Introduction: Proximal femoral fractures fixation pose dilemma on fixation device to use. Western designed copied proximal femoral nail anti rotation is being used in South-East Asian population extensively. The study aims to study of migration in our population representative of the developing nations. Methods: 92 patients enrolled in prospective cross-sectional study for 9 months; 89 were evaluated for final migration studies as 3 major complications occurred. The effects of age, fracture, tip-apex distance, quadrant position in femoral head, blade size and length and Neck Shaft angle on migration were analyzed. Results: There were 42 males and 50 females with the mean age was 68.14 years. At the time of fixation mean Tip Apex Distance was 12.2 mm (7.0mm -25mm). At 6 months follow-ups, migration occurred in 78.65%. On univariate analysis, there was no effect of fracture pattern on migration (p=0.524). Femoral-Neck shaft angles were fixed in varus in 7, 5 in valgus and 77 within normal range. Relatively higher migration did occur with varus fixation but was not statistically significant (p=0.306). Multivariate analyses were done for nail diameter, nail length, old age and fracture patterns with no statistically significant interactions. The position of helical blade in the quadrant of the femoral head with centercenter having minimum migration (p= 0.000). Major complications occurred in 3 patients. Conclusions: All helical blades do migrate but within acceptable range provided fixation in acceptable Tip Apex Distance. Bone Mineral Density should be kept as co-variable in further studies.
Background: Lateral clavicular fracture accounts for has 25% of all clavicle fractures. Non-operative modalities are associated with high incidence of non-union (22%-50%). Union rate of up to 95% can be achieved with surgical management. Treatment with hook plates or K-wires are associated with high complication rates of up to 22%. Recently use of newly available precontoured clavicular locking plate with lateral extension has become popular. Objectives: To evaluate functional outcome of the patients with lateral clavicle fracture treated lateral locking plate using Constant -Murley Score, DASH Score, UCLA Shoulder Rating Score Methods: The study was conducted in the Department of Orthopaedics, BPKIHS, a tertiary care hospital in eastern Nepal, over a period of 12 months from August 2020 to July 2021. Patients with closed lateral clavicle fracture between ages 18-45 years were included. Fifty eight cases were included and analyzed for functional outcome using Constant-Murley score, DASH score and UCLA shoulder rating score. Results: The mean Constant-Murley score at 6 months follow-up was 91.68 ± 2.81. The mean DASH score at 6 months was 6.42 ± 2.74. Similarly, the mean UCLA shoulder rating score at 6 months was 31.27 ± 1.81. The mean time for union was 14.89 weeks. There were 2 cases of superficial surgical site infection.
Conclusion:Use of locking plates with broad lateral extension has shown to result in good functional outcome, high union rate and minimal complication.
Background: Distal femoral fracture constitutes the supracondylar and intercondylar fractures of femur. These are treated by locking plates as well as with nails. Despite the widespread use of both techniques, there are only few comparative studies. The two clinical techniques used to stabilize distal femur fractures are compared in this study.
Objectives: The aim of this study was to compare plating and nailing in terms of functional outcome using the Hospital for Special Surgery (HSS) Knee Score of operative fixation of extra-articular femur fracture.
Methodology: A randomized controlled trial was conducted with a total of 30 patients presenting to BP Koirala Institute of Health Sciences in a period of twelve months. All skeletally mature (>16 years) adult patients with isolated traumatic closed extra-articular fracture of distal femur without distal neurovascular deficit and giving written and informed consent were included. Patients with re-fractures, poly-trauma, fracture dislocations, pathological fracture and compartment syndrome were excluded. They were operated and followed up at 2, 6, 12 and 24 weeks.
Results: The demographic profiles of the two groups were comparable. There was no significant difference in functional outcome (Hospital for Special Surgery score), union or complications between them.
Conclusion: This study showed that there was no significant difference in terms of functional outcome (Hospital for Special Surgery score), union, fracture alignment, range of motion (knee, hip joint), infection, other outcome measures between plating and nailing in the treatment of distal femoral fracture in adults. Hence, further study is required to come to firm conclusions.
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