Sound Union Research Articles

Arthrodesis for Eaton-Littler stage III degenerative trapeziometacarpal arthritis: a retrospective comparative study of fixation methods

Purpose: This study compared clinical outcomes depending on the fixation modality in patients who underwent arthrodesis surgery for Eaton-Littler stage III trapeziometacarpal (TM) joint arthritis between 2009 and 2022. Methods: In total, 39 patients with 44 hands (five patients had surgery on both hands) were selected. Depending on the operative fixation instruments, patients were divided into two groups: group 1, surgery with 25-gauge interosseous wiring and Kirschner wire or headless screw fixation; group 2, surgery with only multiple headless screws for fixation. Bone union was achieved at 62 days after surgery in group 1 and 75 days in group 2 (p=0.165). Results: The preoperative mean visual analogue scores improved during the postoperative outpatient follow-up period in both groups (group 1, from 4.0 preoperatively to 1.0 at the final follow-up; group 2, from 5.0 preoperatively to 2.0 at the final follow-up). Mean grip strength and pinch strength increased after surgery. One patient (4.8%) experienced nonunion in group 1, whereas nonunion occurred in four patients (17.4%) in group 2. This difference was not statistically significant. Four patients in group 1 and no patients in group 2 underwent fixation instrument removal after sound union. Conclusion: Adequate stability can be achieved during arthrodesis by combining interosseous wiring and other implants or multiple headless compression screws, resulting in successful outcomes for patients with Eaton-Littler stage III degenerative TM arthritis.

Patebond technique of open patella fracture

We report a case of 29 yr old male patient with right sided transverse patella fracture in a grade Iamb open wound as per Gustillo Anderson classification due to road traffic accident. As it was an open wound we wanted an early intervention for better recovery of patients ROM around knee without any morbidity. We utilized a novel technique in which we reinforced the patellar tendons by tying it with Krakow technique and the distal pole of transverse fracture patella was tied with superior pole in a crises cross fashion by passing no 5 ethibond sutures through transosseous route in the patella. A good articular congruity with maintained reduction, a sound union without any implantation, improved ROM with rehabilitation and most importantly without any evidence of infection were the positive outcomes.

Management of fractures of radius and ulna using dynamic compression plating

Aim and Objective: This study has been taken to determine the functional outcome of treating diaphyseal fractures of both bones, forearm with Dynamic compression plate at Mediciti institute of medical sciences, Ghanpur from October 2018 to March 2020. Methodology: This is a time-bound prospective study. Twenty cases of fractures of both bones forearm was treated by open reduction and internal fixation with 3.5 mm DCP. The follow-up ranged from 5 months to 18 months. Results: Males predominant with right forearm affection more than left. Most of the fractures due to RTA and fall. The average age was 35 years with fracture being most common in third decade. Most of the fractures of both bones forearm were located in the middle third and the fracture pattern transverse/short oblique was commonest. 18 (90%) patients has sound union in less than 6 months, 2 (10%) patients had delayed union. The results were based on Dash scoring system and in our study, there were 18 (90%) patients with excellent results and 2 (10%) with satisfactory and no unsatisfactory results. Conclusion: Hence the study was on par with the previous studies and DCP is proved to be the best mode of treatment for diaphyseal fractures of both bones forearm.

Lateral Hind-Foot Endoscopic Anterolateral/Posterolateral (LEAP) Subtalar Arthrodesis: An Effective Minimally Invasive Technique to Achieve Subtalar Fusion and Deformity Correction

Arthrodesis surgery aims to provide relief for chronic joint pain and correct limb alignment by achieving a stable union between articulating bones. The key factors to achieving sound arthrodesis is adequate debridement of arthritic cartilage and creating well-apposed bleeding subchondral bone surfaces without compromising the surrounding soft tissue envelope. Arthroscopic subtalar arthrodesis is technically demanding but provides better visualization of the articular surfaces and is safer for the surrounding soft tissues compared to the open approach. Early published reports of the arthroscopic subtalar arthrodesis from the lateral sinus tarsi approach and posterior approach have shown promising results with high rates of union and less wound healing complications. However, there are concerns about access to all facets of subtalar joint, nerve injury, and deformity correction. In this technique, the article authors describe the lateral endoscopic anterolateral/posterolateral (LEAP) approach for subtalar arthrodesis to improve visualization and access to all facets of the subtalar joint to ensure adequate preparation of apposing surfaces, sound union, and facilitate deformity correction of hind-foot. Strategic portal placement also avoids injury to sural nerve. This is a safe and effective minimally invasive technique for subtalar arthrodesis.

Study of clinical outcome in posterior plating for fibula in bimalleolarfracture ankle

Introduction: The anatomy of the joint makes it very unstable in cases of fractures or ligamentous injuries of the ankle, because the whole body weight is transmitted through the ankle and locomotion depends upon the stability of the ankle joint. In the post-operative period, the protocol of mobilization of the ankle has been a topic of conflict. The goals of treatment include achieving sound union of fracture and an ankle that moves and functions normally without pain. Materials and Methods: This is prospective consecutive case series of 60 patients of bimalleolar ankle fracture, undergone internal fixation in the form of plate fixation over posterior surface of fibula for lateral malleolus and cancellous screw fixation for medial malleolus. Data collection was done using history sheet, clinical examination, and radiological examination at intervals while functional outcome was assessed at follow up visits using Weber’s assessment protocol. Results: 50 (83.3%) cases radiological union is achieved by 6 weeks while 10(16.7%) cases union time was 10 weeks. Average time for union was 6.7 weeks. The final outcome as per the Weber’s assessment protocol was 50% as excellent, 40% as good and 10% as poor result which showed good correlation with level of reduction achieved graded from immediate post-operative radiographs. Conclusion: Accuracy of reduction and rigid fixation was found to be a major determinant of functional outcome irrespective of the type of fracture. Posterior plate fixation gives bicortical screw purchase leading to secure fixation, no intra- articular penetration, decreased complications, hardware prominence and wound dehiscence. Keywords: Bimalleolar ankle fracture, Weber’s assessment, Lateral malleolus, Kristensen grade, Lauge-hansen classification.

Résultats du traitement par la technique de la membrane induite des échecs du traitement chirurgical des pseudarthroses congénitales du tibia

BackgroundAlthough a remarkable success in the treatment of congenital pseudarthrosis tibia (CPT) had been achieved, failure rate is still high and the likelihood of amputation is still considerable. The current study evaluates the outcome of induced membrane technique in the treatment of failed previously operated patients of congenital pseudarthrosis of the tibia. We hypothesized that induced membrane technique will improve union rates in CPT with failed previous multiple operations. Patients and methodsNineteen consecutive patients of failed previously operated CPT were prospectively included in the study. All patients were treated by induced membrane technique with autogenous free non-vascularized fibular strut graft augmented by autogenous iliac graft and fixed by intramedullary K-Wire as well as Ilizarov external fixator. ResultsThe mean interval between the 1st and 2nd stages of the procedure was 4.9 weeks. Sound union was achieved in all cases in a mean time of 25.3 weeks. The mean follow up period was 5.02 years (range, 2.4–6.5). No refracture was documented till last follow up. ConclusionInduced membrane technique had proved as a successful method in the treatment of failed previously operated CPT with a satisfactory outcome and low complication rates. Level of evidenceIV.

Induced Membrane Technique Using Combined Free Fibular and Iliac Graft for the Treatment of Infected Nonunion of Long Bones of the Lower Limb

The two-stage induced membrane technique became widely accepted in treatment of infected nonunion. The aim of this study was to evaluate the outcomes of the induced membrane technique using combined free fibular and iliac bone graft in treatment of infected nonunion of long bones of the lower limb. This study comprised 45 consecutive patients (27 femoral, 18 tibial) with infected nonunion of long bones of the lower limb. The mean age of the patients was 35 years. There were 40 males and 5 females. The right side was affected in 30 patients. Comorbidities were present in 22 patients. Thirty cases were smokers. There were 35 cases with diaphyseal fractures and 10 cases with metaphyseal fractures. There were 30 cases with open fractures, 22 patients were treated by intramedullary nail, and 18 patients by plate and screws, while the other 5 patients were previously treated conservatively. The mean follow-up period was 26 ± 5.7 months. The mean defect was 8.16 ± 2.32 cm. The mean interval between the first and the second stage was 7.07 ± 0.79 weeks. The mean time of graft consolidation was 27.4 ± 6.76 weeks after the second stage. The average external fixation index was 1.5 months/cm. Sound union was achieved in 93.3%.The pin tract infection had occurred in all cases. There were residual limb shortening (15.6%), valgus ankle deformity (6.7%), loss of range of knee flexion (33.3%), and refracture (4.4%). No donor site morbidity in either iliac or fibular sites had occurred. Induced membrane technique with autogenous grafting is an alternative biological pathway proved to be effective in the treatment of infected nonunion of long bone of the lower limb with the added value of the use of free fibular graft in such cases.

Outcome of Induced Membrane Technique in Treatment of failed previously operated Congenital Pseudarthrosis of the Tibia

BackgroundAlthough a remarkable success in the treatment of congenital pseudarthrosis tibia (CPT) had been achieved, failure rate is still high and the likelihood of amputation is still considerable. The current study evaluates the outcome of induced membrane technique in the treatment of failed previously operated patients of congenital pseudarthrosis of the tibia. We hypothesized that induced membrane technique will improve union rates in CPT with failed previous multiple operations. Patients and methodsNineteen consecutive patients of failed previously operated CPT were prospectively included in the study. All patients were treated by induced membrane technique with autogenous free non-vascularized fibular strut graft augmented by autogenous iliac graft and fixed by intramedullary K-Wire as well as Ilizarov external fixator. ResultsThe mean interval between the 1st and 2nd stages of the procedure was 4.9 weeks. Sound union was achieved in all cases in a mean time of 25.3 weeks. The mean follow up period was 5.02 years (range, 2.4-6.5). No refracture was documented till last follow up. ConclusionInduced membrane technique had proved as a successful method in the treatment of failed previously operated CPT with a satisfactory outcome and low complication rates. Level of evidenceIV.

Short Term Results of a New Comprehensive Protocol for the Management of Congenital Pseudarthrosis of the Tibia.

Background:Treatment of Congenital Psuedarthrosis of Tibia (CPT) often poses significant challenges due to difficulty in achieving union and subsequent complications like refractures, implant failures, etc. Our new comprehensive protocol is aimed at achieving crossunion between the tibia and fibula.Aims and objectives:The aim of the present study is to evaluate the short-term results of our new protocol and to compare the results with our previously used techniques.Materials and Methods:10 patients with mean age 2.35 years (1 to 6.5 years) who were treated by our new comprehensive protocol were included in Group A, and 11 patients with mean age 2 years (1 to 5.5 years) who primarily underwent intramedullary rodding with bone graft were included in Group B. The new comprehensive protocol consisted of pre-operative Zolendronate infusion, surgery consisting of intramedullary fixation of tibia supplemented with Ilizarov ring fixator and bone grafting aimed at achieving tibia-fibula cross-union. Retrospective evaluation of serial radiographs was performed and outcomes with respect to union and subsequent complications were analysed.Results:10/10 (100%) patients in Group A united, whereas union was achieved in only 8/11 (72%) patients in Group B. The index surgery was successful in achieving union in all 10 patients in Group A, whereas in Group B 2.25 (1 to 4) surgeries were needed to achieve union. The time to union was significantly shorter in Group A (4.68 months) as compared to Group B (30.88 months). The cross sectional area of union was significantly greater in Group A (3.82 cm2) as compared to Group B (1.18 cm2). One patient in Group A needed a subsequent corrective osteotomy for tibial valgus, and one patient underwent tibia lengthening; whereas in Group B, two patients needed corrective osteotomes for residual malaligments.Conclusion:Our study demonstrates that the new comprehensive protocol is extremely effective for achieving sound union in Congenital Pseudarthrosis of Tibia.

Bouquet technique in the treatment of metacarpal fractures

Objectives The aim of this study was to evaluate the results of bouquet technique in fixation of metacarpal subcapital, neck, or shaft fractures regarding fixation stability and functional and radiological outcomes. Background Metacarpal subcapital, neck, or shaft fractures can be managed conservatively or operatively depending on fracture pattern and stability. Patients and methods A follow-up study in Boulak Eldakror Allgemein Hospital from July 2014 to February 2016 was conducted. Thirty cases of unstable metacarpal fractures were managed by antegrade intramedullary K-wires fixation and were documented and evaluated radiographically and functionally with follow-up for 6 months. Result Thirty cases were enrolled in this study. Fracture union was achieved in all cases at the mean of 5 weeks. At the last visit (6 months postoperatively), the total active motion score for 30 patients ranged from 170° to 260°, with mean of 222°. Normal score of 260°, with good functional and completely powerful hand, was recorded in three patients. The range of grip strength was 60–100%, with the mean of 86% compared with the healthy side. The range for Quick-DASH scores for 30 patients was from 15.9 to 0.0. Score 0 with sound union was recorded in 12 patients. Conclusion Antegrade intramedullary K-wires fixation in this study showed good functional and radiographic results with fewer complications.

Augmentative plate osteosynthesis with autologous bone grafting for aseptic non-union of femur with intramedullary interlocking nail in-situ: A prospective study

Intramedullary interlocking nailing has become the gold standard of treatment for femoral shaft fractures with union rate approaching 97% (1, 2). In cases which have comminution at the fracture site however, interlocking nails alone fail to achieve union. This is specially true for fractures involving the metaphysis and metaphyseo-diaphyseal zone. The main reason for the resulting non-union is the failure of the interlocking nailing system not being able to provide adequate rotational stability of the fracture fragments. It is in these circumstances, that augmentative plate osteosynthesis along with autologous bone grafting gives sound union in 20 to 24 weeks. This prospective study was done on 24 patients who presented with aseptic non-union of the shaft of femur within 9 months of primary surgery, who had surgical augmentative plate osteosynthesis done along with autologous bone grafting and all went on to sound bony union, with an average union time of 22.7 weeks (range : 20 to 24 weeks).

Establishing the efficacy of limb reconstruction system (LRS) in the management of complex long bone non- union: A prospective study

In an urban metropolitan city like Chennai, over the years there has been a steady increase of high velocity RTA’s especially with the number of citizens using two wheelers. In these instances, it is common to encounter communited open long bone fractures of the humerus, tibia and femur. Despite the prompt redressal of these cases with adequate debribment and stabilisation, a significant percentage of these cases land up with recrudescence of infection leading to complex non-unions. Some of these cases end up being operated upon several times with an aim to eradicate the infection, the presence of infection leads to scaring of sub adjacent soft tissue and the repetitive surgical intervention leads to devitalisation of the surviving bone. These complex infective non-union presents with not only with problem of indolent infection but with associated deformity, limb length discrepancy, sub adjacent joint involvement, disuse osteoporosis and soft tissue atrophy, as a consequence they turn out to be a complex challenging orthopaedic situation. These complex non-unions have been over the decades been traditionally addressed by the ilizarov ring fixator systems. In comparison limb reconstruction system which are lighter, less cumbersome and structurally rigid and uniplanar, come in as a significantly suitable alternative. It further has the advantage of distraction at one level and compression at fracture site. It permits dynamization of fracture site which is an essential element in the treatment of any non-union. In this prospective case series done between March 2015 to October 2017, we have studied 34 cases of patients reporting with complex long bone non-unions by the application of limb reconstruction system. The present study establishes the efficacy of the limb reconstruction system (LRS) in the treatment of these complex non-unions fractures of the long bone. In our series all cases went in for sound union with only 5.72% (n = 4) requiring resurgery.

Efficacy of percutaneous pedicle screw fixation of ankylosing spondylitis combined with thoracolumbar fractures

Objective To investigate the feasibility and clinical effect of percutaneous pedicle screw fixation in the treatment of ankylosing spondylitis (AS) with thoracolumbar fractures. Methods A retrospective case-series study was performed on 12 AS patients with thoracolumbar fractures admitted from January 2013 to January 2016. There were 9 males and 3 females, aged (42.7±13.0)years (range, 24-63 years). All patients received percutaneous minimally invasive pedicle screw fixation. The operation duration, intraoperative blood loss, length of incision, ambulation time, and time to basic life were recorded. Visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated before and after operation. Postoperative complications and bone fracture union were observed during the follow-up period. Results All patients were followed up for average 22 months (range, 14-36 months). All patients underwent successful surgery, with operation duration and intraoperative blood loss of (178.0±60.2)min and (116.7±44.2)ml respectively. No serious complications such as blood vessel or nerve injury occurred during the operation. The incision length was 1.2-1.5 cm. All the patients were able to do exercise with the help of brace 2-3 days after the operation and returned to basic life after (23.4±7.3)days postoperatively. At 1, 3, 6 and 12 months after operation, VAS and ODI differed significantly from the preoperative detections (P<0.05). During the follow-up, bone fracture union was observed in all patients, with no nail breakage or nail loosening occurred after operation. Conclusion For AS combined with thoracolumbar fractures, minimally invasive fixation can attain satisfactory curative effect, with advantages of minor lesion, little bleeding, fast recovery and sound bone union. Key words: Spondylitis, ankylosing; Spinal fractures; Percutaneous fixation

Juxta-articular Plate Fixation in Distal Radius Intra-articular Fractures with Accompanying Volar Free Fragments beyond the Watershed Line.

BackgroundAlthough distal radius fractures (DRF) are common fractures, intra-articular comminuted DRF with volar free fragments are uncommon. There is considerable difficulty in the fixation of free fragments beyond the watershed line using the existing volar locking plate. We aimed to examine the efficacy and potential complications associated with the use of juxta-articular volar plates in intra-articular DRF accompanied by free fragments beyond the watershed line.MethodsThe patients were enrolled in a consecutive manner between 2007 and 2016. In cases of DRF with free fragments beyond the watershed line, we employed a 2.4-mm small fragment juxta-articular volar locking compression plate using a volar Henry approach. A total of 32 patients were included in this study. There were 15 males and 17 females with a mean age of 52.3 years (range, 33 to 69 years). The mean follow-up period was 14.5 months (range, 10 to 24 months). Preoperative radiographs and three-dimensional computed tomography images were used to analyze fracture patterns and assess the free fragments beyond the watershed line. The mean number of free fracture fragments beyond the watershed line was 2.33. Plain radiographs of immediate postoperative and last follow-up were used to confirm fracture union, incongruence, radial height, volar tilt, radial inclination, and arthritic changes. For functional assessment, we measured grip strength, range of motion (ROM), modified Mayo wrist score (MMWS) and determined Disabilities of Arm, Shoulder and Hand (DASH) scores at the last follow-up. Postoperative complications were monitored during the follow-up period.ResultsAll patients obtained sound union without significant complications. At the last follow-up, 16 cases presented with an articular step-off of more than 1 mm (mean, 1.10 mm). The mean MMWS was 76.3 (range, 55 to 90), mean DASH score was 15.38 (range, 9 to 22), mean visual analogue scale score for pain was 1.2 and mean grip strength was 75.5% of the opposite side. The mean ROM was 74.3° for volar flexion and 71.5° for dorsiflexion.ConclusionsIn cases of intra-articular DRF with free fragments beyond the watershed line, a volar approach with use of a juxtaarticular plate provided favorable outcomes without significant complications.

Elastic nailing in diaphyseal fractures of femur in children

Background: Fracture shaft femur in children is conventionally managed by traction followed by hip spica. Prolonged hospitalization, difficulty in maintaining child with traction for 3 weeks, then hip spica makes toileting and personal hygiene difficult. This may cause malunion/limb length discrepancies, rotational deformities, and sometimes psychological problems. Materials and Methods: A total of 32 children in the age group of 4-16years,25 boys and 7 girls having diaphyseal femoral fractures were stabilized with two stainless steel/titanium elastic nail retrograde way under fracture table. The average duration of surgery was 45 min (30–75 min). Patients were assessed clinically and radiologically before and after surgery for 2 years. Early mobilization and weight-bearing allowed. The results were evaluated using the criteria of Flynn et al. Technical problems and complications were also analyzed. Results: Duration of hospitalization was 4 days (3–7 days). The average duration of appearance of bridging callus was 6 weeks. Radiological union in all cases was achieved in a mean time of 8.7 weeks. All children showed sound union at an average 8 weeks without significant complications. Return to school was early with an average 10–12 weeks. Result assessed for range of motion (ROM), irritation at the distal end of the nail, pain, deformity, limb length discrepancies, union, and malunion. Overall results observed were excellent in 24, satisfactory in 5 and poor in 3 patients. The soft-tissue discomfort near the knee produced by the nail ends was the most common problem encountered. Three patients had decreased terminal ROM at the knee. Later, all the 32 patients had full ROM at hip and knee after 3 months. Conclusion: Elastic nailing in pediatrics femoral shaft fracture-simple and effective, small incisions, biological, dynamic fixation, early mobilization, rapid wound healing, rapid functional recovery.

Treatment of patella fractures by compressive external fixation (CEF)

Recent traditional treatment of patella fractures are related with infection and failure of fixation. The complications that we see can be treated surgically which is cost effective and limits the function of the joint. But our locally made CEF device can effectively treat patella fractures with less complications. The transverse fracture of patella with displacement were treated by compressive external fixation, based on Ilizarov tensioned wire construct. All the patients were allowed to do movements in the joints and weight bearing postoperatively. Twenty five fractures were treated with CEF. 12 patients were treated percutaneously. Sound union was achieved in all the fractures. The CEF device was removed at 6 to 8 weeks. 12 patients regained excellent motion with a mean Insall knee score of 96 points, in an average follow up of 4 years. Minor complications like wire inflammation was observed in 5 patients which was treated by local care and antibiotics. CEF technique is a safe and effective method of treatment in patella fractures with advantages over traditional methods in case with a poor soft tissue envelope. CEF allows rapid recovery and no secondary surgery is needed.

A study of Flap Coverage of Limbs in Orthopaedics

Open / compound fractures of the limbs are very common and challenging in this modern era of industrial and road traffic accident and is a difficult task for the orthopaedic surgeon. The aim of this study is how to minimise the morbidity, mortality, incidence of amputation and other complications of fractures by way of timely intervention with different types of flap coverage of limbs. This study was carried out in the department of orthopaedics and traumatology and department of plastic surgery - Osmania General Hospital, Hyderabad during June 1996 - Feb 1999. A total no. of 68 cases of soft tissue coverage procedures were done including different varieties of flaps like split skin grafting, fascio cutaneous, muscle, cross leg, abdominal, groin and free flaps in patients of 18 - 45 years of age group and more than 80% patients are males. In our study of 68 cases of reconstruction, 38 cases (55.8%) are carried out in the form of skin grafts, 16 cases (23.5%) are local flaps-muscle and fasciocutaneous flaps, 8 cases (11.7%) are cross leg flaps, 2 cases (2.9%) are abdominal flaps, 2 cases (2.9%) are groin flaps and 2 cases (2.9%) free flaps. The grading of results are assessed based on sound union of the fracture, stiffness / range of movements of neighbouring joints, amount of scar, presence / absence of DNVD and flap necrosis. We achieved excellent results in 32 cases (47.0%), good in 20 cases (29.4%), fair in 12 cases (17.7%) and poor in 4 cases (5.9%). It is very much useful by timely intervening and planning for soft tissue coverage in minimising the incidence of infection rate, decreasing the hospital stay and facilitating the congenial condition for further definitive management of fracture union. Flap coverage of the limbs has a most significant role in decreasing the morbidity, mortality and amputations of limbs due to infection of soft tissue and infected non unions.

A study on functional outcome of ilizarov fixation in the management of infected non-union of long bones

Introduction: Nonunion of long bones especially tibia when associated with infection has always been a challenge to orthopaedic surgeons. This study is conducted to report the results of the use of this technique for treatment of infected nonunion of long bones and the study of complications encountered during treatment. Material & Methods: An observational study was done on case records of 20 patients admitted and treated in Katuri Medical College with Ilizarov fixator for infected nonunion of long bones between August 2012 to September 2014 were taken for demographic information, details of treatment, radiological features and number of complications. Results: The mean age of the patients was 39.3 years with majority (65%) in the age group of 30-50 years. Out of the 20 patients, 17 were males and 3 were females. Out of the 20 cases treated with the Ilizarov fixator 19 cases sound union occurred without the need for any other intervention and complete resolution of infection was seen. Five patients had a limb length discrepancy of more than 2.5 cm. 70% had excellent bony results and 50% had excellent functional results. Keywords: Infected non-union, Ilizarov fixation, Functional outcome

Aseptic nonunion of pediatric subtrochanteric fracture: A case report

Nonunion of pediatric fractures related to the extracapsular proximal femur is a rare event if managed appropriately. Varus malposition renders increased stress over the fracture site leading to failure of the sound union. Management of such fractures is difficult owing to limited implant choices and presence of adjacent open physes. Open reduction and freshening of edges, removal of fibrous tissue, internal fixation with intra, or extramedullary implants, and a compliant follow-up are keys to the good functional outcome.

Treatment of Patella Fractures by Compressive External Fixation (CEF)

Recent traditional treatment of patella fractures is related with infection and failure of fixation. The complications that we see can be treated surgically which is cost effective and limits the function of the joint. But our locally made CEF device can effectively treat patella fractures with less complications. The transverse fracture of patella with displacement was treated by compressive external fixation, based on Ilizarov tensioned wire construct. All the patients were allowed to do movements in the joints and weight bearing postoperatively. Eighteen fractures were treated with CEF. 11 patients were treated percutaneously. Sound union was achieved in all the fractures. The CEF device was removed at 6 to 8 weeks. 12 patients regained excellent motion with a mean Insall knee score of 96 points, in an average follow up of 4 years. Minor complications like wire inflammation was observed in 5 patients which was treated by local care and antibiotics. CEF technique is a safe and effective method of treatment in patella fractures with advantages over traditional methods in case with a poor soft tissue envelope. CEF allows rapid recovery and no secondary surgery is needed [1].