External Stabilization System Research Articles

The management of metacarpal and phalangeal fractures of hand by K-wires and Joshi’s external stabilization system

Background: Hand injuries are quite common and affect 15% of people who go to the emergency room. The metacarpals and phalanges are the two bones that fracture most frequently, with a prevalence of between 10 and 15%. Use of K-wires with an external fixation system, such as Joshi's external stabilization system (JESS), is optional. According to the ligamentotaxis theory, JESS functions. Aim was to evaluate the clinical and radiological outcome of metacarpal and phalangeal fractures using k wires and jess. Methods: This prospective study was conducted in post graduate department of orthopaedics SKIMS medical college Bemina, on 40 patients with metacarpal and phalangeal fractures managed by Kirschner wires (K-wires) and JESS. The collected data was analyzed with the help of statistical package for social science (SPSS), version 21 Results: In present study the most of the study subjects were in the age group of 28-37 years (40%), there was male predominance with the male to female ratio 2.5:1, majority of the study subjects were labourer (38%), right side was involved most commonly (62%), the major cause of fracture was road traffic accident (58%) and most (96%) of the study subjects were operated within 24 hours of the injury. Conclusions: The study concluded that augmentation of JESS over K-wires provides a stable skeletal environment with early tissue healing and immediate active and passive mobilization of the uninjured adjacent joints and also provides rotational stability as the majority of the study subjects achieved excellent functional outcome.

Comparative Study of Treatment of Distal end Radius Fracture by Non-Operative Method Versus Operative Method with Joshi’s External Stabilisation System

Background: Distal end radius fractures are the most common fracture. There are various treatment modalities,which include closed reduction and casting, closed reduction and percutaneous pinning, open reduction, andinternal fixation with a variety of implants. A minimally invasive technique like JESS could be ideal technique.Method: 30 patients with distal end radial fractures were selected. Out of 30 patients, 15 were treated with closedreduction and casting, and the remaining 15 were treated with the JESS technique approach. Patients of bothtechniques were studied haematologically and radiologically before undergoing these comparative technologicalstudies, and the pros and cons of both techniques were noted. to justify the ideal method for a lower distal endfracture of the radius.Results: The fewest post-surgical complications were observed with JESS techniques as compared to theconservative group. Excellent outcomes were observed in the JESS technique treatment, with significant statisticalvalues in terms of good anatomical reduction and stabilisation; early mobilisation with regaining full ROM wasjustified.Conclusion: From the present study, it is concluded that closed reduction with JESS fixation under the C arm isa simple, minimally invasive, and cost-effective technique that provides better stability in the treatment of distalend radius fractures with not only a good clinical and radiological outcome but also minimal complications ascompared to conservative treatment.

Treatment of Complicated Clubfoot Using External Fixation: A Scoping Review

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: The treatment of relapsed, resistant, or neglected clubfoot presents a challenge — some patients may not respond to the traditional Ponseti method. Studies involving gradual distraction using external fixators for treatment of these cases have been performed, but no systematic review has been conducted on the subject. Methods: A comprehensive search was conducted of PubMed, Cochrane, CINAHL, Scopus, and Web of Science according to PRISMA guidelines. Only articles that pertained to the treatment of pediatric patients with clubfoot using external fixation and contained three or more human subjects were included. Reviews, professional opinions, and studies with non-human subjects were excluded. Results: Of 6,469 articles generated from the initial search, 25 met inclusion criteria. 609 total feet (490 total patients) were included, and 533 of these feet (445 patients) were treated with external fixation. The mean age of patients was 8.5 [2-18] years with a mean follow-up length of 40.9 [5-126] months. 21 (84%) studies used the Ilizarov apparatus, two used Joshi’s external stabilization system, and one used the Taylor spatial frame. The most reported primary scoring systems were the 60-point International Clubfoot Study Group (ICFSG) score (20%), Dimeglio classification (12%), Pirani score (8%), and Reinker and Carpenter scales (8%). All but one study found significantly improved primary outcomes for the majority of respective patients. Conclusion: External fixation, which may or may not include open surgery, is a promising intervention for neglected or relapsed clubfoot. However, encouraging more standardized outcome measurements would allow for more thorough comparisons between studies.

Comparison of Joshi's external stabilization system and Kirschner wire fixation technique for extra-articular metacarpal fractures

Hand fractures, especially metacarpals and phalanges, account for 15% of emergency department admissions. Metacarpal fractures can be treated using various algorithms. Hand fractures have been treated with K wire fixation, micro plates, and external fixator application devices. A successful functional outcome requires surgical intervention with good fixation principles and a rigid system that allows early mobilization. JESS is a simple, lightweight fixation that can be used with splints or converted to dynamic mobilization units. In open fractures, JESS rigidly fixes bones. Compress, neutralize, or distract a fracture fragment to aggressively treat bone and soft tissue injuries. Moving the proximal and distal joints instantly reduces edema, capsular fibrosis, joint stiffness, and muscle atrophy. Kirschner wires are the easiest, cheapest, and most versatile hand injury treatment. They can be percutaneously introduced. It allows early movements without surgical stress This study compares intramedullary Kirschner wires and Joshi’s external fixator device for unstable extra-articular metacarpal fractures.

A COMPARATIVE STUDY BETWEEN ILIZAROV RING FIXATOR AND JESS IN NEGLECTED/ RELAPSED CTEV

Background: Idiopathic clubfoot is one of the oldest and commonest congenital deformities of mankind, ever since man has adopted the erect posture. Franke (1987-90) used Ilizarov ring xator to correct all components of clubfoot. On the basis of similar principles, Joshi et al devised a simple external xator (Joshi's External Stabilization System- JESS). A total of 21 patients with 28 affected feet who met t Materials and Methods: he inclusion criteria were included in the study and divided into 2 groups; one group of 15 feet treated by Ilizarov xator and other group of 13 feet treated by JESS. All the cases were assessed pre operatively and post operatively clinically using Dimeglio classication scoring system and radiologically using angles and indices. This study included patients of Results and Conclusion: age 3 to 12 years with majority below 8 years. Clinical assessment using Dimeglio scoring system showed improvement in score post operatively in both the groups. In our study, 15 feet were treated by Ilizarov in which 4 feet (27%) had excellent results, 6 (40%) were good, 2 (13%) were fair and 3 (20%) were poor results and 13 feet were treated by JESS in which 2 (15%) had excellent results, 3 (23%) were good, 3 (23%) were fair and 5 (39%) were poor results. In our study, results are better in ilizarov as compared to JESS

Abstract for Thesis on Functional Outcome in Fracture in Lower End Radius in Patients Treated with Joshi External Stabilizing System (JESS FIXATOR)

Abstract for Thesis on Functional Outcome in Fracture in Lower End Radius in Patients Treated with Joshi External Stabilizing System (JESS FIXATOR)

Correction of neglected post-burn severe calcaneo-valgus deformity of foot with Joshi’s external stabilization system: a one stage surgical procedure

Post burn calcaneovalgus is a complex foot deformity and management becomes increasingly difficult especially if deformity is neglected in growing young child resulting in secondary bony deformity. A simple technique of single stage surgical correction with Joshi’s external stabilization system (JESS) is described using principle of distraction osteogenesis or histogenesis without need of extensive plastic surgical procedure. A functional plantigrade foot is achieved after completion of the procedure without need of any bony procedure and least chances of any neurovascular compromise. JESS is a versatile external fixation device for correction of neglected postburn complex calcaneovalgus deformity.

Joshi's external stabilization system and K-wire fixation in the management of hand fractures – A prospective comparative study

Background: Hand fractures can be treated conservatively or surgically, depending on the severity, location, and type of fracture, as in conservative management chance of nonunion, malunion, and stiffness is more if it is displaced or angulated fracture. Various modes of treatment have been used which include K-wire fixation, mini plates, and external fixator application. A modified form of mini-external fixator devised in India is Joshi's External Stabilization System (JESS). Aim: This prospective study was conducted to compare the functional and radiological outcomes following metacarpal/phalangeal fracture fixed with either K-wire or JESS. Materials and Methods: Forty patients with hand fractures (58 fractures – 18 metacarpal and 40 phalanges) were prospectively studied. Twenty patients underwent K-wire fixation and 20 were fixed with JESS, functional and radiological outcomes were assessed, grip strength using dynamometer, visual analog scale (VAS) score, disabilities of the arm, shoulder, and hand (DASH) score, range of motion (ROM) using the American Society for Surgery of the hand scale, tip pinch strength. Student's t-test, Wilcoxon test, Fisher's exact test, and Chi-squared test were used. Results: At 6 months' follow-up, patients fixed with either of the fixation modality showed statistically significant improvement in different outcome variables such as ROM (P < 0.001), quick DASH score (P < 0.001), VAS score (P < 0.001), tip pinch strength (P < 0.001), and hand grip (P < 0.001). All the fractures united at an average 6 weeks. Functional outcomes were excellent in closed fracture fixed with either JESS or K-wire and good to moderate in open injuries. However, overall comparison between K-wire and JESS, no significant difference in these outcome measures was found. Conclusions: K-wires as well as JESS both provide adequate stability and satisfactory results in fractures of the metacarpal and phalanges. This study could not find the superiority of JESS over traditional K-wire fixation.

Joshi’s external stabilization system: A prospective study on delayed presenting CTEV cases

Joshi’s external stabilization system: A prospective study on delayed presenting CTEV cases

Joshi's external stabilization system fixator – A mini solution to avert major disabilities in hand injuries

Background: Fractures of hand bones are often considered minor injuries and treatment is either delayed or neglected. These fractures are usually treated conservatively that leaves behind a residual functional deficit. Surgical intervention should be considered for open, unstable, multiple, comminuted, or intra-articular fractures. Standard surgical treatment includes the use of K-wire, plate, or mini-screws which are associated with unsatisfactory results and high complication rates. Joint stiffness is a commonly reported complication with most of the existing devices used for hand bone fractures. There is a deficit of data pertaining to the effectiveness of Joshi's External Stabilization System (JESS) in avoiding joint stiffness. Joshi's external fixator is a reliable treatment of phalangeal and metacarpal fractures of the hand. It is an economical, simple, lightweight, and stable contract. Patients and Methods: We report a prospective cohort study of 30 patients of hand bone fracture, 10–60-year age range, treated by JESS. Functional evaluation was made using the Duncan et al. scoring. Results: The results recorded were excellent in 31.58% of cases, good in 42.11% of cases, fair in 21.05%, and poor in 5.26% of patients. Conclusion: JESS ex-fix for hand is a useful construct that allows early mobilization of nearby joints. It can be considered a suitable choice for the management of phalangeal and metacarpal fractures of hand to deliver good functional outcome.

SIMPLE AND EFFECTIVE METHOD FOR MANAGEMENT OF FRACTURES OF BASE OF 1ST METACARPAL USING LIGAMENTOTAXIS AND MINI EXTERNAL FIXATOR FRAME

Background- Fractures of the base of rst metacarpal include intra-articular fractures like Rolando fracture and Benette fracture. The ideal management modality of these fractures remains elusive. Management varies from conservative therapy, k wire xations, external xators to formal open reduction and plate xation. Open reduction and anatomic xation though lucrative, is frought with complications like stiffness, implant failure etc due to excessive dissection and soft tissue stripping that is required. Conservative therapy is usually insufcient to allow the fracture to heal in appropriate position as there are numerous muscle forces acting at the base of rst metacarpal which make maintaining the reduction difcult. K wires allow to keep the fracture reduced but obtaining reduction is not an easy task. Here we describe a minimally invasive technique using mini external xator-JESS(Joshi external stabilization system) which requires minimum soft tissue dissection In this prospective study a total of 8 pati Results- ents were included who underwent fracture xation using mini external xator frame. The average time to union was 4 weeks. None of the patients had iatrogenic injury to supercial branch of radial nerve. All of the patients had excellent post xator frame removal hand function. MethodsA prospective analysis was carried out over 8 months. A total of 8 patients met the inclusion criteria and were operated with mini external xator. Regular follow up was done till 8 weeks. At each postoperative visit patients were evaluated for hand function using Kapandji Score Radiographs were taken at each visit to evaluate for fracture alignment and union. Mini Conclusionexternal xator is a simple, minimally invasive surgical technique with excellent functional outcomes for management of Fractures of rst metacarpal

Management of mangled hand injuries with JESS fixator in a tertiary care hospital in North East India: A prospective study

IntroductionMangled hand injuries have proved to be a tough challenge for both the patients and surgeons alike. Severe bony and soft tissue injuries necessitate the requirement of a multidisciplinary approach. MaterialsIn our tertiary care facility, a prospective study was done on the use of the Joshi's external stabilization system (JESS) fixator in the treatment of 31 instances with mangled hand injuries from November 2019 to November 2020. The cases were evaluated for functional outcome at the end of 12 months of follow up. Results31 cases of mangled hand injuries with 43 fractures were treated with the said intervention. The mean age of the patients was 33.7 ± 4.2 years and almost 90% patients were males. Machinery injuries were the most frequent type of injury (55%). Cases were intervened at an emergency basis within 24 h of the injury. Functional evaluation was done by Modified Mayo Wrist Score with an average score of 84 ± 10. Good results were seen in about 60% of cases and there were no Poor results. ConclusionThe application of JESS fixator for the prompt treatment of mangling hand injuries yielded satisfactory results in the working population with an early return to function. The strict adherence to the principles of ligamentotaxis, appropriate wound care and post-operative physiotherapy are other variables in the final outcome of such injuries. Level of evidenceII.

Treatment Outcome of Displaced Proximal Humeral Fractures with Joshi’s External Stabilization System: A Prospective Study

Introduction: Proximal humeral fracture accounts for four to five percentage of all fractures. Undisplaced fractures can be managed conservatively however, for displaced fractures; no particular method is a panacea. In our study we treated displaced proximal humeral fracture with Joshi’s external stabilizing system.&#x0D; Aims: To evaluate functional outcome of displaced proximal humerus fractures managed byJoshi’s external stabilizing system.&#x0D; Methods: This prospective study includedall patients with displaced proximal humerus fracture (Neer’s type two and three); treated with JESS from August 2018 to August 2021at Nepalgunj Medical College, Kohalupurand functional outcome was evaluated using Neer’s criteria at final follow-up. Ethical clearance was obtained from Institutional Review Committee.&#x0D; Results: A total of 40 patients, 23 males and 17 females with mean age of 41.2 years (range from 18 to 60) were included. Mean follow-up duration was 24 ± 1.7 weeks. All fractures united at an average of 13 ± 1.7 weeks. Twenty-nine patients (72.5%) had an excellent result with average score of 92.7 ± 2.3 and remaining 11(27.5%) had satisfactory functional outcome with average score of 84.7 ± 1.7 according to Neer’s criteria. Three patients had bicipital tendonitis that resolved within eight weeks of implant removal while two had pin tract infection which resolved with oral antibiotics and dressing.&#x0D; Conclusion: Joshi’s external stabilizing system is an effective treatment option in patients with displaced proximal humeral fractures.

Functional Outcome of Joshi’s External Stabilization System Fixation in Distal Radius Fractures

BackgroundDistal radius fractures account for almost one-sixth of all fractures in a casualty setting. The usual aim of distal radius fracture treatment is to restore the function of the wrist joint, of which the distal radius is an important part. There seems to be no consensus regarding which mode of treatment is optimal for managing distal radius fracture, particularly when it is associated with distal radioulnar joint instability.ObjectiveTo describe the functional outcome in patients presenting with displaced distal radius fractures who undergo Joshi’s external stabilization system (JESS) fixation.MethodsAn observational study was done among 32 working-age (18 to 55 years) patients presenting with unilateral displaced distal radius fractures (excluding volar displaced) and subsequently treated with JESS fixation. The outcomes of the patients were assessed using the Green and O’Brien Scoring System modified by Cooney et al. at six months and one year following the surgery. Radiographs were also taken postoperatively and during follow-up. The data were analyzed (using IBM SPSS software version 22 and Microsoft Excel) in terms of the proportion of patients with acceptable clinical and radiological outcomes.ResultsAcceptable functional outcomes (good and excellent scores in the Green and O’Brien Scoring System) were observed in 78.1% of the study population. Though the functional outcome scores were higher among the younger age group, a statistically significant difference was not obtained. 96.9% of the patients had acceptable radiological reductions, and infection of the pin tracts complicated 9.4% of the cases. A significant improvement in outcome scores (p-value 0.0001) was observed between the outcome scores at six months and one year after surgery.ConclusionsJESS fixation is an easy and effective method for treating displaced distal radius fractures to achieve good to excellent clinical outcomes. The functional outcome scores were better in the younger age group and male patients, but no statistically significant difference was observed.

To Study Functional Outcome for Upper Limb Phalanx Fracture Treated by JESS Fixator

Purpose: To study functional outcome for upper limb phalanx fracture treated by Joshi’s External Stabilizing System (JESS) fixator. Material and Methods: 68 patients were operated for Upper limb phalynx fracture in a tertiary health care setup with JESS fixator and were reviewed at 3 weeks, 6 weeks and 3months. After the procedure, the patients were assessed for the functional outcome using DASH (Disabilities or Arm, Shoulder and Hand) scoring scale. Results: Mean Adjusted DASH scores of the operated finger over consequent visits at 3 weeks, 6 weeks, and 3 months. We found that the mean adjusted DASH score improved in each consequent visit as compared to the first visit for all the joints (p&lt;0.001). Out of the total 68 study participants, 63 had no complications (92.65%). Only 5 study participants had complications, out of which 2 each had joint stiffness (2.94%) and superficial pin track infection (2.94%) while 1 had pin loosening (1.47%). Conclusion: From the results, we can safely conclude that JESS is an effective alternative treatment for fractures of the phalanges. It is cheap and easily available. Technically, also it is less demanding. Also there is a good functional outcome as suggested by our study findings in terms of improvement in the range of motion as well as the mean adjusted DASH scores over a period of three follow up visits planned at 3 weeks, 6 weeks and 3 months with very few complications.

Neglected paediatric distal radius metaphyseal fractures treated with Joshi’s external stabilization system

Purpose: Malunited distal radius fractures treated with internal fixation devices put the physis at risk of iatrogenic injury, while conservative treatment with a cast usually leads to loss of reduction. While the AO external fixator can be used, the radial inclination cannot be controlled during reduction. The purpose of this study was to ascertain the anatomical and functional outcome of treating malunited distal end radius fractures with Joshi’s External Stabilisation system applied as a bilateral uniplanar construct in the paediatric age group. Methods: Open reduction and external fixation with Joshi’s External Stabilisation System were performed for 4 malunited distal metaphyseal fractures of patients below 16 years. Dorsal open wedge osteotomy with bone graft was performed at the fracture site and two k-wires were passed through both cortices proximal and distal to the site of fracture and reduction was achieved with two distraction rods placed radial and ulnar to the radius bone. The external fixator was removed after the union, and the wrist was mobilised. The patients were followed up till full ROM was achieved. Anatomical outcome analysis was done using Sarmiento’s modification of Lindstrom criteria, and functional outcome analysis was done using Gartland and Werley demerit point system. Results: In our study, 4 patients underwent open reduction and external fixation using Joshi’s External Stabilisation System and all showed fracture union with no complications. The mean age of the patient was 12.25 years (Range-11-14). Meantime to osteotomy after injury was 10.25 weeks (Range-4-22). Mean QuickDASH score improved significantly from 6.25 preoperatively to 1.25 postoperatively (p=0.003). Mean Radial inclination improved significantly from 6.25 to 18 (p=0.009). Ulnar variance improved significantly from 1.75 to 0.25 (p=0.01). Palmar tilt improved significantly from 32.5 to 6.25 (p=0.001). Conclusion: Our study shows good results with fixation using Joshi’s External Stabilisation System for malunited paediatric distal metaphyseal fractures.

Low-Cost Method for Fixation of Distal Humerus Fracture in Elderly Osteoporotic Individuals: Experience from a Resource-Limited, Tertiary-Care Setting in North India

Introduction: About 7% of adult fractures involve elbow and around 2% involve distal humerus. Conventionally, these are managed by ORIF with plates and screws. Often osteoporosis and communition of fracture fragments is observed in elderly presenting with this pattern of injury. This further complicates the situation for reconstruction and stable fixation which is critical for early mobilisation. We present our fixation method of Joshi’s External Stabilizing System resulting in satisfactory outcome Methods: During study period (August 2017-Oct 2019), total of 19 patients (male=8) were treated at Dr Rajendra Government Medical College, Tanda, Himachal Pradesh, India. Seventeen of them were elderly osteoporotic individuals. Closed reduction was achieved in 7 cases who had displaced supracondylar humerus fracture. Open reduction through triceps splitting approach extending longitudinally up to fascial sleeve of forearm was done in one case of one year old neglected supracondylar humerus fracture and all cases of intercondylar humerus fracture (N=9). Articular visualisation and reduction were achieved after flexing to about 110 degrees and applying longitudinal traction through trochlear notch with the help of ribbon gauge, obviating the need of olecranon osteotomy. Results: Union was achieved in 15 cases; one case was lost to follow-up after 8 weeks. Another case is within 4 weeks follow-up. Elbow movements were initiated on first post-operative day in all. Fracture was classified on basis of A.O classification. Mayo elbow performance score system was done to evaluate the final functional outcome (Table 1). Conclusion: Complications encountered include minor pin-tract infections in 6 patients. In one patient, fracture was noted on 5th post-operative day at proximal level of construct. This was the patient with one year old neglected supracondylar humerus fracture. One patient was lost to follow-up. Others are doing well after a follow-up duration of 218 patient-months.

Functional Outcome of Proximal Humerus Fracture Managed Surgically by Joshi's External Stabilizing System

INTRODUCTION: The ideal management of proximal humerus fracture is still controversial despite various treatment options. Conservative treatment with slab is fraught with shoulder stiffness and malunion while surgical treatment with plates and nail is fraught with infection and blood loss. Therefore, Joshi External Stabilization System (JESS) being a minimally invasive percutaneous procedure can be the ideal treatment for these fractures. MATERIAL AND METHODS: This prospective and observational hospital based study was carried out in Orthopedics Department, Universal College of Medical Sciences Teaching Hospital (UCMS-TH) from December 2018 to January 2021. All patients with traumatic proximal humerus fracture who fulfilled the inclusion criteria were enrolled in the study and were treated with JESS. Fracture was classified according to Neer classification and functional outcome was assessed according to Constant Murley Score (CMS) system. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months. RESULTS: There was statistically significant difference in VAS score (p&lt;0.05) measured at six weeks, three months and six months; and CMS (p&lt;0.05) at three months and six months. There was statistically significant difference between fracture type (Neer type) and fracture union (p&lt;0.05). But the association between functional outcome and type of fracture was statically insignificant (p&gt;0.05). CONCLUSION: Displaced proximal humerus fracture when treated surgically with JESS has good functional and radiological outcome. It produces less pain, less stiffness and greater Range of Motion (ROM).

Management of Tibial Metaphyseal Fractures Using JESS Fixator

Introduction: The management of proximal and distal tibia fractures remains challenging due to associated soft tissue injuries. The use of wire fixators for the definitive treatment of such fractures entails a minimally invasive technique of insertion that gives good fracture reduction and stability combined with minimal postoperative complications. Aim: To assess the outcome of treatment of such fractures by the use of Joshi’s external stabilization system (JESS), which is a simple wire based, circular external fixator system. Materials and Methods: A prospective, uncontrolled study was done using JESS on 30 consecutive patients (20 patients of proximal tibial metaphyseal fractures and 10 of distal tibial metaphyseal fractures). Results: In our study, the most common mode of injury was road traffic accidents (21 cases), fall from height (6 cases) and slip injury (3 cases). The patients were operated at a mean interval of 3.2 days (range 1-6 days) due to associated poor soft tissue conditions. The patients were followed up for 24 weeks. Full weight bearing was allowed at 10 to 14 weeks. JESS frame was removed at mean duration of 13 weeks (range 12-16 weeks). According to knee society score (KSS), excellent result (score 80- 100) was seen in 12 patients (60%), good result (score 70-79) was seen in 4 patients (20%), fair result (score 60-69) in 3 patients (15%) and poor result (score &lt;60) in 1 patient (5%) of proximal tibial metaphyseal fracture. According to Olerud and Molander score (OAMS), excellent result (score 91-100) was seen in 5 patients (50%), good result (score 61-90) in 3 patients (30%) and fair result (score 31-60) in 2 patients (20%) of distal tibial metaphyseal fracture. The complication seen was superficial pin tract infection in 4 patients, which was managed by regular pin tract dressing and oral antibiotics. Delayed union (mean at 15.3 weeks) was seen in 2 patients with Schatzker type VI fracture and 1 patient with severe comminuted distal metaphyseal fracture. Conclusion: JESS is a simple, light, effective and cheap method and can be used as a definitive procedure to treat these fractures even with soft tissue compromise.

JESS IN THE TREATMENT OF HAND AND FOOT INJURIES –AN USEFUL ARSENAL AS DAY CARE MANAGEMENT TOOL.

BACKGROUND: Small bone fractures of hand and feet are very common in a developing country like India and consist of 15% to 20% among all patients presenting at trauma centre and orthopaedic opds. Small bone fractures such as fractures of phalanx or metacarpals are often tend to be overlooked and of deemed as less serious in nature. However even a small deformity or disability of hand and feet can hamper the functional and psychological wellbeing of a person in long term. The purpose of this study is to evaluate the functional outcome and complications associated with application principles of JESS (Joshi's External Stabilization System) xation in phalanx, metacarpal and metatarsals and their management as a day care procedure. MATERIAL AND METHODS: This prospective observational study was done over a period of 1 year on 21 patients for injuries of metacarpal, phalanx and metatarsals and followed up for a minimum period of 3 months post frame removal. RESULTS: Young patients constituted almost 60% of the study population. RTA, assault and industrial / factory setup injury is most prevalent mode of injury. Over all closed injury patients had better functional outcome than open fractures. CONCLUSION: JESS is a versatile, easy to use system that can be applied at a very average set up. Optimum management of comminuted, open and unstable small bone fractures of hand and feet is possible with JESS. We advocate more extensive use of such a low cost and versatile system in Indian setup where cost of treatment is a major factor for going forward with a treatment option.