ObjectiveTo evaluate and compare the clinical and radiological outcomes of patients with stable intertrochanteric fractures treated with proximal femoral nail vs. dynamic hip screw.MethodsSixty patients with stable intertrochanteric fractures, aged over 18 years, were randomly divided into the proximal femoral nail and dynamic hip screw groups. Dynamic hip screw with a three-hole side-plate and an anti-rotation screw were used, as well as a modified ultra-short proximal femoral nail for the smaller Asian population. The intra-operative, early and late complications were recorded, and the functional outcome of each group was assessed using the Harris Hip Score.ResultsIn the dynamic hip screw group, the one-month mean Harris Hip Score was slightly lower than that of the proximal femoral nail group. However, at the three- and six-month monthly follow-ups, the dynamic hip screw group presented higher mean scores than the proximal femoral nail group; at the one-year follow-up, both the groups attained similar scores.ConclusionProximal femoral nail provides a significantly shorter surgery with a smaller incision that leads to less wound-related complications. However, the incidence of technical errors was significantly higher in proximal femoral nail when compared with dynamic hip screw as it is a technically more demanding surgery that leads to more implant failures and the consequent re-operations.

ObjectiveTo the best of the authors’ knowledge, no studies in the literature have compared the clinical outcome of the three most common implants used to treat basicervical fractures of the femoral neck in young adults, i.e. CCS, DHS, and PFN. The present study attempts to fill the void in the literature and reach a conclusion regarding the usefulness of these implants in these fractures.MethodsThis was a prospective interventional study including 90 patients with basicervical fracture of the neck of femur treated randomly with cancellous cannulated lag screws or dynamic hip screw, with a derotation screw or short PFN.ResultsMean time for fracture union was 14.4, 13.9, and 13.5 weeks and union rate was 93.2%, 100%, and 100% in groups 1, 2, and 3, respectively. The mean Harris Hip Score at the final follow up was similar among all the groups, i.e. 79.4, 82.2, and 81.9 in CCS, DHS, and PFN groups, respectively. The highest proportion of good to excellent results was noted in the DHS group, i.e. 83.3%, whereas it was 73.6% and 80% in the CCS and PFN groups, respectively.ConclusionMultiple cancellous screws do not provide a sufficiently stable construct during fracture healing. PFN, although associated with lesser implant failures than CCS, have a higher incidence of technical errors. DHS provides sufficient stability in well-reduced basicervical fractures in young adults; it is associated with highest fracture union rates and best functional outcome out of the three implants at final follow-up.

Background:Displaced supracondylar fractures are notorious for difficulty in reduction, maintenance of reduction and frequent involvement of neurovascular structures. No general agreement on the treatment is evident with controversy prevailing regarding the ideal timing of surgery, method of maintenance of reduction and configuration of the pin fixation. A crossed pin configuration, though believed by some to be mechanically more stable than the lateral pins alone, has the risk of ulnar nerve injury due to the medial pin. Lateral pins alone impart less rotational stability to the fracture although it has been attributed mainly to technical errors of pin placement. The aim of this study was to assess the efficacy of treatment of this fracture using one lateral and one trans-olecranon K-wires or lateral entry K-wires alone.Materials and Methods:Ninety cases of displaced supracondylar humerus fractures were included in the study. The mean age of the patients was 6.7 years (range 3–12 years). The male/female ratio was 5:1 and left side was involved in 70% whereas 30% had right sided injuries. The most common mode of trauma was fall from height with elbow in extension. All the 90 consecutively admitted patients had extension type injury with 73.3% fractures being Gartland type III and 26.7% were type II. Posteromedial displacement was noted in 70% whereas 30% fractures were posterolaterally displaced. In 60 cases, lateral entry wires alone were used whereas, in 30 cases, one lateral and another transolecranon transarticular K-wire was used. K-wires were removed at 3 weeks postoperatively and followup was done at 6 weeks and 12 weeks when they were evaluated according to the criteria described by Flynn. Chi-square test was used as a statistical test of significance to compare results among different variables.Results:Results were graded according to Flynn's criteria. Excellent results were achieved in 12 (13.3%), good in 54 (60%), fair in 15 (16.7%) while in nine patients (10%) poor results were obtained.Conclusions:Both lateral entry K-wires and lateral-trans-olecranon wire techniques provide stable fixation when observing the guidelines for wire placement and consistently satisfactory results can be obtained, both cosmetically and functionally with both the techniques.

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A flexion supracondylar fracture of the humerus is an uncommon fracture in children and accounts for only 1% to 10% of all supracondylar fractures. » The injury is caused by a direct fall on the point of the elbow, causing hyperflexion at the elbow, rather than by a fall on an outstretched hand, which is the mechanism in an extension-type fracture.» The ulnar nerve is at higher risk of injury in this fracture by the spike of the proximal fragment or by entrapment in the callus. » This fracture is inherently unstable, leading to difficulty in maintaining reduction intraoperatively and difficult Kirschner wiring in the extension position in which the reduction is achieved.» Kirschner wiring can be done in a flexed position of the elbow by utilizing a push-pull method, a temporary transolecranon pin, or a Kirschner wire as a joystick in the distal fragment to achieve and maintain reduction before the insertion of the final pins.

Case: A 45-year-old man with ankylosing spondylitis with bilateral ankylosed hips presented with subtrochanteric femur fracture with a broken intramedullary nail in situ. The nail was removed by making a hole in the nail using a carbide bit and putting a Steinmann pin in this hole to extract the nail. Conclusions: This novel broken intramedullary nail extraction technique is especially useful for nonunions or implant failures that occur in the proximal shaft/subtrochanteric area, and the instruments used are also readily available. There is minimal radiation exposure, and it is an effective method to remove the distal part of the broken nail.

Background: Catheter associated complications are very common in the emergency departments of medicine, general surgery, orthopaedics and in community. They mostly occur in patients with neurological afflictions because of inexperience of the first handlers as they lack the insight of altered physiology and anatomy in the lower urinary tract because of neurological lesions and also because of an inadequate advice at the time of discharge regarding the catheter care. Objectives of this study were to find the prevalence of per-urethral catheter associated injuries in patients with neurological lesions in a tertiary care centre of south-eastern Punjab and their prevention in completely recoverable neurological afflictions.Methods: This is a cross-sectional observational study conducted in urology department from 1st August 2017-31st August 2018. The data was taken from medicine, general surgery and orthopedic emergency departments. A total of 82 patients were taken from 19-78 years and 49 patients had per-urethral catheter placement. Analysis was done using Statistical Program of Special Sciences, version 20.Results: It was observed that overall neurological lesions are more common in males (80.48%) as compared to females (19.51%) and distributed over an age range of 19-84 years in both sexes. Out of total patients, 59.75% required per urethral catheterization. The prevalence of per-urethral catheter associated complications was 20.40%.Conclusions: Insertion of per-urethral catheter is a simple procedure but an error of omission on the part of health professionals’ results in a serious complication in a neurological patient. Proper insertion technique and catheter care are to be followed to prevent avoidable complications in this subset of patients.

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