Intramedullary Interlocking Nail Research Articles

Clinical and Radiographic Evaluation of Intramedullary Interlocking Nailing for Fracture Repair in Dogs

Clinical and Radiographic Evaluation of Intramedullary Interlocking Nailing for Fracture Repair in Dogs

Outcome of Intramedullary Interlocking Nailing in the Management of Gustillo-I Diaphyseal Fracture of Tibia

Objective: To evaluate the outcome of intramedullary interlocking nailing in the management of Gustillo-I diaphyseal fracture of tibia.
 Study Design: This is an observational study.
 Setting: Study carried out at Orthopaedic Surgery department, Liaquat University of Medical and Health Sciences Jamshoro, form March 2018 to February 2021.
 Materials & Methods: 72 consecutive patients of Gustillo Type-I diaphyseal fracture of tibia. All patients age between 18-60 years with traumatic fracture like Gustillo Type-I diaphyseal fracture of tibia were included in this study. Patients reported chest, abdominal and head trauma with neurovascular deficit were excluded. Patients were prepared for surgery after relevant investigation and radiographs.
 Results: Out of 72 patients included in this study 11.11% were female (N=8) and 88.88% male (N=64); with mean age was 38.26±8.20 years (Range 18 to 60 years). Road traffic accident was common cause of tibia fracture (Gustillo Type-I). Postoperative mean union time of tibial fractures were 9.9±3. 2 week.Postoperatively started partial weight bearing associated with help of two axillary crutches. The patients walking with partial weight bearing allowed at 4.1±1.12 weeks. While patients walking with full weight bearing allowed at 10.8±2.4 weeks. Postoperatively 11(15.27%) patients were complaining of pain. Wound infection observed in 7(9.72%) cases. Clinically excellent results were found in 24(33.33%) patients, while good results remained in 30(41.66%) patients and fairs in 18(25%) patients. 
 Conclusion: We conclude that interlocking intra-medullary nailing may be considered as a suitable option for treatment of Gustilo-I diaphyseal fracture of tibia.

Outcome of Extra-Articular Fractures of Distal Femur: Less Invasive Stabilization on System (LISS) Plating versus Closed Retrograde Intramedullary Interlocking Nail

Objective: To evaluate the functional outcome of extra-articular fracture of distal femur, LISS plating versus retrograde intramedullary interlocking nailing. Study Design: Prospective/Randomized control trial Place and Duration of Study: Department of Orthopaedic Surgery, Ghulam Muhammad Mahar Medical College Sukkur from 1st July 2019 to 31st December 2020. Methodology: One hundred patients of both genders with ages 20 to 60 years presented with fractures of distal femur were included in this study. Patients were equally divided into two groups I and II. Group I contained 50 patients and received LISS plating and Group II contained 50 patients and received closed retrograde intramedullary interlocking nail, Pre and post-operative assessment was done. Post-operative complications were noted at 12th day. Functional outcomes were examined after 6 months by the NEERs criteria. Results: Sixty five (65%) patients were males (35 in group I and 30 in group II) and 35 (35%) patients were females (15 in group I and 20 in group II). Road traffic accident was the most common mode of injury in 62 (62%) patients. Most of the fractures were on right side 66 (66%). According to the NEER criteria, 80% patients shows excellent, 20% patients shows satisfactory with no poor results in Group I and in Group II 30% patients shows excellent, 66% patients shows satisfactory results and 4% shows unsatisfactory results. Conclusion: The LISS plating and closed retrograde intramedullary interlocking nail was safe and effective methods for extra-articular fractures of distal femur but there were less complications found in LISS plating. Keywords: Fracture of distal femur, LISS plating, Interlocking nail

Squat and smile assessment in predicting healing of lower limb fractures fixed with a SIGN nail

BackgroundIrrespective of the treatment method, union is the ultimate goal of any fracture treatment. However, nowadays, rather than the physician-based clinico-radiological methods, the patient-reported outcome measurements assessing their quality of life and function are gaining much popularity. This is specifically true in the part of the world where the patient needs almost complete degree of hip/knee flexion – for social, cultural, religious or occupational reason(s). The ability to squat can assess the mobility and stability of joints and thus the quality of squatting is a proxy reflection of the functional outcome after fixation of lower limb fracture. Thus, we studied to determine the inter-observer and intra-observer reliability of Radiographic Union Score for Tibia (RUST) and Squat and Smile (S & S) test in clinical photograph. We further calculated the sensitivity and specificity of S & S test in predicting healing of lower limb fracture fixed by intramedullary interlocking nail considering RUST as the gold standard. MethodsThis was a retrospective study of prospectively collected data of solid Surgical Implant Generation Network (SIGN) intramedullary interlocking nailing from a single, university-based, high volume tertiary center where 56 consecutive adults with either tibial or femoral shaft fractures fixed with a SIGN nail within one year and not requiring any surgery till minimum of eighteen-month follow-up were included. Cases without either Anterior-Posterior (AP) view and/or Lateral (Lat.) view follow-up x-ray(s) or proper S & S clinical photograph (at least 1.5-year post fixation) were excluded. The x-rays (RUST criteria) and clinical photograph (S & S grading) were scored by two independent and blinded observers each and repeated after 1 month. ResultsThe overall intra-observer reliability was from 0.773 to 0.825 and inter-observer reliability from 0.635 to 0.757 for RUST scoring which was from 0.687 to 0.785 and from 0.301 to 0.650 respectively for S & S scoring. The sensitivity and specificity of S & S in predicting fracture healing were up to 82.22% and 63.64% respectively. ConclusionThe S & S test is reliable to predict the healing of lower limb fracture fixed with an intramedullary nail. The test is more useful to determine healed fractures than to determine non-healed ones. (sensitivity being higher than specificity)

COMPARATIVE STUDY ABOUT THE OUTCOME OF COMMINUTED FRACTURE SHAFT TIBIA FIXED WITH INTERLOCKING NAIL AND BIOLOGICAL PLATING

Incidence of tibial diaphyseal fractures (26 per 100,000 persons per year in an average population) is the highest among long bone fractures. Now-a-days closed reduction with intramedullary interlocking nailing is generally accepted by surgeons to be the most popular method for fixation of tibial fractures in adults. To compare the outcome of fixation of comminuted tibial fractures following minimally invasive plating and nailing. It is prospective study of adult patients admitted to orthopedic department of Sohag university hospitals suffering from comminuted fracture Shaft tibia. The study will be approved by Scientific and Ethical committees at Sohag Faculty of Medicine. An informed written consent will be obtained from all participants. This study is being done on 30 patients of comminuted fracture shaft tibia. The average follow up time was thirty- three weeks (range from 19 to 54 weeks). The average time of union in all our 30 patients was about 13 weeks (range from 8 to 16 weeks). Three of the thirty patients had post operative fracture angulation was less than 5 degrees in the coronal and sagittal planes and one patient had post operative valgus angulation of about 5 degrees. As regard intraoperative exposure to radiation it was less in cases of biological plating There was two patients infected and they required removal of the nail and plates and treated by external fixation they represent about 10% of patients. Out of the 30 fractures managed by this method 24 fractures showed uncomplicated healing within a reasonable period of time. The complication rate was considered minimal. Only one case of non-union, two cases of delayed infection and 4 patients of malunion in valgus or varus malalignment, however we passed through a learning curve during performing this study, with most of the complications occurring in the early cases. So MIPO could attain satisfactory results in uncomminuted tibia shaft fractures, and locked intramedullary nailing is more appropriate in comminuted fractures.

A comparative study of locking plate by minimally invasive percutaneous plate osteosynthesis versus closed interlocking intramedullary nail in extra-articular distal tibia fractures

<p><strong>Background</strong>: To compare functional outcome between minimally invasive percutaneous plate osteosynthesis (MIPO) and intramedullary interlocking nail (IMIL) in the distal one-third extra-articular tibia fracture.</p><p><strong>Methods</strong>: We retrospectively analysed 32 patients with closed distal tibia extra-articular fractures who underwent IMIL nail and locking plate MIPO technique in 16 patients each. All patients were followed for at least one year with assessment of clinico-radiological union and functional outcome scoring.</p><p><strong>Results</strong>: There was comparable functional outcomes, time to union and surgical time both in IMIL nail and MIPO fixation of closed distal extra-articular tibia fractures with similar complication rate. </p><p><strong>Conclusions</strong>: Our study suggests that both IMIL nail and MIPO fixation could be used for closed distal extra-articular tibia fractures as per surgeon’s preference. However, due to small sample size in our study, we cannot draw any definitive conclusions from our preliminary results but consider them as valuable basis for future studies.</p>

A prospective randomised control study on dynamic compression plating versus intra medullary interlocking nailing in humeral diaphyseal fractures

<p class="abstract"><strong>Background:</strong> Surgical fixation of humeral shaft fractures generally involves plating or nailing. Despite the extensive literature comparing outcomes after open reduction with internal fixation (ORIF) with plating and interlocking intramedullary nailing (ILIMN) for acute humeral diaphyseal fractures, the superior treatment strategy still remains controversial. The purpose of this study was to compare the functional outcome of each method of fixation (dynamic compression plating and interlocking nailing) for the shaft of humerus fracture and to analyse statistically significant difference in the results of these two methods in terms of functional outcome, rate of healing and complications.</p><p class="abstract"><strong>Methods:</strong> We conducted a prospective randomized control study and evaluated the results of 50 patients having humeral shaft fracture which were internally fixed with antegrade interlocking nailing (25 patients) and dynamic compression plating (DCP) plate (25 patients). Patients were followed up on average of 11.4 months and their radiological outcomes were assessed with plain radiography and with DASH score.<strong></strong></p><p class="abstract"><strong>Results:</strong> The plating group had statistically significant faster radiological healing and better DASH score compared to nailing group. Also, postoperative complication rate was higher in ILN group which was statistically significant.</p><p class="abstract"><strong>Conclusions:</strong> ORIF with DCP provides better results in terms of good functional outcome, faster radiological union and less post-operative complications compared to ILIM nailing. Hence, we concluded that plating is a superior option than nailing.</p>

Comparative study of functional outcome of dynamic compression plating and interlocking nailing for fracture shaft of humerus in adults

Introduction: Fractures of humeral shaft are commonly encountered by an orthopaedic surgeon, accounting for 1-2% of all fractures. Treatment of these injuries continues to evolve as advances are made both in operative and non-operative management. Most humerus fractures are managed non operatively with anticipated good to excellent results. Surgery is indicated in certain settings, nature of injury, fracture pattern and also patient’s demand. Objective: The aim of this study is to compare the functional outcomes of plating with nailing and also the results of this study with standard works reported in literature, in terms of rate of union in both fixations, the functional outcomes of the treatment and incidence of complications like non-union, infection, radial nerve palsy. Setting: This study was conducted at the orthopedics department of a teaching hospital in India. Design: This was 2 years prospective, longitudinal, hospital based, observational study, and its outcomes. Participants: The study was done in 30 patients diagnosed as fractures of shaft of humerus of traumatic etiology meeting the inclusion & exclusion criteria, admitted at Mahatma Gandhi Memorial Hospital (attached to Kakatiya Medical College,Warangal), from December 2016 to November 2018.These patients were randomized into two groups in which 15 cases were treated by open reduction and internal fixation using the dynamic compression plate (DCP) and 15 cases were treated with closed reduction and internal fixation with intramedullary interlocking nail (ILN). Results: A detailed analysis of the functional outcome of 30 patients treated in the present study was done based on Rommen’s criteria, and out of 15 patients treated with dynamic compression plating,13 had excellent results, 2 had good results. In 15 patients treated with intramedullary interlocking nailing, 10 had excellent re sults and 3 had good results and 2 had poor result. Conclusion: Based on our experience and results

Tips and tricks in interlocking nailing in distal one third humerus shaft and segmental fractures of humerus

Background: The conventional methods like conservative treatments are well accepted for managing shaft fractures of humerus. But this needs continuous frequent vigilance on the clinical and radiological follow up to see any displacements and may need to change the line of treatment requiring surgical intervention. Closed Interlocking nailing of humerus mid shaft is routinely done as frequently as open plating because of its encouraging results. Fractures of distal one third humerus shafts are challenging for nailing especially if there is comminution and segmental fracture with short distal segment. Distal humerus fractures can be stabilised with intramedullary interlocking nails, provided adequate length is available in distal segment. The aim of this study is to explain difficulties faced in closed interlocking nailing of distal one third and below distal one third humerus shaft and solutions to overcome them and remove the hesitancy of performing nailing without any complications in such circumstances in a closed technique with minimal surgical trauma. Materials and Methods: A prospective study of 27 patients with fracture of Humerus shaft at and below one third level fractures was done. They were treated by closed interlocking nailing in period of five years from 2014 -2019. These patients were followed up till fracture union & evaluated further postoperatively for finding its benefits over open plating. Results: In our study, the age varied from 25 to 68 years. The mean age of patients was 45 years. 18 were males (65%) and 9 were females (35%). The results were based on type of fracture and healing period, infection, stiffness of elbow, restriction of movements. The results were encouragingly excellent in clinical radiological and functional outcome. Conclusions: From our present study we conclude that closed nailing of distal humerus fracture is a reliable minimal invasive alternative procedures than extensive open reduction and plating. It is especially benef

Reamer Breakage during Intramedullary Nailing in Tibial Shaft Fractures: A Case Report and Review of Literature

Background: Interlocked intramedullary nailing is the most common treatment for closed tibial fractures. Reaming is a fundamental step in this surgical technique, and reamer breakage is a rare yet challenging complication during this operation. Case Report: A 34-year old male with a tibial shaft fracture was admitted for early closed tibial nailing. During the reaming process, the reamer broke and stuck in the medulla at the isthmus level. We extracted the broken piece by back hammering a cannulated T-handle placed on the ball tip guide pin. Conclusion: In this closed and quick method, we did not use any extra device other than standard equipment of intramedullary nailing.

COMPARATIVE STUDY BETWEEN THE DYNAMIC COMPRESSION PLATING (DCP) AND THE INTRAMEDULLARY INTERLOCKING NAILING IN DIAPHYSEAL FRACTURES OF THE HUMERUS IN ADULTS

AIMS: The aim of our study was to nd the difference between the mean duration of union and functional outcome between the dynamic compression plating (DCP) and the intramedullary interlocking nailing in diaphyseal fractures of the humerus in adults. MATERIALS AND METHODS: From May 2019 to October 2019, 34 patients with diaphyseal fractures of the humerus were treated with compression plating using dynamic compression plate or with intramedullary interlocking nail. The time taken for radiological union in the two groups was compared. After satisfactory radiological union, the functional outcome was assessed by the “Disabilities of Hand, Shoulder and Elbow (DASH) Questionnaire”. RESULTS: All fractures united and a marginal difference was noted in the time taken for union. The functional outcome was better in DCP group compared to interlocking nailing group which was statistically signicant (P= 0.010). The complication associated with interlocking group was more than the DCP group. We are of the opinion that when surgery is opted as a choic CONCLUSION: e of treatment, both the modalities of treatment i.e. dynamic compression plating and interlocking nailing are good as far as union of the fracture is concerned, but considering the number of complications and functional outcome, we opine that dynamic compression plating offers better result than antegrade interlocking nailing with respect to pain and function of the shoulder joint.

Surgical management of compound fracture tibia using an unreamed interlocking intramedullary nail

Background and Objectives: Tibial fractures are one of the most common long bone fractures with increasing number of motor vehicle accidents. Complications like compartment syndrome, neurovascular injuries, malunion are common. Reaming before insertion of nail disrupts the medullary blood supply. Infection rate with reaming is high because the foreign bodies, dust, etc are pushed deeper into the tissues with reaming. Thus considering all these factors, the unreamed intramedullary nail can be used for the management of compound fractures of tibia. Materials and methods: The present study was conducted at the Department of Orthopedics, Adichunchangiri Institute of Medical Sciences, B G Nagara, Mandya district after obtaining ethical clearance. This study was conducted on 20 patients involving both male and female. Study was conducted for a period of 18 months from December 2018 to June 2020. Cases were followed up with 4 visits.Results: Compound fractures of the tibia treated by unreamed interlocking intra medullary nail gave excellent results measured by surgical outcome and patient satisfaction. This technique boasts lower rates of complications in comparison with other treatment modalities. Interpretation & Conclusion: Unreamed interlocking nailing is a lucrative option in management of compound and segmental tibial fractures. It promotes early union. Also it has low risk of infection. Early mobilisation can be advocated. It helps early return to activities.

To study the outcome of retrograde nailing in distal one-third femoral shaft fractures

Objectives: With antegrade nailing, it is difficult to achieve perfect reduction of distal shaft femur fracture because of mismatch of size of medullary canal. Short juxta-articular segment is under the influence of deforming muscle forces and the large metaphyseal volume does not allow the intramedullary nail to have cortical contact that can aid in the reduction of the fracture. Distal femur fractures typically shorten and displace into recurvatum in the sagittal plane. In the coronal plane, the fractures have a tendency to displace or angulate according to the fracture morphology. This study was performed to assess the outcome of “Distal One-Third Shaft Femur Fracture” with Retrograde Intramedullary Interlocking Nail. Its intraoperative and postoperative complications and ease of surgery using retrograde intramedullary nailing. Using intraoperative time taken for completion of surgery and total number of C-Arm exposures.Materials and Methods: The study will include 30 cases with distal one third shaft femur fractures, who will undergo surgery using retrograde nail. Patients will be followed up for a period of 6 months at 1st, 3rd and 6th month. Patients will be assessed on the basis of Demographic analysis, Mode of injury, Classification of fracture based on AO Classification, Duration of surgery, number of C-ARM exposures, Outcome of fracture, Sagittal/Coronal plane deformity, Limb Length Discrepancy/Rotational, alignment, Range of motion. Pain, functional outcome of knee using lysholm knee score and Complications observed. Results: Two patients shows malalignment rest twenty patients had normal alignment. In our study radiological union was seen in 16(72.7%) patients and nonunion was observed in 6(27.3%) patients.Conclusion: We strongly recommend the use of Retrograde Intramedullary Nail with multiple distal locking options in the patients with distal one-third femoral shaft fractures, keeping the distal end of the nail in subchondral bone.

Osteosynthesis in midshaft humerus fractures with plating versus interlocking intramedullary nailing

The humerus shaft fractures are treated conservatively for a long time, but now the operative treatment is becoming more common. But the choice of operative intervention in humerus shaft fractures requiring surgical intervention is still a debate. The present study compares functional and radiological outcome of compression plating and intramedullary nailing in management of humerus midshaft fractures. This prospective comparative study over a period of three years in management of acute midshaft humerus fractures with compression plating and antegrade interlocking intramedullary nailing was done. In the period of study total 19 cases with midshaft humerus fractures were included after satisfying the inclusion and exclusion criteria. These patients are randomized and then 10 patients were treated with compression plating and 9 patients were treated with interlocking nailing. Postoperative assessment was done and functional scoring was done by Rodríguez-Merchán criteria and radiological outcome was assessed by serial radiographs. The minimum follow-up period was of 6 months and functional score at the end of 6 month follow up was considered. In this study excellent and good results were relatively higher in compression plating group with less number of complications. However sample size is small in this study. Further such studies are needed.

Результат лечения пациентки с поражением бедренных костей множественной миеломой

Introduction Multiple myeloma (MM) is a malignant tumor that causes widespread bone damage. The bone is involved in 90 % of MM patients, and 60% of patients develop pathologic fractures. Material and methods We report a case of combined surgical treatment and chemotherapy of a multiple myeloma patient who sustained a pathological diaphyseal fracture of the left femur and later presented with a lytic myeloma lesion in the right femur. Closed reduction and interlocking intramedullary (IM) nailing of the left femur was performed for the patient who was diagnosed with bone destruction in the shaft of the right femur a few months later. The right femur was fixed with interlocking IM nail for prophylaxis. Results The left femur consolidated at 6 months. The patient had no pain in the right femur, and enlargement in the bone destruction was not seen in the femur. The patient could ambulate with a cane with signs of deforming arthritis in the adjacent joints of the lower limbs. Discussion Three common surgical approaches used for bone tumors being complicated or not complicated by a pathologic fracture include nailing/plating, bone replacement and joint arthroplasty. Bone tumor replacement with oncological endoprostheses can be produced in specialized oncological orthopaedic units and is not available with regular trauma and orthopaedic services for different reasons. The operating orthopedic surgeon is to choose the appropriate implant to address the tumor involvement. Conclusion Interlocking IM nailing can be the method of choice for a pathologic fracture or for prophylactic bone fixation with appropriate indications identified with the Mirels's scoring system. Intramedullary nailing offers the advantage of minimally invasive stability for the operated limb and early weight-bearing in contrast to plate fixation treatment for fractures and prophylactic plating.

Treatment of diaphyseal forearm fracture with interlocking intramedullary nailing: A pilot study

IntroductionThe present study was done to assess the functional outcome and complications of interlocking intramedullary (IM) radius ulna nailing to treat radio-ulna fractures in adults. MethodologyThirty adult patients with diaphyseal or segmental fractures of radius and ulna were included and treated with IM nailing. Grace and Eversmann rating system was used to assess functional evaluation and grip strength was measured using grasp dynamometer. ResultsMean age of the 30 eligible patients was 33.5 years, and males comprised 77% of the study population. Intra-operative complications like nail impaction and proximal screw locking problem for radius was present in one patient each. Increased swelling in three patients (10%) and posterior interosseous nerve palsy in one patient (3%) were observed post-operatively. In the post-operative period, all patients were able to move fingers, had 100° elbow range of motion and good grip strength. Pronation and supination till 80° was present in 80% and 57% of the patients respectively. Wrist flexion and dorsiflexion till 90° was present in 80% and 57% of the patients. Fracture union was confirmed radiologically in all cases at a mean of 3.6 weeks. Functional outcome was excellent in 73% and good in 13%. Grip strength was judged to be excellent in all cases. ConclusionsExcellent and good functional outcomes were obtained in 86%, and no case developed mal-union or delayed union. Based on our results, IM nail for surgical treatment of radial and ulnar diaphyseal fractures can be used.

Treatment Of Fracture Shaft Humerus By Intramedullary Interlocking Nail

The goal of this study is to evaluate surgical treatment outcomes of fracture shaft humerus by using intramedullary interlocking nail. Fifteen patients (ages ranged from 51 to 70 with an average age of 64.20 ± 6.338 years, (10 males and 5 females) with shaft humeral fractures from Beni-Suef University and General hospitals during the period from December 2012 to June 2014. The selected participants were treated with intramedullary interlocking nail. Patients were followed up for a mean of 9 (range 6–12) months. The mean length of hospital stay was 3 (range 1–5) days. All the fractures united radiographically after a mean of 14 (range, 12–20) weeks. Conclusion: That the majority of humeral shaft fractures can be treated safely and effectively by non-operative methods. However, for the subset of patients requiring surgical treatment, intramedullary nailing provides predictable means of achieving fracture stabilization and ultimate healing. Poor outcome in intramedullary interlocking nailing is attributable to rotator cuff tear and shoulder impingement and lack of expertise of surgeon.

Clinical management of humerus fracture using intramedullary humerus nailing system

Introduction: Intramedullary nail fixation has gained popularity and interest for the treatment of operative proximal humeral fractures. A diaphyseal fracture of the humerus is a common event accounting of approximately 3-5% of all fracture. Hence the present study was conducted with the aim to check the efficacy of interlocking nails in the treatment of diaphyseal fracture of humerus in adults. Materials and Methods: A total of 40 patients who satisfied the criteria were included in the study. All the patients were followed up at monthly interval for the first 3 months later at 2 monthly intervals till fracture union and once in 6 months till the completion of study. They were examined in details clinically and special stress was laid on shoulder and elbow range of movements and subjective complaints. Results: The overall results were analysed at the end of the study. The excellent result was obtained in the 24 patients, good result was obtain in 12 patients and poor result was found in 4 patients. Along the humerus fracture, there were 10 patients who had associated fracture. Discussion and Conclusion: Compared to other surgical modalities, closed intramedullary interlocking nailing is the least invasive surgical technique and has got least chance of post-operative infection and also reduces the hospital stay. Excellent results were seen in patients with associated injuries when humeral diaphyseal fractures were fixed with intramedullary interlocking nail as shown in the reduction in operative time and early rehabilitation. The advantages of intramedullary nailing are minimal surgical exposure, better biological fixation, and minimal disturbances of soft tissues and early mobilization of neighbouring joints.

Prospective study on functional outcome of fracture shaft of femur (Winquest Hansen type 1, 2 and 3) treated with intramedullary interlocking nail

The management of femoral shaft fractures using intramedullary nailing is a popular method. The purpose of this study was to evaluate the functional outcome after antegrade intramedullary nailing of traumatic femoral shaft fractures. In a prospective study, patients with a femoral shaft fracture but no other injuries to the lower limbs or pelvis were included. A total of 40 patients met the inclusion criteria. All were operated by standard procedure of antegrade intramedullary interlocking nailing. Patients were reviewed at 1,3,6,12 months and we used KLAUSS & KLEMN CRITERIA and McNAIRS LOWER LIMB QUESTIONNARE for quantification of functional outcome. Mean age of such fractures was 24 years(+/- 5 years) majority being male and main mechanism of injury being RTA. There were 2 cases of fat embolism and 2 cases of superficial infection which healed by conservation method. Average time of radiological union was 12-24 weeks. There were no case of non-union but 1 case of delayed union for which dynamization was done.Final functional outcome came out to be good to excellent in all the patients.

Microbiological Profile of Orthopaedic Implant Associated Infections: A Prospective Study

Introduction: The incidence of orthopaedic implantation and implantation associated infections were correspondingly increasing among the elderly and trauma patients. The resistance among the pathogens pose a unique challenge to the clinicians in the management of the infection. Extended-Spectrum Beta-Lactamase (ESBL), AmpC beta-lactamases (AmpC), Metallo Beta-Lactamases (MBL) and Methicillin-Resistant Staphylococcus aureus (MRSA) producing bacterial pathogens are responsible for a high rate of relapsing infections and outbreaks of nosocomial infections. Aim: To focus on accounting the incidence of ESBL, AmpC, MBL and MRSA and its antibiogram for effective management of implant associated infection. Materials and Methods: The present study was a prospective observational study which was conducted using various samples like pus, wound swab, serous discharge. These samples were collected under aseptic precautions in sterile containers for the period of one year (February 2015-February 2016). A total of 200 samples were inoculated on Blood agar and McConkey agar and identified. The isolates were tested for detection of ESBL, AmpC, MBL and MRSA as per standard protocol. The statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 20.0 Chicago, USA. Results: Most commonly used implants were intramedullary interlocking nail 138 (65.7%) followed by dynamic compression plates 23 (11.0%) and anatomical plates 18 (8.6%). Of the total of 200 samples, 190 (95%) samples yielded monomicrobial isolates and 10 (5%) samples yielded polymicrobial isolate. gram negative isolates 108 (51.4%) were marginally higher than gram positive isolates 102 (48.6%). The predominant isolate was S. aureus 81 (38.5%) followed by Klebsiella spp. 28 (13.3%) and Pseudomonas aeruginosa 21 (10.0%). In gram negative isolates, 76 (70.4%) were ESBL and/or AmpC producers. Of which, 48 (44.4%) were ESBL and AmpC co-producers. There were no MBL producing isolates. In gram positive isolates, majority were S. aureus 81 (79.4%) followed by Coagulase-negative Staphylococcus 21 (20.6%). Out of 81 S. aureus isolates, 46 (56.8%) were MRSA. Out of 21 CoNS, majority 17 (81%) isolates were methicillin-resistant. Implant failures were observed in 28 (14%) cases. Out of 28, majority 12 (42.8%) of the implant failures were MRSA. Conclusion: High rates of ESBL, AmpC and MRSA infections associated with implant surgeries indicate the necessity to formulate antibiotic policies and control measures. ESBL and AmpC producing strains were found to show higher rates of resistance to the various class of antibiotics when compared to non-ESBL and non-AmpC producers. MRSA isolates were found to show higher rates of resistance to various classes of antibiotics when compared to MSSA