Treatment Of Such Fractures Research Articles

Surgical Treatment of Type 31-A1 Two-part Intertrochanteric Femur Fractures: Is Proximal Femoral Nail Superior to Dynamic Hip Screw Fixation?

IntroductionThe implant of choice for two-part intertrochanteric femur fracture is still under debate. This study was done to compare the operative parameters and functional outcome of two-part intertrochanteric fractures treated by dynamic hip screw (DHS) and proximal femur nail (PFN).MethodsFifty-four operated cases of two-part intertrochanteric (AO 31A1) were analysed and divided into two groups based on implant used (PFN 30, DHS 24). Operative details, which include blood loss and duration of surgery, were obtained from hospital records. All patients were followed up for six months and assessed for radiographic and functional outcome. The functional outcome was calculated with modified Harris hip score and Parker mobility score.ResultsThere was no significant difference in the operative parameters (p > 0.05) between DHS and PFN. The average blood loss for DHS and PFN was 202.5 ml and 198 ml respectively while operative duration was 136 min and 126 min, respectively. All patients had good functional outcome at the end of six months with average Harris hip score of 69.7 and Parker score of 8. No difference was found between the two surgeries in terms of functional outcome as well (p > 0.05).ConclusionThere is no conclusive evidence to show that PFN is superior to DHS in the treatment of two-part intertrochanteric (31A1) fracture. Both DHS and PFN are equally effective in treatment of such fractures.

Hip fractures in children and adolescents.

Femoral neck fractures account for <1% of the fractures in children, and are produced by high energy trauma. The most commonly accepted treatment for such fractures is gentle manual anatomical reduction and internal fixation, yielding a healing rate between 80% and 90%. Electronic search through major web databases (Medline, Cochrane and Google Scholar). All types of article were eligible for inclusion, except for reviews, systematic reviews, meta-analyses and case reports. The methodological quality of the studies was assessed using the Methodological Index for NOn-Randomized Studies (MINORS). Both open reduction and internal fixation (ORIF) and closed reduction and internal fixation (CRIF) can be used to manage hip fractures in paediatric patients. ORIF is more accurate in reducing and fixing the fracture, with better clinical and functional outcomes, and lower complication rate. Delayed fixation decreases the rate of acceptable outcome and increases the rate of complications. The methodological quality of the included studies is average-low, and the published evidence is not of sufficient quality to allow to draw final conclusion on the topic. Good results were reported for both ORIF and CRIF techniques, but are not supported by scientific evidence of adequate quality. More and better studies, including randomized trials, should be carried out to provide more scientifically evidence based conclusions.

Concepts and Challenges in the Surgical Management of Edentulous Mandible Fractures: A Case Series

Functional rehabilitation of complex edentulous or atrophic mandibular fractures is surgically demanding. The high incidence of bone fractures in geriatric age group is secondary to the loss of bone mineral content with age. So far, there is no consensus regarding the best treatment for repair of fractures of the severely atrophic mandible. Thus, the choice of treatment for such fractures should be based on the degree of atrophy, considering its inverse relationship to the amount of rigid fixation required. Hence, open reduction and internal fixation (ORIF) is considered to be a reliable method for treating the edentulous mandible fractures. The authors present a case series of patients treated with ORIF with load bearing (LB; reconstruction plate) and load sharing (LS; miniplates) principles. No complications related to infection, plate exposure, fibrous union, nonunion, and trismus, were observed.

Extension block and direct pinning methods for mallet fracture: A comparative study.

BackgroundMallet fracture can easily occur during sports activities or in daily life; however, the principles and methods of treatment for such fractures remain debated. Among the surgical treatments, various methods of closed reduction have been proposed. We treated patients with the extension block method (EBM) and the direct pinning method (DPM), and then compared the results. We assessed differences in range of motion and measurements of finger movement after surgery.MethodsA total of 41 patients who underwent surgery from August 2013 to September 2015 were evaluated retrospectively. Among them, 21 patients were treated with the EBM and 20 patients were treated with the DPM. We then compared extensor lag, range of motion, and outcomes according to Crawford’s criteria between before surgery and at 6 to 8 months postoperatively.ResultsThe postoperative extensor lag improvement was 4.28° and 10.73°, and the postoperative arc of motion was 55.76° and 61.17° in the EBM and DPM groups, respectively. The Crawford assessment showed no statistically significant difference between the groups, although the score in the DPM group was higher than that in the EBM group (3.5 vs. 3.1).ConclusionsAs closed reduction methods for the treatment of mallet fracture, both the EBM and DPM showed good results. However, the DPM proved to be superior to the EBM in that it produced greater improvements in extensor lag and range of motion.

TIBIAL PLATEAU FRACTURES

Background: Tibial fractures is most common type of long bone fractures. Highspeed lifestyles with vehicles motorcycles as well as growing waves of violence, contributingincrease occurrence of tibial fractures. Tibial plateau fractures continues to be a challenge fororthopedic surgeon. Treatment of these fractures have been plagued by complications. Recentimprovements in the techniques and development of hybrid external fixator have revolutionizedthe treatment of such fractures. Objective: To evaluate the clinical outcomes of hybrid externalfixator in high energy Schatzkar V and VI tibial plateau fractures. Study Design: Descriptive,Case series. Period: 27 June 2013 to 26 June 2016. Setting: Nishtar Hospital, Multan. Materialand methods: A total of 125 patients with open and close tibial plateau fractures, 20 to 50 yearsof age of both genders were included in the study. Patients having history of pervious surgeryor intervention tibial plateau fractures, and h/o malignancy were excluded. All the patients wereoperated by a consultant orthopedic surgeon. Outcome was assessed at 16 weeks by serialradiological x-ray by formation of callus and noting any grade of pin track infection. Results; Ourstudy comprised of 125 patients having Schatzker V and Schatzker VI tibial plateau fractureswho met our inclusion criteria. Mean age of 38.925 ± 7.09 years. Majority of the patients 47(37.60%) were between 41 to 50 years of age. Mean duration since injury in our study was 13.18± 4.79 hours. Out of 125 patients, 102 (81.60%) were males and 23(18.40%) were females withmale to female ratio of 1.2:5.4. Fifty three (42.4%) patients presented with Schatzker V and 72(57.6%) had Schatzker VI type of tibial plateau fractures. In our study, non-union was seen in10cases (8.0%) and pin track infection was noted to be present in 19 (15.20%) patients. So, theacceptable outcome (achievement of union without non-union or pin track infection during 16weeks) was seen in 96(76.8%) patients. Conclusion: This study concluded that there is highrate of acceptable outcome (achievement of union without any non-union or pin track infectionduring 16 weeks) after hybrid external fixator of the open and closed fractures of tibial plateauamong the patients having schatzker-V and VI.

Continuously declining incidence of hip fracture in Finland: Analysis of nationwide database in 1970–2016

BackgroundHip fractures of older adults are a major public health issue. MethodsWe determined the current trend in the number and incidence (per 100,000 persons) of hip fracture among older adults in Finland by taking into account all persons 50 years of age or older who were admitted to hospitals for primary treatment of such fracture between 1970 and 2016. ResultsThe number of hip fractures rose sharply till the end of 1990s (from 1857 in 1970 to 7122 in 1997), but since then, the rise has slowed down (7716 fractures in 2016). Similarly, the age-adjusted incidence of hip fracture increased until 1997 but declined thereafter. The decline was especially clear in women whose age-adjusted incidence was 537.9 (per 100,000 persons) in 1997 but only 344.1 in 2016. In men, the corresponding incidence was 256.5 in 1997 and 194.7 in 2016. With the current 2016 incidence rates, the number of hip fractures in Finland will increase by 44% by the year 2030 due to the sharp growth of the population at risk. The only way to limit the rise is to have a further decline in fracture incidence in 2016–2030. ConclusionsThe decline in the incidence of hip fracture in Finland has continued through the entire new millennium. Despite this we have to effectively continue implementation of the fracture prevention efforts, because our elderly population will grow rapidly in the near future.

Comparing the Intramedullary Nail and Extramedullary Fixation in Treatment of Unstable Intertrochanteric Fractures

Treatment options for unstable intertrochanteric fractures include intramedullary nail and extramedullary fixation, although evidence regarding the most appropriate treatment for such fractures remains controversial. Our hypothesis was that there would be no obvious differences in mortality rates, functional outcomes and complications between the two groups. We therefore conducted a meta-analysis to compare the relative advantages of intramedullary nail and extramedullary fixation. A total of 10 randomized controlled trials including only patients with unstable intertrochanteric fractures were included in the final analysis. We found that no statistically significant difference in one-year mortality was observed between the two groups (RR: 0.78, 95% CI: 0.55–1.10, p = 0.160). Analysis of exact p values from five included studies indicated that functional outcomes were markedly better for patients of the intramedullary nail group when compared with those of the extramedullary fixation group (p = 0.0028), although evidence remains controversial. Higher incidences of all complications were noted for extramedullary fixation (RR:1.48, 95% CI: 1.12–1.96, p = 0.006). However, no significant differences in implant-related complications were observed between the two groups (RR:1.20, 95% CI: 0.73–1.97, p = 0.475). Therefore, comparing with extramedullary fixation, the intramedullary nail method would be more reliable and should be encouraging for unstable intertrochanteric fractures.

Non neurologic burst thoracolumbar fractures fixation: Case-control study

Study designBurst fractures not associated with any neurological deficits are frequent but not therapeutic agreement on their management is available to date. This case-control study was conducted to try to help guide therapeutic decision in the treatment of such fractures. Materials and methodsThis case-control study includes consecutive retrospective evaluation of 25 case-patients treated by posterior short-segment fixation associated with kyphoplasty (SFK) in the treatment of A3 thoracolumbar unstable fractures, as compared to a control-group composed of 82 patients treated by long-segment (LF) pedicle screws. ResultsSFK patients bled significantly less than the LF patients (p=0.04). Assessment of deformation progression, vertebral height restoration and reduction of the regional kyphotic angle in the SFK and LF groups revealed no statistically significant superiority of one approach on another. In contrast, the height of endplates was significantly increased in the SFK group (p=0.006). The patients’ pain levels were significantly improved in the SFK group (p=0.002). However, patients from the SFK group stood earlier postoperatively (1.7 vs 3.7days, p=0.001). ConclusionWe believe that SFK in vertebral fractures is as efficient as LF for bone consolidation and spine stabilization. In addition, SFK patients may use fewer analgesics.

The efficacy of rotational control designs in promoting torsional stability of hip fracture fixation.

ObjectivesFractures of the proximal femur are a common clinical problem, and a number of orthopaedic devices are available for the treatment of such fractures. The objective of this study was to assess the rotational stability, a common failure predictor, of three different rotational control design philosophies: a screw, a helical blade and a deployable crucifix.MethodsDevices were compared in terms of the mechanical work (W) required to rotate the implant by 6° in a bone substitute material. The substitute material used was Sawbones polyurethane foam of three different densities (0.08 g/cm3, 0.16 g/cm3 and 0.24 g/cm3). Each torsion test comprised a steady ramp of 1°/minute up to an angular displacement of 10°.ResultsThe deployable crucifix design (X-Bolt), was more torsionally stable, compared to both the dynamic hip screw (DHS, p = 0.008) and helical blade (DHS Blade, p= 0.008) designs in bone substitute material representative of osteoporotic bone (0.16 g/cm3 polyurethane foam). In 0.08 g/cm3 density substrate, the crucifix design (X-Bolt) had a higher resistance to torsion than the screw (DHS, p = 0.008). There were no significant differences (p = 0.101) between the implants in 0.24 g/cm3 density bone substitute.ConclusionsOur findings indicate that the clinical standard proximal fracture fixator design, the screw (DHS), was the least effective at resisting torsional load, and a novel crucifix design (X-Bolt), was the most effective design in resisting torsional load in bone substitute material with density representative of osteoporotic bone. At other densities the torsional stability was also higher for the X-Bolt, although not consistently significant by statistical analysis.Cite this article: J. D. Gosiewski, T. P. Holsgrove, H. S. Gill. The efficacy of rotational control designs in promoting torsional stability of hip fracture fixation. Bone Joint Res 2017;6:270–276. DOI: 10.1302/2046-3758.65.BJR-2017-0287.R1.

A study of management of trochanteric fracture of femur treated with dynamic sliding hip screw-plate device vs. proximal femoral nail

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;The incidence of intertrochanteric fractures has been increasing significantly due to the rising age of modern human populations. Generally, intramedullary fixation [proximal femoral nail (PFN) and gamma nail] and extra-medullary fixation [dynamic hip screw (DHS)] are the 2 primary options for treatment of such fractures. &lt;/span&gt;&lt;span lang="EN-IN"&gt; &lt;/span&gt;&lt;span lang="EN-IN"&gt;Objectives: The goal of this study is to compare the clinical and radiographical results of DHS and PFN for the treatment of trochanteric hip fractures. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Patients with trochanteric fractures were treated either with DHS or PFN in the Department of Orthopaedics, M.G.M. Medical College and L.S.K Hospital, Kishanganj, Bihar from October 2010 to October 2012 were included for this study&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Forty three patients (24 male and 19 female, ratio of M:F 1.26:1) surgically treated for trochanteric fractures were divided into two groups. Group 1: 25 hips treated with DHS and group 2: 18 hips treated with PFN. The outcome for each group was analyzed, and total operative time, time to union, complications (early and late), and mortality were recorded. The results were statistically compared. Out of 25 cases of DHS, majority cases (13) took between 1 hour 36 minutes to 2 hours. Whereas, out of 18 cases of PFN, majority (8) took 1 hour to 1 hour 30 minutes. The mean time to union for group 1 was 2.09 months and 1.69 months for group 2. Early and late complication rates between treatment groups revealed no statistically significant differences. Total duration of surgery was significantly lower for PFN than it was for DHS. A comparison of time to union and overall mortality demonstrated no statistically significant differences. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;We detected no differences between the two treatment groups in regard to early versus late complications, time to union, and overall mortality; however, with its shorter operative period, PFN is a good alternative to the DHS.&lt;/span&gt;&lt;/p&gt;

Prospective study of management of close or compound segmental fracture tibia by close reduction and internal fixation with interlocking nail

Background: Fractures of tibia are rated as one among the list of common and major skeletal injuries as one third of its surface is subcutaneous. Segmental tibial fractures feature a unique fracture type characterized by a completely isolated intercalary osseous fragment separated by at least two different fracture lines. Since tibia is a large bone and one of the principal load bearing bones in the lower extremity, fractures can cause prolonged morbidity, extensive disability unless treatment is appropriate. Treatment of such fractures in adults is a challenge to orthopaedic surgeons due to its poor soft tissue coverage and poor blood supply. Moreover, compartment syndrome, neurovascular injuries and infection might add to the burden. Later non union, delayed union and Mal-union may occur. The acceptable treatment goal for the segmental fracture tibia is union maintaining normal length, normal alignment without rotational deformity, normal joint movements and reduced hospital stay. Interlocking nailing has proven to be the method of choice for fixation of these fractures. The intramedullary nailing under image intensifier fulfills the objective of stable fixation with minimal tissue damage resulting in better and quicker fracture unions. Materials and methods: This study included 51 patients admitted in the Department of Orthopaedics with either open (37) or close segmental tibia fractures with compromised soft tissue (14) and treated with interlocking nail. Anterioposterior and lateral radiograph were done to diagnose fracture type. Routine preoperative investigation was followed. Patients were operated within 48 hours of hospital admission. Patients were followed up periodically on an outpatient basis on 2nd, 4th, 6th, 10th, 14th, 18th week and 6th month. Clinical and radiological assessment was done for pain, deformity, shortening, range of motion of knee, ankle, subtalar joints and radiological union.The final outcome was assessed using Johner and Wruh’s criteria Results and Discussion: In our series, out of 51 cases, 47 (92.15%) had acceptable Johner and wruth's criteria for functional results (sum of excellent and good results). Excellent in 36 (70.59%), good in 11 (21.57%), fair in 3 (5.87%) and poor in 1 (1.97). These results were comparable with results btained by Ekeland and Alho who reported results excellent in 29, good in 13 and fair in 2 and poor in one out of 45 cases.Conclusion: From this study, it was concluded that the preferred method of initial fracture stabilisation is the use of unreamed interlocking inramedullary tibial nail with immediate soft tissue cover whenever possible, this procedure require less surgical time, hospital stay, is cost effective and have minimum complications with good functional outcome.

Le fratture del terzo distale dell’omero

Distal humerus fractures are complex fractures as they are often comminuted, rare fractures, associated with severe soft tissue and neurovascular injuries, as well as to osteoporosis. Their treatment is complex and there is no consensus among surgeons, and options include conservative treatment, plate osteosynthesis, axial and hinged external fixators, associations of plate and external fixator. The goal we must achieve, independent of the type of osteosynthesis that has been used, must be to reach functional elbow stability, without pain. The aim of our work was to demonstrate that external fixation may be considered as a valid method not only in case of emergencies, but also for the definitive treatment of such fractures.

Segmental tibial fractures treated with unreamed interlocking nail – A prospective study

Introduction: Fractures of tibia are common and major skeletal injuries. Treatment of such fractures in adults is a challenge to orthopaedic surgeons due to its poor soft tissue coverage and poor blood supply. The aim towards treatment for the segmental fracture tibia is union maintaining normal length, normal alignment without rotational deformity, normal joint movements and reduced hospital stay. Method: In our department since 2012 to 2014, 51 segmental tibia fractures were treated with unreamed interlocking intramedullary nailing technique with one proximal and one distal locking screws. Postoperatively, early mobilization exercises and weight-bearing were begun. The functional results were assessed by measuring union period and knee range of movements at 6 months. Results: Fracture healing was obtained in 49(96%) cases within the expected time period. 2(3.9%) patients had non union between proximal and middle segment. 46 (90%) were anatomic (valgus/varus

UNSTABLE FRACTURE OF THORACOLUMBAR SPINE;

Objectives: To evaluate the functional outcome of unstable thoracolumbarfractures fixed with pedicular screws and rods. Study Design: Descriptive case series. Setting:Department of Orthopedics and Spine surgery Ghurki Trust Teaching Hospital Lahore. Period:February 2013 to October 2015. Material &amp; Methods: Patients of either gender or all ageswith thoracolumbar fractures fulfilling the inclusion criteria were fixed with pedicular screwsand rods under general anesthesia. Post operatively patients were reviewed monthly for oneyear and results were analyzed according to modified McNab criteria as excellent, good, fairand poor at final follow up. Results: A total of 281 patients including 193(68.68%) males and88(31.32%) females with mean age 28.32 years (range 18 to 60 years) were included in ourstudy. Majority (91 patients) had fractures of L1 followed by L2 (73 patients) fracture and D12(67 patients) fracture. Pre operatively 95(33.81%) were neurologically graded as Frankle gradeD,73 (25.98%) grade C while 49(17.44%) were graded as Frankle grade E.Post operatively finalfollow up at one year yielded excellent clinical outcome in majority (91.46%,n=257) while goodand fair outcomes were reported in 6.41%(18 patients), and 2.14%(6 patients) respectivelyaccording to modified McNab criteria. No post op neurological detoriation, mortality or othermajor complication was reported in the study. Conclusion: Pedicular screw and rod fixationfor unstable thoracolumbar fractures gave excellent functional results in majority of patient as itreduces complications of recumbency and helps in early mobilization. We recommend it as afirst line treatment for such fractures.

Advances in the treatment of distal radius fractures in the elderly

Distal radius fractures often occur in the elderly.At present, there has not yet reached a consensus on how to take effective measures for the treatment of such fractures in clinical.There are many different therapeutic methods for this fracture with different effect.Based on the summary of the relevant literature, the epidemiological characteristics of fractures of the distal radius, treatment, implant selection, surgical procedure, complications and prevention were summarized, in order to provide references for clinical treatment. Key words: Distal radius fractures; Closed manipulative reduction; Elderly

Can Distal Radius Fractures be Primarily Immobilised in Circumferential Plaster Cast?

Objective: To assess whether primary immobilisation in a full circumferential plaster cast after reduction of a distal radius fracture is associated with a higher neurovascular complication rate. Study design: Descriptive analytical study Methods: All consecutive patients with distal radius fractures needing manipulation and primarily treated with a full plaster cast were analysed for fracture type, complications and final outcome. A questionnaire survey on the telephone was also done of the local hospitals of Punjab to see the trend of the treatment of such fractures in their emergency departments. Results: Out of 357 patients, 89.7% (n=320) had no complications, 10% (n=36) patients had swelling of the fingers and 0.3% (n=1) complained of symptoms associated with median nerve compression. In all these cases, their symptoms were relieved by simply splitting the cast longitudinally down to the skin. Conclusion: This study shows that a full plaster cast can be safely applied after manipulation of distal radius fracture. A few patients may need splitting of the cast in the event of finger swelling.

Reoperations and mortality in 383 patients operated with parallel screws for Garden I-II femoral neck fractures with up to ten years follow-up

IntroductionThe objective of this study was to identify indications and predictors for subsequent surgeries in the same hip and to evaluate life expectancy following screw fixation of undisplaced femoral neck fractures (FNF). The study further aimed to determine the necessary follow-up time for future studies aiming to evaluate the treatment of such fractures. Materials and methodsThis is a single-center retrospective cohort study with prospectively collected data including skeletally mature patients with undisplaced FNFs operated between 2005 and 2013. Gender, age at fracture, American Society of Anesthesiologists score, smoking status and excess use of alcohol were retrieved from electronical medical records. Further, complications leading to all consecutive reoperations were registered along with time from primary operation to all reoperations, type of procedure during subsequent surgeries and time of death. Results383 patients with a median (range) follow-up of 77 (23–125) months were identified. Within 1, 2 and 5 years from primary surgery, 8%, 17% and 21% respectively, had at least one subsequent surgery in the same hip. 10% of the patients underwent salvage arthroplasty, however, in long time survivors; conversion to arthroplasty was estimated in one out of four. Posterior tilt of the femoral head was a predictor for new surgeries due to instability of the bone-implant construct, but not for later avascular necrosis. For patients 70 years or older, the one-year mortality in men was 32% with an expected survival of approx. 2.5 years, compared to 17% and 5.5 years in women. ConclusionsScrew fixation of undisplaced femoral neck fractures appears to be a safe procedure in particular in the absence of a posterior tilt of the femoral head. Conversion to arthroplasty was estimated to occur in one out of four of long time survivors. Men have a particularly poor medical prognosis and should receive careful medical attention. In order to capture 80% of reoperations, clinical studies and register studies must have a follow-up time of at least two years.

Recent advances in wrist trauma.

Scaphoid fractures are the most common type of carpal fractures and occur frequently in young men. Nonunion, avascular necrosis and osteoarthritis, are the complications caused by a delay in diagnosis and treatment, hence early diagnosis and treatment for such fractures are critical to achieve better outcomes [1]. The traditional clinical sign snuffbox tenderness was found no more useful in diagnosis of scaphoid fracture and authors have recommended early recourse to sophisticated imaging methods. A systematic review and meta-analysis compared the diagnostic performance of bone scintigraphy, MRI and CT for diagnosing suspected scaphoid fractures. Bone scintigraphy and MRI have equally high sensitivity and high diagnostic value for excluding scaphoid fracture, however, MRI is more specific and better for confirming scaphoid fracture. The study emphasized the need for paired design studies or randomized controlled trials to compare CT with MRI or bone scintigraphy. Similar study presented to the ASSH reviewed 100 consecutive patients who were suspected of having a scaphoid fracture on clinical grounds despite having normal findings on initial radiographs. They concluded that magnetic resonance imaging had a better predictive value, both positive and negative and was a reliable modality for screening missed out fractures. Displaced scaphoid fractures are often treated with screw fixation. Many studies have proven that computer assisted screw placement significantly reduce radiation exposure, time, and the number of attempts for guide wire placement [2]. Dias et al concluded that on longer-term follow-up, the outcome of cast treatment of scaphoid fractures when compared with surgery showed that malunions were more common in the surgical treatment group and increased scapho-lunate angle were more likely in the casting group. Distal radial fracture is a public health concern, particularly among the elderly who often experience fragility fractures. A recent prospective study evaluating the rate of functional improvement after treatment with the volar locking plating system demonstrated similar rates of recovery between patients in two age groups (20–40 years and >60 years). The volar maintains good anatomic reduction and makes it easier for elderly patients to resume to their day-to-day activities earlier than conservative cast immobilization. However, for elderly patients with lower disutility due to mal-union and/or painful malunion one may still prefer non-operative treatment. In an another prospective randomized trial of patients with complex or unstable fractures of the distal part of the radius with one group having external and the other having internal fragment-specific fixation the conclusion was, the group with internal fixation had significantly better grip strength, wrist motion, and forearm motion with no difference in the DASH score. The long-term advantages of improved reduction after distal radial fracture remain unclear. The only available long term follow up study (33–42 years) by Forward et al. showed 68% of the patients with intra-articular fractures had posttraumatic arthritis and none had had salvage surgery [3]. Interestingly, a study revealed that most physicians with the primary designation as orthopedic surgeon still predominantly practiced closed methods for the treatment of distal radial fractures. Conversely, physicians with the primary designation as hand surgeon were much more inclined to employ internal fixation methods [4].

Spinal fractures in patients with ankylosing spondylitis and neoplastic disease (primary and metastatic)

Ankylosing spondylitis (AS), bony tumours affecting the spinal column and rheumatoid arthritis all predispose to a risk of pathological fracture. These conditions are all associated with increased bony fragility due to loss of the mineral content of affected bone. Spinal fractutres associated with AS are usually of a highly unstable pattern. Plain radiography may be falsely reassuring and a high index of suspicion and low threshold for axial imaging is required. Surgical stabilization is often, but not invariably, required. Primary and secondary bony tumours are often associated with osteolysis and consequent spinal fracture. The treatment of such fractures requires careful consideration of the prognosis for the patient's malignant disease as determined by tumour biology and the extent of neoplastic spread. Clinical and radiological parameters may help decision-making but management of these patients is often difficult and confounded by uncertainty about the disease prognosis. Rheumatoid arthritis is associated with bony erosions and osteoporosis both as a direct consequence of the disease and of pharmacological treatments. The most common fractures in rheumatoid arthritis are insufficiency fractures which can lead to debilitating pain and occasionally to spinal deformity. Cement augmentation and bisphosphonate infusion are useful strategies in the treatment of these common fractures.

Assessment of various fixation options for the treatment of femur fracture: A comparative study

Background: Incidence of intertrochanteric fractures has been found to be significantly increasing in today’s modern human populations. Generally, intramedullary fixation and extramedullary fixation are the 2 primary options for treatment of such fractures. The dynamic hip screw (DHS), commonly used in extramedullary fixation, has become a standard implant in treatment of these fractures. Proximal femoral nail (PFN) and Gamma nail are 2 commonly used devices in the intramedullary fixation. Hence; we prospectively analyzed and compared the DHS and the PFN method of fixation in intertrochanteric fracture of femur in the adults. Materials & Methods: Analysis of a total of 100 patients reporting from 2010 to 2014 with intertrochanteric femur fracture was done in the present analysis. Out of 100 patients 50 patients were treated with P.F.N. and 50 with D.H.S. In this study more than 50 years of age patient were surgically fit who has been diagnosed as having intertrochanteric fractures. The fracture was classified using Orthopaedic Trauma Association classification. Implant either DHS or PFN was randomly selected by operating surgeon. A combination of 3rd generation Cephalosporin and Amino glycoside was administered intravenously 30 min. prior to the skin incision. Patients were encouraged calf and ankle exercises from day one and mobilized non-weight bearing from the second postoperative day depending upon the physical condition of the patient. All drains were removed by 24 h. Follow-up the patients were maintained and results were analyzed. Results: 00 confirmed cases of intertrochanteric femur reporting from 2010 to 2014 were analyzed. Out of 100 cases, 50 were treated by a dynamic hip screw and 50 were treated by proximal femoral nail. The average age was 64.5 years. Out of 100, 40 were males and 60 were females. Accidents were the most common reason for occurrence of fractures in the present study. There were a total of 12 A-1 fractures, 29 A-2 fractures and 9 A-3 fractures. Measurement of blood loss was done by using mop count and collection in suction drain. Blood loss was comparatively less for PFN cases. The average blood loss in the P.F.N group and DHS group were 110 ml and 260 ml respectively. Blood transfusion was required in 10 cases of DHS group. At one month’s follow-up time, hip score in the D.H.S group was less than that of the P.F.N group. Conclusion: Fracture dimensions and quality of bone decides the type of fixation. For the achievement of best post-surgical results, a good quality reduction and proper positioning of the implants favour good prognosis.