria. Results: The 25 patients in the study comprised 20 males and 5 females with an average age of 44.80 ± 18.51 years. According to the Paley pseudoarthrosis classification, 16 (64%) patients were Type B1, 5 (20%) were Type B2, and 4 (16%) were Type B3. According to the Solomin long bone defect classification, 4 (16%) patients were Type B2, 14 (56%) were Type C1, and 7 (28%) were Type C2. In some patients, due to the fixation problem, early fixation was achieved with minimally invasive plate osteosynthesis or intramedullar nailing by removing the Ilizarov fixator after the necessary length and alignment was achieved for the purpose of early rehabilitation. Early fixation was achieved before consolidation was completed in 16 of 25 patients. Fixator duration was 360 ± 130.77 days in the group without additional fixation and external fixation index (EFI) was 61.63 ± 29.81 days/cm, while the fixator duration was 273.33 ± 116.82 days in the early fixation group, and EFI was 57.22 ± 29.05 day/cm. Complications were evaluated according to Paley’s criteria. A total of 39 complications were recorded, the most common being pin tract infection. The ASAMI bone results were found to be excellent in 7 patients, good in 9, moderate in 4, and poor in 5. The functional results were excellent in 5 patients, good in 11, moderate in 4, and poor in 5. In addition, 5 (20%) of 25 patients whose results were evaluated had depressive illness. Moreover, the results of these patients were found to be poor according to the ASAMI criteria. Conclusion: The Ilizarov method is a very safe and successful option in the treatment of open fractures with tibial segment loss resulting from high-energy traumas. Nevertheless, when making the decision for treatment with this method, the patient’s current depressive disorder should be taken into consideration in addition to the clinical problems of the patients.

Early Bony Fixation and Soft Tissue Coverage in Type IIIB Open Proximal Tibia Fractures: A Cross-sectional Study

Introduction: The tibia, the second largest bone in the human body, is largely enveloped by subcutaneous fat and skin, rendering it vulnerable to fractures and soft tissue injuries. This unique anatomical configuration contributes to a heightened susceptibility to open fractures. Notably, an aggressive treatment protocol involving radical debridement, internal fixation, and immediate or early soft tissue coverage with muscle flaps has demonstrated improved rates of bony union and reduced incidences of infection. Aim: To assess the clinical outcomes of early bony fixation and soft tissue coverage in Type IIIB open proximal tibia fractures. Materials and Methods: This cross-sectional observational study was conducted at the Department of Orthopaedics, BRD Medical College, in Gorakhpur, Uttar Pradesh, India. Total of 30 cases were enrolled between August 2021 and November 2022. The parameters assessed in the study encompassed patient demographics, including age and gender distribution, the aetiology of fractures, soft tissue coverage outcomes, time to bone union, knee joint movement postsurgery, and the incidence of complications such as superficial infections and chronic osteomyelitis. The analysis was conducted using Statistical Package for Social Sciences (SPSS) version 26.0, primarily employing descriptive statistics to present the results, with percentages and frequencies serving as the primary modes of representation. Results: All cases of Gustilo-Anderson Type IIIB high-grade open tibial fractures were included in this study, with the majority of patients being males 26 (87%) aged between 20 to 40 years. Road traffic accidents accounted for 25 (83.3%), while falls from height were responsible in 5 (16.7%) cases. Assessment of soft tissue coverage revealed 73.33% with good healing, 20% with fair healing, and 6.67% with poor healing. The time to bone union varied, with 10% of cases showing non union. Postsurgery, most cases demonstrated knee joint movement of over 120° (86.67%) and a few cases with movement ranging between 90-120° (13.33%). The incidence of complications was relatively low, with 3 (10%) cases presenting superficial infections and 2 (6.7%) suffering from chronic osteomyelitis. Conclusion: Early bony fixation and soft tissue coverage utilising the medial gastrocnemius flap, along with Split-Thickness Skin Grafting (STSG), demonstrate efficacy in treating high-grade open proximal tibia fractures (Gustilo-Anderson Type IIIB). This approach facilitates expedited bony union and contributes to a reduction in postoperative complications.

“Ah! To Become the Balzac of America!”: The Balzacian Subtext of Sister Carrie

“Ah! To Become the Balzac of America!”: The Balzacian Subtext of <i>Sister Carrie</i>

A prospective study to evaluate the functional and clinical outcome of anterior cruciate ligament reconstruction with standard hamstring autograft

Background: The anterior cruciate ligament (ACL) is the primary stabilizer of the knee and prevents the knee against anterior translation. It is also important in counteracting rotational and valgus stress. The arthroscopically aided approach has the advantages of smaller skin and capsular incisions, improved viewing of the intercondylar notch for placement of the tunnel and attachment sites, less postoperative pain, fewer adhesions, earlier motion, and easier rehabilitation. The advantages with semitendinosus grafts are the availability of a greater sectional area and the unaffected integrity of the extensor mechanism. Moreover, the tensile strength of quadrupled hamstring is found to be even better than a normal ACL. The rate of complications such as extension loss, anterior knee pain, and surgical site infections was also lower than in other procedures such as in BPTB grafts. Cortical suspension devices have the necessary biomechanical properties with regard to ultimate failure strength, displacement, and stiffness for the initial fixation of soft tissue in the femoral tunnel for ACL reconstruction. The aperture fixation methods such as the interference screws allow for early firm fixation and heal with a tight bone–tendon interface.Objective: A prospective study to evaluate the functional and clinical outcome of ACL reconstruction with standard hamstring autograft.Materials and Methods: The study results included 30 patients admitted with clinical and radiological deficiency of ACL from September 2019 to March 2021 using endobutton and bioabsorbable interference screw in terms of range of motion, postoperative knee stability, subjective knee functions, and prospective assessment of functional outcome using Tegner Lysholm knee scoring system.Results: Sports injuries were the most common mode of injury (n = 17, 56.7%). The mean size of graft used was 8.2 ± 0.39 mm. Postoperatively at 2-year follow-up, 30 cases (100%) had 0 grade pivot-shift test, 0 grade Lachman test, and anterior drawer test. The mean postoperative Lysholm score improved from preoperative score of 62.83 ± 5.2–91.0 ± 5.54. The overall satisfactory result (excellent + good) at 6-month follow-up was (excellent – 30 and good – 70) 100%. Out of this, 27 (90%) patients had returned to preinjury level of activity in 1 year. In this study, one patient had superficial infection and two patients had knee pain.Conclusion: Arthroscopy-assisted ACL reconstruction using hamstring tendon autograft provides a stable knee, reduces postoperative morbidity, and enables early rehabilitation.

To study of functional outcome and complications of proximal humerus fracture dislocation managed with reduction internal fixation with various methods

Background: Fracture-dislocation of the humerus refers to the fracture of the proximal part of humerus associated with dislocation of the head from the humero-glenoid joint. It is occurs most commonly in elderly due direct low velocity trauma, while in younger age group, high-velocity trauma is needed.1 Management of fracture dislocation of proximal humerus needs early reduction and fixation. In or prospective study we have observed the functional outcome and complications of management of displaced proximal humerus fragments with various methods.;Methods: A two-year prospective study was conducted after getting ethical approval at tertiary care centre on cases admitted with proximal humerus fracture dislocation as per the inclusion criteria based on Neer’s classification evaluation was done after investigations like xray CT scan and surgery was performed. Postoperative follow-up was done at 1st, 6th month and 1 year and outcome were evaluated for each case based on Neer’s shoulder score of constant score.Results: 30 cases were studied which were operated according to neers classification by various methods. Mean age was 42.6 years. Constant Shoulder score was good in maximum patients (46.67%) followed by excellent in 33.67%, three patients (10%) had fair score while it was poor in 2 patients (6.66%).Conclusions: Proximal humerus fracture dislocation can be managed with various methods of treatment. Each method has its own advantage and disadvantages.

A clinical study to determine the early functional outcome of ACL injuries managed by arthroscopic reconstruction using four strand hamstring graft with interferrence screw

Anterior cruciate ligament is the most commonly injured ligament. Arthroscopic reconstruction of anterior cruciate ligament with aperture fixation of graft using the interference screw on the tibial side allows for early Firm fixation and healing with tight bone-tendon interface.Even after better surgical techniques and fixation devices many athletes retire early due to residual knee instability. Hence in this study, I am making an effort to assess the early clinical outcome of anterior Cruciate Ligament injuries managed with arthroscopic reconstruction using hamstring graft with Interference screw. Due to rise of RTAs need for study of function outcome of ACL injuries treated by arthroscopic reconstruction in non sports individuals. This prospective comparative observational study related data were captured between october 2020 to april 2022 in a Karnataka institute of medical sciences. About 35 patients with arthroscopic anatomic ACL reconstruction using hamstring tendon graft with interference screw were evaluated and followed up for functional outcome. Patients were evaluated for functional outcome and stability of knee using International knee documentation committee subjective score and Lysholm score over a period of 18 months. This prospective comparative observational study related data were captured between october 2020 to april 2022 in a Karnataka institute of medical sciences. About 35 patients with arthroscopic anatomic ACL reconstruction using hamstring tendon graft with interference screw were evaluated and followed up for functional outcome. Patients were evaluated for functional outcome and stability of knee using International knee documentation committee subjective score and Lysholm score over a period of 6 months.The larger percentage of cases was operated less than 6 months from the date of injury. On evaluation of the patients during the follow up by IKDC and LGS, 100% of the patients had excellent to good results, and were able to return to pre injury level of activity.The technique of arthroscopic ACL reconstruction offers an excellent knee function, knee stability and restoration of preoperative functional status with minimal complications.

Open reduction and internal fixation of displaced Lisfranc fracture dislocations using k-wires

Introduction: Open reduction and internal fixation has been recommended as the treatment for most unstable injuries of the Lisfranc (tarsometatarsal) joint. It has been thought that purely ligamentous injuries have a poor outcome despite such surgical management.Aim and Objective: The aim of this study was to evaluate the outcome of early open reduction and internal fixation in the management of patients with Lisfranc injuries. Materials and Methods: The study was conducted in the Department of Orthopaedics, Govt. Bone and Joint, Hospital, Barzulla an associated Hospital of Govt. Medical College, Srinagar on Lisfranc joint. In this study a total of 18 cases of Lisfranc injuries were enrolled. Results: Full weight bearing was allowed at 10-12 weeks. Anatomical reduction was obtained in 17 (94.44%) patients. At the follow-up of 6 months the average calculated AOFAS Score was 83.28. In this study overall complications were seen in 4 (22.22%) patients. Good to fair results were seen in 17 (94.44%) patients. Conclusion: Open reduction and internal fixation with Kirschner wire offers excellent curative effect and can avoid postoperative complications and improve the patients' quality of life.

РЕЗУЛЬТАТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПОВРЕЖДЕНИЙ ТАЗОБЕДРЕННОГО СУСТАВА

Hip neck fractures occur most often in elderly and senile people. The fracture is also facilitated by concomitant osteoporosis, which is observed at this age. The purpose of surgical treatment of patients with femoral fractures is early immobilization; therefore, in the practice of modern medical institutions, methods are used that contribute not only to early fixation, but also to the load on the limb. The aim of the study is to study the results of surgical treatment of patients with various types of hip joint injuries in the Department of Orthopedics of the Khorezm branch of the RSSPMC of Traumatology and Orthopedics. Material and methods. The results of primary hip end prosthesis were studied in 32 patients: 20 women (62.5%), 12 men (37.5%). All patients were admitted to the clinic within 20 days to 3 months after the injury. Results. Wound healing by primary tension was observed in 29 patients (90.6%). In 3 patients (9.3%), the wound healed by secondary tension. Femoral neck fractures were detected in 10 (31.2%) patients, 22 (68.7%) patients with a false hip joint. In the group with hip fractures, 10 patients (53.2%) had positive results. In the group of patients - 20 (47.6%) with false joints, excellent results were noted in 16 (80%) patients. Satisfactory results were observed in 4 (20%) patients. Conclusion. End prosthesis of large joints of the lower extremities, in particular the hip joint, is one of the most common orthopedic operations. Every year there is an increase in the need for such interventions. The number of patients requiring end prosthesis is characterized by an increase in age and the number of concomitant diseases. To obtain optimal treatment results, it is necessary to avoid a long delay in surgery after indications for joint end prosthesis.