Internal Splint Research Articles

Anatomic Double Bundle Posterior Cruciate Ligament Reconstruction Using an Internal Splint

Techniques for reconstruction of posterior cruciate ligament (PCL) tears are rapidly evolving. One problem with current techniques is that laxity may develop early in the postoperative period, leading to relapsed posterior translation of the tibia. Therefore, maintaining tibial reduction during graft incorporation is a target for improvement. We describe using an internal splint to optimize the 4-tunnel, double-bundle allograft PCL reconstruction.

Significant advancements of 4D printing in the field of orthopaedics

Researchers, engineers and doctors are continuously focusing on the development of orthopaedics parts characterised by the required responses. So, advanced manufacturing technologies are introduced to fulfil various previously faced challenges. 4D printing provides rapid development with its capability of customization of smart orthopaedics implants and appropriate surgical procedure. This technology opens up the making of innovative, adaptable internal splints, stents, replacement of tissues and organs. Thus, to write this review based article, relevant papers on 4D printing in medical/orthopaedics and smart materials are identified and studied. 4D printed parts show the capability of shape-changing and self-assembly to perform the required functions, which otherwise manufactured parts are not providing. Smart orthopaedics implants are used for spinal deformities, fracture fixation, joint, knee replacement and other related orthopaedics applications. This paper briefs about the 4D printing technology with its major benefits for orthopaedics applications. Today various smart materials are available, which could be used as raw material in 4D printing, and we have discussed capabilities of some of them. Due to the ability of shape-changing, smart implants can change their shape after being implanted in the patient body. Finally, twelve significant advancements of 4D printing in the field of orthopaedics are identified and briefly provided. Thus, 4D printing help to provide a significant effect on personalised treatments.

Sequential Delivery of Cryogel Released Growth Factors and Cytokines Accelerates Wound Healing and Improves Tissue Regeneration.

Growth factors and cytokines that are secreted by cells play a crucial role in the complex physiological reaction to tissue injury. The ability to spatially and temporally control their actions to maximize regenerative benefits and minimize side effects will help accelerate wound healing and improve tissue regeneration. In this study, the sequential targeted delivery of growth factor/cytokine combinations with regulatory functions on inflammation and tissue regeneration was examined using an internal splint wound healing model. Four examined growth factors and cytokines were effectively incorporated into a novel chitosan-based cryogel, which offered a controlled and sustained release of all factors while maintaining their biological activities. The cryogels incorporated with inflammation modulatory factors (IL-10 and TGF-β) and with wound healing factors (VEGF and FGF) were placed on the wound surface on day 0 and day 3, respectively, after wound initiation. Although wound area gradually decreased in all groups over time, the area in the cryogel group with growth factor/cytokine combinations was significantly reduced starting on day 7 and reached about 10% on day 10, as compared to 60–65% in the control groups. Sequential delivery of inflammation modulatory and wound healing factors enhanced granulation tissue formation, as well as functional neovascularization, leading to regenerative epithelialization. Collectively, the chitosan-based cryogel can serve as a controlled release system for sequential delivery of several growth factors and cytokines to accelerate tissue repair and regeneration.

Role of percutaneous vertebroplasty in osteoporotic compression fractures: A prospective study

Background: Osteoporotic vertebral compression fractures have gradually evolved into serious health care problem globally. Vertebroplasty is an outpatient procedure for OVCF. Materials and methods: Our Prospective Study Consists of Twenty Patients of Which Fifteen Wre Female and Fiove Were Male. Percutaneous Vertebroplasty Was Done In Single Level For 14 Patients Double Level For 4 Patients And Three Level For 2patients. Results: Results After 2 Year Follow up Was Excellent In 14 Patients Good In 3 Patients Fair In 1 Patient. 2 patients had cement leakage. Conclusion: Percutaneous vertebroplasty is a technically feasible treatment in patients with osteoporotic compression fractures which doesn’t respond to the best possible conservative treatment. Percutaneous vertebroplasty works as internal splint for the microfractures of vertebral body by methyl methacrylate cement which helps to relief severe pain.

Elastic Stable Intramedullary Nailing of Pediatric Tibial Fractures.

Most pediatric tibial shaft fractures (75%)1 can be treated nonoperatively; however, unstable and open fractures require surgical intervention. Titanium elastic nails have become a popular technique for fixation of pediatric tibial shaft fractures. They act as internal splints that impart relative stability to the fracture, promoting callus formation at the fracture site2. After the patient is placed in the supine position, the proximal tibial physis is marked using fluoroscopy. An anteromedial and anterolateral incision are made distal to the physis. Entry holes are created in the proximal part of the tibia, and appropriately sized titanium nails are introduced into the bone. Nail size should be 40% of the width of the canal, yielding 80% canal fill when 2 nails are used. The nails are prebent into a gentle C-shape to increase cortical contact at the apex so that 3-point fixation is achieved. The nails are passed to the fracture site, and the fracture is then reduced. The nails are then passed across the fracture site and stopped proximal to the distal tibial physis. The nails are then cut and tamped distally until there is just a short portion of nail left out of the proximal part of the tibia so that the nails can be removed once the fracture is healed. The wounds are then closed, and postoperative immobilization is applied. Many pediatric tibial shaft fractures can be treated with closed reduction and cast immobilization. Open fractures, or fractures that fail nonoperative management, can be treated with external fixation, open reduction and internal fixation (ORIF), or intramedullary stabilization3. Anatomic reduction and fracture compression can be achieved with ORIF; however, a drawback to this technique is the lack of soft-tissue coverage in the diaphyseal area of the tibia, which can lead to infection and wound-healing problems4. External fixation has traditionally been the technique of choice for open tibial fractures; however, with the ability to use flexible tibial nails in both open and closed tibial fractures, external fixation is now reserved for open fractures with large soft-tissue defects or in fractures with segmental bone loss. Intramedullary flexible nailing can be used in both open and closed tibial fractures, provides excellent fracture fixation, and utilizes incisions that are more cosmetically appealing to patients5,6. Outcomes following flexible nailing for pediatric tibial fractures are excellent. In a study of 19 patients undergoing flexible nailing for tibial shaft fractures, 18 had excellent or satisfactory results7. Compared with patients who had external fixation, those treated with flexible nails had less pain, shorter time to union, and better functional outcomes2. Compared with patients treated with ORIF, those who underwent flexible intramedullary nailing spent less time in the operating room and had lower rates of wound complications4. In the immediate postoperative period, clinicians should be aware of the risk of compartment syndrome, particularly in patients with high-energy injuries, older patients (>14 years old), and heavier patients (>50 kg)8. There is also an increased risk of soft-tissue irritation and fracture malunion in heavier patients treated with flexible nails9,10. Nail size should be 80% of the canal diameter (e.g., two 4.0-mm nails should be chosen for a canal that measures 10 mm).Nails should be properly contoured to avoid corticotomy of the far cortex during insertion; apex of the bend should be positioned at the level of the fracture.During insertion, leave room to advance nails further after they are cut proximally.Do not bury the proximal nail tips beneath the cortex as extraction will be difficult.Ensure that the ends of the nails are not lying up against the proximal tibial physis as this may cause premature growth arrest.

Poor prognostic factors of femoral shaft fractures in children treated by elastic intramedullary nailing.

Introduction: Femoral shaft fractures in pediatric patients are treated by elastic intramedullary nailing using titanium or stainless-steel nails. The elastic stable intramedullary nailing behaves as an internal splint, promoting early mobilization. This type of treatment involves a minimally invasive approach, no damage to the growth plates, and no impairment of femoral head blood supply. Purpose: The aim of our study was to identify the negative predicting factors that might lead to an increased complication rate after elastic stable intramedullary nailing of femoral shaft fractures in children. Methods: We conducted a retrospective study on 137 patients with femoral shaft fractures treated by elastic stable intramedullary nailing. Patients’ age ranged between 4 and 17 years. We used data from the medical records of the patients to evaluate postoperative complications. Plain radiographs were analyzed to determine the fracture type, fracture location, and postoperative complications such as delayed union, angular deformities, and limb length discrepancies. Multivariate analysis was conducted to identify predictors for poor outcomes. Results: Complications occurred in 29 patients (21%) and consisted of delayed union, axial deformities, or lower limb length discrepancies. In the group of patients that suffered from complications, mechanism of injury, age, and weight were significant. They were older by an average of 5 years; half of them weighed more than 50 kg and over a half were involved in a road traffic accident. Conclusions: Elastic nailing is a successful tool to treat femoral shaft fractures. Three factors were demonstrated to influence the outcome. The mechanism of injury, age > 11 years, and weight > 50 kg are the most important and are predictors for development of complications such as delayed union or deformity.

A study on role of intramedullary interlocking nailing in the complex femoral shaft fractures

<p class="abstract"><strong>Background:</strong> Fractures of the shaft of the femur are a major cause of morbidity and mortality in patients who sustain high energy trauma. Morbidity arises from limb shortening, malalignment, knee contractures and other complications of fracture.</p><p class="abstract"><strong>Methods:</strong> The aim of our study is to analyze the results of complex femoral shaft fractures treated by intramedullary interlocking nailing in our institution. Totally 20 cases of complex femoral fractures from 2007-2009 were treated with intramedullary interlocking at Krishanakumar Orthopedic Care Hospital, Nagercoil were included in our study.<strong></strong></p><p class="abstract"><strong>Results:</strong> We found that fracture of femur is most common in 2nd, 3rd and 4th decade of life, with mean age of 35.85 years. Vehicular accident in 17 patients was observed to be the main cause of fracture in our series (85%). 4 patients started full weight bearing at 10th week, 9 patients were able to bear full weight at 12th week, 4 patients at 14th week and 2 at 16th week. Average time of full weight bearing was 12.4 weeks. One patient developed deep infection (osteomyelitis) at 12 weeks and later non union was seen and unable to bear full weight.</p><p class="abstract"><strong>Conclusions:</strong> Intramedullary interlocking nailing for complex femoral fractures has been established worldwide as the gold standard treatment because of its load sharing property, internal splinting, and rotational stability. These contribute the stable osteosynthesis.</p><p class="abstract"> </p>

A prospective study on the functional and radiological outcome of paediatric shaft of femur fractures treated with TENS nailing: A case series of 22 cases

Introduction: Shaft of femur fracture are one of the most common diaphyseal fractures in children with an incidence of about 19/1 lakh population. The aim of treatment is mainly anatomical reduction and realignment with proper functioning of hip and knee joints. TENS is now the preferred treatment of choice because it involves the insertion of two or three titanium nails. Aim of Study: The aim of this study was to assess functional and radiological outcome of paediatric shaft of femur fractures treated with TENS nail. Materials and Methods: The study has been conducted in Department of Orthopaedic, K.R. Hospital December 2017 and December 2018. Patients underwent operative treatment on table with manual traction. After proper reduction of fracture, small skin incision was given on either side of distal thigh around 2 cm proximal to distal epiphyseal plate. Titanium elastic nail of the correct size with curve ends were introduced from both medial and lateral side simultaneously till fracture site after it one nail was passed across the already reduced fracture site followed by another one. Postoperatively patients were encouraged quadriceps strengthening and knee bending exercises as soon as patients could tolerate (Usually within 24 hours of surgery) and for few days, patients were kept non-weight bearing following which partial weight bearing allowed depending on the stability of fracture and callus formation but full weight bearing was allowed only after radiological evidence of firm union. Results: Total 22 patients with shaft femur fracture were operated between December 2017 and 2018 with TENS nail in the Department of Orthopaedics K.R Hospital. There were 15 boys and 7 girls aged between 5-15 years who were taken. Most of the cases were due to RTA (54%) and self-fall accounted for 46%. Out of the fractures, proximal accounted for 9%, mid-shaft fractures 68% and remaining were distal. The most common side affected in our case series was right which was in 17 kids (77%). Out of all types of fractures, transverse accounted for 31%, spiral 22% and the remaining were oblique. Closed reduction and internal fixation was done with negligible blood loss. Our patients underwent an average stay of 5 days in the hospital with minimum of 2 days and maximum of 8 days. Union in our study was achieved at an average of 9.2 weeks and cases were followed up at 2, 6, 12, 16 weeks. Conclusion: TENS is a good method of choice for paediatric fracture shaft of femur fractures particularly in the age of group of 5-15 years of age as it acts an internal splint without disturbing periosteum, promotes faster bridging and callus formation and finally early mobilization.

Management of Rib Fractures

The therapy of rib fractures is controversially discussed. Neither does an osteosynthesis have to be performed for each individual rib fracture, nor is the internal splinting by ventilation or respiratory therapy sufficient for each patient. Rib fractures are common in polytrauma patients after car and motorcycle accidents or falls from great heights. However, rib fractures are also increasingly occurring in older patients with falls from low heights. Anamnesis and clinical examination are groundbreaking for the diagnosis and therapy decision of rib fractures. In radiological diagnostics, projection radiography comes first, followed by sonography and CT. Computed tomography should be required for planning an operation. Accompanying injuries must be taken into account when deciding on therapy. We see a complicated organ injury, dislocated rib serial fractures, flail chest and respiratory insufficiency as indications for rib stabilization. As a relative indication for rib stabilization, we see a high suffering pressure due to pain and an intrathoracic volume restriction due to dislocated rib serial fractures. New osteosynthesis material and minimally invasive techniques standardize the procedure and minimize surgical trauma. In any case, adequate pain and respiratory therapy are always crucial for successful treatment.

DOZ047.106: Internal stents and external splints for complex airway obstruction

Abstract Background Life-threatening airway obstruction due to severe tracheobronchial stenosis or tracheobronchomalacia not amenable to tracheobronchopexy or resection is still a challenge, and warrants aggressive innovative strategies. In this study, our experience with placement of balloon-expandable stents and/or external bioabsorbable splints in children with severe tracheobronchial obstruction was reviewed. Methods All patients with symptomatic severe airway obstruction who underwent interaluminal stent and/or external splint placement (1997–2019) were retrospectively reviewed. The data collected included age, type of obstruction (stenosis or malacia), associated malformations, technical and clinical success, complications, and outcomes. Airway stents were placed under fluoroscopic guidance. Bioabsorbable splints (RapidSorb, Synthes CMF) were custom molded and then secured externally on the collapsing areas under simultaneous bronchoscopic and direct visualization. Results Seventeen patients underwent 14 airway stents (trachea = 5, bronchi = 9) and/or 11 external bioabsorbable splints (trachea = 5, bronchi = 6) at a median age of 5 months (IQR 3–9 months). Fourteen stents were placed in 8 patients, 10 external splints in 8 patients; one patient had two stents and one splint. Indications for stenting were stenotic airways in 11 patients (postoperative = 7, congenital = 4) and severe distal airway malacia in 3. All the external bioabsorbable splints were placed in patients with severe airway malacia secondary to lack of cartilaginous support and/or extrinsic compression. During follow-up 3/9 stented patients and 3/9 splinted patients did not experience any significant adverse events. Six of nine stented patients experienced serious adverse events: significant in-stent stenosis (n = 3), stent migration, and obstructive granulation tissue (n = 1), erosion through airway wall (n = 1), and death (n = 2). Of the nine splinted patients, one bronchial splint fractured, requiring replacement, and five patients required tracheostomies for continued respiratory failure from unilateral pulmonary hypoplasia and residual distal tracheal stenosis (n = 1), severe tracheomalacia (n = 2), subglottic stenosis (n = 1), and laryngeal cleft (n = 1). One patient died a week after surgery. Conclusion Airway internal stenting and external bioabsorbable splinting are effective therapeutic strategies for selected patients with complex airway abnormalities. Bioabsorbable splints are effective in maintaining airway patency, and being absorbable allow for age-proportional growth of the airways. Airway stents can be associated with significant adverse events and therefore should be reserved for patients who have failed other therapeutical strategies.

Surgical Fixation of Atypical Femur Fractures in Bisphosphonate-treated Patients.

ObjectiveTo evaluate the outcomes of the surgical fixation of atypical femoral fractures in bisphosphonate-treated patients with an intramedullary device.Materials and methodsThis multicentric study was carried out at the department of orthopedics, Dr. Ruth Phau Civil Hospital and Medicare Hospital, Karachi, Pakistan, between 2013 and 2018. In this retrospective observational study, we reviewed 10 bisphosphonate-treated patients, fixed surgically with an intramedullary nail after presenting with radiologically characteristic atypical femur fractures identified according to the American Society for Bone and Mineral Research criteria. We excluded patients with fractures sustained by high-energy trauma, road traffic accidents, fall from a height, and those associated with underlying malignancy.ResultsA total of 11 atypical femoral fractures in 10 patients were included, all of whom were females with a mean age of 68.6 (range 57-82) years. Out of 11 fractures, 81.8% (n=9) were located in the subtrochanteric region and two were located in the femoral shaft. The mean bisphosphonate use was 58.3 months. All patients were treated with intramedullary devices; an intramedullary interlocking nail in two cases and proximal femoral nail antirotation in nine cases. The mean follow-up duration was 12 months. All fractures were united in an average time of 9.9 months (range 6 - 16 months). Implant failure and/or nonunion were not observed, whereas delayed union was noted in five patients.ConclusionIntramedullary fixation is a reliable method for the treatment of atypical femur fractures in bisphosphonate-treated patients owing to its intramedullary placement. These devices act as an internal splint and can provide much more axial stability, reducing the risk of implant fatigue failure due to a delay in fracture healing from prolonged bisphosphonate use.

Functional evaluation of early tendon transfer for foot drop.

Early tendon transfer has shown good outcomes in peripheral nerve injuries of upper limb. However, there is lack of knowledge on early tendon transfer for peripheral nerve palsy in lower limb. This study has been designed to study the functional outcomes of early tendon transfer in the lower limb, particularly for foot drop. We enrolled 30 cases of foot drop due to traumatic sciatic/common peroneal nerve (CPN) palsy between September 2012 and March 2016. We performed nerve exploration with repair and early tendon transfer in all patients. All patients were followed up for a minimum period of 24 months. Functional evaluation was carried out using Stanmore assessment questionnaire. At the end of 24 months postoperatively, the Stanmore assessment questionnaire score showed a significant improvement from a mean preoperative score of 17.5 to mean postoperative score of 86.2. All patients were free of ankle-foot orthosis (AFO). All patients were subjectively satisfied. Time to return to original job was 5.2 months on an average. Ankle dorsiflexion of the operated limb was comparable to the normal limb in cases where there was nerve recovery. Planovalgus foot, a known complication of this procedure, was noted in 24 patients. However, it was not disabling to any patient. Early tendon transfer in CPN palsy/sciatic nerve palsy has a definite place in the management of the injured patient. The transfer, if appropriately carried out, acts as a helper, an internal splint, a substitute, or perhaps all of the three at varying times in the rehabilitative phase of the patient. Dorsiflexor clearance in swing phase of locomotion was quickly restored in all patients, obviating the need for AFO.

Acute Fixation of Type IV and V Acromioclavicular Separations: An Internal Splint Technique.

Background:There is no standard method for the surgical treatment of acromioclavicular (AC) joint separations. Current techniques have associated complications, including need for device removal, coracoid fracture, and inadequate reduction.Purpose:To evaluate the clinical outcomes of an internal splint technique without graft augmentation or rigid fixation to treat acute Rockwood type IV and V AC joint injuries.Study Design:Case series; Level of evidence, 4.Methods:A retrospective analysis was performed of 26 patients who underwent a novel internal splint fixation technique between 2011 and 2016. Patients had type IV (n = 2) and type V (n = 24) acute AC separations. The mean time to surgery was 13.7 days (range, 1-28 days). The surgical technique included an open approach with coracoclavicular suture and tape fixation and AC suture fixation. Range of motion, strength, and radiographs were evaluated after surgery. Patient follow-up included the DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire at a mean 3.3 years postoperatively (range, 6 months–8.6 years). DASH questionnaires were obtained for all patients via email. Patients were also surveyed on cosmetic appearance and willingness to undergo the operation again.Results:All patients regained full strength and range of motion following surgery. All postoperative radiographs demonstrated well-maintained reduction of the AC joint. The mean DASH score was 3.4 at final follow-up, and 23 of 26 respondents were satisfied with their postoperative shoulder appearance. There were no reoperations, and all patients stated that they would have the operation again given the same circumstances.Conclusion:The results of this study demonstrate a reliable new technique for acute fixation of type IV or V AC joint injuries via an internal splint construct. This technique enables reduction in the coronal and sagittal planes without the need for graft augmentation or a rigid implant, allowing healing of the coracoclavicular and AC ligaments.

A century of tibial intramedullary nailing

Intramedullary nailing is the mainstay of treatment for displaced closed or open tibial fractures. Acting as an internal splint, the nail facilitates healing and allows the patient early weight bearing. The use of metallic intramedullary devices dates back to World War I but this treatment was not fully accepted until Küntscher introduced his technique in the 1940s. The evolution with improvements in design and technique of intramedullary nailing has been ongoing since that time. This article examines the history, the advances, the outcomes, and controversies over the decades that have led to a treatment method that is largely successful if performed correctly and with appropriate indications.

Three-Dimensional Analysis of Nasal Symmetry Following Primary Correction of Unilateral Cleft Lip Nasal Deformity.

To evaluate nasal symmetry using three-dimensional photogrammetry following primary tip rhinoplasty with or without an internal splint in patients with unilateral complete cleft lip/palate. We captured three-dimensional images of patients with unilateral complete cleft lip/palate who underwent nasolabial repair by rotation-advancement of the lip and primary tip rhinoplasty, either with or without an internal resorbable splint, and normal control subjects. We assessed nasal symmetry by identifying the plane of maximum symmetry and the root-mean-square deviation between native and reflected surfaces. We imaged 38 controls and 38 subjects with repaired unilateral complete cleft lip/palate (20 with, 18 without an internal splint). Nasal asymmetry root-mean-square deviation clustered between 0.19 and 0.50 mm (median = 0.24 ± 0.08 mm) for controls; whereas, those with repaired unilateral complete cleft lip/palate ranged from 0.4 to 1.5 mm (median = 0.75 ± 0.40 mm). Although root-mean-square deviation ranges overlapped, patients with repaired unilateral complete cleft lip/palate had significantly greater asymmetry than controls (P < .001). We found no difference in asymmetry between patients with or without an internal splint (P = .5). Three-dimensional photogrammetry was used to successfully compare symmetry among different patient and control groups. Although "normal" nasal symmetry was attained in some patients following cleft lip/nasal repair, most had persistent asymmetry compared with normal controls. Placement of a resorbable internal splint did not improve symmetry in patients with unilateral complete cleft lip/palate.

Functional outcome of treatment of paediatric diaphysial femur fractures operated using titanium elastic nailing

Objectives: to review the experience of clinical recovery in treatment of pediatric shaft femur fracture with titanium elastic nailing. Observation: common type of fracture were transverse (41.5%) and spiral (39%) fracture. And at 12 weeks only 2 (4.9%) patients had the significant tenderness, 4 (9.8%) of patients had limb length discrepancy of 1 to 2 cms, and 41 (100%) radiological union was seen in (100%) patients. The final outcome according to Flynn’s criteria shows that excellent outcome seen in 35 (85.3%) of patients, while 4 (9.8%) patients showed satisfactory outcome. Conclusion: Titanium elastic nail seems advantageous over other surgical methods particularly in this age group because it is simple, is a load shearing device, internal splint that doesn’t violate open physis, allows early mobilization and maintains alignment. Micromotion conferred by the elasticity of the fixation promotes faster external bridging callus formation. The periostium is not disturbed and being a closed procedure there is no disturbance of fracture hematoma, thereby less risk of infection.

Surgical Fixation of Traumatic Flail Chest: An Early Experience at a Major Trauma Centre

Purpose: Traumatic flail chest injury is a potentially life threatening condition. Traditionally flail chests were managed with positive pressure ventilation to provide ‘internal splinting’ to the thoracic cage as well as improving oxygenation. However, a few studies recently suggested that some patients might benefit from early fracture fixation, allowing earlier weaning from mechanical ventilation and reducing respiratory complications. We report our very early experience in surgical fib fixation at Liverpool Hospital. Methodology: Four patients with traumatic flail chest underwent surgical rib fixation. Early in 2016 we made a decision to internally fix flail chests based on recent evidence and we report the outcomes of our first four patients. Results: The median age was 57 years old. All patients were male. Two had flail chest from motor vehicle accidents, one fell from a horse and 1 fell from ladder. All had New Injury Severity Score of 16. Number of flail segments ranged from 4 to 7. Lung contusion and pneumothorax were present in 2 patients. All patients were operated within 1 week of injury. There was no surgical mortality. Postoperative non-invasive ventilation (NIV) was needed in 2 patients, lasting 10 and 24 hours respectively. Median total length of stay (LOS) in intensive care unit (ICU) was 9.5 days, postoperative ICU stay was 3 days and hospital stay was 15.5 days. Conclusion: No mortality was associated with surgical fixation of fractured ribs. The LOS and the duration of postoperative NIV were satisfactory. As our experience grows we will be reporting more comprehensive and longer-term outcomes.

Effect of Cold Hip Bath on Autonomic Variables in Healthy Individuals - A Randomized Control Trial

Objectives: Laksha Guggulu, an Ayurvedic formulation advocated to enhance the fracture healing in ancient Indian texts, was selected to validate its effect on fracture healing on certain scientific parameters like Radiological, Serological and Histopathological studies in an experimental rat model. Methods: Eighteen Wistar rats (Rattus norvegicus) were taken to create identical fractures by a transverse osteotomy of Radial bone of their left fore limb under Ketamine and Xylazine anesthesia (intraperitoneally). Intact ulna acted as an internal splint hence, no other external or internal support to the fractures was given. Post operatively injectable antibiotic (Gentamicin) was given. These osteotomised rats were divided into three groups of six each. Group I rats were given 13.5mg/100gm body weight of the trial drug (Laksha Guggulu) twice daily through oral route. Group II rats were given half of the Group I dose of the trial drug whereas in Group III, no drug was given (Control group). The drug was given oraly with Cow’s milk. Total duration of trial was of four weeks. Healing was assessed Radiologically, Biochemically and Histopathologically. Results: Assessment of results was done according to pre-designed protocol and data analysis done statistically. Histopathological and Serological studies revealed significant results in Group I animals as compared to Group II and Group III. Radiologically the difference between the groups was not detectable. Conclusion: Laksha Guggulu has got a definite role in the enhancement of fracture healing by forming early and improved quality of the callus. However, further studies on large sample size, with more advanced investigations like Histomorphometery, Bone turnover markers and Micro CT scanning are required

Internal splinting method for isolated zygomatic arch fracture using endotracheal tube: A new method

Internal splinting method for isolated zygomatic arch fracture using endotracheal tube: A new method

Evaluation of single stage protocol using Locked plate as primary fixation in treatment of infected non-union of long bones

Background: Infected non-union of long bones is one of the most challenging problems in clinical practice. In the treatment of infected non-union it is often difficult to achieve union and eradication of infection. The treatment strategy of infected non-union generally involves two stages: control of infection by local radical debridement of dead tissue and external fixator application followed by definitive treatment of bone stabilization and bone-grafting. Treatment with different methods of external fixators like Ilizarov, Orthofix had been gold standard in the past decade. However due to complications like prolonged fixation time, poor patient compliance, pin loosening and refracture after removal, there is need for alternative method of primary bone stabilization in infected non-union of long bones. The present study evaluates the results of single stage protocol of aggressive local radical debridement and internal fixation with locking compression plate as a primary means of stabilization in the treatment of infected non-union. Materials and Methods: Twenty one cases of infected non-union (5 femurs, 15 humerus, 1 tibia) were included in present study. The procedure included single stage protocol of exploration of the nonunion with aggressive local debridement, implant removal and reaming of intramedullary canal, antibiotic spacers and beads and Locking compression plate (LCP) as primary means of stabilization. Based on requirement and judgment by treating surgeon, revision debridement and removal of antibiotic bead with bone grafting was done as planned procedure. The evaluation of results included the union of the bone (both clinically and radiological), eradication of infection, complication rate, number of reintervention surgery. Result: The mean follow-up was 14 months (range 6 months to 5 years). We had achieved infection free union in 19 cases out of total 21cases. In 1 patient with previous infection had recurrence for which revision surgery with implant removal and refixation with L.C.P and bone grafting done? In another patient additional L.C.P plate with bone graft is applied. Infection free union is achieved in both cases. The functional outcome was satisfactory in most cases. The time to bone healing averaged 4.2 months (range 3 to 7 months) Conclusion: The proposed technique is effective in treating infected nonunion with resolution of infection and bone union. The inclusion of locking compression plate as internal splint improves stability of fixation, and along with proper and adequate local radical debridement, can be used as alternative method of fixation for obtaining fracture union with a good functional result.