Pin Tract Research Articles

Efficacy analysis of a double-Schanz screw external fixator combined with anti-rotating Kirschner wire in the treatment of proximal humerus fractures in skeletally immature patients

ObjectivesThe objective of this study is to evaluate the efficacy of a double-Schanz screw external fixator combined with anti-rotating Kirschner wire in the treatment of displaced Salter–Harris type II proximal humerus fractures in skeletally immature patients.MethodsA retrospective analysis was performed on 22 cases of displaced Salter–Harris type II proximal humerus fractures in skeletally immature patients who were treated with a double-Schanz screw external fixator combined with anti-rotating Kirschner wire. Patients included were the Neer–Horowitz (N–H) type 2, 3, and 4 of fracture. The basic information of the patients was recorded, fracture healing and shoulder range of motion were assessed at the last follow-up visit. The disabilities of the arm, hand (DASH) score and Constant—Murley score of the shoulder were performed to observe the occurrence of complications.ResultsThe mean age at the time of surgery was 12.41 years, and all patients completed a median follow-up of 18.18 months. There were two cases of N–H type 2, 12 cases of N–H type 3, and eight cases of N–H type 4 among the patients. At the last follow-up, all patients were able to achieve pain-free shoulder movement. There was no significant difference in shoulder function between the injured side and the uninjured side. The DASH score mean was 2.43 (95% CI 1.44–3.52). The constant score mean was 98.55 (95% CI 97.73–99.27). All patients returned to their pre-injury daily life and physical activities, and there was no significant difference in bilateral limb length at the last follow-up (p < 0.05). The most common complication of double-Schanz screw external fixator combined with anti-rotating Kirschner wire surgery was pin tract infection, which occurred in 5 cases (22.7%). There were no complications such as deep infections, vascular and nerve damage, failure of fixation, secondary fracture displacement, non-union of fracture, osteonecrosis of the humerus, joint stiffness, rotator cuff weakness and limb deformity.ConclusionThe double-Schanz screw external fixator combined with anti-rotating Kirschner wire is a safe and effective treatment for displaced Salter–Harris type II proximal humerus fractures in skeletally immature patients over the age of 10 years.

Treatment of camptodactyly with a new progressive correction device

The aim of this study was to introduce a new progressive correction device and present treatment results in camptodactyly patients. Eight patients (11 fingers) were treated for camptodactyly by an external fixator between February 2019 and April 2020. Mean follow-up was 28.7 ± 3.3 months (range, 24–35 months). Operative times and treatment complications were recorded. Pre- and post-operative flexion contracture, total active range of motion (TAM) and esthetic satisfaction were evaluated at final follow-up. Esthetic satisfaction was rated by the patient on a 1–5 point scale. Seven patients were male, and 1 female. Mean age was 21.6 ± 8.5 years (range, 15–42 years). Mean surgery time was 14.9 ± 2.4 min (range, 10−18 min). Mean preoperative flexion contracture was 85.9 ± 7° (range, 75−95°), and mean postoperative flexion contracture was 4 ± 3° (range, 0−10°). Transient proximal interphalangeal joint swelling was seen in 1 case and pin tract infection in 1. TAM was perfect in 5 fingers and good in 6. Patients were either very satisfied (n = 5) or satisfied (n = 3) with the esthetic appearance of each operated finger. Camptodactyly could be managed with a hinged external fixator simply and effectively with gratifying results in selected patients. Level of evidenceLevel IV, case series.

OUTCOME ANALYSIS OF DISTAL RADIUS FRACTURES TREATED WITH K-WIRES VS CASTING

Background Distal radius fracture has long been treated by closed reduction and casting . Although casting sufces in a proportion of cases, it may fail to maintaining the reduction is usually a problem. Hence, in a majority of cases, with cast satisfactory reduction can lost resulting in a poor anatomical and in some cases functional outcome. Percutaneous K-Wire xation1-3 is a simple way of providing additional stability to immobilization in casting an unstable fracture of distal radius in which acceptable anatomical reduction is obtainable. The technique is simple, minimally invasive and inexpensive. It is much less intrusive than other methods such as external xation. Though it has its own set of complications e.g. pin tract infection, supercial radial neuropathy etc. It still forms an effective tool in the surgical armamentarium for treatment of distal radius fractures. The present study was conducted at the de Methods partment of orthopaedics Andhra medical college/ king George hospital Visakhapatnam between 2020 and 2021.Sixty patients who fullled inclusion criteria were taken up for study n=60. They were randomly divided into two groups with 30 members each belonging to casting and k-wire xation groups. In Results both treatment methods radial length, ulnar variance, radial angulation are restored to near normal but correction of dorsal tilt is not complete. This is because the fact that volar ligaments are stronger on distraction before relatively 'Z' oriented dorsal ligaments. So, on distraction volar cortex is brought out to length before dorsal cortex preventing full correction of dorsal tilt.Cast immobilization alone could not maintain reduction in unstable fractures resulting in poor anatomical outcome.53% patients of cast immobilization had moderate to severe deformity, compared with only 11.76% patients of K wire and casting group having moderate deformity. At the end of 12 weeks, functional outcomes in the studied both types were almost similar with no signicant difference in DASH scores. At the end of the study, we concluded that Conclusion both the techniques of managements K wire xation and casting and closed reduction and casting gives near equal results in terms of functional outcome. Better anatomical reduction and maintenance of reduction can be expected with K wire xation and casting group.

Supracondylar Displaced Fracture of Elbow in Children Treated with Closed Reduction and Percutaneous K Wire Fixation

Objective: To compare the closed reduction and percutaneous K wire fixation method outcomes in the treatment of supracondylar displaced fracture of elbow in children. Study Design: Prospective study Place and Duration of Study: Department of Orthopaedics, Arif Memorial Teaching Hospital, Lahore from 2nd April 2021 to 31st September 2021. Methodology: One hundred and seventy children were included. Those children having supracondylar displaced fractures of elbow with a grade 3 were included in the study as participant. K wires of 1.5-2cm were used after closed reductions were satisfactorily achieved. Padded-Back slabs at posterior position of elbow were applied. At 2 weeks’ suture removal and pin configuration was also observed. Callus production was observed through radiological x ray images. Results: Majority of the children belonged to the age group of 6-10 years. There were 59.4% males while 40.58% were females. Within the total number of cases 55% were administered two lateral parallel K wires while 45% were administered cross K wire. Pin tract infection was formed in 2.5% of lateral K wire cases while it was observed in only 1.2 % of Cross wire cases. Most of the children got the fracture while playing a sport. The recovery phase was of 3.5 months while fracture joined in a mean value of 1 month. Conclusion: Lateral percutaneous pin technique for the management of supracondylar fracture of humerus bone is a more suitable method and offers same results without involvement of iatrogenic ulnar nerve injury. Keywords: Humerus, Ulnar nerve, Pin method, K-wire, Deformation

Subacute two stage metatarsal lengthening with gradual distraction for brachymetatarsia: A consecutive case series and literature review

BackgroundThis study examined the functional and clinical outcomes of subacute two stage metatarsal lengthening with gradual distraction for brachymetatarsia. This technique was developed to overcome the disadvantages of one-stage metatarsal lengthening and gradual distraction. MethodsFour feet of three patients with congenital brachymetatarsia underwent subacute two stage metatarsal lengthening with gradual distraction. Pain, function, and alignment were assessed preoperatively and at follow-ups using the American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal–interphalangeal scale, and any complications were recorded. ResultsThe patients were followed up for a mean of 18.1 ± 6.9 (range, 12.6–28.1) months. The mean metatarsal length gain was 15.2 ± 3.2 (range, 12.1–18.5) mm, and the corresponding percent increase was 32.5 % ± 7.0 % (range, 25.7–41.1 %). The mean AOFAS score (0−100) was 97.5 ± 5.0 at the final follow-up. The external fixator index was 10.2 ± 1.5 (range, 8.1–11.6) days/cm. None of the patients experienced metatarsophalangeal stiffness, subluxation or dislocation of the metatarsophalangeal joint, loss of correction, pin tract infection, delayed union, nonunion, or angular deformities. ConclusionSubacute two stage metatarsal lengthening with gradual distraction is a reliable alternative treatment for brachymetatarsia.

When the center cannot hold in conventional orthopedic and trauma treatments, things will not fall apart with linear rail system: A hospital based retrospective study

Background: Distraction osteogenesis is a method of producing unlimited quantities of living bone directly from a special osteotomy (cortico to my). Advances in methods of external fixation have made limb lengthening a feasible option achieved by distraction osteogenesis. Complex trauma cases such as failure of fractures to unite after several attempts, significant soft tissue infection, significant bone loss ab initio, the presence of significant soft tissue loss, or chronic osteomyelitis that may warrant significant bone resection are a nightmare to the surgeon the patient and the patients relations as well. The linear rail system and the Ilizarov device oppose other methods of bone gap management permits the realization of compression, distraction, bone-lengthening, and deformity correction, as such improving the quality of life of the patients, good fracture union with insignificant complications.Methods: A hospital based retrospective study conducted at The Potters Specialist Hospital Jos between January 2018 and December 2020. Patients were recruited following a perusal of the operation register. A proforma was filled which included the patient’s demographics, clinical characteristics. Clinical outcomes during the treatment such union at fracture site, length gained and complications during treatment were included in the proforma. Patient’s quality of life after the treatment was also assessed. Data was analyzed using SPSS version 23.Results: Thirty-six patients were enrolled into the study. Patients mean age was 39.36±10.64. Age group 31-40 accounted for 47.2% of those recruited. Males were 83.3% and complications of fracture management were noticed to account for 22 (61.1%) of the indications for surgery. Those who had two surgeries done during treatment were 27.8% with interval corticotomy counting as a separate surgery. Limb lengthening was done in 52.8% of the patients and the leg was found to be operated limb 75% of cases. Though 72.6% did not develop any problems, among those with problems, pin tract infection was noticed in 13.9%. Similarly, 88.9% had no complications but amongst complications noted limb length discrepancy in 5.6%. All of them had their fractures united and limb lengths equalized to an acceptable level. Regarding quality of life most patients (44.4%) rated it as good and the other 22.2% very good and when asked about the satisfaction their current health 50% said they were satisfied and another 19.4% were very satisfied.There was significant association noticed between quality of life and indications for surgery, between complication and aim of surgery and noticed between complication and length gained.Conclusion: The use of the linear rail system in the treatment of complex major limb fractures yielded satisfactory results with improved quality of life and less problems and complications.

Assessing the outcomes of treatment of infected long bone nonunion fracture with distraction osteogenesis using the linear rail system

Background: The treatment of bone gap due to an infected nonunion and open infected fracture is very interesting and controversial topic in orthopedics due to factors such as poor vascularity of surrounding tissue. Distraction osteogenesis is a method of producing unlimited quantities of living bone directly from a special osteotomy site. This study was performed to assess the role of bone transport by rail fixator (Pitkar, India) in treatment of bone gap in long bones due to infected long bones nonunion fracture.Methods: Patients folders were perused, proforma formed and data collected partly from the folder and partly filled by the enrollee. Information as regards biodata, clinicoradiological characteristics, Outcome of management were taken. Patient also filled the quality of life questionnaire. Data analyzed using SPSS version 23 and represented as charts and tables.Variables were compared and conclusions drawn’.Results: 85.7% were males. M:F ratio 6:1. Ages 32-40 were the most operated (50%). Limb lengthening was done in 53.6% while bone transport in 39.3%.the tibia was the bone most operated in 85.7% of cases. Most distractions were less than 7cm (50%).Pin tract infection was the most common problem found in 5 out of the 28enrollees, most had no problems.Limb length discrepancy was found in 7.1%.There were associations found between complication and aim of surgery and also with length gained.Conclusion: The linear rail system is vasatile in the treatment of infected long bone nonunion fractures with excellent result, little complications and a very satisfactory quality of life.

Management of calcaneal fractures using the minimally invasive, the ilizarov ring fixation technique

Introduction: The calcaneal fractures usually result from high energy trauma such as fall from height, road traffic and industrial accidents. Calcaneal fractures constitute about 2% of all skeltal fractures. These fractures are usually displaced and intraarticular in about 60 to 75% of cases and the treatment varies accordingly, however there is still controversy regarding the treatment of calcaneal fractures.Materials and Methods: The current study retrospectively analyzed 30 cases of calcaneal fractures using the minimally invasive, the ilizarov ring fixation technique at the Postgraduate Department of Orthopaedics, Government hospital for Bone and Joint Surgery Barzulla, an associated hospital of GMC Srinagar from date June 2020 to June 2021.Results: There were 12 (40%) excellent, 9(30%) good, 5(16.66 %) fair and 4(13.33%) poor. We achieved good alignment in all cases except 4 (13.33%) feet and had varus deformity at the last follow‑up. Superficial pin tract infection occurred in 5 (16.66%) fractures which was controlled with local antibiotics and frequent pin care. The range of movement of the subtalar joint was >25° in 23 (76.66%) patients. In 7 (23.33%), the range of movement of the subtalar joint was

Outcomes of PIPA/DIPA with Retrograde Screw Fixation for Correction of Lesser Toe Deformities

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Hammertoes and other lesser toe deformities represent extremely common foot problems, affecting nearly one-third of the general population. When surgery is indicated, correction of these deformities has traditionally been described using a PIP arthroplasty technique with a smooth, temporary Kirschner-wire for fixation. This method can produce excellent results, but there are well-described risks including deformity recurrence, secondary deformities, painful nonunion, and pin tract infections. Our goal is to describe a more modern technique that includes preparation and arthrodesis of both the PIP and DIP joints with intramedullary screw fixation. Methods: A retrospective chart review was conducted at one tertiary referral center of patients who underwent correction of lesser toe deformity between 2017 and 2021. Inclusion criteria were patient age greater than 18, use of the PIPA/DIPA technique with screw, and a minimum 10 weeks of follow up with radiographs. Charts were reviewed for patient demographics, comorbidities, preoperative characteristics, and postoperative complications. Our primary outcome variable was deformity correction achieved and maintained at minimum 10 weeks postoperatively based on both chart review and radiographs. Secondary outcomes included hardware failure, infection, vascular complication, screw removal for any reason, nonunion, and amputation. Results: 129 patients and 374 operative toes were identified on chart review and met inclusion criteria. Of these patients, 370 toes (98.9%) maintained deformity correction both clinically and radiographically at 10 weeks and did not undergo revision surgery. 17 toes (4.5%) required screw removal for any reason. 3 toes (0.8%) experienced deep infection, and 1 patient experienced superficial infection that resolved with oral antibiotic treatment. Furthermore, in addition to a concomitant deep infection, one toe experienced vascular compromise and required amputation. There were no symptomatic nonunions, and there were 7 (1.8%) asymptomatic nonunions as seen on radiographs. Conclusion: With respect to previously and classically described methods of lesser toe deformity correction, the PIPA/DIPA technique with a retrograde screw presents an acceptable and safe method for sustained deformity correction.

Temporary spacer rod and plate technique: a novel intraoperative technical tip for minimizing the docking site malalignment during bone transport for bone loss in Gustilo IIIb open tibial fractures.

Distraction osteogenesis is a safe and reliable option for managing bone defects of the tibia following major open fractures. Even though the Limb Reconstruction System (LRS) is a popular option, it may result in malalignment, necessitating an additional procedure to correct the alignment. The objective of the study is to assess the efficacy of a novel surgical technique in minimising malalignment. This was a retrospective cohort study conducted at a level 1 tertiary trauma centre consisting of 35 patients with primary bone loss following open tibia fractures. A uniplanar LRS frame was applied using a combined spacer rod with plate technique. Radiological assessment of docking site characteristics (translation, angulation) and functional assessment using ASAMI score was done. The mean distraction regenerate length was 8.4 ± 3.45cm. At the docking site, 18 patients did not have any deformity, 13 had a minor deformity of ≤ 5°, 2 had a moderate deformity of 6°-10° and 2 with a severe deformity > 10°. Circumferential docking was seen in 88.5% (31/35). According to the ASAMI functional scoring, 13 patients had excellent outcomes, 19 had good, one had fair, and two had poor outcomes. Six patients had pin tract infections, three had deep infections, and 17 had a delayed union. Our study had a lower incidence of malalignment compared to similar studies in the literature. The use of this simple and economical intra-operative technique allowed for much higher precision in aligning the fracture ends, thus minimising the docking site malalignment. III. Level I Tertiary trauma centre.

External Locking Plate Fixation for Femoral Subtrochanteric Fractures.

IntroductionInternal fixation is the treatment of choice for subtrochanteric fractures in most conditions. However, it may be an unsuitable procedure for patients with poor health status, osteomyelitis, and surrounding soft tissue compromise. This study aimed to ascertain the viability and reliability of using external locking plate fixation for these difficult cases.MethodsEleven patients with femoral subtrochanteric fractures who received external locking plate fixation in our institute from January 2014 to December 2019 were enrolled in our study. The bone union time, wound complication, alignment, and necessity for narcotic agents were evaluated.ResultsThe average length of follow-up was 17.5 months (range, 14-26 months). The mean time for bone union was 17.7 weeks (range, 15-21 weeks). The indications included poor health condition, soft tissue compromise, and post-operative osteomyelitis. Pin tract infection was noted in two patients who were treated successfully with oral antibiotics administration and removal of the involved screws. Osseous union with varus deformity <10° was achieved in all patients except one. Three patients required an orally administered pain killer at the final visit. The average Harris Hip Score at one year post-operatively was 66.6 (range, 49-80).ConclusionsAlthough the current study only involved 11 patients, we believe that our method may serve as a valuable alternative for the treatment of a femoral subtrochanteric fracture in selected cases.Level of EvidenceLevel IV, retrospective case series

Minimally Invasive Osteosynthesis of Intraarticular Calcaneus Fracture Augmented by Femoral Head Allograft: A Retrospective Study.

Aim: The aim of this retrospective study is to report the results of minimally invasive osteosynthesis when used for the treatment of intraarticular calcaneus fracture. This old technique is regaining popularity recently with the multiple advances added by different institutes when it is used in the management of intraarticular calcaneus fracture.Methods: Twenty-four patients who suffered from intraarticular calcaneus fractures between 2014 and 2019 were included. Twelve of them had Sanders II fractures (group A) and 12 had Sanders III + IV fractures (group B). The mean follow-up duration was 37.5 months. The mean age at presentation was 54.23 ± 12.48 years. The skin condition at presentation was poor (blood-filled blisters) in 25% of patients equally distributed between the two groups. The mean time to surgery was 5.6 days where patients with poor skin conditions were treated lately. The technique involved percutaneous ascending proximal-to-distal pinning of the calcaneus after reduction using a 2 cm mini-incision below the lateral malleolus and augmenting the fixation with femoral head cancellous allograft. The primary outcomes variables analyzed in this study are post-operative Bohler angle, post-operative Gissane angle, American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score at long-term follow-up (Excellent>95, Good 75-94, Fair 51-74, poor 0-50), and the delta angle benefit score. The secondary outcomes included post-operative complications such as infection and osteoarthritis.Results: The radiological results showed significant improvement of Bohler angle from 6.09° ± 21.6 pre-operatively, to 31.79° ± 14.1 postoperatively with a p-value <0.001. An adequate reduction was achieved in 54.16% to 70.8% of patients. There is a trend to normalization of overcorrected fracture especially Sanders II with a mean reduction of 12,71° ± 11,88 at one year post-operatively (p=0.05). AOFAS score at the last follow-up shows 20.83% poor results (AOFAS<50), 50% fair results (AOFAS between 51-74), 16.67% good results (AOFAS 75-94), and 12.5% excellent results (AOFAS>95. The satisfaction rate was 83.3% (45.8% partially satisfied, and 37.5% fully satisfied). The incidence of superficial infection (wound inflammation and pin tract infection) was more prevalent in higher group B (40%) compared to group A (0%) with p=0.014. Other complications including osteoarthritis and varus deformity were found in 95.8% and 58.3% of patients respectively at three-year follow-up.Conclusion: The combination of minimally invasive osteosynthesis and femoral head allograft for the treatment of intraarticular calcaneus fractures seems to give fair to good functional results. Radiological data demonstrated that when the Bohler angle is over-reduced >40°, there was a tendency to autocorrection over time. This may be due to progressive depression of the angle over time as weight bearing is authorized; however, this must be analyzed carefully due to the low number of patients who were overreduced (seven patients). Our study demonstrates that this technique has a low early complication rate (especially low infection and soft tissue problems) but carries high long-term complications such as osteoarthritis and hindfoot varus.

Outcomes of Primary Ilizarov Ring Fixator for Segmental Tibial Fracture with Compromised Skin: A Prospective Study

Background: Tibial diaphyseal fracture is the most commonly encountered fracture in orthopedic practice. There are various methods to treat the same, ranging from conservative to operative treatment. The operative methods include internal fixation using nailing and plating and external fixation using fixator/ring fixator. This study aims to evaluate the results of primary treatment of segmental tibial fracture in patients with a compromised skin condition using the Ilizarov fixator and look for complications.&#x0D; Methods: This prospective study was conducted at a tertiary level health care center. It included a series of 40 patients with segmental tibial fractures. Classification of the segmental tibial fractures was done according to Melis et al. The fixator was designed with three fixation blocks and two working length sections. The patients were evaluated for the progression clinically and radiographically at 2-week intervals for the first 2 months and were then followed by 4-week intervals. Results were evaluated according to the Association for the Study and Application of the Methods of Ilizarov (ASAMI) classification.&#x0D; Results: We treated 40 patients with a segmental tibial fracture with compromised skin using the Ilizarov ring fixator. Patients were followed up after surgery with an average follow-up of 13.8 months. The average union time came out to be 27.6 weeks for the proximal segment and 33.31 weeks for the distal segment. Out of the total patients, 15 (37.5%) patients had pin tract infection, and one (2.7%) patient had nonunion, which later required bone grafting. Bone results of patients at final follow-up as evaluated by ASAMI score were 91.7% excellent, 5.6% good, and 2.7% poor. Functional results of patients at final follow-up as evaluated by ASAMI score were 80.5% excellent, 1.7% good, and 2.8% poor.&#x0D; Conclusion: In the existing literature, segmental tibial fractures have always been difficult to treat. They are associated with high complication rates due to the lack of surrounding soft tissues. The proximal and distal fragments may be more difficult to treat because of the serious direct injury to the soft tissues overlying the segment and the difficulty stabilizing this bone segment with implants. With the use of Ilizarov technique, there is a good mean time to union, a low rate of reoperations, and good functional and general health-status outcome.

Long-term results of trans-scaphoid perilunate fracture dislocations treated by open reduction and internal fixation

PurposeThe paper holds the research purpose of confirming the long-term results of trans-scaphoid perilunate fracture dislocations (TSPFD) under the treatment of open reduction and internal fixation.MethodsAnteroposterial-lateral radiographs of the patient's wrist were taken before and after surgery. We use a dorsal approach for all cases. Postoperative clinical and radiographic assessments were performed routinely. The scapholunate angle (SLA), estradiol angle (RLA), as well as lunotriquetral distance (LTD) assisted in the radiographic assessment. Clinical assessment was performed using the Krimmer score, modified Mayo wrist score (MWS), active flexion extension arc (FEA), radial deviation and ulnar deviation arc (RUDA) and grip strength. A visual analog scale (VAS) assisted in the pain evaluation, the VAS score ranges from 0 to 10.ResultsTwenty-two TSPFD patients due to the wrist trauma received operative treatment and we retrospectively analyzed the surgical results, together with evaluating their clinical and radiological follow-up. These patients held a mean age of 30 years old. Herzberg’s perilunate fracture-dislocation classification was taken into account to find that 19 males and 3 females suffered dorsal dislocation. The fellow-up time lasted 98.3 months on average. All cases obtained sufficient union after open reduction and internal fixation. The last follow-up found the median of grip strength was 20.00 (interquartile range, 20.00–21.25), which was 84.5% of the normal side. The modified Mayo wrist score evaluation scale considered 12 cases as excellent, and 10 good. The median of VAS and Krimmer scores at the final follow-up were 1.50 (interquartile range, 0.75–2.00) and 100.00 (interquartile range, 100.00–100.00), respectively, higher relative to the pre-operation (P < 0.001). No patients showed nerve damage preoperatively or postoperatively, or pin tract infection in any of the patient.ConclusionsIt is necessary to diagnose such complicated biomechanical damage in early stage and adopt the open reduction and stable fixation for treatment; appropriate treatment can contribute to a functionally adequate and anatomically integrated wrist.

Complication of lengthening and the role of post-operative care, physical and psychological rehabilitation among fibula hemimelia.

There is a clear clinical need for efficient physiotherapy and rehabilitation programs during and after bone lengthening and reconstruction for gaining the optimal effect and also prevention or treatment of lengthening side effects. Pin tract infection is the most prevalent side effect during lengthening which could be prevented and treated initially via proper wound care. Muscle contractures are typically a consequence of the generated tension on the distracted muscle. It can be managed by physiotherapy initially and surgically in later severe stages. Furthermore, it is essential to avoid muscle contracture development, which is the demonstration of the imbalanced muscle appeals on the joint to inhibit the following subluxation. The knee is the furthermost affected joint by the aforementioned problem due to the inherent lack of ligamentous and bony stability. Joint stiffness is the other possible unfavorable effect of lengthening. It happens because of extensive muscle contractures or may possibly be attributed to rigidity of the joint following the amplified pressure on the joint surface during the process of lengthening. Physiotherapy and occupational therapy including endurance and strength exercise as well as stretching play an important role during the rehabilitation periods for the prevention and also the treatment of muscle contracture and the following deformity and also joint stiffness. Likewise, the effect of mental and physical rehabilitation programs should not be overlooked.

Old but effective during this lockdown period a modifies pin plaster technique to treat distal tibia fractures

&lt;p class="abstract"&gt;There are various methods for treating fractures of the distal tibia. The purpose of this study was to introduce a modified technique of ‘pin in plaster’ in treating the distal 1/3rd tibia fractures. Fifteen patients with fractures of the distal tibia AO classification A1 and A2 were followed for one-year post-application of the cast. Patients were excluded if they had complicated fractures or grade III b fractures or crush injuries, with multiple injuries or any pathological fractures or with any nerve or vascular injuries. Range of movement and functional results were calculated periodically at the 3rd and 6th months. Three cases developed pin tract infection in the study, all of which were treated with oral antibiotics successful. The fibula was fixed with plating in selected cases There were no cases of nerve injuries and no cases of tendon injury. All the cases that were treated were successful and completely weight-bearing by the end of the 4th month. Our modified technique is simple quick and effective to restore anatomic congruity and maintain the reduction in fractures of the distal tibia.&lt;/p&gt;

Comparative Study of the Functional Outcome of Elbow Joint in Supracondylar Fractures of Children Treated With k Wire Fixation Using Lateral and Posterior Approaches

Introduction: Supracondylar fractures of the humerus are the most common elbow fracture reported in children. When closed reduction fails, open reduction and pinning will be used as a definitive procedure. In this study, we compare the functional outcome of lateral and posterior approaches of open reduction and assess the range of elbow movements and carrying angle by using Flynn's criteria.Methods: This is a prospective study conducted on 30 children with supracondylar fracture of the humerus in Adichunchanagiri Hospital from a period of December 2018 to August 2020. A total of 30 children were selected for this study. Fifteen children underwent open reduction and pinning using the lateral approach (group 1) and 15 children underwent open reduction and pinning using the posterior approach (group 2) and all were followed up for six months. Functional outcome was assessed at the end of six months using Flynn's criteria.Results: There were 20 boys and 10 girls in the study group. The mean age was 9.43 ± 1.69 years. The majority of children sustained injury due to falls on an outstretched hand (80%). One case of pin tract infection occurred in both the study groups. One patient had a superficial infection (6.7%) with the lateral approach, whereas two patients had a superficial infection with the posterior approach (13.33%). The lateral group fared better than the posterior group in comparison using Flynn criteria.Conclusion: Lateral approach might be better than the posterior approach for unreduced supracondylar fractures necessitating open reduction and k wire fixation.

FUNCTIONAL OUTCOME OF DISPLACED AND UNSTABLE DIAPHYSEAL FRACTURES OF BOTH BONES OF FOREARM IN CHILDREN TREATED WITH INTRAMEDULLARY KIRSCHNER WIRE FIXATION.

Introduction Diaphyseal fractures of forearm are very common in children. 90% of the fractures can be managed with closed reduction and cast immobilisation. Surgical intervention is needed in displaced, unstable fractures to prevent angulation and rotation deformity. This work is done to analyse the Functional outcome of displaced and unstable diaphyseal fracture of both bones of forearm in children treated with intramedullary kirschner wire fixation in Department of Orthopaedics, Adichunchanagiri institute of Medical Sciences,B G Nagara, Mandya. In ou Method r series of 30 cases there were 22 males and 8 females, maximum age of 12 years and minimum age of 3 years with mean age of 8.63 years. Fracture reduction and fixation were done with closed reduction and percutaneous nailing or mini open reduction and intramedullary fixation. Our average union time was 8.6 weeks and average kirschner wire removal time was 12.23 weeks. Patients were closely monitored for compartment syndrome and osteomyelitis. Th Results e functional outcome based on Price criteria was excellent in 83.3% (25) of cases, good in 10% (3) of cases and fair in 6.7% (20 of cases. There was no case with poor outcome. 2 patients had refracure other 5 patients had minor complication (pin tract infection(3 cases) , superficial radial nerve injury(1 case) and delayed union(1 case). From this study we consider that intramedullary kirschner wire fixation for unstable and displaced diaphyseal fracture of both bones of forearm in children is an excellent treatment modality. 1.Treatment of displaced and unstable diaphyseal fract Conclusion ures of the both bone forearm with Kirschner wires is an effective method of maintaining reduction 2.This is simple for fracture fixation with preservation of fracture haematoma. 3.Shorter period of surgery with minimal exposure . 4.Minimum invasive surgery with minimum expertise.

Identifying Predictors of Radiographic Distal Phalangeal Nonunion After Fingertip Replantation

This study aimed to estimate the risk factors for distal phalangeal nonunion in cases involving Kirchner wire fixation after successful fingertip replantation. This study retrospectively analyzed 116 digits of 111 patients, including 74 and 42 digits with replantation in Tamai zones I and II, respectively. Univariate and multivariable analyses were performed to assess the influences of 15 independent variables on nonunion, including age, sex, medical history of diabetes mellitus, history of smoking, injured hand and digit, injury type (clean, blunt, and crush-avulsion), amputation type (complete or incomplete), length of the distal bone fragment (mm), fracture type (simple or comminuted), presence of a bone defect, length of the fracture gap after fixation (mm), number of Kirchner wires used, evidence of venous repair, and the occurrence of pin tract infections after fixation. At 12 months after replantation, 100 digits showed bony union and 16 (13.8%) digits showed radiographic nonunion or equivalent complications, including 9 digits with asymptomatic nonunion without a secondary operation, 5 that underwent an additional operation for nonunion or a complication, and 2 with distal bone resorption. A multivariable analysis indicated that the postfixation fracture gap was the only significant predictor influencing nonunion (odds ratio, 3.30; 95% confidence interval, 1.92-5.68). The extent of the postfixation fracture gap had the greatest influence on preventing distal phalangeal nonunion, indicating the importance of reducing the fracture gap in primary fixation as much as possible. Prognostic IV.

Functional and radiological outcomes of primary ring fixator versus antibiotic nail in open tibial diaphyseal fractures: A prospective study

Management of open fractures of tibia is still a matter of debate due to high incidence of infections. Traditionally external fixators have been advocated in managing open tibial fractures. Due to limited efficacy of systemic antibiotics, recently antibiotic coated intramedullary interlocking nails have been developed for the management of open tibia fractures. Therefore, we conducted this prospective randomized study to compare the functional and radiological outcomes of primary ring fixator versus antibiotic coated nail in open diaphyseal tibial fractures. The study included 32 patients with Gustilo-Anderson type II and type IIIA fractures of tibial diaphysis. Out of them 16 patients were managed with Ring External Fixator (Group I) and 16 were managed with OssiproÒ gentamicin intramedullary interlocking tibial nail (Group II). The radiological and functional outcomes were assessed at final follow-up according to and SMFA criteria. Statistical analysis of the data was performed using IBM SPSS statistics 2.0 software. Chi square test and independent student t-test were used and a P value <0.05 was considered statistically significant RESULTS: Union was achieved in 15 patients (93.8%) in group I and 13 patients (81.2%) in group II. Pin tract infection was seen in 6 patients (37.5%) in group I, whereas infection was present in 2 patients (12.5%) in group II. Bone results were excellent in 13 patients (81.3%), good in 2 patients (12.5%), poor in one patient (6.3%). In group II, bone results were excellent in 12 patients (75%), good in one patient (6.2%), poor in 3 patients (18.8%). At 1 year of final follow up, mean SMFA score was 24.41±5.87 in group I, whereas mean SMFA score was 23.703±8.02 in group II. Ring fixator as well as antibiotic coated tibial interlocking nail achieved comparable rates of union in the present study. Complication rates were similar in both the groups and the functional and radiological outcomes were comparable in both groups. Results of this study indicate that although ring fixation is an established option for management of open tibial fractures, antibiotic-coated intramedullary nail is also a reliable option in open Grade II and grade IIIA injuries. Level II.