IntroductionThe surgical treatment of humeral shaft atrophic, gap nonunion following failed surgical fixation is challenging. We intended to evaluate the surgical outcome of failed fixation of humeral shaft atrophic, gap nonunions using locking compression plate (LCP) and autologous nonvascularized fibular graft (ANVFG) and autologous iliac crest bone graft (AICBG). MethodsThrough our database search between 2015 and 2018, we identified 12 patients with humeral shaft atrophic, gap nonunions with failed surgical fixation underwent open reduction and internal fixation using LCP with autologous fibula graft and iliac crest cancellous bone graft. ResultsWe have followed all twelve patients for a minimum period of 24 months. All patients had radiological and clinical union with a mean time to union of 17 weeks. In one case superficial surgical site infection was noted and successfully treated with intravenous antibiotics, and in another, transient peroneal nerve palsy was identified and resolved in six months. ConclusionLCP with ANVFG and AICBG is a reliable option for "complex" diaphyseal humerus atrophic and gap non unions, especially with significant bone loss. This construct provides mechanical stability and supports biological healing in these complex fractures.
<p class="abstract"><strong>Background:</strong> In the elderly population, proximal femur fractures are most common which can result in increase of morbidity and mortality. Pre and postoperative mobility patterns, also depends upon the Mental Status of the patient. Incidence of Mental health disorders of patient can increases with age and co morbidities. The aim of the study was to evaluate the effect and relationship of preoperative mental status, on postoperative mobility in proximal femur fracture patients. On null hypothesis; there exists no co-relation between pre-operative mental status on pre and postoperative mobility those had surgery for proximal femur fractures.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective study, carried out during the period of 14<sup>th</sup> March, 2016 to 14<sup>th</sup> March, 2017 at BIRRD (T) Hospital. All the patients who underwent proximal femur fracture surgeries were included in the study. Patients were evaluated for Abbreviated Mental Score Test pre-operatively. Mobility patterns were before injury and after surgery evaluated in patients with proximal femur fractures. Postoperatively patients were followed up to one year.<strong></strong></p><p class="abstract"><strong>Results:</strong> 50 patients were included into the study, where 12 patients could not present to follow-up due to various reasons, thus we have complete data of 38 patients. There is significant reduction in mobility status of individuals i.e. from 6.18 (preoperative pre fracture mobility) to 5.36 (postoperative mobility). Average abbreviated mental test score is 7.55. There exists a correlation between the variables.</p><p class="abstract"><strong>Conclusions:</strong> Null hypothesis remains rejected. There is statistically significant relationship between the variables (pre and postoperative mobility, and abbreviated mental test score), which appears to be positive correlation.</p>
<p class="abstract"><strong>Background:</strong> Humeral shaft fractures have an incidence of 13 per 100000 per year and account for 3% of total fractures. The following study is carried out with intention for determining and verifying facts around plate osteosynthesis on anteromedial surface of humerus through anterior approach.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study of 38 patients presenting with humerus shaft fracture and non-union to the Balaji Institute of Surgery Research and Rehabilitation for the Disabled (BIRRD) from April 2015 to March 2016.<strong> </strong>Inclusion criteria<strong> </strong>were age>18 years, acute humerus shaft fractures and nonunion of humerus shaft. Exclusion criteria were undisplaced fractures, fractures associated with neurovascular injury, compound and pathological fractures, infected non unions. The functional outcome was graded based on the QuickDASH score. Fisher’s exact test was used to find the association between categorical data.<strong></strong></p><p class="abstract"><strong>Results:</strong> Clinical union was noted in 87% of the patients and radiological union in 74% at the end of three months. The average time period required to achieve union was 13.57 weeks. Based on Quick DASH score, 66% of them had excellent outcome, 24% had good outcome, 10% had fair outcome, and none had poor outcome.</p><p class="abstract"><strong>Conclusions:</strong> It may be concluded that, anteromedial plating through anterior approach for the treatment of humerus shaft fractures and non union leads to a satisfactory functional outcome in most of the patients. Most of the fractures were united by 3 months with good range of motion of shoulder and elbow.</p>
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