We compared the outcome of patients treated for an intertrochanteric fracture of the femoral neck with a locked, long intramedullary nail with those treated with a dynamic hip screw (DHS) in a prospective randomised study. Each patient who presented with an extra-capsular hip fracture was randomised to operative stabilisation with either a long intramedullary Holland nail or a DHS. We treated 92 patients with a Holland nail and 98 with a DHS. Pre-operative variables included the Mini Mental test score, patient mobility, fracture pattern and American Society of Anesthesiologists grading. Peri-operative variables were anaesthetic time, operating time, radiation time and blood loss. Post-operative variables were time to mobilising with a frame, wound infection, time to discharge, time to fracture union, and mortality. We found no significant difference in the pre-operative variables. The mean anaesthetic and operation times were shorter in the DHS group than in the Holland nail group (29.7 vs 40.4 minutes, p < 0.001; and 40.3 vs 54 minutes, p < 0.001, respectively). There was an increased mean blood loss within the DHS group versus the Holland nail group (160 ml vs 78 ml, respectively, p < 0.001). The mean time to mobilisation with a frame was shorter in the Holland nail group (DHS 4.3 days, Holland nail 3.6 days, p = 0.012). More patients needed a post-operative blood transfusion in the DHS group (23 vs seven, p = 0.003) and the mean radiation time was shorter in this group (DHS 0.9 minutes vs Holland nail 1.56 minutes, p < 0.001). The screw of the DHS cut out in two patients, one of whom underwent revision to a Holland nail. There were no revisions in the Holland nail group. All fractures in both groups were united when followed up after one year. We conclude that the DHS can be implanted more quickly and with less exposure to radiation than the Holland nail. However, the resultant blood loss and need for transfusion is greater. The Holland nail allows patients to mobilise faster and to a greater extent. We have therefore adopted the Holland nail as our preferred method of treating intertrochanteric fractures of the hip.
With a reversing ageing pyramid and an increasing incidence of osteoporosis,
Introduction: Posterior cruciate ligament (PCL) is stronger and less vulnerable to injuries than its anterior counterpart. Injuries to the PCL, either due to bony avulsion or intra-substance tears, if left untreated, can result in chronic pain, patellar degenerative changes and instability. The basic approach to manage PCL bony avulsion varies from open reduction and internal fixation to arthroscopic fixation with screws or sutures. Although both the approaches have their pros and cons, in this study, we present the results of open reduction and internal fixation with cannulated cancellous screws. Material and Methods:The study group comprised of 18 patients (14 males and 4 females) with PCL avulsion injury between January 2013 to January 2018 who were operated at R L Jalappa hospital and followed up regularly with clinical and radiological assessment. The patient's details and radiographs were collected from patient records in hospital medical record department. Patients were called for examination, and the functional and radiological status was noted. Functional assessment was done using Lysholm knee scoring system. Results: Mean age of the patients was 39.2 ranging from 21 -55 years. 3 patients had associated femur shaft fractures, while 2 patients had tibia fracture. The mean Lysholm score was 92.6 (87-96). Clinically, no symptoms of instability were evident, and no signs of PCL deficiency were present. Full range of movements was achieved in all the patients at last follow-up. Conclusion:Posterior Cruciate Ligament avulsion treated with open reduction and internal fixation with cannulated cancellous screws using Burks and Schaffer approach gives excellent results with minimal morbidity.
Fractures of the forearm bones may result in severe loss of function unless adequately treated. Severe loss of function may result even though adequate healing of the fracture occurs 1, 4. Fractures of the forearm present a unique management problem for years. A forearm fracture involving both bones requires open anatomical reduction with stable fixation. 2, 3 various treatment modalities were introduced from time to time and each of them had some edge over the previous one. The forearm represents the critical anatomic unit of upper limb, permitting the effector organ of the upper limb, the hand, to perform multiaxial daily activities of living. Historically, the closed management of forearm fractures has been met with frustration in adults and resulted in poor functional outcome, hence perfect fracture reduction and rigid fixation is mandatory and achieved by plating. 3, 5, 7 The number of forearm fractures is increasing faster than the predicted rate due to increasing number of road traffic accidents, increased incidence of violence, rapid industrialization, and various sports activities. Conservative treatment has resulted in malunion, non-union, synostosis and ultimately poor functional outcome 4, 6, 7. compression techniques have a lower incidence of non-union and are found to hasten rehabilitation, with less joint stiffness.the various modalities of plating have developed each has edge over the other. there are very less studies on indian population this study has taken up to analyse the outcome between two most commonly used plates in forearm shaft fracture treatment i.e DCP (dynamic compression plate) and LCP (locking compression plate). Aims and Objectives of The Study: 1) To study and compare the functional and radiological outcome after surgical intervention by using and open reduction and internal fixation with dynamic compression plating vs locking compression plate in the treatment of closed diaphyseal fractures of forearm. 2) To study and compare the complications associated with these two modalities of the treatment. Materials And Methods: About 60 patients with both bone forearm fractures treated with LCP or DCP in RLJ hospital attached to Sri Devaraj Urs Medical College between maech 2013 to june 2017, will be taken up for the study after obtaining the informed consent. This is a retrospective study with follow up period of 6 months minimum. The functional outcome was assesed according to Anderson scoring system which included evaluation of the movements and the radiological union. Conclusions: Statistically, both LCP and DCP have similar outcomes in the treatment of diaphyseal fractures of both bones forearm. Whereas, LCP group had a faster recovery as compared to DCP group. Thus, we conclude that both LCP and DCP have similar results for the diaphyseal fractures.
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