Superficial Pin Tract Infection Research Articles

Post-traumatic cubitus varus: long-term follow-up of corrective osteotomy using the Ilizarov method of compression distraction osteogenesis.

The term cubitus varus describes the inward inclination of the supinated forearm on the extended elbow. The deformity manifests clinically as a decreased carrying angle, decreased range of motion (ROM) along with a cosmetically unsightly appearance. The aim of the present study was to evaluate the technique of compression-distraction osteogenesis using the Ilizarov apparatus in the management of patients with post-traumatic cubitus varus deformity. The objectives were to study the impact of this method on the ROM, the Humerus Elbow Wrist (HEW) angle as well as the Lateral Prominence Index. A total of 32 patients who presented with a cubitus varus deformity of ≥10° at the elbow were retrospectively analyzed using data retrieved from a computerized hospital database. All patients had undergone a mini-incision subperiosteal osteotomy followed by application of an Ilizarov frame. Cinico-radiological follow-up was carried out at regular intervals until union was achieved and yearly thereafter. The mean time to union was 11 weeks. The mean follow-up period ranged from 2 to 12 years (mean 4.0 years). Results were graded as excellent in 25 cases (78.1%), good in 2 (6.3%) and poor in 5 case (15.6%) using the grading system of Oppenheim. The mean HEW angle at final follow-up improved from 20° of varus to 6° of valgus. The mean flexion/extension improved from 121°/-3° preoperatively to 125°/-4° at final follow-up. The Mayo Elbow Performance scores at final follow-up were excellent in 23 cases, good in 7 and fair in 2. Complications encountered included superficial pintract infections in three cases, lateral condylar prominence in one case, loss of terminal flexion in three cases and valgus over-correction in one case.

Outcome of complex tibial pilon fractures definitively treated with external fixator

<p class="abstract"><strong>Background:</strong> Complex tibial pilon fractures are typically sustained with high-energy mechanisms and they are often associated with severe soft tissue compromise that can frequently results in severe complications. The purpose of this prospective case series was to evaluate the radiological and clinical outcomes after the use of external fixation combined with minimally invasive osteosynthesis, as primary and definitive treatment of complex tibial pilon fractures.</p><p class="abstract"><strong>Methods:</strong> A prospective study was undertaken during the period from March 2012 to June 2016. A total number of 109 patients with complex tibial pilon fractures were managed in our institution and included in the study. All the patients were treated with external fixation and minimally invasive osteosynthesis. The mean follow-up period was 47 months (31-60 months). Clinico-radiological progression of fracture union as well as the functional outcome were studied.<strong></strong></p><p class="abstract"><strong>Results:</strong> Eighty fractures resulted from traffic accidents and type 43-C3 fracture according to AO/OTA classification was the most common. Seventy-eight were open fractures and 94 patients had associated distal fibular fractures. All patients were treated with monolateral external fixators for definitive management. The average time to union was 14 weeks (range 9-19). Eleven patients (10%) suffered superficial pin tract infection. One patient developed septic arthritis and evidence of radiological osteoarthritis was present in ten cases (9%) at final follow-up. The American orthopaedic foot and ankle society (AOFAS) score was 84.4±8.1, translating to good clinical results.</p><p class="abstract"><strong>Conclusions:</strong> This review concludes that external fixation, combined with minimally invasive osteosynthesis, consistently produces good functional results without serious complications.</p>

MANAGEMENT OF INTRAARTICULAR FRACTURE OF THE BASE OF THE FIRST METACARPAL BONE BY DYNAMIC EXTERNAL FIXATOR

Background: Fractures of the hand are common injuries and in particular, fractures involving the articular surfaces can present difficulties to the orthopedic surgeon in practice. Objective: To assess how to surgically manage intra-articular fracture of the base of the first metacarpal bone by Dynamic K-wire External Fixator. Subjects and methods: This was a non-randomized clinical trial carried out at Al-Azhar University Hospitals on 10 patients, during the period from March 2018 till May 2020. Results: The mean time before operation was 9.5±5, Blunt trauma was most common type of trauma with a percent of 60%.The mean operative time (minutes) was 40.1 ±2 with range of (30-45) minutes and mean time for k wire removal was 28.1 ±5 with range of (15-41).There was significant improvement of Quick DASH functional scoring. There was high significant improvement of range of motion. There is significant difference between the normal and operated side as regard range of motion. Regarding complications, 10% of cases had post-operative pain which continued whole period of follow up, 0% had secondary arthrosis, 10% had superficial pin tract infection and 0% had valgus deformity. Conclusion: Closed reduction and external fixation can be effective and safe treatments for unstable fractures at the base of the first metacarpal. Such external fixation structures were simple and versatile and able to simultaneously achieve effects such as meeting the retractor, adjusting the angulation, and shortening the displacement, especially for local wounds.

MANAGEMENT OF INTRAARTICULAR FRACTURE OF THE BASE OF THE FIRST METACARPAL BONE BY DYNAMIC EXTERNAL FIXATOR

Background: Fractures of the hand are common injuries and in particular, fractures involving the articular surfaces can present difficulties to the orthopedic surgeon in practice. Objective: To assess how to surgically manage intra-articular fracture of the base of the first metacarpal bone by Dynamic K-wire External Fixator. Subjects and methods: This was a non-randomized clinical trial carried out at Al-Azhar University Hospitals on 10 patients, during the period from March 2018 till May 2020. Results: The mean time before operation was 9.5±5, Blunt trauma was most common type of trauma with a percent of 60%.The mean operative time (minutes) was 40.1 ±2 with range of (30-45) minutes and mean time for k wire removal was 28.1 ±5 with range of (15-41).There was significant improvement of Quick DASH functional scoring. There was high significant improvement of range of motion. There is significant difference between the normal and operated side as regard range of motion. Regarding complications, 10% of cases had post-operative pain which continued whole period of follow up, 0% had secondary arthrosis, 10% had superficial pin tract infection and 0% had valgus deformity. Conclusion: Closed reduction and external fixation can be effective and safe treatments for unstable fractures at the base of the first metacarpal. Such external fixation structures were simple and versatile and able to simultaneously achieve effects such as meeting the retractor, adjusting the angulation, and shortening the displacement, especially for local wounds.

Cubitus varus deformity correction by uniplanar supracondylar humeral osteotomy with preset k-wires fixation: Our experience

Introduction: Cubitus varus deformity is the late complication after malunited supracondylar fracture of humerus in children. Various Osteotomies have been described in the literature and are associated with complications like nerve palsies, persistent varus deformity, infection, lateral condylar prominence, unsightful scar and loss of fixation.We report our experience for correction of cubitus varus deformity by uniplanar supracondylar humeral osteotomy and preset k-wires fixation with least complications. AIM: To study the results of of cubitus varus deformity correction by uniplanar supracondylar humeral osteotomy and preset k-wires fixation with least complications. Materials and Methods: A prospective study of 15 cases of cubitus varus deformity were included in the study. Pre-operative assessment of Carrying Angle and Elbow ROM was done. Uniplanar supracondylar humeral osteotomy and preset k-wires fixation was done in all cases. Results were evaluated using Mitchell and Adams criteria. Results: The average age at the time of injury was 5 years. The average age at corrective surgery was 6 years. The average operative time was 70 minutes. All cases were followed up till 1 year. All patients had increased carrying angle, increased elbow ROM and improved cosmetic outcome. The results were evaluated using Mitchell and Adams criteria. 1 patient had superficial pin tract infection, 1 pt had re-injury due to fall. The overall assessment showed excellent results in 80% and good results in 20% as per Mitchell and Adams criteria. Conclusion: From our study we conclude that cubitus varus deformity correction by uniplanar supracondylar humeral osteotomy with preset k-wires fixation is stable, simple, effective and safe method with least complications. Hence three dimensional tri planar correction of the deformity is not required for cubitus varus deformity correction.

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

IntroductionMedial 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. MethodWe 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. ResultsAt 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 revision of the osteotomy. . ConclusionHTO 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.

Results of JESS (Joshi's External Stabilizing System) in Relapsed, Neglected and Neurogenic Clubfoot in an Age Group of 2-10 Years.

Joshi's External Stabilization System (JESS) is an external fixator based methodology to correct different deformities of club foot using differential distraction. 31 difficult clubfeet feet in 24 patients who were neglected, neurogenic or relapsed were treated using JESS between July 2013 to June 2015 with an average follow-up of 4. 2 years. There were 16 males and 8 females in an age group of 2-10 years. 30 feet belonged to the severe and most severe group as per the Dimeglio Scoring System. All patients achieved correction of all components of the clubfoot. However, one patient required tibialis anterior transfer for dynamic forefoot adduction at the end of treatment. The mean total duration in JESS fixation was 69.5 days/foot (range 44-123 days) and the mean time to achieve correction within JESS averaged 52 days. The deformities improved from a mean Dimeglio score of 14.06 to 2.93. The objective radiological assessment of the deformities revealed improvements in the talocalcaneal angle on AP view from 16.39° to 34.52° and on lateral view from 15.97° to 33.03°. The Talo-1st metatarsal angle (AP view) improved from 35.29° to 7°. Complications included 11 cases of superficial pin tract infection, two instances of pin loosening and a case of pin cut out. There were three cases of 1st metatarsophalangeal dislocation that were managed by reversing the process of distraction. JESS is an effective method for managing difficult clubfeet.

Arthrodiastasis in the Management of Perthes’ Disease: A Systematic Review

Abstract Background This systematic review explores the relevant literature to assess the efficacy of the use of arthrodiastasis in the management of Perthes disease. Until this moment, arthrodiastasis is not well established for its use in Perthes disease as opposed to other containment procedures. Furthermore, there are no clear indications for its use in this disease. Methodology 12 articles were matched to the inclusion criteria and all articles were reviewed and radiological and clinical data was collected and compiled. Results a significant increase in postoperative range of motion compared to the preoperative ones was found. Final Stullberg classification was ascertained showing majority of patients ending with stages two and three. Complications were also assessed with majority of them being superficial pin tract infections. Conclusion the use of arthrodiastasis is a valid treatment option for Perthes disease however more articles need to be produced showing comparative data of arthrodiastasis versus other containment procedures. Index Terms- Arthrodiastasis, Perthes’ Disease, LCPD, Hinged Distraction the preservation of an intact and congruent femoral head. It is proposed that by applying distraction early in the disease, before any significant collapse of the femoral head had occurred, further fragmentation would be halted.[3]Articulated hip distraction maintains the proper head position by containment in abduction, extension, and neutral rotation. It also decreases joint pressure and thus decreases the deforming force and provides a good environment for cartilage repair. The femoral head deformity that develops in Perthes’ disease is believed to occur during this fragmentation phase of the disease. The possibility for joint motion allows for articular cartilage nutrition and the molding effect of the acetabulum. The aim of the articulated distraction method is to neutralize muscle and weight-bearing forces, to prevent stress fractures of subchondral immature bone, and to encourage synovial circulation and promote creeping substitution by breaking the ‘vicious circle’ of necrosis.[4]

Results of JESS (Joshi’s External Stabilizing System) in Relapsed, Neglected and Neurogenic Clubfoot in an Age Group of 2-10 Years

Background. Joshi’s External Stabilization System (JESS) is an external fixator based methodology to correct different deformities of club foot using differential distraction. Material and methods. 31 difficult clubfeet feet in 24 patients who were neglected, neurogenic or relapsed were treated using JESS between July 2013 to June 2015 with an average follow-up of 4. 2 years. There were 16 males and 8 females in an age group of 2–10 years. 30 feet belonged to the severe and most severe group as per the Dimeglio Scoring System. All patients achieved correction of all components of the clubfoot. Results. However, one patient required tibialis anterior transfer for dynamic forefoot adduction at the end of treatment. The mean total duration in JESS fixation was 69.5 days/foot (range 44-123 days) and the mean time to achieve correction within JESS averaged 52 days. The deformities improved from a mean Dimeglio score of 14.06 to 2.93. The objective radiological assessment of the deformities revealed improvements in the talocalcaneal angle on AP view from 16.39° to 34.52° and on lateral view from 15.97° to 33.03°. The Talo-1st metatarsal angle (AP view) improved from 35.29° to 7°. Complications included 11 cases of superficial pin tract infection, two instances of pin loosening and a case of pin cut out. There were three cases of 1st metatarsophalangeal dislocation that were managed by reversing the process of distraction. Conclusion. JESS is an effective method for managing difficult clubfeet.

Treatment of unstable metacarpal fractures using transverse Kirschner-wire fixation technique

Background Several methods of fixing unstable metacarpal shaft fractures have been described. The aim of the study was to assess the clinical and radiological results of transverse Kirschner (K)-wire fixation technique for the treatment of unstable ulnar four metacarpal fractures. Patients and methods A prospective study was held between 2014 and 2016 at Benha University Hospital on 25 patients (22 males and three females) who had unstable metacarpal fractures affecting second to fifth metacarpals treated with transverse wiring technique. The patients’ mean age was 30.9 years. The dominant hand was affected in 21 patients, whereas in four patients, the nondominant hand was affected. Under fluoroscopy, closed reduction and percutaneous fixation with three K-wires, one proximal and two distal to the fracture site, was done. The mean operative time was 28.8 min. The inclusion criteria included patients with acute metacarpal shaft fracture with unaccepted shortening, angulation, and rotation. Results The mean follow-up period was 12.1 months. Bony union was achieved at an average of 6.8 weeks. At the final follow-up, all patients had almost full range of motion, with a mean total active range of motion of 260° (245–270°). None of the patients had any clinically detectable rotational deformity, and the functional outcome was satisfactory, with mean grip strength of the injured hand of 97% in comparison with the noninjured side. The average Quick Dash score was 1.5±1.6, ranging from 0 to 4.5 points. The mean visual analog score for pain was 0.92±1.1. All patients returned to their ordinary jobs and were cosmetically and functionally satisfied with the results of their surgery. Two patients presented with superficial pin-tract infection and one patient united with 15° radiological angulation of the fifth metacarpal without any functional affection. No other complications occurred. Conclusion Transverse K-wire technique is an effective, easy, and safe method for treating unstable metacarpal fractures, without significant complications.

Acute ulnar osteotomy versus gradual distraction by external fixator to correct missed monteggia type 1 fracture-dislocation; A comparative study

Background: Monteggia fracture-dislocations are complex injuries. These injuries, especially neglected ones, remain a challenge for orthopedic surgeons. The aim of this study is to compare the results of acute and gradual ulnar lengthening osteotomies in treating chronic Monteggia fractures in children. Patients and Methods: The study includes two groups of patients, treated at our institution in the period from April 2014 to September 2018. The first group (Group A) included nine patients who were treated by an overcorrective ulnar osteotomy with acute lengthening with bone grafting. The second group (B) includes 11 children who were treated by Ilizarov distraction osteogenesis for differential lengthening of forearm bones. There were 14 boys and 6 girls. The left elbow was involved in five patients and the right elbow 15 patients. All fractures were classified as Bado type I with anterior radial head dislocation. The average age at the time of surgery was 7 years and 4 months. Results: The mean interval from the injury to surgical interference was 8.6 months. There was a significant improvement of the elbow range of motion and Mayo elbow performance score. In group B, the mean external fixation time was 9.7 weeks (range from 9 to 15 weeks). The mean total treatment time was 12.3 weeks (ranged from 12 to 16 weeks). Superficial pin-tract infection occurred in all cases and was managed without further sequelae. Conclusions: Both approaches yielded equally good results. The open surgery approach entails a more invasive procedure, but more convenient to the patient and no arduous postoperative follow-up is needed. On the contrary, differential lengthening of forearm bones is a percutaneous procedure with the application of Ilizarov principles in a controlled biological manner; with no graft materials needed. Both techniques effectively reduced the radial head.

Evaluation of Clinical Outcomes of Management of Pediatric Both Bone Forearm Fractures Using the Titanium Elastic Nailing System: A Prospective Study of 50 Cases

Context: Forearm fractures are common injuries in children. In older children, their management is difficult due to increased chances of redisplacement after closed reduction. Aims: The aim of this prospective study was to evaluate the clinical outcome of managing pediatric forearm fractures using the titanium elastic nailing system (TENS). Subjects and Methods: Fifty patients in the age group of 6–14 years with fractures both bones forearm were managed by internal fixation using the TENS, and prospective follow-up was done for 6 months. Results: On final evaluation, we had excellent outcomes in 92% patients and good in 8%. There were no significant complications except for superficial pin-tract infections at entry site of nail in only 6% of patients. Conclusions: We conclude that TENS is an effective and minimally invasive method of fixation of forearm fractures with excellent results in terms of bony union and functional outcomes with minimal complications and without jeopardizing the integrity of the physis.

Early hybrid nonbridging external fixation of unstable distal radius fractures in patients aged ≥50 years.

ObjectiveWe evaluated hybrid nonbridging external fixation (NBEF) supplemented by K-wires as an effective and safe treatment option for osteoporotic distal radius fractures (DRFs) in a retrospective case series.MethodsSixteen extra-articular and one intra-articular DRF were treated by NBEF from 2016 to 2018 (mean patient age, 61.8 years; 15 women, 1 man). Radiographic parameters (volar tilt, radial inclination, and ulnar variance), range of motion, grip power, the visual analog scale score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed at 4 weeks, 6 weeks, 6 months, and 12 months postoperatively.ResultsThe volar tilt and radial inclination were restored after surgery and maintained well. The mean visual analog scale score was 4 ± 1 at 4 weeks. Range of motion was restored to 79% to 91% at 6 weeks. The DASH score was good before NBEF device removal. Two superficial pin-tract infections were easily treated with antibiotics.ConclusionsHybrid NBEF transfixes DRFs in a multiplanar fashion, and augmentation with percutaneous K-wires provides direct fixation in radial shift and withstands axial loads in fracture fragments. It allows early mobilization with rigid fixation. Hybrid NBEF is reliable for unstable extra-articular and simple intra-articular DRFs in older patients.Clinical Study registration numberChiCTR1900021712

Arthrodiastasis in the management of Perthes disease: a systematic review.

This systematic review explores the relevant literature to assess the efficacy of the use of arthrodiastasis in the management of Perthes disease. Until this moment, arthrodiastasis is not well established for its use in Perthes disease as opposed to other containment procedures. Furthermore, there are no clear indications for its use in this disease. Twelve articles were matched to the inclusion criteria and all articles were reviewed and radiological and clinical data were collected and compiled. As regards the hip flexion range of motion, the average preoperative flexion range of motion was 55.32°, while the postoperative was 90°. The average preoperative hip abduction range of motion was 12.28° and postoperative was 35.28°. Mean preoperative hip internal rotation range of motion was 8.69° and postoperatively was 24.93°. Mean preoperative external rotation range of motion was 21.73°, while the postoperative range was 33.71°. Final Stulberg classification was ascertained showing most patients ending with stages two and three. Complications were also assessed with most of which being superficial pin tract infections. The use of arthrodiastasis is a valid treatment option for Perthes disease; however, more articles need to be produced showing comparative data of arthrodiastasis versus other containment procedures. Level of evidence - level 1: systematic review.

Percutaneous fixation of fractures of the calcaneus and its functional outcomes

Background: Closed fractures of the calcaneum are common fractures of the lower limb and which usually result from by high velocity axial loading of the calcaneum. Open reduction and internal fixation methods have formed the mainstay of their treatment. However the associated wound complications have made the management of such injuries more difficult. Percutaneous fixation techniques provide an effective method of closed treatment of these fractures and can help avoid wound related complications.Methods: Twenty- four patients with fractures of the calcaneum were treated with percutaneous reduction with Essex-Lopresti technique and fixation with Steinman pin and K-wires, followed by immobilization with a slab. The American orthopaedic foot and ankle score (AOFAS) was calculated at the final follow up. Also the heel width (with a vernier caliper) and the heel height (from lateral malleolus to the ground surface) were recorded at the final follow up.Results: Of the total patients 8 had excellent, 10 had good and 6 had fair results. None of the patients had heel widening or loss of calcaneal height of more than 1 cm as compared to the contralateral limb. Complications seen were superficial pin tract infections (3) which were treated with early implant removal and appropriate antibiotics. The Bohler’s angle at follow up was at a mean 30 degrees. Conclusion: The percutaneous reduction of closed fractures of the calcaneum provides good functional results as per AOFAS score. It also helps avoid wound related complication seen in open techniques. The Essex-Lopresti technique of reduction of such fractures has a short learning curve and can be reproduced at most operative setups. Long term follow up studies and bigger sample sizes can help support our conclusions.

The treatment of neurotrophic foot and ankle deformity of spinal bifida: 248 cases in single center

Objective:To evaluate the functional outcome of foot and ankle deformity secondary to spinal bifida treated by various methods.Methods:A retrospective analysis of 248 patients with foot and ankle deformity secondary to spina bifida with an average age of 25.5 years and underwent surgical treatment in our hospital from March 2012 to April 2016. The deformity correction was achieved by various methods like soft tissue procedure, bony procedure combined with external fixator application. All the patients were followed up at regular interval. Post operative rehabilitation and protective splints were provided after fixator removal. The final outcome was evaluated with American Orthopedic Foot and Ankle Society (AOFAS) score and Qin’s criteria for deformity correction, matched T-test was used to compare the data pre and post surgery.Results:According to the short term follow up, all these patients were achieved complete correction and able to achieve full weight bearing. Out of 248 patients, 13 patients were lost follow up. 235 patients were followed up for an average of 28.5 months. We noted various minor complications like superficial pin tract infection was seen in 5, pin breakage in 4, pin tract burn injury in 1, and recurrence of deformity was noted in 20 patients especially in children, anterior dislocation of the tibiotalar joint in 3 patients with severe clubfoot deformity. At the final follow up, the mean AOFAS score increased to 88.7, with a significant improvement compared with the score before surgery (P < 0.05). Based on Qin’s criteria for deformity correction, the outcome was graded as excellent in 180 patients, good in 55, and fair in none of the cases.Conclusion:Through orthopaedic treatment, combination of soft tissue and bony procedures along with external fixator helps to achieve complete correction of deformity, healing of ulcer, restoration of functional activity for spinal bifida sequelae patients.

Using the Ilizarov technique for the correction of coxa vara

Background and objective: Coxa vara was treated previously by subtrochanteric and inter-trochanteric valgus osteotomies with internal fixation. Recently; more attention was paid for achieving corrections of limb deformities and length discrepancies through less invasive means using external fixator systems including Ilizarov fixation. This study aimed to describe the performance of Ilizarov fixation technique in the surgical correction of coxa vara of different etiologies and limb lengthening. Methods: In this case series study, nine patients (11 hips) with coxa vara of different etiologies were treated surgically by sub-trochanteric osteotomy done percutaneously with the use of Ilizarov fixation device, in 15 months at Erbil teaching hospital. Patients between four and ten years of age with coxa vara with neck – shaft angle less than 120° or Hilgenreiner epiphyseal angle of more than 40° were included in this study. Results: All osteotomies achieved the targeted correction in the Hilgenreiner –epiphyseal angle and the neck-shaft angle with a P value <0.001. All osteotomies healed primarily and on follow-up, no intra-operative complications developed, and no patient needed the post-operative blood transfusion. Three patients needed limb lengthening, one patient needed shelf osteotomy, and two patients had superficial pin tract infection. Four patients had postoperative knee stiffness which resolved completely. Radiological analysis revealed a maintained improvement in the Hilgenreiner-epiphyseal angle and neck-shaft angle. Conclusion: Ilizarov technique is a safe and less invasive technique for the surgical management of coxa vara of different etiologies and limb length discrepancy.

Functional outcome and complications of displaced supracondylar fracture in pediatric population treated with open reduction internal fixation with K wires

Objective: The objective of this study was to analyse clinical outcome of treatment of supracondylar fracture of humerus by open reduction and internal fixation with K-wires and to analyse complications of the procedure.Introduction: Treatment of displaced supracondylar humerus fracture (SCHF) is a challenge to the orthopaedic surgeon owing to its neurovascular and other complications.Open reduction and K-wire fixation is widely accepted standard treatment and is an effective way in managing such fracture with goals of obtaining correction and maintenance of alignment, avoiding deformity, and getting functional range of elbow movement. The aim of our study was to evaluate the functional results of open reduction and internal fixation with k wires in the treatment of displaced (Gartland’s type III) supracondylar fractures of the humerus.Methods: 50 cases of displaced (Gartland’s type III) supracondylar fractures treated byOpen reduction and internal fixation with K-wires were studied between february 2013 – January 2016 at our institution and followed for an average of 6 months.Results: In our study of 50 cases, all were closed Gartland’s type III fractures with mean age of 6.3 years, posteromedial displacement in 32 patients. 4 patients had associated distal end radius fracture. Majority of patients operated on 2nd day and discharged on 3rd postoperative day. 32 had 0-5° loss of range of motion, 36 had 0-5° loss of carrying angle. 6 patients had superficial pin tract infection, 4 had traumatic median nerve palsy, 4 had migration of K-wire, 2 had Cubitus varus deformity and 2 had loss of motion >15.

Jess Fixator for Metacarpal and Phalangeal Fracture

The fractures of metacarpal and phalanges of the hand are the most common injury encountered in emergency department. Most often these injuries are neglected as minor injuries and later on develops a functional limit of the hand. Joshi’s external stabilizing system (JESS) fixator based on the principle of ligamentotaxis, stabilize the unstable and intraarticular fractures of metacarpal and phalangeal and also provides an environment for rapid soft tissue healing without further damaging the microvascular circulation. The study includes total number of 38 patients with a diagnosis of fracture of Metacarpal and phalanx of hand admitted in Nepal Medical college and Teaching Hospital who were treated with JESS fixator. The functional outcome after the removal of JESS fixator was assessed by calculating American Society for Surgery of Hand and Total Active flexion (ASSH TAF). Among the 38 patients, all fractures went to union with an average union period of 6 weeks. The mean period of treatment for metacarpal fractures was12 weeks and for phalangeal fractures 16 weeks by which time patients regained full functional activity of hand and returned back to their respective works. The functional outcome assessed by ASSH-TAF score was excellent in 28 patients, good in 10 patients and none of them had a poor result. The complication was seen in 9(23.68%) cases, superficial pin tract infection and K Wire Loosening. JESS fixator is cheap, easily available and less technically demanding, provides with an effective treatment for the metacarpal and phalanges fracture, as it provides adequate stability that allows early rehabilitation with soft tissue care and has got a good functional outcome

Ilizarov method combined with reversed sural or saphenous neurocutaneous island flaps transfer for posttraumatic equinus with soft tissue defects on ankle and foot

Objective To evaluate the clinical effects of the Ilizarov method combined with two kinds of reversed neurocutaneous island flaps transfer for posttraumatic equinus with soft tissue defects on ankle and foot. Methods Data of 21 cases of posttraumatic equinus with soft tissue defects on ankle and foot who were treated with the Ilizarov external fixation combined with the two kinds of reversed neurocutaneous island flaps transfer from June 2006 to January 2018 were retrospectively analyzed. There were 17 males and 4 females, aged from 26 to 65 years, with an average age of 43.9 years. The soft tissue defect dimensions ranged from 6 cm×5 cm to 10 cm×9 cm, and the time from the initial trauma to the operation ranged from 2.5 to 240.0 months. The mean preoperative equinus contracture was -38.9° (range, -25° to -66°), and total ankle range of motion (ROM) was 7.1° (range, 0°-18°). All cases were treated with the Ilizarov external fixation combined with the two kinds of reversed neurocutaneous island flaps transfer. Two weeks after the flap transfer, distraction of the Ilizarov fixator was initiated to gradually correct the equinus foot. The flap survival was observed in the postoperative period, and the International Club Foot Study Group (ICFSG) score was collected at the latest follow-up. The criteria were used to assess the morphological and functional outcome. Results A total of 21 resversed flaps were transferred, including 15 sural neurocutaneous flaps and 6 saphenous neurocutaneous flaps. The sizes of flaps were from 7 cm×6 cm to 11 cm×10 cm. Among them, 17 patients underwent primary flap transfer, and 4 patients underwent a delayed second-stage procedure 2 weeks after primary surgery. The 4 delayed flaps contain 3 sural neurocutaneous flaps and 1 saphenous neurocutaneous flap. All 21 patients were followed up and the average periodof follow-up was 20.3 months (range, 8-96 months). Among the 21 flaps, 19 survived completely. Although marginal necrosis was observed in 2 cases, these wounds healed after subsequent debridement and dressing change treatment. No major complication was seen, but superficial pin tract infection was present in 4 cases who then received dressing change and oral antibiotic. Deformities were corrected, and ankle motion had increased significantly. The mean ankle activity at the latest follow up was 22° (range, 8°-38°), and postoperative ICFSG score at the latest follow-up was 5.67±3.09, which significantly reduced compared with preoperative one (30.81±3.63). The difference was statistically significant (t=32.815, P=0.035) . The results were excellent in 13 feet, good in 7, and fair in 1, with the excellent and good rate of 95.24% (20/21). The local infections were cured without recurrence at operative site. Equinus deformities were corrected, and the latest follow-up results showed that all patients walked normally without recurrence. Conclusion Ilizarov method combined with reversed sural and saphenous neurocutaneous island flap can improve the limb function and the flap can survival with good clinical effect. Key words: External fixators; Surgical flaps; Equinus deformity