Background:With changing trends in treatment of displaced midshaft clavicle fractures (DMCF), plating remains the standard procedure for fixation. An attracting alternative method of fixation is the titanium elastic nailing (TEN). However, prospective randomized studies comparing the two methods of fixation are lacking. We assessed the effectiveness of minimally invasive antegrade TEN and plating technique for the treatment of DMCF.Materials and Methods:80 unilateral displaced midclavicular fractures operated between October 2010 and May 2013 were included in study. This prospective comparative study was approved by the local ethical committee. Followups were at 2nd and 6th weeks and subsequently at 3, 6, 12, 18 and 24 months postoperatively. Primary outcome was measured by the Constant score, union rate and difference in clavicular length after fracture union. Secondary outcome was measured by operative time, intraoperative blood loss, wound size, cosmetic results and complications.Results:During analysis, we had 37 patients in the plate group and 34 patients in the TEN group. There was no significant difference in Constant scores between the two groups. However, faster fracture union, lesser operative time, lesser blood loss, easier implant removal and fewer complications were noted in the TEN group.Conclusion:The use of minimally invasive antegrade TEN for fixation of displaced midshaft clavicle fractures is recommended in view of faster fracture union, lesser morbidity, better cosmetic results, easier implant removal and fewer complications; although for comminuted fractures plating remains the procedure of choice.
Background:Nonunion of patella is an uncommon entity prevalent more commonly in developing countries. Many of them have a functional knee joint and only those with a wide gap and failed extensor mechanism need surgery. We report an analysis of nonunion of fracture patella treated by 3 surgical method.Materials and Methods:35 patients of nonunion/delayed union of patella with significant gap and failure of quadriceps mechanism, underwent three different methods surgically: 1) V–Y plasty and tension band wiring (n=10); 2) patellar traction followed by tension band wiring without V–Y plasty (n=15); and 3) patellar traction followed by partial or total patellectomy (n=10). We compared the results of the treatment in terms of Knee Society Score (KSS), Melbourne patella score, time of union, pain, range of movement, quadriceps power, and ability to do daily activities and complications encountered.Results:The 15 cases of patellar traction followed by tension band wiring showed the best results in terms of time to return to normal activities and complications encountered. Cases with patellectomy showed the next best results but they had a longer period of rehabilitation with ultimately lesser patient satisfaction. V–Y plasty gave the worst results both in complication rate and function return.Conclusion:Preoperative patellar traction followed by tension band wiring is a good procedure giving better results than either patellectomy or V–Y plasty.
Objective:Despite new developments in the management of osteoporotic fractures, complications like screw cutout are still found in the fixation of proximal femur fractures even with biomechanically proven better implants like proximal femoral nail antirotation (PFNA). The purpose of this cadaveric study was to investigate the biomechanical stability of this device in relation to two common positions (center-center and inferior-center) of the helical blade in the femoral head in unstable trochanteric fractures.Materials and Methods:Eight pairs of human cadaveric femurs were used; in one group [center-center (C-C) group], the helical blade of PFNA was fixed randomly in central position both in anteroposterior and lateral view, whereas in the other group it was fixed in inferior one-third position in anteroposterior and in central position in lateral view [inferior-center (I-C) group]. Unstable intertrochanteric fracture was created and each specimen was loaded cyclically till load to failureResults:Angular and rotational displacements were significantly higher within the C-C group compared to the I-C group in both unloaded and loaded condition. Loading to failure was higher in the I-C group compared to the C-C group. No statistical significance was found for this parameter. Correlations between tip apex distance, cyclic loading which lead to femoral head displacement, and ultimate load to failure showed a significant positive relationship.Conclusion:The I-C group was superior to the C-C group and provided better biomechanical stability for angular and rotational displacement. This study would be a stimulus for further experimental studies with larger number specimens and complex loading protocols at multicentres.
A nine-month-old male infant was brought to orthopaedic outpatient department of N.R.S. Medical College and Hospital, after his mother noticed a swelling over his left distal forearm 1 month back. The swelling gradually increased in size and was painful. He avoided using his left hand during activities. He also had decreased appetite and Failed to gain weight since he started weaning at 6 months of age. There were episodes of evening rise of temperature and night cries in the previous 3 months. There was no preceding history of significant trauma or chronic cough. As his symptoms persisted even after taking analgesics and antibiotics, he was referred to our hospital. He was the only child of his parents. He was born through normal delivery, at term in a government hospital weighing 2.7 kilograms at birth and underwent BCG vaccination. Apart from his mother, he was breastfed occasionally by his maternal aunt. His aunt had a history of pulmonary tuberculosis, treated 5 years back with multidrug therapy of anti-tubercular drugs.General examination was normal and showed no pallor, icterus or any signs of malnutrition. He was apparently a healthy playful child. His developmental milestones were on par with his age. On local examination there was a tender globular swelling of about 3 cm diameter involving the volar aspect of left distal radius with smooth surface, hard consistency, diffuse margin. The swelling was fixed and continuous with the underlying bone. Skin was normal without any scar, ulcer or discharging sinus. Wrist joint was mobile but range of movement could not be examined as it was painful. There was no neurovascular deficit. No significant enlargement of axillary lymph nodes was palpated. On laboratory examination, haemoglobin level and leucocyte count were within normal limits. ESR was 45mm/hr and C-reactive protein was elevated. Chest X-ray was within normal limits. X-ray of forearm with wrist showed an oval expansile cystic lesion located eccentrically in the metaphysis of the left distal radius [Table /Fig-1a,b]. It had a dimension of 2cmx3cm with thinning of the overlying cortex and without any marginal sclerosis. The bone was osteopenic around the lesion. MRI was not done as the patient could not be sedated. Previously, FNAC was done outside and it was suggestive of granulomatous lesion but the slides were not available for re-evaluation.An open biopsy was performed under general anaesthesia and under tourniquet control. A cortical window at distal radius was made through a volar approach and caseous material was found. Thorough curettage of the lesion was done and collected samples were sent for investigations. The irrigated cavity was then filled with synthetic bone substitute (beta tricalcium phosphate granules). The wrist and forearm were immobilized with an above elbow back slab, which was removed subsequently at 4 weeks. The curetted material demonstrated acid fast bacilli and histopathological examination showed granulomatous inflammation, suggestive of tuberculosis [Table/ Fig-2 Tuberculo...
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