Background: Fractures around the hip not only are very prevalent, but need more attention also, since the enhanced average life expectancy, the resultant elderly-osteoporotic-population pool has expanded, present orthopaedic surgeons are aflood with such cases[1–4]. The intertrochanteric fractures comprise 50% of the fractures around the hip[5]. Intertrochanteric fractures in the elderly are associated with high rates of mortality, ranging from 15 to 20%, as they are at a high risk for deep vein thrombosis (DVT), urinary tract infections, and pulmonary embolism when they fail to mobilize or ambulate early[6]. Early mobilization is only possible when stable fixation is achieved with less post-operative pain and when patients become haemo-dynamically stable.
Aims & Objective:
1. Even though minimally invasive DHS surgery is popular since last decade, still we intended to develop a truly minimally invasive technique without the need of any special instrumentation.
2. To confirm whether the proposed minimum incision allows sound fixation, without damaging the corners of the skin incision.
Materials & Methods: This is a prospective study done over a period of 2 years at the Department of Orthopaedics at a Tertiary Care Centre. Patients presenting to the Department of Orthopaedics, Index Medical College with intertrochanteric fractures were evaluated and analysed to be included in the study. 54 patients, who presented with an intertrochanteric femur fracture and who fulfilled the inclusion criteria were enrolled in the study Generally, for an AO 31 A1.1 and an A1.2 fracture, a two hole DHS plate is enough(14), but when we are not sure of the quality of implants or sound purchase of the screws in cortex, we use four hole standard barrel side 135 degrees plate. It is inserted first beneath the muscle inside-surface-out, grasping the barrel then slid along the shaft and then again turned inside-surface-inside, manually.
Results:
1.
Introduction: Controversy exists regarding whether spinal implants need to be removed to treat postoperative deep wound infections (DWIs). This retrospective study aimed to determine whether the removal or retention of implants impacts the successful treatment of a DWI after spine surgery. Methods: Postoperative spine surgery patients presenting with signs of infection who underwent irrigation and debridement (I&D) at Twin Cities Spine Surgeons at Abbott Northwestern Hospital, Minnesota, USA, were studied. First, the persistence of infection when implants were retained or removed was assessed. Second, we analyzed the persistence of infection with respect to the number of I&D, the use of vacuum-assisted closure (VAC) treatment, pseudoarthrosis status, and functional outcomes. Results: One hundred thirty-five patients were included. Treatment of infection with retention of implants occurred in 64% (87/135); of these, 7% (6/87) had a persistent infection. Of patients with implant removal (36%, 48/135), 6% (3/48) had a persistent infection. Thus, we observed no difference between treatment with implants present compared to implants removed (p = 1.0). Fifty of the 135 patients (37%) received I&D and primary wound closure, and 85 (63%) patients received I&D and VAC treatment. There was no statistical difference between primary wound closure and VAC treatment (p = 0.15) with respect to persistence. Repeat I&D with VAC (three or more times) had a significantly lower rate of recurrence than those with two I&Ds. Pseudoarthrosis and persistent infection were unrelated. At minimum one-year follow-up, achieving a minimum clinically important difference in functional outcome was independent of persistent infection status. Conclusion: Persistent infection was unrelated to the retention of implants. When VAC treatment was deemed necessary, more than two I&Ds resulted in a significantly better cure for infection. Those with a persistent infection were no more likely to exhibit pseudoarthrosis than those with no persistent infection. All patients showed improvement in functional outcomes at minimum one-year follow-up.
<p class="abstract"><strong>Background:</strong> Distal femur is a complex fractures and most of times a personalized approach is needed for these fractures. Over a period of time variety of approaches and implants have been used for these fractures. The use of retrograde femur nail for fixing femur fracture, using entry from inter-condylar notch of femur, is a known method of treatment, but most surgeons are apprehensive of making an entry from the knee joint because of possible complications like knee pain, arthro-fibrosis, infections etc .The aim of this study was to investigate its effectiveness in fixation of distal 1/3<sup>rd </sup>fracture of femur with special emphasis on the outcome and inherent surgical challenges<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> A prospective study of 40 patients with fracture femur diaphysial distal one third were treated by retrograde nailing, from July 2010 to January 2016, after obtaining required approval from the Institutional ethical & research committee. All the patients were followed till fracture union and evaluated on the basis of demography, duration of healing, complications and surgical challenges.<strong></strong></p><p class="abstract"><strong>Results:</strong> We observed that mean age of patients was 35.8 years (18 years to 62 years) where 87.5% were male and 12.5% were female. Average duration of healing was 17.75 weeks (ranging from 10 weeks to 36 weeks) with 100% healing achieved. Mean knee range of motion was 124.5 degree (70 to 140 degree), rate of knee pain 10% (4/40), re-operation rate 5% (2/40), infection rate 2.5% (1/40), and fat embolism 2.5% (1/40)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Retrograde femoral nailing is a reliable alternative to antegrade nailing or plate fixation for diaphyseal fracture distal one third femur, and may be in some situations even advantageous when antegrade nail entry is challenging like ipsilateral hip fractures, previous implant in hip & proximal femur, ipsilateral pelvi-acetabular injury, bilateral femoral shaft fracture, floating Knee injuries, poly-trauma and obese patients<span lang="EN-IN">.</span></p>
<p class="abstract"><strong>Background:</strong> <span>Accurate placement of the femoral tunnel is critical for long-term clinical success following anterior cruciate ligament (ACL) reconstruction.</span> <span> Current trends in ACL reconstruction favor anatomic positioning of ACL attachment sites. Surgical inaccuracy in femoral tunnel positioning can lead to potential early graft failure and early-onset osteoarthritis. The purpose of this study was to evaluate</span> the functional outcome in patients who underwent arthroscopic anatomic ACL reconstruction using hamstring tendon graft<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> The<strong> </strong>study was conducted in the Orthopedics Department of IIMCHRC, Indore the placement of femoral tunnel, using femoral off set guide with other techniques. All the patients who were diagnosed clinically and radiologically with ACL tear and all who gave the consent were included in the study. All patients were enrolled to undergo primary arthroscopically assisted ACL reconstruction.<strong></strong></p><p class="abstract"><strong>Results:</strong> In the present study out of 42 patients; 23 patients (55%) had right sided ACL injury and remaining 19 patients (45%) had left sided ACL injury. We assessed functional outcome of the patients through pre-operative and post-operative IKDC scoring. The mean of the pre-op IKDC scoring was 33.61 with SD of 9.67 and the mean of the post-operative IKDC scoring was 77.95 with SD of 15.15<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The commercially available off set guide technique of the femoral tunnel placement in arthroscopic ACL reconstruction is easy, reliable and reproducible with the foot print at anatomical place on the femoral site<span lang="EN-IN">.</span></p>
Distal radioulnar joint (DRUJ) arthritis is a common cause of ulnar wrist pain in rheumatoid and osteoarthritis. Modified arthroplasty for the DRUJ is a minimally invasive procedure for the treatment of isolated DRUJ osteoarthritis. The purpose of this study was to evaluate the efficacy of the procedure and the incidence of related ulnar wrist pathology as well as the incidence of subsequent ulnar wrist surgeries. All patients having modified arthroplasty for the DRUJ between 1994-2008 were retrospectively reviewed. Measurements included range of motion, grip strength, and subjective status. Data regarding other wrist surgeries was recorded. There were 29 patients, 23 of which had a follow-up of over 8 weeks (average 16 months (SD=24). Fourteen patients had no to minimal pain, 6 had pain with heavier activities (2 severe), and 2 reported constant pain at the surgical site. Of the 4 more painful patients, three had additional surgery after the DRUJ arthroplasty. In all 96% of the patients had another procedure involving the ulnar- wrist complex either prior to surgery, at the time of surgery or following surgery for modified arthroplasty. We suggest that pathology involving the ulnar-wrist complex is often a syndrome consisting of multiple related diagnoses including but not limited to arthritis of the DRUJ. Multiple procedures may be needed, or a more aggressive approach such as ulnar head replacement may be indicated so that pathology at both the distal radioulnar and ulnocarpal joints is addressed concomitantly.
Background: Fracture of lateral end clavicle constitutes merely 15% of clavicle fracture, only a third of these fractures are displaced (Neer’s Type 2/Edinburgh Type 3B1).(1) No single treatment technique has been hailed as the most preferred technique to manage fracture lateral end clavicle, yielding consistently good union, with least complications.
Objective: This initial study attempts to evaluate the role of Clavicle Hook Plate, in the treatment of lateral end clavicle fractures, whether it promises to be the most preferred technique.
Material and Methods: To evaluate the results and long term effects in use of this plate we performed a retrospective analysis with a mean follow up of 24 months (2 years) of 16 consecutive patients with acute displaced lateral clavicle fractures, treated with the clavicle hook plate.
Results: Our short term results in all patients were good to excellent. None underwent non- union. Impingement symptoms were detected in 3 patients, our 2 patients had skin issues and 1 had significant infection, warranting premature implant removal. Sixteen patients were re-evaluated at a mean follow-up period of 2 years. The Constant-Murley score was 97 and the DASH score was 3.5.
Conclusions: Clavicle hook plate presents as a reasonably good primary treatment choice in treating the acute displaced lateral clavicle fractures. Proper selection of patients with good skin conditions and infection control are essential, in this part of the world.
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