High-velocity Trauma Research Articles

SOCIO-DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF THE PATIENTS SUFFERING FROM DISTAL FEMORAL FRACTURE

Background: Distal femoral fractures are the fractures which occurs in distal femur involving the intercondylar and supracondylar region. Currently they account for less than 1% of all fractures whereas among femoral fractures they account for 3% to 6%.These fractures are difficult to treat and notorious for the complications. Aim: To find the socio-demographic and clinical characteristics of the patients suffering from distal femoral fracture. Methodology: The present observational and prospective study was conducted in theDepartment of Orthopaedic, Govt. Medical College, Jammu, J&K for period of 1 year on 27 patients. General information including age, sex, residence, religion, marital status, side of fracture etc. were noted on separate sheet. All fractures were classified as per AO/Müller’s classification. Results: Majority of patients i.e. 40.8% were between 18-30 years age group. 66.6% patients were males and only 33.4% were females. 63% patients were from rural area and 37% patients from urban area. Maximum percentage of patients i.e. 59.3% from Hindu community and 66.7% were married. RTA was the most common mode of injury involving 74.1% patients whereas, right limb fractures were most commonly involving 66.7% patients. As per AO/Muller’s classification B3 and C1 were most common fractures affecting 18.6% patients each. Conclusion: From present study we conclude that the distal femoral fractures were more common in young age group and RTA is the most common cause. Hence it is recommended to the authorities to implement strict traffic rules so that over speeding of vehicle can be prevented which may lead to decrease in incidence of high velocity trauma. Key words: Fractures, Road traffic accidents, Injury.

Functional outcome of distal femoral fractures managed surgically using locking compression plate laterally and augmented with titanium elastic nail system medially

Background: Distal femur fractures are generally due to high velocity trauma particularly form road traffic accidents and fall from height. The treatment of distal femur fractures has evolved from conservative to operative to fixation of both lateral and medial columns of femur.
 Aims and Objective: The aim of this study was to evaluate the functional outcome of operated cases of comminuted fracture of lower end of femur fixed with locking compression plate laterally and augmented with titanium elastic nail system medially.
 Materials and Methods: The present study was a prospective study carried out in Bharati Vidyapeeth Medical College and Hospital, Sangli after approval from institutional ethical committee. In this study, 20 patients with communited fracture of lower end of femur were included on the basis of a predefined inclusion and exclusion criteria. Detailed history was taken and clinical examination was done in all cases. After preanesthetic evaluation and relevant investigations patients were treated by reduction (close or open) and fixation was done by locking compression plate laterally and augmented with titanium elastic nail system medially. Patients were followed up at 6, 10 and 14 weeks for functional outcome by Neer’s scoring system and degree of flexion at knee joint.
 Results: Out of 20 studied cases there were 16 (80%) males and 4 (20%) were females with a M:F ratio of 4:1. The mean age of male patients was found to be 42.81+/-14.79 whereas mean age of female patients was 40.5 +/- 14.36. The mean age of male and female patients was found to be comparable with no statistically significant difference (P=0.78). Most of the patient were diagnosed with the fracture of AO TYPE C3 (7 cases), followed by AO TYPE C1 (4 cases). Full weight bearing was achieved in 8 (40%) patients within 18 weeks whereas remaining 12 (60%) patients required more than 20 weeks for full weight bearing. 14 (70%) patients had excellent outcome whereas, Good, Fair and poor outcomes were seen in 4 (20%), 1 (5%) and 1 (5%) patient. On one-way ANOVA analysis, showed that the flexion was significantly higher in 12 weeks as that of the 6 weeks (P =<0.0001). Further the flexion was significantly higher in 24 weeks as that of the 6 and 12 weeks (P =<0.0001).
 Conclusion: Our study found that locking compression plating laterally augmented with titanium elastic nail system medially for comminuted distal femoral fractures is a good fixation system and provides good angular stability.

Outcomes and complications of the INFIX technique for unstable pelvic ring injuries with high-velocity trauma: a systematic review and meta-analysis.

The pelvic INFIX technique has been proposed as a useful alternative to symphyseal plating for management of unstable pelvic ring injuries. The minimally invasive nature of the procedure, shorter operative time and less perioperative blood loss have been purported as potential advantages. This systematic review and meta-analysis were conducted to determine the outcomes and complications of the INFIX technique for unstable pelvic ring injuries. A systematic review of literature was performed on the PubMed, EMBASE and Scopus databases. Prospective and retrospective studies in all languages, whether comparative or non-comparative, pertaining to the use of INFIX in pelvic fractures were included. Studies which did not evaluate INFIX, case reports, conference abstracts and those with less than 10 cases were excluded. Cadaveric studies, technique papers and studies that did not describe the prespecified outcome measures were also excluded. Meta-analysis consisted of two different arms: a comparative arm, to compare INFIX to symphyseal plating, and a non-comparative meta-analysis arm, to determine pooled rates of outcomes and complications. Risk of bias was determined by the Methodological Index for Non-Randomised Studies (MINORS) tool. A total of 22 studies were included in the systematic review, of which 7 were comparative and 15 were non-comparative. 746 patients were included for qualitative analysis and pooled analysis done for 589 patients. The average follow-up of these studies ranged from a minimum of 5.4months to a maximum of 54months. Comparative meta-analysis (n = 3 studies) of plating and INFIX showed significantly lesser blood loss (mean difference = 176.46mL; 95% CI -207.54 to -145.38) and shorter operative time (mean difference = 26.43min, 95% CI -31.79 to -21.07) with INFIX, but no significant difference in the overall complication rates (OR 1.59, 95% CI 0.83-3.05) and functional outcome scores (mean difference = -2.51, 95% CI -5.73 to 0.71). Pooled analysis showed overall good radiological (mean percentage of excellent to good reduction = 91.4%, 95% CI 0.860-0.969) and functional outcomes (mean Majeed score = 86.48, 95% CI 83.34-89.61) with INFIX. The most common complications were lateral femoral cutaneous nerve (LFCN) injury (overall rate 28%, 95% CI 15.1-41%) and heterotopic ossification (HO) (overall rate 9.4%, 95% CI 5.5-13.3%); rates of other complications were low. Significant heterogeneity was noted in the pooled analysis of blood loss, operative time, functional outcome, HO and LFCN injury. The overall strength of evidence was found to be weak. The INFIX technique can be considered as a viable alternative to symphyseal plating for unstable pelvic ring injuries. It has the advantages of shorter operative times and less blood loss, along with comparable functional outcomes, when compared to plating. Overall, good functional outcomes can be expected. However, well-designed, multi-center randomized controlled trials are needed to conclusively prove the benefit of this technique.

Low Intensity Pulsed Ultrasound (LIPUS) for Orthopaedic Trauma: A Pilot Study

Introduction: The incidence of non-union is 5% for all fractures. Non-operative biophysical modes to stimulate osteogenesis and fracture healing have explored electrical, laser and ultrasound modalities to varying degrees of success over the past few decades. Methods: This pilot study was undertaken at a District general hospital (DGH) in a publicly funded healthcare delivery system to assess the benefits and report the healing rate/success with use of Low intensity pulsed ultrasound (LIPUS) ExoGen device in delayed and non-unions of closed appendicular skeletal fractures. A standard device that delivered acoustic radiation at an operating frequency of 1.5 MHz with a temporal average power of 30 mW/cm2 and self-administered by the patient for 20mins/day for 250 sessions was used. Results: 11 adult patients enrolled into the study were followed-up until the end of their treatment and seven of them had clinical plus radiological union with excellent outcomes. The mean age of patients was 54.9years (range: 26 to 71y). The mean follow-up duration was 18.5months (range: 10.0 to 24.5m). The mean duration from sustaining the fracture to application of ExoGen to hasten osteosynthesis was 4.1months (range: 1.0 to 9.0m). Two patients warranted revision surgery to achieve fracture union. Of the remaining two patients, one with fibrous non-union was coping satisfactorily whilst a salvage procedure was proposed for another. Discussion: LIPUS was used as an ‘Alternative’ to surgery (and revision surgery) in all but one patient where it was used as an adjunct with surgery. There were no complications with its use and the healing rate was 63.6% (7/11 patients). There was an estimated cost savings of at least £10,000 in this small cohort of patients. Smoking status, high velocity trauma, advancing age or gender did not influence the outcomes.

MIDDLE PATH REGIMEN FOR THE MANAGEMENT OF TRAUMATIC DISLOCATION OF KNEE JOINT WITH VASCULAR DEFICIT.

Background: Dislocation of the knee joint is one of the most under-reported orthopaedic emergencies due to its ability to undergo spontaneous reduction. It carries a high risk of involving the popliteal artery and peroneal nerve both acutely, or in the long term. Due to this catastrophic potential of the condition, it has been well established that it warrants prompt diagnosis and management. It may be secondary to ultra-low, low or high velocity trauma which makes every dislocation case unique due to involvement of different joint structures, capsule or fractures of the articulating bones. A broad spectrum of treatment modalities (both conservative and surgical) has been documented for this condition, with the latter showing better results across most studies. In developing countries like India, the nancial chasm is relatively bigger with a major chunk of the population unable to bear the cost of complete surgical management. Objective: To assess the functional outcome in patients with frank knee dislocations with multiligamentous injuries and vascular decit treated by a middle path regimen of an extended period of external xator and immobilization. Method: A prospective study was undertaken from January 2018 to July 2020 involving 10 patients with knee joint dislocations with vascular decit and multiligamentous injury, treated by an extended period of external xator application and immobilization. Fasciotomy was done wherever needed, in association with split thickness skin grafting. The assessments were made using Lysholm knee scoring scale (LKSS), International Knee Documentation Committee Scores (IKDC), range of motion (ROM), antero- posterior tibial translation (AP translation) and overall patient satisfaction on every follow-up. Results: The mean LKSS score was 78.3±6.23, mean IKDC score was 68.17±5.34, mean ROM progressively increased to 135.8⁰ with a mean extension lag of 2.2⁰, while the mean AP tibial translation was noted to be 9.16 mm. No poor result or complication was reported. Conclusion: The middle path regimen provides an affordable alternative for providing a stable knee to patients who are ill-affording and are expected to have a sedentary lifestyle, without indulging into rigorous activities

Current concepts in the assessment and management of multiligament injuries of the knee.

Multiligament knee injuries (MLKIs), though rare, pose significant challenges to the patient and surgeon. They often occur in the setting of high-velocity trauma and are frequently associated with concomitant intra- and extra-articular injuries, the most immediately devastating of which is vascular compromise. A detailed evaluation is required when acute or chronic MLKIs are suspected, and stress radiography, MRI and angiography are valuable adjuncts to a thorough clinical examination. Surgical treatment is widely regarded as superior to non-surgical management and has been demonstrated to improve functional outcome scores, return to work, and return to sport rates, though the incidence of post-traumatic osteoarthritis remains high in affected knees. However, acceptable results have been obtained with conservative management in populations where surgical intervention is not feasible. Early arthroscopic single-stage reconstruction is currently the mainstay of treatment for these injuries, but some recent comparative studies have found no significant differences in outcomes. Recent trends in the literature on MLKIs seem to favour early surgery over delayed surgery, though both methods have distinct advantages and disadvantages. Due to the heterogeneity of the injury and the diversity of patient factors, treatment needs to be individualised, and a single best approach with regards to the timing of surgery, repair versus reconstruction, surgical technique and surgical principles cannot be advocated. There is much controversy in the literature surrounding these topics. Early post-operative rehabilitation remains one of the most important positive prognostic factors in surgical management and requires a dedicated team-based approach. Though outcomes of MLKIs are generally favourable, complications are abundant and precautionary measures should be implemented where possible. Low resource settings are faced with unique challenges, necessitating adaptability and pragmatism in tailoring a management strategy capable of achieving comparable outcomes.

Medial swivel dislocation of talonavicular joint due to low energy trauma

<p>Medial swivel variant of talonavicular dislocation is rare. Usually, it is caused by high velocity trauma. They are relatively easier to reduce and are associated with fewer complications than pure dorsal dislocations and sub talar dislocations. We report a case of medial swivel dislocation of talonavicular caused by a low energy trauma, its management and one year follow up result.</p>

Study on effectiveness of retrograde nailing with long intramedullary supracondylar nail for shaft and supracondylar fractures of femur

Introduction: Due to modern lifestyle changes, the incidence of distal femur fractures has risen and more so in association with shaft fractures of femur because of fast world and high velocity trauma occurring in road traffic accidents. Dilemma arises when we face distal third shaft and associated supracondylar or inter-condylar fracture of femur. The aim of this study is to remove the hesitancy of performing retrograde nailing by long IMSC nail without any complications. Materials and Methods: A prospective study of 150 patients with fracture of femur shaft and supracondylar fractures was done. They were treated by using this technique, from January 2003-2017. These patients were followed up till fracture union & evaluated further postoperatively for finding its benefits. Results: In our study, the mean age of patients was 35 years. 65.3% were males and 34.7%% were females. The mode of injury in case of majority of the patients had RTA (road traffic accident) 93 patients (62%). In the present, surgical and technical related complications were encountered in 10 patients (6.7%). Our patients had a mean value of 80 points according to Neer score. Conclusions: We conclude that retrograde long IMSC nail is reliable as an alternative for conventional procedures like ante-grade nailing and plate fixation in femoral fracture shaft and supracondylar region. It is especially beneficial in conditions like osteoporosis, pregnancy & previous implant or prosthesis on ipsi-lateral side and ankylosed hip. Retrograde nailing can be done on simple radio-luscent top operating tables which are commonly available everywhere. Keywords: Femur shaft fractures, Supracondylar femur fractures, Retrograde long IMSC nailing, Fracture union.

Management of intertrochanteric fractures by dynamic hip screw VS proximal femoral nail

Introduction: Inter trochanteric fractures are more common in the age group of 20 years to 60 years due to high velocity road traffic accidents, Whereas inter trochanteric fractures may also be seen in elderly people due to mild to moderate severity of trauma in addition to high velocity trauma. The management of stable intertrochanteric fractures in young and old individuals either by Dynamic Hip Screw (DHS) or by Proximal Femoral Nail (PFN) and management of unstable IT fractures by PFN in both the age groups young and old. Materials and Methods: The study is conducted in the department of orthopaedics at Shadan Institute of Medical Sciences (SIMS). A total no. of 43 patients are included in the study out of which 20 are stable fractures, remaining are unstable fractures. The mean age is 34 years (range 20-60 yrs). The mean follow up period is 34 months (12-36 months). Results: Out of 20 patients with stable fractures treated by DHS, 15 pts (%) are excellent outcome, 3pts (%) good, 2 pts (%) fair, poor result is nil. Out of 23 patients with unstable IT fractures treated by PFN, 18 pts (%) are excellent, 3 pts (%) good, 1 pt (%) fair & 1 pt (%) with poor result. Conclusion: All IT fractures which are stable in young and old patients can be treated either by DHS or PFN with satisfactory outcome and all unstable fractures in young and elderly people should be treated by PFN. Irrespective of type of fracture, fixed by PFN has got the advantage of early mobilisation and weight bearing. Keywords: Proximal Femoral Nail, Dynamic Hip Screw, Intertrochanteric fractures, Osteoporosis, Derotation screw.

Fractography of Long Bones with High-Velocity Projectile Trauma

Previous studies of bone fractography have examined only cases of blunt trauma. Here we assess whether fracture surface features are also found on bones subjected to high-velocity projectile trauma. Civil War–era long bones were assessed for the presence of fracture surface features identified in previous studies. Of 60 bones examined, which included all major long bones, fracture surface features were identified on 57 (95%). Arrest ridges and cantilever curl were located most often and were observed on most specimens (85% and 72% of cases, respectively). Bone mirror was observed, though less frequently (2% of cases); no instances of bone hackle or wake features were found. There does not appear to be a relationship between the number of observed features and bone type or projectile type. These results demonstrate that fractography features are observed in fractures related to high-velocity projectile trauma, but additional research is needed to understand the relationship between projectile trauma and the location and orientation of these features.

Serum GFAP and UCH-L1 Distinguish Brain Injury Caused by High Velocity Trauma versus Anoxia/Hypoxia, Spontaneous Hemorrhage, and Other Etiologies

Rafter, Daniel J MD; Li, Zhuliu; Sterk, Brett; Kuang, Rui; Samadani, Uzma Author Information

English

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

Epidemiology of pelvic fractures in adult: Our experience at two tertiary care hospital in Dhaka, Bangladesh

PurposeIn Bangladesh the incidence of pelvic fracture is increasing day by day due to suboptimal roads and heavy traffic. However, there is no epidemiological study of these injuries in Bangladesh. Our aim was to study the epidemiology of patients admitted with pelvic fractures at two tertiary care hospital in Dhaka, Bangladesh. MethodsThis was a prospective study carried out on trauma patients with pelvic fracture at two level 1 trauma care center of two tertiary care hospital in Dhaka, Bangladesh. The study period was from July 2015 to June 2019 (48 months). Patient’s data including demography of patients, mechanism of injuries, fracture types, associated injuries, method of treatment, post-operative complications, length of hospital stay were recorded according to a unified protocol. ResultsThe study population was comprised of 696 patients, where 556 (79.88%) were male and 140 (20.12%) were female. Mean age was 37.75 years and road traffic accidents were the most common mode of injuries. Lateral compression fractures were the most common injuries and Urethral injuries were the most common associated injuries. Death was the outcome in 3.5% of the cases due to high energy trauma. ConclusionThis study revealed that pelvic fractures were significantly more frequent in men. Most frequent cause was road traffic accident. The majority of these cases did not required surgery. Mortality was associated with high velocity trauma with severe injuries.

Clinical Evaluation and Management Outcomes of Isolated Anterior Wall Frontal Sinus Fractures Fixation with Low Profile Miniplates

Background: Frontal sinus fractures are relatively commonwith high-velocity injury trauma. Isolated anterior wall fracturesrepresent one third of all cases. The main goals offixation are to restore the premorbid aesthetic condition andto preserve a safe and functional sinus. The ideal platingsystem used for fixation of the anterior frontal wall fracturesis the micro plating system owing to its many advantages.However, it is also feasible to utilize the low-profile miniplatingsystem as it has the same advantages.Patients and Methods: A prospective study conducted onpatients admitted to trauma unit in two departments (Maxillofacialdepartment; Assiut University Hospital and PlasticSurgery Department; Qena University Hospital) from August2017 to July 2019 (two years’ duration). The study includedall patients with anterior wall fracture of frontal sinus thatneeded open reduction and internal fixation (ORIF) with sinuspreservation. Materials used: Low profile miniplate system;KLS Martin compact system; 1.5mm craniofacial plates withthickness 0.7mm, miniscrew 1.5mm with 5mm in length anddrill bit 1.1mm diameter. Statistical analysis: Data was analyzedusing the Statistical Package for Social Sciences (SPSS)version 22. p-value <0.05 was considered significant.Results: Follow-up period ranged from 6-12 months.Clinical data revealed that none of the patients complainedfrom these miniplates concerning its palpability under theskin, sensitivity to temperature changes. No plate exposureor extrusion recorded. Only two patients had wound infectionsthat resolved by antibiotic therapy. Patients complained onlyfrom minor symptoms such as pain, supraorbital paresthesiaand facial edema. CT imaging showed good fracture healing,good alignment of the anterior wall and no plate failure(fracture). Patients were satisfied with restoration of theforehead contour and excellent aesthetic results.Conclusion: Isolated anterior wall frontal sinus fracturesare common due to high incidence rate of motor car accidentsin our country. Main lines of treatment aimed to restore a safefunctional sinus, prevent forehead contour deformity andobtain good aesthetic results. These goals can be obtained byfracture fixation with this low profile miniplate system withresultant patient satisfaction.

Incidence and Outcome Analysis of Vertebral Artery Injury in Posttraumatic Cervical Spine.

Objective:Vertebral artery injury (VAI) after cervical spine trauma often remains undiagnosed. Despite various clinical studies suggesting simultaneous occurrence of VAI with cervical spine trauma, guidelines regarding screening and management of posttraumatic VAI are yet to be formulated. The primary objective of the current study was to formulate a low-cost screening protocol for posttraumatic VAI, thereby reducing the incidence of missed VAI in developing countries.Materials and Methods:This was a single-center prospective study performed on 61 patients using plain magnetic resonance imaging (MRI) as a screening tool to assess the frequency of VAI and routine X-ray to detect morphological fracture patterns associated with the VAI in posttraumatic cervical spine cases. If the MRI study showed any evidence of vascular disruption, then further investigation in the form of computed tomography angiography was done to confirm the diagnosis.Results:This study showed the incidence of VAI was 14.75% (9/61). Of 61 patients, 16 had supraaxial, and 45 patients sustained subaxial cervical spine fractures. In the cohort of nine cases of VAI, eight patients had subaxial cervical spine injuries, of which seven were due to flexion-distraction injury. C5–C6 flexion-distraction injury was most commonly associated with VAI (4 cases). Of the nine cases, five succumbed to injury (mortality 55.55%), and 19 patients from the non-VAI group succumbed to injury (mortality 36.53%). From surviving four cases with VAI, two had improvement in the American Spinal Injury Association scale by Grade 1.Conclusion:VAI in cervical spine trauma is an underrecognized phenomenon. Plain MRI axial imaging sequence can be an instrumental low-cost screening tool in resource-deficient parts of the world. VAI has tendency to occur with high-velocity trauma like bi-facetal dislocation, which has a high mortality and poor neurological recovery.

Effect of Covid-19 lockdown in trauma cases of Rural India

Covid-19 has shocked the world and forced almost all the countries to a dumbfounded state. This virus has minimised the movement of humans, showing changes like never seen before. Positive effects have already been seen in nature and wildlife in the form of pollution control. The adverse effects of lockdown are seen as economic collapse. In this study, all the trauma patients coming to Acharya Vinobha Bhave Rural Hospital, Wardha were included irrespective of their age and mode of trauma. Period of two weeks before and two weeks after the initiation of lockdown in India from 23rd march 2020 have been taken into consideration. Both the outpatient and emergency patients were included in our study. We have observed a significant fall on overall trauma cases as expected due to the lockdown. There was a fall in the total number of cases by around three times. Our study showed that the demography of geriatric trauma, which remained almost the same and nearly all of them were old age females. Low-velocity trauma has shown an increase after lockdown from 42% to 64%, while the total numbers of cases are still less as compared to before the lockdown. High-velocity trauma cases have been reduced from 52% to 31% after lockdown, which indicates less road traffic-related injuries. During the lockdown, however, we have seen a significant fall in head neck and face trauma when compared to the upper limb and lower limb trauma.

Importance of MDCT for evaluating proximal tibia fractures

Proximal tibia fractures are most challenging fractures treated by surgeons, usually caused mainly due to high velocity trauma as motor vehicle accidents, sports injuries, due to varus or valgus load with or without axial loading or high energy trauma. Early diagnosis and better visualisation through recent radiological modalities can result in good prognosis in form of anatomical reduction and osteosynthesis and preventing impending compartment syndrome and later joint stiffness ,early mobilisation and finally good outcomes in form of patient and surgeon satisfaction. Initial diagnosis is usually made with plain skiagram in both anteroposterior and lateral views. NCCT knee with 3d reconstruction are newer modalities which help surgeon in planning for maintainance of articular surface and bone fragments than plain skiagrams. Material and methods: 30 patients were included in the study with isolated proximal tibia fractures. MDCT with plain skiagram was performed for deciding management as per Schatzker classification and were planned and managed accordingly Results: Out of thirty patients , majority of the patient classified as schatzker type 2 . The patients were managed accordingly as per fracture pattern. Conclusion: The importance of MDCT for proximal tibia fracture is very crucial in diagnosing as per classification and for better planning. Keywords: MDCT, Proximal fractures, Tibia

Assessment of functional outcome of distal intra-articular fracture of femur treated with distal femoral LCP by Neer’s score

Background: Intra-articular fracture of the femur is a composite and complex injury that poses various challenges for orthopaedic surgeon. Fracture of the distal femur are one of the most prevalent fracture encountered in high velocity trauma which are associated with high morbidity and mortality if not managed well. This necessitates early stabilization of fracture. Materials and Methods: We conducted a prospective interventional study on 25 consecutive patients with intra-articular fracture of distal femur treated by ORIF with LCP from January 2018 to December 2018 at R.N.T. Medical College Udaipur All patients were regularly followed up with x-ray and clinical examination. Post-operatively all patients were followed up for a minimum period of 1 year. The functional and radiological outcome was evaluated by Neer’s score criteria at the end of 1 year.Results: All patients were evaluated to assess their functional and radiological results using Neer’s scoring system and compared with available literature. The results were analysed using different parameters. The results were excellent in 16(64%), good in 4(16%),fair in 3(12%) and poor in 2(8%).Results were found to be excellent in majority of the patients with mean knee flexion being 950. Conclusion: Surgery in the form of open reduction and internal fixation is recommended for intra-articular fracture of femur for good outcome and early mobilization with minimum preventable complication.

A comparative study of extra-articular distal tibia fractures managed by intramedullary nailing vs locking plate

Introduction: Distal tibial fractures are common long bone fractures that occur mainly due to a high velocity trauma. These are difficult to treat because of its subcutaneous location and poor blood supply. Many studies have been published on modalities of treatment of distal tibia fractures. Available options are Intramedullary nails, locking plates and external fixators. The aim of our study was to compare intramedullary interlocking (IMIL) nailing and locking plate (LP) for the treatment of these fractures. Materials and methods: This is a prospective study consisting data of 20 patients with distal tibial fractures operated for IMIL nailing and LP. Patients were followed up for radiological and clinical outcome using The American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: The functional outcome was assessed by AOFAS score. Overall 10 patients obtained an excellent result (50%) and 8 obtained a good result (40%) and 2 obtained fair result (10%). IMIL nailing shows lower rate of delayed wound healing and superficial infection and plating may avoid malunion and knee pain. Discussion: The study suggests superiority of IMIL nailing over LP in terms of less rates of infections, early rate of union, early weight bearing. Whereas LP is better in anatomical and fixed reductions of the fracture and less knee pain. Hence the modality of treatment should be based on the patient’s injury pattern, surgeon’s expertise and clinical condition.

Extramedullary versus Intramedullary bone fixation Treatment of peritrochanteric fractures

Abstract Background In the last few decades the rate of peritrochanteric fractures has increased because of increased rate of high velocity trauma accident and bone rarefaction due to osteoporosis in old age. DHS and PFN are the gold standard treatments used in treatment of these fractures. Nineteen studies were identified for analysis from 2007 to 2017 that meet our points of comparison. Aim of the Work Assessing of efficacy and complications of treatmeant of preitrochantric fracture by DHS versus PFN. Materials and Methods Outcomes from included trials will be combined using the systematic review manger software and manually screened for eligibility to be included. PRISMA flowchart will be produced based on the search results and the inclusion /exclusion criteria. After pooling of the collected data from the desired search studies, the relative risk of each of intended outcome measures of interest will be calculated and compared between each of the two main methods of peritrochanteric bone fixation treatment to reach a satisfactory conclusion. Evidence of publication bias will be sought using the funnel plot method. Results PFN is better for treating unstable peritrochanteric fractures as it has less complications and better efficacy than DHS. Conclusion The present study supports the treatment of peritrochanteric fractures with PFN, as it has less failure of fixation, decreased wound infection, less duration of surgery and less non-union complication than DHS.