Superficial Pin Tract Infection Research Articles

Ultrasound-guided techniques for managing length- unstable femoral shaft fractures in children

ObjectiveThe management of length-unstable femoral shaft fractures(LUFSFs) in pediatric patients is still controversial. This study aims to explore the clinical efficacy of ultrasound-guided closed reduction combined with external fixation for treating LUFSFs in children.MethodsWe conducted a retrospective analysis of clinical data from 19 pediatric patients with LUFSFs who underwent ultrasound-guided closed reduction and external fixation between January 2018 and January 2023. Ultrasound was employed not only to facilitate closed reduction of the fracture but also to guide real-time insertion of Schanz pins and monitor pin length as it traversed the opposite cortex. Surgical time, intraoperative fluoroscopy count, hospital stay length, fracture fixation duration, complication incidence, fracture reduction quality at the final follow-up were recorded.ResultsThe patients’ average age was 7.5 years( range: 5 to 11 years). The mean surgical duration was 70.4 min (range: 48–105 min), and the average intraoperative fluoroscopy count was 6.5 (range: 2–16). Fracture fixation lasted an average of 10.9 weeks (range: 7–20 weeks). All patients were followed up for more than one year. 6 cases of superficial pin tract infection occurred, which resolved with oral antibiotics and enhanced needle tract care. No deep infections were observed. Temporary stiffness of the knee joint was observed in 2 patients. According to Flynn’s efficacy evaluation system, fracture reduction quality at the final follow-up was rated as excellent in 11 cases and satisfactory in 8 cases, yielding a combined success rate of 100% (19/19).ConclusionsThe technique of ultrasound-guided closed reduction combined with external fixation offers favorable outcomes for children aged 5 to 11 years with LUFSFs, reducing reliance on fluoroscopic guidance.

External Fixator Stabilization Following Open Reduction and Combined Pelvic and Proximal Femur Osteotomy in Developmental Dysplasia Hip: A Surgical Note

Introduction: Maintenance of hip joint reduction after combined pelvic and femoral osteotomy in developmental dysplasia of the hip (DDH) in children using a hip-spica cast has the potential to cause numerous cast-related complications. We proposed a modification of the surgical technique where the hip reduction is maintained with an external fixator to avoid cast-related complications. Methodology: The surgical technique involved the placement of Scahnz pins along the iliac crest or lateral aspects of the ilium, in the supra-acetabular region below the pelvic osteotomy site, and the proximal femur. The pins were connected and stabilized with tubular/solid rods. Six children with 10 dysplastic hips [4 bilateral and 2 unilateral, International Hip Dysplasia Institute (IDHI) grade IV] were operated on with pelvic and femoral osteotomies and external fixator construct. The fixators were removed after 8 weeks and the children were followed up at 3, 6, 12, and 18 months. Results: The average age of the children was 6.5 years (range: 4 to 11 y). After an average follow-up of 10 months, the hips were reduced with IDHI grade of I in 7 hips and IDHI grade of II in 3 hips. There were no wound complications. Superficial pin tract infections were seen in all patients but responded to topical antibiotic application. There was no unplanned visit by the parents and no one complained of perineal hygiene issues. Conclusion: The external fixator construct maintains the hip reduction in DDH and allows the osteotomy sites to heal without any wound-related complications.

A systematic review of the operative techniques for treating cubitus varus deformity in children.

A systematic review of the operative techniques for treating cubitus varus deformity in children was performed using research databases including PubMed and Embase. Outcome measurements included mean angular correction of the humerus-elbow-wrist angle, complications, revisions and outcome scores. A total of 45 papers and 911 patients were included. Lateral closing wedge osteotomy (LCWO) (427 patients) was the most common procedure and 5.56% of these patients experienced lateral condylar prominence. This technique had the highest revision rate at 3%. The step-cut osteotomy (111 patients) yielded zero postoperative infections or loss of motion. Distraction osteogenesis (92 patients) was the least common technique. Superficial pin tract infections occurred in 18% of patients and 88.04% of patients reported excellent results, the highest of any technique in this study. The infection rate of dome osteotomy (151 patients) was 9.45% and 4.72% of patients experienced loss of motion. 3D osteotomy (130 patients) had no infections, 87.78% of patients reported excellent outcomes, and 2.22% of patients reported poor outcomes, the lowest of all techniques. For unidimensional correction, LCWO provides a technically simple procedure and reasonable outcomes. Step-cut osteotomy has less lateral condylar prominence but is more complicated than LCWO. Distraction osteogenesis is a minimally invasive alternative to LCWO and step-cut osteotomy, but it has more superficial infections and can be bothersome to patients. For a multidimensional correction, 3D osteotomy is superior to dome osteotomy due to its lower infection rate and higher rate of functionally excellent outcomes.

Functional and union outcome of combined column tibial plateau fracture treated with hybrid external fixator.

To determine the combined column tibial plateau fracture treated with a hybrid external fixator in terms of knee functionality, union outcome and complications. The quasi-experimental study was conducted at the Department of Orthopaedic Surgery, Mayo Hospital, Lahore, Pakistan, from July 5, 2019, to December 31, 2021, and comprised patients of either gender aged 20-50 years who presented with 2-column or 3-column fractures of proximal tibia classified according to the 3-column classification system after being diagnosed using radiographs and three-dimensional computed tomography scan. Knee function, union and complications, like neural, vascular, infection, delayed union, nonunion, malunion and implant failure, were evaluated. The Knee Society Score was used to assess knee function, and modified Rasmussen score for the union, while complications were assessed clinically on the 2nd, 6th, 12th, 16th, 24th, 36th weeks and one year post-operatively. Data was analysed using SPSS 26. Of the 113 patients, 91(80.53%) were males and 22(19.47%) were females. The overall mean age was 35.56±9.00 years. From the 12th week to the 24th week 45(39.83%) patients had good and 59(52.21%) patients had excellent functional outcomes. Union outcome in the 16th and 24th week was good in 57(50.44%) patients and excellent in 47(41.59%) patients. No neurovascular injury was observed. Superficial pin tract infection was observed in 21(18.6%) cases that healed with wound debridement and antibiotics. No delayed union, malunion and implant failure was observed. Good to excellent functional and union outcomes with minimum complications were observed with the hybrid external fixator.

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

SHORT TERM FUNCTIONAL OUTCOME OF CLOSED REDUCTION AND FIXATION OF COLLES FRACTURE USING MODIFIED-JOSHIS EXTERNAL STABALIZATION SYSTEM - A PROSPECTIVE STUDY

Colles fracture is the most common fracture seen in adult population. It is never an isolated fracture of the distal radius, but is associated with fracture of ulna styloid which may be displaced or undisplaced instability of the distal radio-ulnar joint complex and may be associated with injury to triangular fibro cartilaginous complex. The aim of study was to determine functional outcome of management of closed reduction and fixation of comminuted colles fracture using a rigid and stable modified-Joshis External Stabalisation System as soon as possible. In our study we have tried to bring associated soft tissue and bony injuries around the wrist joint as a highlighter and focused on fixation and restoration of anatomy to near normal with fixation of all the above mentioned injuries without exposing the joint, and as an immediate and definative management. Out of a total of 30 patients included, 26 patients had an excellent outcome as measured using quick-disability arm shoulder hand score and modified-mayo wrist scoring system. One patient had a superficial pin tract infection and was managed with oral antibiotics. The patients were able to resume the activities of daily living by end of eight weeks. It can be concluded that this method can be employed in immediate and definative management of comminuted colles fractures as it leads to a better functional outcome, lesser hospital stay, early mobilization of the joint, lesser exposure to radiation, avoids joint exposure, has a low learning curve, early resumption of activities of daily living and avoids re-surgery at a later date for implant removal.

Outcome of monolateral rail fixator in infected nonunion of femur diaphysis developing after intramedullary fixation.

Consensus is lacking regarding management of posttraumatic infected diaphyseal nonunions of femur following intramedullary nailing. Present study reports outcomes of single stage standardised treatment protocol using monolateral rail external fixator/limb reconstruction system in this type of infected diaphyseal femoral nonunions. This retrospective study included 26 patients with mean age of 31.7years having posttraumatic infected diaphyseal femoral nonunions following intramedullary nailing and managed with radical debridement and monolateral rail fixator. The results were assessed by Association for the Study and Application of the Method of Ilizarov criteria. Mean intraoperative bone gap was 4.34 (range, 2-7) cm. Mean gain in bone length was 4.04 (range, 0-7) cm. Fracture united primarily in 22 cases and after freshening of edges, fixator adjustment and fibular grafting in three more patients. Infection persisted in one patient. Most common complications were superficial pin tract infection (15 patients) and loss of more than 30° knee flexion (13 patients). The bone results were excellent, good, and poor in 15, 9, and 2 patients, respectively. The functional results were excellent, good, fair, and poor in 11,13,1 and 1 patient, respectively. Single stage procedure including radical debridement, acute docking, distraction osteogenesis at corticotomy site and stabilization with monolateral rail fixator reliably achieves good to excellent bone and functional results, union and eradication of infection in majority of infected nonunions of femoral diaphysis developing after intramedullary fixation. We recommend acute docking in bone gap ≤ 5cm.

Effectiveness of Ilizarov Ankle Arthrodesis in the Treatment of End-Stage Varus Ankle Osteoarthritis: A Retrospective Study.

ObjectiveTo evaluate the outcomes of Ilizarov ankle arthrodesis in the treatment of end‐stage varus ankle osteoarthritis (OA).MethodsThis was a retrospective study of 63 patients with varus ankle OA who underwent Ilizarov ankle arthrodesis between June 2013 and December 2018. There were 24 males and 39 females with an average age of 56.57 ± 4.45 years (range, 47–64 years). Thirty‐six cases were affected on the left side, and 27 were affected on the right side. The patients' mean body mass index (BMI) was 25.18 ± 2.93 kg/m2. According to the modified Takakura staging criteria, there were 18 cases of stage 3b (28.57%) and 45 cases of stage 4 (71.43%). Nine patients were primary (14.29%), 48 were traumatic (76.19%), and six were caused by rheumatoid OA (9.52%). Functional assessments were performed according to the American Orthopedic Foot and Ankle Society (AOFAS) ankle‐hindfoot score, Ankle Osteoarthritis Scale (AOS), and visual analogue scale (VAS). The tibial anterior surface angle (TAS), coronal plane tibial‐talar angle (CPT), talar tilt angle (TT), deformity angle (DA), and tibial lateral surface angle (TLS) were assessed on X‐ray films.ResultsThe average operation time was 147.84 ± 13.67 min (range, 135–168 min). The average follow‐up time was 34.24 ± 8.72 months (range, 24–61 months). Bony fusion was achieved in all ankles, and the fusion time was 12.43 ± 1.99 weeks on average. The average AOFAS score at the final follow‐up increased from 42.14 ± 8.66 to 80.90 ± 6.80. The average VAS score and AOS pain and disability scores at the final follow‐up decreased from 7.29 ± 1.27 to 2.24 ± 0.94, from 67.94 ± 7.68 to 27.92 ± 5.82, and from 71.64 ± 9.37 to 41.32 ± 8.99, respectively. The average TAS, CPT, and TLS at the final follow‐up increased from 77.76° ± 4.44° to 89.81° ± 1.25°, from 69.04° ± 3.73° to 90.43° ± 1.80°, and from 82.14° ± 3.77° to 88.67° ± 2.50°, respectively. The average TT and DA at the final follow‐up decreased from 8.76° ± 4.30° to 2.05° ± 1.28° and from 20.95° ± 3.73° to 1.57° ± 0.93°, respectively. Three patients developed superficial pin tract infections, all settled with local dressing and antibiotic treatment. Two patients were found to have subtalar arthritis and underwent conservative treatment.ConclusionAnkle arthrodesis using the Ilizarov technique is efficient in treating end‐stage varus ankle OA.

The Use of Calcium Sulphate Beads in the Management of Osteomyelitis of Femur and Tibia: A Systematic Review.

Calcium sulphate is a recent alternative for delayed antibiotic elution in infected bones and joints. The purpose of this study is to evaluate the use of antibiotic impregnated calcium sulphate (AICS) beads in the management of infected tibia and femur, with regards to patient outcomes and complication rates (including reinfection rate, remission rate and union rate). Searches of AMED, CINAHL, EMBASE, EMCARE, Medline, PubMed and Google Scholar were conducted in June 2020, with the mesh terms: "Calcium sulphate beads" or "Calcium sulfate beads" or "antibiotic beads" or "Stimulan" AND "Bone infection" or "Osteomyelitis" or "Debridement" AND "Tibia" or "Femur". Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of interventions (ROBINS-i) tool, and quality assessed via the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. Out of 104 relevant papers, 10 met the inclusion criteria for data extraction. Total infection remission was 6.8%, which was greater than that of polymethylmethacrylate (PMMA, 21.2%). Complication rates varied. The main issue regarding AICS use was wound drainage, which was considerably higher in studies involving treatment of tibia alone. Studies using PMMA did not experience this issue, but there were a few incidences of superficial pin tract infection following surgery. Where AICS was used, it was consistently effective at infection eradication, despite variation in causative organism and location of bead placement. Wound drainage varied and was higher in papers regarding tibial cases alone.

Management of Comminuited Intra/Juxta Articular Fracture of Distal Radius Using Bridging External Fixator

Background: Distal radius fractures are the third most common osteoporotic fractures and are frequently treated in emergency department. They have a trimodal peak of occurrence and there has been a significant increase in incidence of involvement in elderly females and young males. Management of these fractures comes with lots of treatment options and challenges to provide good functional outcome. This prospective study was done for the management of communited intra/juxta articular fractures of distal end radius using a bridging external fixator on 25 patients. The principle of ligamentotaxis was used for alignment of fracture fragments and wrist spanning external fixator was used to maintain the fracture reduction.Methods:25 patients of either sex with age group 16 to 80 years were taken from the orthopedic department. After proper primary care, cases were classified using Fernandez classification, and posted for surgery as soon as investigations and fitness were taken.Results:Patients involved in the study were in range of 16 to 78 years with 16 patients having dominant side with road traffic accident as leading cause.Radiological union was seen at an average of 7.3 weeks, 4 patients had superficial pin tract infection, 3 patients had stiffnes and a single case had malunion. Conclusions:Modified clinical scoring system of Green and O’Brien was used to evaluate the overall functional results which showed excellent to good results in 84% of cases. Hence, properly planned and executed bridging external fixator is an easy, cost-effective and reliable treatment modality through the “Principle of Ligamentotaxis”.

Buried vs. Exposed K-wire Fixation in Lateral Condyle Distal Humerus Fractures in Children

Introduction: Distal humerus lateral condyle fractures are common injuries in childhood and need effective treatment to prevent complications. Open reduction and internal fixation with Kirschner (K) wires is a proven, cost-effective and convenient technique for treating pediatric lateral condyle distal humeral fractures. K-wires may be buried beneath the skin or inserted through the skin with the wire ends exposed. There is no clear consensus as to whether K-wires should be buried or left exposed outside the skin. The aim of this study to compare the results and complications of divergent buried and non-buried K-wires in the treatment of lateral condyle fractures of the distal humerus. Methods: A study was conducted between March 2019 to August 2020 in 32 pediatric patients with lateral condyle fractures of distal humerus who were treated with open reduction with divergent k-wire fixation in our hospital. All patients under the age of 14 years presenting with lateral condyle humerus fractures with more than 2 mm displacement were included in the study. The exclusion criteria were open fractures, undisplaced fractures treated conservatively, and pathological fractures. Results: 32 patients under the age of 14 years were included in this study and were divided into two groups (Buried K-wire group and Exposed K-wire group) based on the treatment they received. Out of the 16 cases with exposed wires, 2 cases had superficial pin tract infection. And out of 16 cases with buried wires, 3 cases developed an infection, and 5 cases had skin erosion. However, no case of severe infection was seen. No cases of non-union were seen and all patients returned to preinjury function.

Treatment Result Following Fluoroscopic Guided Close Reduction and Internal Fixation by Per-Cutaneous Crossed K-Wires of Extension Type Gartland Type-II and Type-III Supracondylar Fracture of Humerus in Children

Background : Supracondylar fractures of the humerus is one of the most common fractures in children. Failure to treat properly leads to malunion of the fracture site. For that, closed reduction and percutaneous pinning is considered to be the golden choice for treatment. There are many methods in which percutaneous k-wire fixation can be done. The aim of this study is to report the advantages of percutaneous fixation using cross pinning from both medial and lateral sides.
 Materials and methods : A total number of seventy pediatric patients with Gartland type II and type III supracondylar fracture of the humerus were recruited from the outpatient department of two different hospitals between January 2018 and September 2020. All of them were treated using closed reduction and internal fixation using percutaneous crossed k-wires. The treatment outcomes were evaluated using Flynn’s criteria and were compared with other similar studies.
 Results : The mean age of study subjects was 8.14 ± 2.8 and the male to female ratio was 1.6:1. In 27(38.6%) cases the left arm was involved while in 43(61.4%) cases the right arm was involved. Preoperative complications included 1(1.4%) case with radial nerve palsy and 4(5.7%) cases with pulseless pink hand. When evaluating cosmetic outcome using Flynn’s criteria, there were 57(81.4%) excellent, 10(14.3%) good and 3(4.3%) fair outcomes. On evaluating outcome according to range of motion deficit outcomes were excellent in 35(50%), good in 22(31.4%), fair in 5(7.2%) and poor in 8(11.4%) children. Post-operative complications were 1(1.4%) ulnar nerve neuropraxia and 5(7.2%) superficial pin tract infections.
 Conclusion : Closed reduction and internal fixation using percutaneous crossed kwires placed from the medial and lateral side gives satisfactory cosmetic and functional outcomes in majority of the patients with Gartland type II and III supracondylar fractures of the humerus.
 Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 32-36

A Comparative Study to Determine the Outcome of Supracondylar Fracture of Humerus in Children Treated with Percutaneous Cross Pinning Versus Two Lateral Pinning

Objective: Analysis and assessment of anatomical refurbishment with the use of percutaneous cross pinning versus two lateral pinning and to determine the functional consequences of these procedures, to evaluate the hurdles faced in these treatment methodologies, and the comparison between the patient acceptances in both methods. Methods: This research was a comparative cross-sectional analysis which was conducted at Orthopedics department of Ayub Teaching Hospital Abbottabad for duration of six months i.e from March 2021 to August 2021. The sample size for the research was 50 patients who were admitted both at the (outpatient department) OPD and in the emergency ward. All the patients were clinically examined carefully and thoroughly, and all of their details were recorded. Base line investigations and X-rays were performed of every patient. Results: Percutaneous cross pinning or two lateral pinning methods were used to treat 50 patients suffering from supra-condylar fracture of humerus. Two groups were formed, each had 25 patients. Group A consisted of patients were treated from PCP, while group B patients were treated from TLP. Among the patients of Group, A, 20(80%) were male, 5(20%) were female, with a female: male ratio of 1:5, while in group B patients, 22(88%) were male, 3(8%) were female, with a female: male ratio of 1:8. The average age of both the groups was 7.30+3.30 years. The most prominent reason of fracture in the designed study was fall during playing (54%), 24% patients reported falling from bicycle, while only 22% patients had fallen from trees, the height of which was around 5-7 feet. Postero-medial displacement was observed in 66% patients, while Postero-lateral displacement was observed in 34% patients. Among the list of complications, in TLP, 8% patients suffered from superficial pin tract infection, 12% patients suffered from non-union, and 4% patients had K-wire migration and 4% had Cubitus varus. On the other hand, in PCP group patients, one patient developed superficial pin tract infection, 8% patients had nonunion, and 4% patients had K-wire migration. When the results were analyzed using the Flynn criteria, they were excellent (48% group A patients versus 36% patients of group B), 32% patients in group A had good results and 28% in group B, 20% patients of group B versus 12% patients of group A were regarded as fair, and 8% patients of group A versus 16% patients of group B were considered as poor. The patients who carried angle loss were 12% of group A versus 24% of group B, and who complained about loss of motion were 15% patients of group A versus 25% patients of group B were classified according to Flynn criteria Conclusion: Percutaneous cross pinning is concluded as the better, and more predictable treatment method in terms of management, as compared to two lateral pinning method to treat the Supra-condylar fractures. Key Words: Percutaneous cross pinning, two lateral pinning, supra-condylar fracture, humerus

Management of Tibial Metaphyseal Fractures Using JESS Fixator

Introduction: The management of proximal and distal tibia fractures remains challenging due to associated soft tissue injuries. The use of wire fixators for the definitive treatment of such fractures entails a minimally invasive technique of insertion that gives good fracture reduction and stability combined with minimal postoperative complications. Aim: To assess the outcome of treatment of such fractures by the use of Joshi’s external stabilization system (JESS), which is a simple wire based, circular external fixator system. Materials and Methods: A prospective, uncontrolled study was done using JESS on 30 consecutive patients (20 patients of proximal tibial metaphyseal fractures and 10 of distal tibial metaphyseal fractures). Results: In our study, the most common mode of injury was road traffic accidents (21 cases), fall from height (6 cases) and slip injury (3 cases). The patients were operated at a mean interval of 3.2 days (range 1-6 days) due to associated poor soft tissue conditions. The patients were followed up for 24 weeks. Full weight bearing was allowed at 10 to 14 weeks. JESS frame was removed at mean duration of 13 weeks (range 12-16 weeks). According to knee society score (KSS), excellent result (score 80- 100) was seen in 12 patients (60%), good result (score 70-79) was seen in 4 patients (20%), fair result (score 60-69) in 3 patients (15%) and poor result (score <60) in 1 patient (5%) of proximal tibial metaphyseal fracture. According to Olerud and Molander score (OAMS), excellent result (score 91-100) was seen in 5 patients (50%), good result (score 61-90) in 3 patients (30%) and fair result (score 31-60) in 2 patients (20%) of distal tibial metaphyseal fracture. The complication seen was superficial pin tract infection in 4 patients, which was managed by regular pin tract dressing and oral antibiotics. Delayed union (mean at 15.3 weeks) was seen in 2 patients with Schatzker type VI fracture and 1 patient with severe comminuted distal metaphyseal fracture. Conclusion: JESS is a simple, light, effective and cheap method and can be used as a definitive procedure to treat these fractures even with soft tissue compromise.

Prospective study on outcome in management of distal radius fracture by closed reduction and percutaneous 5 K-wire fixation

Aims: In this study we are evaluating the outcome in management of distal radius fracture by closed reduction and percutaneous 5 k-wire fixation in both young and elderly patients in most types of distal radius fracture types where closed reduction is possible and where ulna is intact or reconstruct able.Material and Methods: A total of 50 patients with distal end radius fractures associated with or without other fracture were treated in in the department of Orthopaedics at all hospitals attached to SMS Medical College & Hospital, Jaipur. The patients were treated with closed reduction and 5 k-wire (1.8mm) fixation under anaesthesia. Clinical scoring system of green and o’brein modified by Cooney and Sarmiento’s modification of Lindstorm criteria was recorded.Results: The most commonly encountered complications were superficial pin tract infection (25.5%) and extensor tendon tethering (6.4%) which were less serious complications and resolved completely on removal of k –wires. Cooney modification of Green and O‘ Brien‘s score was showed higher excellent case (84%) than good (10%) and fair (6%)Conclusion: According to our study perfect closed reduction and five k-wire fixation technique is a versatile tool which provides functional outcomes better than conventional k-wire fixation and volar plating in distal end radius fractures.

Functional Outcome of High Tibial Osteotomy in Patients with Medial Compartment Osteoarthritis Using Dynamic Axial Fixator

Objectives:Medial Compartment Osteoarthritis of the knee is becoming a widespread problem. The surgical options include high tibial osteotomy, unicompartmental knee replacement, and total knee replacement. Replacement surgeries are not advised in the younger age group, so in these patients, high tibial osteotomy is the only option. In this study, we have assessed the functional and radiological outcomes of high tibial osteotomy done by hemicallostasis method.Methods:We report the outcome of 30 patients (30 knees) who underwent hemicallostasis with a dynamic external fixator for medial compartment osteoarthritis of the knee. The radiological assessment was done with the help of Hip Knee Ankle angle. The functional scoring was done via Oxford knee score, IKDC, KOOS, and WOMAC score.Results:At a mean follow up of 35 months, the preoperatively mean HKA angle was 172 ± 30. The mean HKA angle postoperatively was 184 ±10. Appropriate correction of the HKA angle was achieved in 24 of 30 patients (80%). Whereas, there was under correction in 3 patients (10 %) and overcorrection in 3 (10%) patients. All the functional scores showed significant improvement in the postoperative scores. There was a positive correlation between the HKA angle and oxford, IKDC, KOOS, and WOMAC Score. Complications like superficial pin tract infection were seen in 3(10 %) patients, deep infection in 1(3%), and early union of osteotomy in 1 (3%) patient leading to re-osteotomy.Conclusion:HTO is effective in improving pain, function, activity of daily living, and quality of life in patients suffering from medial compartment Osteoarthritis of the knee. Hip Knee Ankle Angle is an important parameter to restore for better functional outcomes. The Advantage of using a dynamic axial fixator is the precision in achieving calculated correction without any implant in the bone once the correction is achieved along with good healing rates.

MINIMALLY INVASIVE TREATMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES

Background: Calcaneal fractures have considerable debate of the appropriate methods of management and how to lessen potential complications. Objective: Evaluation of intra-articular calcaneal fractures that treated by minimally invasive methods. Patients and Methods: A prospective study has been conducted on twenty patients having intra-articular calcaneal fractures and were managed by minimally invasive methods of fixation at Al Azhar university hospitals, Cairo, Egypt, after that they have been followed up for 6 months. Results: According to the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hind foot Score. There was: excellent (5 feet (25%), good (11 feet (55%), fair (2 feet (10%) and poor (2 feet (10%). The average score was 83 with a range of 68 to 95. No patient in this series experienced any failure of hard-ware, or developed deep infections. Complications included: superficial pin tract infection, varus heel deformity, flexion deformity of the big toe, reflex sympathetic dystrophy, subtalar arthritis and painful heel. Conclusion: Management of calcaneal, intra-articular, fractures by minimally invasive techniques is a viable surgical alternate as it provides shorter time of surgery, nominal invasiveness, less serious wound problems, and no residual hardware (in case of pinning). Their drawbacks include technical issues and inadequate reduction fracture fragment.

A comparative study of cross pinning versus lateral pinning technique in the management of completely displaced type-III supra condylar humerus fracture in the rural India children: A prospective study

Context: Supracondylar fractures of the humerus (SCFH) are the most common type of pediatric fracture and related to significant morbidity with the complication of nerve injury and loss of reduction. Closed reduction and percutaneous Kirchner wires pinning either by lateral pin fixation or cross pin fixation for the displaced fractures are the mainstay treatment. Aims: This study has purpose to compare the construct stability, functional, and radiological results between the two methods of fracture fixation. Subjects and Methods: A total of 61 children with Gartland III SCFH were placed randomly into two groups, Group A (n = 30) managed by lateral pinning technique and Group B (n = 31) were managed by cross pinning techniques. Both groups were quite comparable with regard to age, gender, duration of injury, and degree of displacement of the fracture. The results were analyzed in terms of clinical and radiological outcome, Flynn functional scoring system, and complications. Fisher's exact test and unpaired t-tests were used. The results were expressed as mean, and the P < 0.05 was considered statistically significant using the SPSS software (version 22). Results: Statistically, there was no significant difference in clinical or radiological results between the two groups at 6 months after operation (P > 0.05). There was no significant loss of reduction found in either of the groups. There was one (6.6%) case of the lateral pinning group that had a minimal loss of reduction and two (6.4%) cases of the iatrogenic ulnar nerve neuropraxia in the cross pinning group. Neuropraxia recovered fully. Superficial pin tract infection was seen in two (6.67%) cases of the lateral pinning group. Conclusions: Although it appears that cross spinning is a more stable construct, the lateral pin fixation provides the same result without risk of iatrogenic nerve injury with comparable results.

Surgical Management of Supracondylar Fractures of the Humerus in Children by Closed Reduction and Percutaneous Pinning with Kirschnner Wires-A Cross-sectional Study

Introduction: Supracondylar Humerus Fracture (SCHF) is frequently encountered in paediatric age group and constitutes nearly three fourth of all upper extremity fractures. Most commonly used technique for surgical treatment in the displaced SCHF in children is closed reduction and stabilisation with percutaneous pins. Aim: To find out the outcome and safety of percutaneous pinning techniques in terms of functional and radiological outcome and to note the associated complications with this method of fixation. Materials and Methods: This was a cross-sectional study, conducted on patients admitted to Department of Orthopaedics, Hassan Institute of Medical Sciences, Hassan, between January 2017 to December 2019. Thirty paediatric cases were retrospectively reviewed. These were admitted with a supracondylar fracture and had reported to the hospital over a three-year period. All fractures were treated with closed reduction and fixation with percutaneus K-wire followed by immobilisation in above elbow slab for three weeks. K-wires were removed at three weeks and mobilisation with physiotherapy was advised. Outcome was measured by Flynn’s Criteria. The results were analyzed as per appropriate descriptive statistical tests. Results: The mean age of the patients was 7.4 years (range 3-15years). Males outnumbered females. Total 22 (73.3%) patients had left-sided fracture and 8 (26.6%) had fracture on right side. Fracture union was seen in all the patients at a mean interval of 4.2 weeks (range 3-5 weeks), in a follow up of 12 weeks. Most (90%) of the injuries were the result of trauma, including fall. 70% of the fractures were Gartland Type III supracondylar fracture. Cross K- wire fixation was done in 21 patients and lateral-only pin in 9 patients. Among the 21 patients, who had type III fracture, 4 of them were fixed with 2 Lateral K- wire pinning and 17 of them with crossed K-wire pinning configuration. The commonest post-operative complication observed was a superficial pin tract infection, seen in 4 (13.3%) patients. Outcome according to the Flynn’s criteria 25 patients (83.3%) had excellent result, 3 (10%) patients had good result, 1 (3.3%) had fair result and 1 (3.3%) patient had poor functional result. Conclusion: The present study concludes that close reduction and percutaneous k-wire pinning techniques give a favorable outcome in displaced supracondylar fractures of the humerus in children, without any serious complications.

Treatment of Paediatric Supra Condylar Fracture Humerus

Introduction: One of the most frequent elbow fractures in childhood, is supracondylar fracture whichrequires rapid diagnosis and treatment. It is usually associated with neurovascular, functional problems and deformity.&#x0D; Objectives: To assess demographic, clinical features and treatment outcomes of the patients who underwent closed reduction and splinting, stabilization by percutaneous pinning or Open Reduction and Internal Fixation(ORIF).&#x0D; Materials and Methods: This retrospective study was conducted in the department of orthopedic surgery, CMH, Bogura from June 2017 to December 2018. The inclusion criteria was Gartland type I,II,III fracture who attended in emergency and casualty, between 2 to 13 years of age. Total 40 patients with the mean age 7.5 years were included in the study group.&#x0D; Results: All were closed fractures, 2flexion and 38 extension type. Two (5%) Gartland type I, 24(60%) and 14(35%) had type II and III fracture respectively. 2(5%) were treated by cast immobilization,8(20%)of type llby closed reduction &amp; splinting, 22(55%) and 8(20%) of type ll&amp;lll by crossed k-wire or by ORIF respectively. According to Flynn’s criteria our study shows 33(82.5%) excellent, 4(10%) good, 2(5%) fair and 1(2.5%) poor outcome.4(10%) had ulnar nerve neuropraxia, 1(2.5%) elbow stiffness,1(2.5%) cubitusvarus, 2(5%) experienced superficial pin tract infection.&#x0D; Conclusion: Management of supracondylar fracture should be decided according to patient’s age, fracture pattern and deformity status. Closed reduction and stabilization by percutaneous wiring provides an effective and safe treatment, when failed, open fractures or associated neurovascular complications ORIF should be preferred.&#x0D; JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 171-174