Minimal Soft Tissue Dissection Research Articles

Functional Outcome of Solid Interlocking Nail in Open Tibial Fracture at a Tertiary Care Center: A Descriptive Cross-sectional Study

Introduction: There is a high incidence of open fractures accounting 23% of all tibial fractures. The minimal soft tissue and precarious blood supply of the shaft of tibia make these fractures vulnerable to complications. The treatment should be decided through thoughtful analysis for personality of injuries and the status of the soft tissue. Intramedullary nailing allows stable fixation with minimal soft tissues dissection and preserve the soft tissue and allows early joint motion with higher rate of union. The purpose of our study was to find the outcome of open tibial fractures lower than Gustilo type IIIb, that were treated by unreamed solid interlocking intramedullary nails. Methods: A descriptive cross-ectional study was conducted from December 2021 to June 2023 after taking approval from ethical committee. All 34 patients treated with solid interlocking intramedullary nail, without reaming for open tibial fracture during 18 months period were included in the study. Final follow up was done at one year and the outcome was assessed by Modified Ketenjian’s criteria. Results: The mean time of union rate was 15.82±3.95 weeks. Complications were: superficial infections in 4 (11.76%) patients and deep infection in 1 (2.94%) patient. Using Modified Ketenjian's Criteria, 26 (76.47%) patients had an excellent result followed by good in 7 (20.59%), fair in 1 (2.94%) and there was no case with poor outcome. Conclusions: Solid intramedullary interlocking nail is an effective treatment with minimal soft tissue dissection for open tibia fracture less than GA III B as it provides stable fixation with early mobilization and provides a high rate of union, less complication and early return to function.

Relationship between femoral component placement and patient-specific anatomical rotational landmarks in robotic arm assisted total knee Arthroplasty- a multicentric study

IntroductionOsteoarthritis of the knee is a common problem in the elderly, leading to severe morbidity. Total Knee Arthroplasty (TKA) is a widely validated surgery to provide a remarkable extent of knee function and simultaneously alleviates pain for knee osteoarthritis (OA). It is clearly understood that precision of the rotational alignment and accuracy of the technique in the placement of the femoral component is a prerequisite for excellent and successful outcomes of TKA. Advanced technology has now allowed surgeons to understand patient-specific variabilities in anatomical reference landmarks and the relationship of component positioning in relation to the reference landmarks to achieve accurate gap balancing with minimal soft tissue release.14 Robotic Arm Assisted-Total Knee Arthroplasty (RAA-TKA) is a semi-automated system that enables us in replicating the same. Using this technology, the bony resections, component positions, probable component sizing and gap balancing can be tentatively planned preoperatively with CT Scan Analysis and executed intraoperatively. Hence this study was undertaken to estimate the relationship between femoral component placement to normal rotational landmarks such as the Posterior Condylar Axis (PCA) and to quantitatively evaluate coronal and sagittal plane correction obtained. Also, we aimed to use the data to detect any anatomical variations in the study population and evaluate the accuracy of predicted component sizing, including gender-based evaluation. Materials and methodsA Prospective Observational Study of 1073 knees of patients of either sex above 50 years of age with Kellgren Lawrence Grade 4 Osteoarthritis of the knee which were confirmed with X-Ray undergoing RAA-TKA using MAKO Robotic System using Stryker Triathlon (Cruciate Substituting) CS Knee was conducted during the period between 2022 and 2023 in two South Indian hospitals specializing in joint replacement surgeries. ResultsWe found a statistically significant difference between the native Posterior Condylar Axis (PCA) (4.82 ± 2.15°) and final femoral component external rotation (3.24 ± 1.29°) with a p-value of <0.001 at 95% confidence interval. The accuracy of component size prediction was 99.8%. Also, analysis in our study has shown the most common implant sizes to be 4 in males and 2 in females. We also found no statistically significant difference based on age, size, laterality, or primary varus deformity. ConclusionsRAA-TKA provides patient-specific alignment/restricted kinematic alignment which might further enhance the outcome for the patient. Reliable deformity correction in coronal and sagittal planes can be achieved. Accurate flexion and extension gap balancing can be done through component placement and with minimal soft tissue dissection. Irrespective of all the advantages noted in RAA-TKA, further follow-up and long-term outcome studies are required to properly gauge and analyze this new technology.

Soft Tissue Structures at Risk With a Percutaneous Focal Dome Osteotomy: A Cadaver Study

The focal dome osteotomy allows deformity correction through frontal plane rotation, and if needed, anterior or posterior translation. This percutaneous technique allows extracapsular ankle realignment with minimal soft tissue dissection. While circumventing a standard anterior incision, this technique encounters soft tissue structures that must be considered. Focal dome osteotomies were simulated on 10 fresh-frozen below the knee cadavers. Centered proximal to the tibial plafond at the physeal scar, a radial arm using a 4-hole Rancho cube was used to map the dome. Medial, lateral, and central incisions were made to allow access for drilling and measured to nearby anatomic structures. Among 10 cadavers, the age and weight were 70 ± 7.96 years and 134.7 ± 30.8 pounds, respectively. In all cadavers, the hole below the most proximal posthole provided the ideal position for the creation of the osteotomy. The medial and central incisions were closest to the tibialis anterior tendon measuring 3.37 ± 2.48 mm and 0.43 ± 0.9 mm, respectively. The lateral incision and half-pin used to create the distal axis of rotation were closest to the extensor hallucis longus tendon, measuring 1.97 ± 1.92 mm and 1.27 ± 1.5 mm, respectively. Drilling the second hole from the top on a 4-hole Rancho cube, forming a 2.50 cm radial arm, created the ideal osteotomy arc. Though neurovascular structures were further away from respective incision and half-pin sites compared to tendons, in several specimens, anatomic variations held them closer, warranting preoperative handheld Doppler and mapping. Care should be taken to protect anterior ankle anatomy during dissection, drilling, and completing the osteotomy.

Prospective study of radiological and functional outcomes of humeral mid-shaft fractures by anterior bridge plating technique

Background: The humerus can be considered the most versatile bone in the human body. Can be successfully approached by a variety of methods for fracture fixation including functional bracing, plating (posterior, lateral, and anterior), and intramedullary nailing (antegrade and retrograde). Notably, many humeral fractures can be successfully managed conservatively due to the wide range of acceptability for reduction. Anterior bridge plating (ABP) which utilizes the minimally invasive approach popularly known as the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique can be said to be the latest entrant in this list. The present study was undertaken to evaluate the efficacy of ABP. Methods: The study was carried out from July 2020 to July 2022 in DR. D. Y. Patil medical college and hospital, Nerul, Navi Mumbai, involving 32 patients who met the selection criteria and were operated at the tertiary care centre. Informed consent was obtained from all the patients for use of their clinical and imaging data. Ethical committee approval was taken. The assessment of the patients was done based on functional and radiological outcomes periodically. Results: Majority of patients belongs to age group 18-25 years (46.87%). Majority of side of injury were found right side (65.62%). In most of the cases, the extent of the displacement of fractures were 2-5 cm (71.87). Conclusions: In conclusion ABP is a very good technique in treating mid-shaft humeral fractures with minimal soft tissue dissection, smaller scars, and early return to overhead activities.

"Cave-in" decompression under unilateral biportal endoscopy in a patient with upper thoracic ossification of posterior longitudinal ligament: Case report.

Thoracic ossification of the posterior longitudinal ligament (TOPLL) requires surgery for spinal cord decompression. Traditional open surgery is extremely invasive and has various complications. Unilateral biportal endoscopy (UBE) is a newly developed technique for spine surgery, especially in the lumbar region, but rare in the thoracic spine. In this study, we first used a different percutaneous UBE "cave-in" decompression technique for the treatment of beak-type TOPLL. A 31-year-old female with distinct zonesthesia and numbness below the T3 dermatome caused by beak-type TOPLL (T2-T3) underwent a two-step UBE decompression procedure. In the first step, the ipsilateral lamina, left facet joint, partial transverse process, and pedicles of T2 and T3 were removed. In the second step, a cave was created by removing the posterior third of the vertebral body (T2-T3). The eggshell-like TOPLL was excised by forceps, and the dural sac was decompressed. All procedures are performed under endoscopic guidance. A drainage tube was inserted, and the incisions were closed after compliance with the decompression scope via a C-arm. The patient's preoperative and postoperative radiological and clinical results were evaluated. Postoperative CT and MR films conformed complete decompression of the spinal cord. The patient's lower extremity muscle strength was greatly improved, and no complications occurred. The mJOA score improved from 5 to 7, with a recovery rate of 33.3%. UBE spinal decompression for TOPLL showed favorable clinical and radiological results and offers the advantages of minimal soft tissue dissection, shorter hospital stays, and a faster return to daily life activities.

Success and Complications of Microsurgical Over-Top Decompression for Lumbar Spine Stenosis: Experience in a Limited Resource Center

Objective: The overtop decompression is also called the outside-in technique or bilateral decompression from the unilateral approach. The objective of the study was to evaluate the success and complications of microsurgical over-top decompression for single-level lumbar spine stenosis. Material and Methods: This observational study was conducted at the Neurosurgery unit at Lady Reading Hospital Peshawar from Jan 2018 to December 2021. All those patients who had undergone over-top decompression for single-level degenerative lumbar spine stenosis irrespective of age and gender were included in our study. Results: We had a total of 187 patients who underwent microscopic over-top decompression for lumbar spine stenosis. Four patients lost their final follow-up. The mean age of the patients was 46 years (ranging from 18 – 68 years). Spinal stenosis was more common in men (58.3%) and at L4/5 (51.87%) level. The mean duration of surgery was 56 minutes (range 35-86 minutes). Leg pain improved in 83.1% of the cases with overall patient satisfaction after surgery in 82.5% of the cases. The most common (6.95%) complication of the procedure was iatrogenic durotomy. Most of the complications were minor and treated conservatively. Conclusions: Overtop decompression is a safe and effective minimally invasive procedure for lumbar spine stenosis. It has good results in symptomatic improvement. There is minimal soft tissue and bony dissection. Therefore, mobility and stability of the spine are preserved. Moreover, the learning curve for microscopic overtop decompression is shallow and surgery time is short.

Management of Open Ankle Fractures in Elderly Patients With a Fibula Nail is a Safe and Reliable Technique.

Ankle fractures are becoming more common in the elderly and their management is frequently challenging. There is increasing evidence of good outcomes following fibula nail fixation in the management of ankle fractures. The use of a fibula nail in open fractures comes with potential advantages such as minimal soft tissue dissection, early rehabilitation, and decreased wound complications. We aimed to assess their use in the management of open ankle fractures in the elderly. A review of patients aged 60 years or older with an open ankle fracture treated with a fibular nail at a major trauma center was conducted. All patients were managed with joint Orthopaedic and Plastic Surgical input to determine their optimal management. Functional outcome scores, postoperative complications, and re-operation rates were determined. Fifteen patients were identified with a mean age of 76 years. Patient-reported outcomes (Olerud and Molander Score) were calculated in 73% of patients. Our results demonstrated excellent outcome scores (>91) in 1 patient, good outcome scores (61-90) in 7 patients, and fair outcome scores (31-60) in 3 patients. There were no postoperative complications or re-operations within our study group. This article is the largest series presenting the outcomes of fibula nails in the management of open ankle fractures in elderly patients. We conclude that it can be used as a treatment option to safely manage open ankle fractures in the elderly. It provides a stable fixation, early weight-bearing, low risk of postoperative complications while maintaining good patient-reported functional outcomes. Level 4.

Hybrid external fixator as primary fixation in the management of proximal tibia fractures in low resource setting –our experience

Tibial plateau fractures consists of 1% of all fractures. The goals in management of such fractures are anatomical reduction and maintaining joint congruity,stable fixation of fracture fragments, restoration of joint alignment with minimal soft tissue dissection and early mobilization.The purpose of the study is to highlight the technique and assess the utility and functional outcome of hybrid external fixation in periarticular fractures of tibia.A prospective study to determine the functional and radiological outcome of hybrid external fixation in management of periarticular fractures of proximal tibia which included both open (Gustilo Anderson IIIA &amp;B) and closed injuries(Shatzker 5 &amp;6) at our institution. 81 patients with 36 months follow up showed excelled and good outcome in 88% with Rasmussen’s knee score using hybrid external fixator as primary modality of treatment with less than 20% of cases requiring additional procedures and all cases united and there was no case of non union.The hybrid external fixator provides proper osseous stability without compromising the soft tissue and allows early mobilization which results in good functional outcome.

Comparative study between delto-pectoral and deltoid splitting approach in surgical treatment of proximal humerus fractures using philos plating

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The present study was done to compare the two approaches of proximal humerus PHILOS plating on the basis of functional outcome of patients and other perioperative parameters.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 40 patients with type 2 and type 3 proximal humerus were assigned to group A and B pre-operatively using random alternate allocation. Patients in group-A were operated with deltoid splitting approach while patients in group-B were operated with delto-pectoral approach. Functional outcome was assessed at 6 weeks, 3-months and 6-months. Perioperative parameters like duration of surgery, associated complications, and hospital stay were also noted and compared.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In each group, there were 12 two-part fractures and 8 three-part fractures. For 2-part fractures the mean duration of surgery was 51.33 min for group A and 63.37 min for group B. While for 3-part fractures it was 67.5 min and 80 min respectively. Irrespective of fracture type, there was statistically significant difference between the constant scores in both groups at 3 months (2-part: group A: 67.67; group B: 44.7; p value=0.001. 3-part: group A: 66; group B: 48; p value=0.001). However, the difference between two groups at 6 months was not statistically significant.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Both approaches show satisfactory outcomes over a long period. However, the significantly less operative time and minimal soft tissue dissection in deltoid splitting approach can be used as an advantage in particular cases. Moreover, there was an early return to day-to-day activities for the deltoid splitting group which should be considered when treating an active individual.&lt;/p&gt;

Surgical outcomes of intramedullary screw fixation for metacarpal fractures: a systematic review

Background: Metacarpal fractures account for 33.3% of hand fractures. New surgical techniques have been developed to address this common injury, including retrograde intramedullary (IM) screw fixation. This technique has grown in popularity in recent years and has shown promising results but has been met with skepticism by some surgeons because of the lack of adequate large-scale outcome studies. The purpose of this study was to review all existing literature on clinical and functional outcomes for metacarpal fractures managed operatively with IM screw fixation. Methods: A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Clinical and functional outcomes as well as complications were analyzed. Results: The database search yielded 12 studies, including a total of 554 metacarpal fractures that were surgically managed with IM screw fixation. Average follow-up after surgery was 23.1 wk. Fracture union rate was 100%. Postoperative grip strength was shown to average 99.3% that of the contralateral uninjured hand. Total active range of motion averaged 249.8 degrees. The overall complication rate was 5.6%, and 3.1% required a second surgery. Conclusions: This systematic review demonstrated that intramedullary screw fixation for metacarpal fractures yields excellent clinical and functional outcomes with low complication rates. IM screw fixation provides rigid internal fixation with minimal soft-tissue dissection without extramedullary hardware, thus precluding the need for prolonged postoperative immobilization and limiting the potential for extensor tendon adhesions and digital stiffness. IM screw fixation is a viable and safe option for surgical management of metacarpal fractures. Level of Evidence: Level III.

Percutaneous Distal Metatarsal Mini-Invasive Osteotomy: Comparison Between Standard vs Modified Intraosseous Approach: A Cadaveric Study

Category:Midfoot/ForefootIntroduction/Purpose:Minimally invasive surgery (MIS) of the forefoot has gained popularity as an alternative to traditional open procedures for the treatment of metatarsalgia and hammertoe deformity. Distal metatarsal mini-invasive osteotomy (DMMO) is an extraarticular osteotomy done in a percutaneous manner, with minimal soft tissue dissection that permits elevation as well as shortening. However, there is concern for damage to vital structures due to lack of direct visualization. The objective of the study was to evaluate the structures at risk in standard versus modified DMMO.Methods:11 thawed fresh-frozen cadaveric specimens underwent minimally invasive DMMO using both the standard and modified approach. The standard technique was performed by moving the burr in a circular motion with an angle of 45° (right- handed surgeon), which cut sequentially the left, plantar, right and dorsal cortices. It was compared to a modified intraosseous technique requiring less wrist supination while remaining intraosseous. After completion of the procedures, the cadavers were fully dissected and analysed to identify unintentional injury to soft tissue structures and to verify if cuts were completely extraarticular and performed with proper angulation.Results:In the standard group the most commonly injured structures were the metatarsal joint capsules (MJC) (27%), extensor digitorum longus (EDL) (18%), and extensor digitorum brevis (EDB) (9%). The modified intraosseous group demonstrated injury to the EDL (27%), while MJC (0%) and EDB (0%) were not damaged. Distances between osteotomies and structures were 6.08 +- 3.99 mm from the dorsal metatarsal head articular surface (DMHAS), 4.85 +- 2.45 mm from EDB and 0.76 +- 1.72 mm from the EDL in the standard group and 9.92 +- 3.42 mm from the DMHAS, 4.71 +- 3.24 mm from EDB and 1.24 +- 1.84 mm from the EDL in the modified group. Statistically significant difference was found among osteotomy site and DMHAS (p=0.02).Conclusion:The most frequently injured structure was the EDL tendon with both DMMO techniques used. Intra-articular positioning of the osteotomy was more frequently observed in the standard technique. There was also a statistically significant difference between the distance of the osteotomy site and the dorsal metatarsal head articular surface when comparing the standard group and the modified group. Overall, it appears that the modified method could be a safer, less complex alternative to the standard DMMO technique, especially for the inexperienced surgeons.

RETROGRADE INTRAMEDULLARY INTERLOCKING NAILING: A PROSPECTIVE STUDY IN SUPRACONDYLAR FRACTURE OF FEMUR

Introduction: In addition, a retrograde intramedullary supracondylar nail has got distinct advantages of preservation of fracture hematoma, decreased blood loss, minimal soft tissue dissection, less operative time, and reduced rate of infection. The purpose of this study is to evaluate the results of supracondylar and intercondylar fracture of the femur, treated by close or open reduction and internal xation using a retrograde intramedullary supracondylar nail. Methods: A total number of 32 patients were enrolled in this study who presented with supracondylar femur fracture and had undergone a closed reduction and internal xation by Retrograde Femoral nail. Neer's and Sander's evaluation scoring system was used for evaluation. Results: Neer's rating was used to assess the result, according to which there were good to excellent results in 74.20% of cases. Conclusion: Supracondylar femur nail is an optimum tool for many supracondylar fractures of the femur, but it needs attention to technique to prevent the difculty

Locked Plating Versus Retrograde Intramedullary Nailing for Distal Femur Fractures: a Systematic Review and Meta-Analysis.

Modern advances in techniques and implants have allowed for a better operative fixation for distal femoral fractures. Both locked plating and retromedullary nail have allowed surgeons to stabilize these fractures with minimal soft tissue dissection and preserve blood supply. Although both the implants have been used extensively for such types of fractures, the superiority of one implant over the other is still doubtful. Therefore, we conducted this meta-analysis to compare locked plating and retrograde intramedullary nailing in distal femoral fractures. Based on prisma guidelines, electronic databases, including PubMed, Embase, Scopus, and Ovid Medline were searched using a well-defined search strategy. Outcome measures which were studied included blood loss, implant failure, infection, knee range of motion, malunion, non-union, pain, surgical duration and union time Surgical duration (95% CI 2.90 to 17.13, p <0.01) and blood loss (95% CI 69.60 to123.18, p <0.01) favoured plating group and the difference is significant. But while analysing parameters like implant failure, knee range of motion, non-union and union time, our analysis favoured nailing group, but the difference is not significant. Overall, both locked plating and retrograde intramedullary nailing are comparable with respect to union and complications in distal femur fractures, but we need further larger and high quality randomized studies to evaluate the difference.

Mini-anterior approach for surgical reduction of developmental dysplasia of the hip: a case series

Background: Our hypothesis was that the mini-anterior approach gives adequate exposure with satisfactory result in patients with developmental dysplasia of the hip. Methods: Twenty-three hips in 20 patients who had developmental dysplasia of the hip (18 girls and two boys) underwent surgical reduction using the mini-anterior approach. The incision extended from a point about 1 cm below and medial to the anterior iliac superior spine obliquely to a point about 1 cm lateral to the femoral pulsation. The average patient age at the time of surgery was 15 mo. Results: Clinical results were evaluated according to the modified McKay criteria and the cosmetic appearance of the wound. Excellent wound cosmetic appearance was present in all patients. Twenty-two hips (95.7%) were rated clinically as excellent to good, whereas only one hip was rated as fair. According to radiographic Severin grading, 20 hips (86.4%) were rated as excellent to good and only three hips (13.6%) were rated as fair. Conclusions: The mini-anterior approach can be used safely in patients with dysplasia of the hip who are younger than 20 mo with adequate exposure and minimal soft-tissue dissection. Level of Evidence: Level IV.

Elastic intramedullary nailing in the management of forearm fractures in children: A clinical study

Introduction: Forearm fractures are the most prevalent in childhood and adolescence and correspond to between 30% and 50% of all lesions that affect the immature skeleton. Successful treatment of fracture shafts of Radius and Ulna must aim at restoring full function of pronation and supination without which full use of hand is not possible. With conservative treatment, there are increased chances of redisplacement leading to high rates of failure. Intramedullary fixation is an attractive option because of short operative time, excellent cosmesis, minimal soft-tissue dissection, ease of hardware removal and early motion. Materials and Methods: This was a prospective study of 32 children of forearm fractures treated by elastic intramedullary nailing and their outcome. The study was conducted in the Department of Orthopaedics, Hindu Rao Hospital, Delhi in between March 2015 to April 2016. Forearm fractures of all children admitted through Emergency Department and Out Patient Department were included in the study. Their functional results were analysed using Price et al criteria. Results: Majority of patients were males accounting to 78.12% (n=25). Male to Female ratio was 3.6:1. Mean age of patients was 9.4 years with standard deviation (S.D) of 1.9. Fall during play accounted to majority of the cases (81.25%, n=26). Majority of the patients in this study had fractures on the left side accounting to 62.5% (n=20). Left: Right ratio was 5:3. Majority of the patients in this study had fracture both bone forearm (22A3) accounting for 53.12% (n=17). In majority of the patients, intra-operative reduction was achieved by closed means (87.5% n=28), while open reduction was required in (12.5% n= 4). Conclusion: Closed intramedullary fixation is a biological method of fixation with less damage to the muscles and the periosteum, the fracture hematoma is intact, thus leading to early bridging callus formation. The undisturbed surrounding muscles and soft tissues help in spontane

A prospective study of distal 1/3rd tibia fracture treated using locking compression plate by minimally invasive percutaneous plate osteosynthesis technique

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Distal tibia fractures are common and represent 6-8% of all lower limb fractures treated by an orthopaedic surgeon. Anatomical reduction with good fracture stability and minimal soft tissue dissection give good functional results. Locking compression plate combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) technique has yielded good results. In this prospective study, authors studied 30 patients treated with LCP using MIPPO technique to know the functional outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total 30 patients were studied in this technique, which include both male and females of different age groups treated with LCP using MIPPO technique. All the patients were followed up for 12 months between March 2018 to March 2019 in orthopaedic department. The functional and radiological outcomes were assessed.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total 30 patients both male and females were studied with age groups between 18 to 65 years. Average follow-up was 12 months using Olerud and Molander scoring system authors had excellent results in 16 patients (54%), good in 9 patients (30%), fair in 4 patients (12%) and poor outcome in 1 patient (4%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Surgery with locking compression plate along active physiotherapy proved to be better for distal tibia fractures.&lt;/p&gt;

Minimally invasive percutaneous plate osteosynthesis for closed proximal tibia fractures: A study of 30 cases

Tibial plateau fractures comprises about one percent of all fractures and complex bicondylar fractures comprise of 30% of all Tibial plateau fractures. Minimally invasive percutaneous plate osteosynthesis [MIPPO] is a method of biological fixation where a plate is percutaneously inserted and fixed at a distance proximally and distally from the site of fracture. By minimal exposure, this aids in the protection of the essential fracture hematoma, minimal soft tissue dissection, avoidance of periosteal stripping and providing a sufficient fixation. So the need for the study is to assess the effectiveness of the technique in achieving fracture union, functional outcome and to know the rate of complications associated with MIPPO. The purpose of this study was to assess the results and the efficacy of MIPPO for of the proximal tibia fracture. This is a prospective study of 30 patients with tibial condylar fractures treated by minimally invasive percutaneous plate osteosynthesis at Karpaga vinayaga institute of medical sciences and research center, Chengalpattu, Tamil Nadu. These patients were followed both clinically and radiologically after surgical fixation. A total of 30 patients with tibial condylar fracture were included in the study. The mean age of the participants was 38.70±14.14 years, with 21 (70%) males and 9 (30%) females. In our study containing 30 patients operated by MIPPO, we had 66.67% had excellent result, 20% had good results, 6.67% had fair results and remaining 6.67% had poor results. In our study it was found that high velocity injuries (type IV – VI) have poorer outcome than low velocity injuries (type I-III). In this way cautious patient selection, careful preoperative planning, delicate and reasonable soft tissue and bone handling, precise contouring of plates and vigorous postoperative rehabilitation and patient education appears to be the key to success of the procedure.

Premeasured Intramedullary Nails for the Treatment of Metacarpal Fractures: Novel Instrumentation and Technique

With nearly 36% of hand fractures occurring at the metacarpal, a variety of treatment interventions have been developed. Although many nondisplaced metacarpal fractures can be treated with conservative management, displaced, unstable, open, and extra-articular fractures require surgical attention. Compared with open reduction with plate fixation, closed reduction with intramedullary fixation has shown advantages of a simplified technique, minimal soft tissue dissection, and reduced tendon irritation and scar formation. The current study reports on the improved surgical technique associated with the use of novel instrumentation for the closed reduction and intramedullary fixation of extra-articular metacarpal fractures. The design and surgical technique of the premeasured Secure Intramedullary Nail improves fracture fixation, minimizing rotation and backing out, while reducing concerns for soft tissue irritation complications at the base of the metacarpal. Our reported case series suggests procedural efficiency, a low complication rate, and fast recovery for those with indicated extra-articular fractures.

Endoscopically Assisted Myectomy for Intramuscular Lipoma of Pronator Quadratus

Intramuscular lipoma is usually growing infiltratively and can affect any muscle, although the proximal muscles of the extremities are mostly commonly involved. This lesion can occur in the pronator quadratus. Because of muscle is small and deep seated, the intramuscular lipoma usually involves the whole muscle and even has an extramuscular component before it presents clinically. In this Technical Note, we report the technique of endoscopically assisted myectomy of the pronator quadratus for infiltrating intramuscular lipoma of the muscle. This has the advantage of minimally invasive surgery of minimal soft tissue dissection and fewer soft tissue complications.

Evaluation of functional outcome of distal femur fractures treated by closed reduction and internal fixation with retrograde femoral nail

Introduction: ‘Distal femoral fractures’ are defined as fractures up to 15 cms from distal femoral articular surface. Their traditional management comprised of skeletal traction, closed manipulation of fracture and external immobilization in the form of casts and cast bracings. These led to various complications. The trend of open reduction and internal fixation has become evident in the recent years, with a variety of implant options. This study aims to evaluate the functional outcome of 35 adult distal femur fractures treated with closed reduction and internal fixation with retrograde femoral nail. Materials and methods: 35 adults with distal femur fractures without neurovascular injury were considered for this study. After fixation, they were evaluated in regular follow-ups for functional outcome using Neer’s score and radiological union. Results: In our study, the average time for radiological union was 16.89 weeks. There were 3 patients with superficial infection. There were no varus collapse or implant failure. Functionally, 21 (60%) patients had excellent, 12 (34.29%) patients had good and 2 patients (5.71%) had fair results. There were no poor results. Conclusion: With the present study, we concluded that retrograde intramedullary supracondylar nail is a very good fixation system for distal third femoral fractures, particularly in extra-articular type fractures, due to minimal soft tissue dissection, preservation of fracture hematoma, reduced hospital stays, reduced infection rates and early mobilization.