Early Union Research Articles

Evaluation of outcome of distal metaphyseal extraarticular tibia fractures treated by locking plates and intramedullary nailing in medical college setup

Background: Distal tibia metaphyseal extra articular fractures are associated with great dilemma for operating surgeon. It is associated with high rate of delayed and non-union due to precarious blood supply and less muscle coverage. Has poor outcomes and high complication rates. Although multiple treatment modalities are described to treat these fractures, there is no consensus on the best method of treatment. We hereby want to evaluate the outcome of metaphyseal extra articular tibia fractures treated by plating and intramedullary nailing.Methods: This study was undertaken in patients who were operated in between October 2015 to January 2018 at Dr. Ulhas Patil medical college and hospital Jalgoan Maharashtra. Study included 39 patients with distal tibia metaphyseal extraarticular fracture treated by surgery. All the fractures were closed. Twenty four patients underwent expert tibia nailing whereas 15 patients were treated by locking plates. Patients were followed up at 6 weeks, 12 weeks, 4.5 months, 6 months and 9 months with x-rays.Results: Thirty nine patients included in study and they were divided into two groups as nailing group and plating group. Plating group included 15 patients whereas nailing group included 24 patients. The mode of injury was road traffic injury in 27 cases, followed by self-fall in 9 cases and sports related injury in 3 cases. The average duration of surgery in nailing was group was 70 minutes (range, 60-130 minutes) whereas average duration of surgery in plating group was group was 88 minutes (range, 80-130 minutes). Average distance of fracture from articular surface was 6 cm in nailing group and 4 cm in plating group. The average time for union was 13.5 weeks for nailing group and for plating group it was 17 weeks.Conclusions: Both intramedullary nailing and plating are the optimal methods of treatment. Plating is preferred in cases where fracture is close to articular area but requires more time than intramedullary nailing. There is little early union rate for nailing of 13.5 weeks as compare to plating of 17 weeks. Complication rates of plating like infection and wound complication are more than nailing because plating is open procedure than closed nailing procedure. Rest complication are comparable.

A Cohort Comparison of Predictors of Young Adult Union Formation and Dissolution in the US.

The theory of the second demographic transition argues that as educated Americans began valuing self-actualization and individual autonomy, delays in union formation spread through the US. The accelerated adulthood theory suggests that socioeconomic disadvantage distinguishes young adulthood such that those with fewer resources have shorter, more informal (i.e. cohabitation) unions, and those with more resources delay but achieve marriage and have greater union stability. We use two large, nationally representative samples of young adults collected about twenty years apart, the National Longitudinal Surveys of Youth 1979 and 1997 cohorts to examine cohort differences in union formation and dissolution and test interaction effects in demographic and socioeconomic correlates. We found that the NLSY97 cohort 1) entered into unions earlier than the NLSY79 cohort, 2) entered direct marriage (marriage without premarital cohabitation) later than the NLSY79 cohort, and 3) entered cohabiting unions earlier than the NLSY79 cohort. A greater proportion of young adults in the NLSY97 cohort dissolved their first union between ages 16 and 30. We found that socioeconomically disadvantaged young adults had earlier unions by some indicators (e.g. lower maternal education) and later unions by other indicators (e.g. unemployment) in both cohorts. We also found that in both cohorts, socioeconomic disadvantage undermined union stability. We also found evidence for interaction effects; some indicators of socioeconomic disadvantage (e.g. income, employment, and maternal education) had exacerbated effects on union formation and stability in the NLSY97 as compared to the NLSY79 cohorts perhaps because inequality grew over the twenty years between cohorts.

Intramedullary Interlocking Nail in Distal One Third Tibia Fracture: A Retrospective Study in Tertiary Care Center

AIM: To assess functional outcome of intramedullary interlocking nail in distal tibia fracture where distal locking screw is applied after inserting proximal locking screw. PATIENTS AND METHOD: This is a retrospective study which was conducted in Universal college of medical sciences. This study was started one year back and last case was followed for one year. All thirty three cases with distal tibia extraarticular fracture 42A1 and 43A3, according to AO classification, within 7 cm from the ankle plafond of skeletally mature person presented in emergency along with Gustillo Anderson (GA) I, II, IIIa and fibula fracture are included in the study. Intrarticular fracture, GAIIIb and lost follow up cases were excluded from the study. Proximal interlocking screws are placed at first followed by distal interlocking screw. Mechanism of injury, age, sex, union time, foot function index, secondary procedure, complications, deformities are analyzed in the study. RESULTS: All patients were retrospectively analyzed. We could not find any significant relation between post operative malalignment and better foot function index (p = 0.975). Early union may not improve overall foot function index (p = 0.202). Automobile accident is the commonest mode of injury (48.5%) followed by automobile pediastrian (39.4%). Postoperative malalignment consist of cornal (3%), saggital (3%) and shortening (3%). Infection is one of the commonest complication found in our study (6.1%).

The Stability Paradox: Why Expansion of Women's Education Has Not Delayed Early Union Formation or Childbearing in Latin America.

Despite substantial improvements in women's education, the age at which Latin American women marry (cohabit) or become mothers for the first time has barely decreased over the past four decades. We refer to this as the "stability paradox." We examine the relationship between years of schooling and transitions to first union or child, analyzing retrospective information from 50 cohorts of women born between 1940 and 1989 in 12 Latin American countries. Absolute and relative measures of schooling are compared. Data is drawn from 38 Demographic Health Surveys (DHS) conducted between 1986 and 2012 in these countries. Results show that expected postponement in family transitions due to educational expansion was offset by a rise in union formation and childbearing within strata of absolute education, but stayed approximately constant within strata of relative education. The relative measure of education retains the stratifying power of education but neutralizes any effect attached to a specific number of years of schooling and the learning skills associated with them. This is consistent with the idea that access to education in Latin America reproduces existing patterns of socioeconomic advantage, rather than creating a more equitable distribution of learning opportunities and outcomes.

PAEDIATRIC FEMUR FRACTURE

Objectives: To evaluate the outcome of retrograde flexible intramedullary nailsin treatment of paedriatic diaphyseal fractures in comparison with the traditional treatment ofimmediate hip spica cast. Hypothesis: We hypothesised that in children with femur fracturewho are managed with flexible intramedullary nails have better outcome in comparison tothose managed with immediate hip spica cast. Study Design: Randomized control trail. Place& Duration of Study: Lady Reading Hospital, Peshawar from June 2016 to October 2017.Methods: A group of forty-eight children aged 6-12 were randomly allocated either elasticintramedullary nail or immediate hip spica casting and were followed up to six months. Fracturealignment (coronal and sagittal angulation, leg length discrepancy), time for fracture union,recovery mile stones (time to start weight bearing with aids, independent walking, knee rangeof movement) and the presence of complications including surgical site infection were recordedand compared between two groups. Results: Children treated with elastic intramedullary nailsin comparison with those treated with immediate hip spica had early union (p<0.001), shortertime to start weight bearing with support or independently (p<0.001). Leg Length discrepancy(p<0.001), coronal and sagittal angulation (p<0.001 and p=0.02) was significantly higher in hipspica group. Difference observed between the two groups regarding knee range of movement(p=0.085) and surgical site infection (p=0.076) was not significant. Conclusion: Children aged6-12 years treated with elastic intramedullary nail for femoral diaphyseal fracture had earlierunion, reduced rate of shortening, malunion and allowed earlier rehabilitation.

RETROGRADE ELASTIC INTRAMEDULLARY NAILS VERSUS IMMEDIATE HIP SPICA CAST IN TREATMENT OF PAEDIATRIC FEMUR FRACTURE: A PROSPECTIVE, RANDOMIZED STUDY

Objectives: To evaluate the outcome of retrograde flexible intramedullary nailsin treatment of paedriatic diaphyseal fractures in comparison with the traditional treatment ofimmediate hip spica cast. Hypothesis: We hypothesised that in children with femur fracturewho are managed with flexible intramedullary nails have better outcome in comparison tothose managed with immediate hip spica cast. Study Design: Randomized control trail. Place& Duration of Study: Lady Reading Hospital, Peshawar from June 2016 to October 2017.Methods: A group of forty-eight children aged 6-12 were randomly allocated either elasticintramedullary nail or immediate hip spica casting and were followed up to six months. Fracturealignment (coronal and sagittal angulation, leg length discrepancy), time for fracture union,recovery mile stones (time to start weight bearing with aids, independent walking, knee rangeof movement) and the presence of complications including surgical site infection were recordedand compared between two groups. Results: Children treated with elastic intramedullary nailsin comparison with those treated with immediate hip spica had early union (p<0.001), shortertime to start weight bearing with support or independently (p<0.001). Leg Length discrepancy(p<0.001), coronal and sagittal angulation (p<0.001 and p=0.02) was significantly higher in hipspica group. Difference observed between the two groups regarding knee range of movement(p=0.085) and surgical site infection (p=0.076) was not significant. Conclusion: Children aged6-12 years treated with elastic intramedullary nail for femoral diaphyseal fracture had earlierunion, reduced rate of shortening, malunion and allowed earlier rehabilitation.

Lessons from historical monetary unions - is the European monetary union making the same mistakes?

This article examines three historical monetary unions: the Latin Monetary Union (LMU), the Scandinavian Monetary Union (SMU), and the Austro-Hungarian Monetary Union (AHMU) in an attempt to derive possible lessons for the European Monetary Union (EMU). The term ‘monetary union’ can be defined either narrowly or broadly depending on how closely it conforms to Mundell’s notion of ‘Optimal Currency Area’. After examining each of the historical monetary unions from this perspective, the article concludes that none of them ever truly conformed to Mundell’s concept, nor does the EMU. Nevertheless, the article argues that some lessons may be learned from these historical experiences. First, it is necessary that there exist robust institutions such as a common central bank and a unified fiscal policy in order to withstand external shocks. The three early unions could not withstand the shock of WWI. Another important lesson is that continuing national rivalries can undermine any monetary union.

Comparison of radiological and functional outcome in patients with femoral neck fracture operated with dynamic hip screw versus multiple cannulated screws

Introduction: Intracapsular fractures of neck femur have always presented a great challenge to orthopaedics surgeons and remain in many ways the unsolved fracture as far as treatment and results are concerned especially in younger population. Intracapsular fracture neck of femur is regarded as an orthopaedic emergency and needs to be reduced with rigid internal fixation which is believed to improve the circulation of femoral head and prevent the nonunion and avascular necrosis. In our country sliding hip screw is not commonly used for intracapsular neck femur fracture fixation as compared to cannulated screw fixation, we have undertaken this comparative study to assess the outcome of both fixation modalities as well as factors influencing the results of these fixations in our population. Materials and Methods: This is a prospective randomized study conducted at tertiary care hospital in department of Orthopaedics consists of 62 patients which were randomized into 2 groups. Group A(n=31) patients were operated with 3 cannulated cancellous screws and Group B(n=31) patients were operated with Dynamic hip screw. Results: We have found DHS not only to be to be more stable but also allows better compression across the fracture, allowing early mobilization and early union. There was no complication of non-union in patients managed with DHS while 3 patients managed with CC screw progressed to non-union. Average time for union in our study was 14 weeks for patients managed with DHS while it was 18 weeks for patients managed with CC screw. Conclusion: We recommend use of DHS with derotation screw for managing all the patients of fracture neck femur i/v/o early mobilization, early union and reduced risk of non-union.

Use of intramedullary implants in adult diaphyseal fracture both bone forearm

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Fractures of the forearm bones are very common. The most common form of stabilization is plate and screw fixation. The role of Intramedullary nailing of fractures of the shafts of the adult radius and ulna is still to be defined. This study was perform to analyze anatomical and function outcome of the patients treated by Talwarkar square nail.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">We evaluated 46 patients (29 males and 17 females) had fracture both bone forearm treated by intramedullary nail. We analyzed patients in two broad group one with close fracture or grade I, II open fracture (34 patients) and other have open fracture grade IIIA or IIIB (12 patients). First group patients further analyzed weather close (22 patients) or open reduction (8 patients) required. Functional outcome was calculated by Grace and Eversman system</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Out of 32 patients of close fracture or open grade 1 or 2 fracture, 29 (90.62%) have excellent or acceptable result. All the patients (100%) in whom close reduction succeeds achieved excellent result. 22 (64.70%) patients close nailing possible.12 patients in whom open reduction required 9 (75%) goes into union. Close nailing have overall success rate is 90.62% where it fail and open nailing require success rate bring down to 75%.. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">IM nailing gives satisfactory results. Advantages of close nailing are- early union, low incidence of infection, small scars, less blood loss, short operating time with minimal surgical trauma, easier implant removal. Even though plate and screw fixation is the gold standard for stabilization of both bone forearm fracture but intramedullay implant can be used in selected cases with good result. To achieve acceptable result – early surgery, proper selection of the case, pre-operative planning, proper assessment of diameter, length and radial bowing of the nail, is required.</span></p>

Management of diaphyseal fractures of both bones of forearm by internal fixation using locking compression plate and screws

Background and objective: The fractures of both bones forearm are one of the commonest fractures found and can be treated by different methods. The accepted management for fractures of both bones forearm is open reduction and internal fixation using compression plating. The present study is undertaken to verify the claims made by the authors of the new design of the plate (LCP) and to learn the techniques, advantages and complication of the new method of internal fixation of forearm fractures. Materials and methods: It is a prospective study which was carried out from November 2012 to October 2014 in Karnataka Institute of Medical Sciences, Hubli. In this study period 20 cases of fractures of both bones of forearm were treated by open reduction and internal fixation using Locking Compression Plate. Results: In our series, majority of the patients were males, middle aged with road traffic accidents being the commonest mode of injury, involving middle third of forearm. Transverse or short oblique fractures were most common. All twenty ulna fractures and nineteen radius fractures united. Excellent results or full range of mobility of elbow and wrist joints were present in 15 patients(75%), 4(20%) patients having good range of movements and 1(5%) patient with failure. Conclusion: The fixation with LCP for forearm fractures produces excellent results, the advantage being early mobilization, early union but the complication, duration of surgery and surgical techniques remains unchanged.

Intramedullary Interlocking Nail in Distal One Third Tibia Fracture: A Retrospective Study in Tertiary Care Center

AIM: To assess functional outcome of intramedullary interlocking nail in distal tibia fracture where distal locking screw is applied after inserting proximal locking screw. PATIENTS AND METHOD: This is a retrospective study which was conducted in Universal college of medical sciences. This study was started one year back and last case was followed for one year. All thirty three cases with distal tibia extraarticular fracture 42A1 and 43A3, according to AO classification, within 7 cm from the ankle plafond of skeletally mature person presented in emergency along with Gustillo Anderson (GA) I, II, IIIa and fibula fracture are included in the study. Intrarticular fracture, GAIIIb and lost follow up cases were excluded from the study. Proximal interlocking screws are placed at first followed by distal interlocking screw. Mechanism of injury, age, sex, union time, foot function index, secondary procedure, complications, deformities are analyzed in the study. RESULTS: All patients were retrospectively analyzed. We could not find any significant relation between post operative malalignment and better foot function index (p = 0.975). Early union may not improve overall foot function index (p = 0.202). Automobile accident is the commonest mode of injury (48.5%) followed by automobile pediastrian (39.4%). Postoperative malalignment consist of cornal (3%), saggital (3%) and shortening (3%). Infection is one of the commonest complication found in our study (6.1%).

Single oblique cage posterior lumbar interbody fusion with local bone graft as an alternative to double straight-ahead cages posterior lumbar interbody fusion with iliac crest graft

Background Posterior lumbar interbody fusion (PLIF) is a fusion technique with reliable and rapid fusion results. The traditional technique describes the use of two cages filled with bone graft and inserted in a straight-ahead direction within the prepared disc space. Bone graft used is usually harvested from the posterior iliac crest. This study evaluates the use of a single cage inserted diagonally through unilateral discectomy and filled with bone fragments obtained from the local decompression procedure. Patients and methods Fourteen patients underwent pedicle screw-rod supplemented PLIF and spinal canal decompression for symptomatic spinal canal stenosis, instability, or spondylolisthesis refractive to conservative treatment. PLIF was performed using a single PEEK cage filled with impacted graft from the locally excised bone. The PEEK cage was inserted into the prepared intervertebral disc space in an oblique (diagonal) manner to obtain near-symmetrical end-plate loading across the midline. Results The mean follow-up period was 15 months. The mean duration of surgery was 170 and 225 min for single-level and double-level fusions, respectively. The mean volume of blood loss was 850 and 1050 ml for single-level and double-level fusions, respectively. The mean duration for hospital stay was 5 days. Postoperative radiographs showed a mean increase in the disc height by 24.4% and a mean increase in lordosis angle by 4.3°. Pain and functional scores showed marked improvement. The mean Visual Analog Scale decreased from 7.8 to 2.2. The mean Oswestry Disability Index decreased from 82 to 28. The mean Economic Prolo Scale was 3.2 whereas the Functional Prolo Scale was 3.8. Interbody fusion was assessed using lateral radiographs. Loss of demarcation of the bony end-plates with consolidation of graft through the cage was the indication of successful fusion. At final follow-up, 10 patients showed solid fusion, three patients showed delayed fusion, and one patient showed loss of reduction of spondylolisthesis after a traumatic incident and required a revision surgery. Yet, patients with delayed union did show similar improvement to those with early union on the Visual Analog Scale and Oswestry Disability Index. Conclusion The use of single unilateral and obliquely inserted PEEK cage is an effective safe procedure for interbody fusion that gives comparable results to the traditional double-cage technique while shortens the operative time, lowers the blood volume loss, and also lowers the cost for implants used without endangering reliability of the technique.

Management of pediatric open tibia fractures with supracutaneous locked plates.

We evaluated the novel application of supracutaneous locked plates in pediatric open tibia fractures. Pediatric open tibia fractures stabilized with a locked supracutaneous plate from January 2011 to December 2014 were reviewed. Twenty-eight children, mean age 8.9 years, with 29 open tibia fractures were included. Nine of these children who had metaphyseal or metadiaphyseal fractures did not require joint spanning. The mean follow-up duration was 13.5 months. The mean time to uneventful union was 11.46 weeks, with no unacceptable malunion. Supracutaneous locked plates showed early union and no refractures. They could favorably replace tubular external fixators in stabilizing pediatric open tibia fractures.

Comparative study of operative management of humeral shaft fractures by dynamic compression plating versus locked intra-medullary nailing

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Operative management of humeral shaft fractures is mostly accomplished by surface plating or intra-medullary nail osteosynthesis. Both the treatment options have been variably reported to give good rates of union and functional outcome. We compared both the options to know the better one in multitude of variables.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Thirty patients with fracture shaft of humerus were followed up for a period of 12 to18 months. 15 patients each underwent open reduction and internal fixation with dynamic compression plate and closed antegrade locked intra-medullary nailing. All patients were clinically and radiologically assessed till fracture union</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Diaphyseal humeral fractures in all the patients treated with nailing united and had a tendency to unite early compared to plating. Shoulder pain was initially complained by 2 patients from the nailing group and got subsided later on. The incidence of complications was more in the plate osteosynthesis group. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">In our study Intra-medullary nailing turned out to be superior to plating for amenable diaphyseal fractures of humerus in terms of higher rate of union, early union and lesser complications.</span></p>

Comparative study of functional outcome of dynamic compression plating and interlocking intramedullary nailing for fructure shaft of humerus

<p class="abstract"><strong>Background:</strong> Fracture of the diaphysis of humerus and its complications are a major cause of morbidity in trauma patients. Fracture of the humeral shaft account for 20% of humeral fractures & about 3% of all fractures. There is a debate between the choices of operation in humeral shaft fractures.</p><p class="abstract"><strong>Methods:</strong> A comparative study of management of acute humeral shaft fractures treated by Dynamic Compression Plate (DCP) and Intra Medullary Interlocking Nail (IMILN) fixation over a period of one half years. 18 patients of IMILN and 20 patients of DCP were included after considering inclusion and exclusion criteria. Functional scoring criteria were used for postoperative assessment & the average follow up period was one year.<strong></strong></p><p class="abstract"><strong>Results:</strong> A high rate of excellent & good results & a tendency for early union was seen with the plating group than nailing group.</p><strong>Conclusions:</strong> Plating shows better results than nailing.

Minimally Invasive Plate Osteosynthesis Using Locking Plates for AO 43-Type Fractures: Lessons Learnt From a Prospective Study.

Managing fractures of distal tibia is still a subject of debate for orthopaedic surgeons in terms of both, reduction and fixation. Subcutaneous location and soft tissue anatomy predisposes it to angular and rotational instability as well as other bony and soft tissue complexities. Minimally invasive plating offers many advantages over conventional open techniques. It causes minimal soft tissue dissection and surgical trauma to the bone. Minimally invasive plate osteosynthesis(MIPO) maintains biological configuration of distal tibia and fracture hematoma and also provides a construct, which is biomechanically more stable. Evaluation of results of MIPO in management of distal tibia fractures considering radiological union, ankle function restoration, and complications. In our study, 25 closed distal one-third tibia fracture with/without articular extension were taken, fulfilling the inclusion criteria (AO classification: 10, 43A1; 3, 43A2; 2, 43B1; 4, 43B2; and 6, 43C1). MIPO with locking plates was the treatment undertaken. Patients were followed up for 18 months prospectively. Average injury-hospital interval was 11.16 hours and average injury-operation interval was 2.44 days. All fractures showed radiological union at an average duration of 20.5 weeks (14-28 weeks). Olerud and Molander score was used for evaluation at 3, 6, and 18 months. One patient had union with valgus angulation >5° but there was no nonunion. There was 1 superficial postoperative wound infection. Our study shows that plating with MIPO is an effective treatment for closed distal one-third tibia fractures, considering union time and complications rate. Younger age promotes early union and functional recovery. Therapeutic, Level II: Prospective.

Comparison between antegrade intramedullary nailing (IMN), open reduction plate osteosynthesis (ORPO) and minimally invasive plate osteosynthesis (MIPO) in treatment of humerus diaphyseal fractures

IntroductionThe three currently used methods of treatment: namely open reduction plate osteosynthesis (ORPO), Minimally invasive plate osteosynthesis (MIPO), antegrade intramedullary nailing(IMN) are all reported as satisfactory procedures for treatment of humeral shaft fractures. However none of the published reports have a comparison of superiority of one procedure over the other. We evaluated the clinical, radiological and functional outcome of the three procedures. Materials and methodsWe studied adult patients with humerus shaft fractures over a period of 2 years from May 2014 to May 2016 in a level 1 trauma center. Forty-four were treated with IMN, 34 treated with ORPO, and 34 with MIPO. The null hypothesis tested in this study is that there is no difference between IMN, ORPO, MIPO with respect to union time, surgical time, complication rate, non-union rate and functional outcome. Functional outcome was studied by comparing the UCLA shoulder and MEP scores in the three groups. Results112 patients were studied consisting of 83 males and 29 females with mean age of 39 years (range 18-70). IMN group showed early union with mean of 12.73 weeks compared to MIPO (14.45 weeks) and ORPO(13.58 weeks), (p<0.05). MIPO had no events of non-union, as compared to ORPO (5 non-unions) and IMN (10 non-unions), (p=0.04).The range of movement at the shoulder with the UCLA score was significantly better with a score of 32.26 in MIPO as compared to 27.54 in IMN and 28.82 in ORPO (p<0.05). The difference in MEPS score in the three groups was not significant (p=0.31). IMN required a mean of 117.95 minutes intraoperatively as compared to 131 and 150.58 mins in MIPO, ORPO respectively. ConclusionMIPO is overall better with respect to non-union, functional outcome and complications rate. The surgical time depends on the surgeons’ skill and learning curve. Thus considering the advantages and risks involved in the various procedure and surgical acumen, each case should be individualized to have a good outcome. We advocate that MIPO can be safely used as an alternative in treating these fractures.

DHS osteosynthesis with internal bone grafting in unstable delayed presented intracapsular neck femur fractures

ObjectivesThe aim of this study was to assess fracture union and complications following use of dynamic hip screw (DHS) with internal bone grafting in treatment of unstable delayed presented intracapsular neck femur fractures in patients younger than 65 years of age. Material and methodsThirty two patients with displaced intracapsular neck femur fractures(Garden III and IV, Pauwels III, with comminution) with delayed presentation (15–60 days) in the 45–65 year age group (mean 54.4±10.2 years) were included in this study. All patients were treated with dynamic sliding hip screw with closed cancellous bone grafting through a tunnel of a triple reamer. The average time to union was 3.8 months (3–5 months). Satisfactory union was achieved in all patients except two. One case developed avascular necrosis of the femoral head. Other complications were coxa vara in two, shortening of less than 10mm in three cases but there were no cases of infection or implant failure. Excellent results were achieved in 27, good/fair in 4 and poor in 1 patient. ConclusionOsteosynthesis with DHS and primary cancellous bone grafting in indicated cases is a simple, providing biological stimulation for early union. Failure in a particular case can be treated with any appropriate second procedure.

TENS for the surgical management of femoral shaft fractures in 6-14 years age group children

Background. Fracture shaft of femur in pediatric age group is one of the most common leading emergencies. Children in the age group of 6-14 years are treated with either traction, hip spica, flexible/elastic stable retrograde intramedullary nail, or external fixators. We conducted a clinical prospective study on the use of Titanium Elastic Nailing System (TENS) for the treatment of femoral shaft fractures in children.&#x0D; Methods. The prospective study included 45 cases of fresh femoral shaft fractures. The Inclusion Criteria were a) Age group of 6-14 years, b) Recent fracture of femur shaft c) Transverse, short oblique, minimally comminuted fractures.&#x0D; Results. The clinical results were evaluated using Flynn’s criteria of scoring as, Excellent in 40 patients (88.89 %), Satisfactory in 5 patients (11.12 %) and poor in none. Radiological criteria for fracture union were assessed by using Anthony et al scale. Nine patients developed bursitis at entry point of the nail. Three patients had superficial infection due to bursitis. Full weight bearing was possible in mean time of 8.7 weeks (range; 7-12 weeks).&#x0D; Conclusion. TENS is very effective in management of paediatric shaft femur fractures in the age group of 6-14 years with advantages of early union, early mobilization and manageable complications.

Comparison of the functional outcome of DHS versus cannulated cancellous screws in pauwels type II and III fracture neck femur in young adults

Fracture neck of femur remains the unsolved fracture even in modern orthopaedics. It is an enigma to orthopaedic surgeons and curse for an individual with complications like avascular necrosis and nonunion. No clear difference exists with regards to the clinical results of patients treated with Cannulated screws or Dynamic hip screw fixation. 43 patients with fracture neck of femur were treated with either multiple cannulated cancellous screws (CCS) or dynamic hip screw (DHS) at Department of Orthopaedics, Hamidia hospital, Bhopal. Patients were called for follow up radiologically and clinical examination post operatively. Functional results were calculated with Modified Merle d’aubigne and postel method. Statistical analysis was done using p value.Fracture type, anatomical reduction and proper implant selection are the most important factor affecting the outcome of management of fracture neck femur. Patients treated with DHS had better Modified Merle d’aubigne score and earlier union. Average blood loss and mean operating time was higher in patients fixed with DHS. Dynamic Hip Screw (DHS) is a better implant in management of fracture neck femur in young adults in pauwels type II and III but complication rate does not depend on implant selection.