<p class="abstract"><strong>Background:</strong> Trochanteric fractures are one of the commonest injuries sustained predominantly in patients over sixty years of age. They are three to four times more common in women. These usually occur through bone affected by osteoporosis; trivial fall being most common mechanism of injury Approximately 10-30% of patients die within one year of an intertrochanteric fracture.</p><p class="abstract"><strong>Methods:</strong> A prospective study comprising of patients identified for surgical treatment of fracture in the intertrochanteric region of femur admitted to Sri Siddhartha Medical College, Tumkur from 2016 to 2017 where 30 patients with 30 intertrochanteric fractures of femur were selected with equal distribution of 15 dynamic hip screw devices and 15 intramedullary devices.<strong></strong></p><p class="abstract"><strong>Results:</strong> The purpose of the present study is to verify theoretical advantages of intramedullary device over the dynamic hip screw devices and also whether it actually alters the eventual functional outcome of the patient. Excellent results were seen in 2 patients (13.3%) in the DHS group and in 6 patients (40%) in the PFN group. The overall functional outcome of patients treated with the PFN was significantly better than those treated with DHS (p=0.037). However when we compared the stable and unstable fractures separately, we found that there was no significant difference in the outcomes of the stable fractures in the two groups (p=0.198).</p><p><strong>Conclusions:</strong> We conclude that in stable intertrochanteric fractures, both the PFN and DHS have similar outcomes. However, in unstable intertrochanteric fractures the PFN has significantly better outcomes in terms of earlier restoration of walking ability as it is an intramedullary implant which can tolerate higher cylindrical loading when compared to DHS type of implants. In addition, as the PFN requires shorter operative time and smaller incision, it has distinct advantages over DHS even in stable intertrochanteric fractures. Hence, in our opinion, PFN may be the better fixation device for most intertrochanteric fractures.</p>
ABSTRACT:The fracture of the lower pole of the patella is a common type of fracture of the patella. The treatment involves internal fixation or excision of the lower fragment. This study was undertaken to study the efficacy of cancellous screw fixation combined with tension band wiring in the treatment of these fractures. Twenty patients with lower pole patellar fractures were treated by this technique and evaluated by Gaur's criteria for knee evaluation. Excellent good results were noted in 19 cases and fair result in one case. There were no poor results and there were no major complications hence it was concluded that cancellous screw fixation combined with tension band wiring is a good method for treating lower pole patellar fractures. KEYWORDS: Distal Pole Patella, Fracture, Cancellous Screw, Encerclage. INTRODUCTION:Fracture of the patella constitutes almost 1% of all skeletal injury 1 and fracture of the lower pole of the patella is a commonly encountered type of fracture patella. The fracture patella occurs as a result of direct or indirect force. 2, 3 It is twice as common in men as women. 2 Fracture of the lower pole is commonly an avulsion injury as a result of violent contraction of the quadriceps muscle or as a result of subluxation or dislocation of patella 4 especially as a sports injury occurring in young individuals. Hence there is more likelihood of extensive retinacular tear. 2 This retinacular tear precludes conservative treatment and operative treatment is the mainstay of lower pole patellar fractures.Various treatment modalities have been advocated for fracture of the lower pole of patella including Magnusson wiring, cancellous screw fixation, tension band wiring, cerclage wiring, fixation of the lower pole augmented by a patellotibial SS wire loop, basket plate fixation and excision of the lower pole of the patella. [1][2][3][5][6][7][8] However in spite of having these myriad of options for treatment there is no consensus about the treatment of choice for these fractures. Some surgeons prefer excision of the lower pole with fixation of the patellar tendon to the upper fragment by non-absorbable sutures and others swear by internal fixation as the better method of treatment 5 . This study was undertaken to evaluate the efficacy of cancellous screw fixation augmented by tension band wiring in fractures of lower pole of patella.
AIM & OBJECTIVE:The primary aim was to evaluate the efficacy and response rate of non-surgical treatment in diabetic Chronic Osteomyelitis. RESEARCH DESIGN & METHODS: All patients with Diabetic Chronic Osteomyelitis seen in outpatient & inpatient Orthopedic and Surgical department of tertiary care medical college hospital from January 2012 to January 2013 were evaluated. Response rate to non-surgical treatment was measured in terms of absence of infection at site of initial injury or contiguous site for a follow up period of 6 months. Patients were evaluated in terms of demographic, clinical and therapeutic variables, which included probe testing, swab culture and sensitivity and empiric antibiotic sensitivity testing. RESULTS: 100 consecutive patients aged between 30years to 70 years (mean age 60.2±4 yrs (mean ± SD)) with co-existing diabetes since last 15-20 years were included in study. CONCLUSION: Pus culture based and bone culture based antibiotic therapy was proved as primary variable leading to remission with avoidance to surgical debridement and curettage or amputation. Secondly Staphylococcus aureus followed by Pseudomonas aeruginosa along with MRSA and ESBL were major source of infection.
<p class="abstract"><strong>Background:</strong> Intracapsular femoral neck fractures are common in elderly population after a simple fall. To avoid the drawbacks of internal fixation and for the early mobilization, hemiarthroplasty is performed in elderly. The aim of this study is to compare the outcome AMP with uncemented bipolar prosthesis in geriatric patients.</p><p class="abstract"><strong>Methods:</strong> 51 patients above 60 years and an acute displaced fracture of the femoral neck were randomly allocated to treatment by either AMP (Austin Moore prosthesis) or bipolar hemiarthroplasty, in the Department of Orthopaedics, Sri Siddhartha medical college, Tumkur between April 2014 and May 2017. The patients were summoned at 6 weeks, 12 weeks, 6 months and 1 year. Functional outcome was assessed and compared with modified Harris hip score and radiological parameters.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean Harris hip score in bipolar and AMP group was 86.31±12.1 and 79.86±15.42, respectively (p=0.182). The range of motion was 204.52±28.2 and 183.62±36 (p=0.014) respectively. Functional activities like use of public transport and ability to wear shoe or socks was better with bipolar group. Incidence of complications like painful hip, posterior dislocation, periprosthetic fracture and acetabular erosion was encountered in AMP group.</p><p class="abstract"><strong>Conclusions:</strong> The use of uncemented bipolar endoprosthesis in the management of displaced femoral neck fractures in the elderly was associated with better mean Harris hip score and incidence of complications was limited. Hence, bipolar would be a better option in elderly patients with fracture neck of femur.</p><p class="abstract"> </p>
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