Background: Hemiarthroplasty is now being considered as a primary treatment for comminuted unstable type of IT fracture in elderly on the grounds that it allows early mobilization and full weight bearing. Recently popular modality is fourth generation of intramedullary nails like the Proximal Femoral Nails. The goal of treatment is restoring mobility safely and efficiently, while minimizing the risk of medical complications and technical failure.Methods: A Forty patients, having Intertrochanteric fractures treated with PFNA or cemented BH at our institution between April 2016 and April 2017. The primary outcomes measures were postoperative complication and hip function. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, postoperative haemoglobin and hospital stay.Results: Seventeen patients in PFNA group and 23 patients in BH group were included for analysis. There were no significant differences between the two group regarding to the Harris Hip Score at 6 months follow up. Significant differences were found between PFNA and BH group in comparison of intraoperative blood loss (p < 0.001), length of stay (p = 0.006), surgical time (p < 0.001), postoperative transfusion (p < 0.001), and decrease of hemoglobin (p=0.001).Conclusions: These findings indicate that PFNA has obvious advantages over the BH in treatment of intertrochanteric fractures in case of surgical trauma and postoperative complication.
Medial Swivel-type dislocation are dislocation of talonavicular joint (TNJ) medially and the calcaneus swivels under the talus, with the calcaneocuboid joint intact. This is a rare injury due to the strong network of ligament and tendinous structures. An 11-year-old girl presented after 1 week of injury to the left foot. She had pain, swelling on the mid-foot and inability to weight bearing. X-ray and computerized tomography (CT) scan showed medial dislocation of TNJ, with fracture of cuboid body. A closed reduction was attempted but it failed. Patient then underwent open reduction with K-wire fixation and immobilization by below knee cast for 3 weeks. After K-wire removal, the foot was stable with near normal ankle and sub-talar joint range of motion and patient started to partial weight bearing Midtarsal dislocations of the foot are rare injuries. In this case dislocation is resulted from high-energy medial forces to the forefoot. The associated cuboid fracture possibly as a result of tensile forces through the lateral structure of midfoot with adduction. ‘Swivel dislocation’ in which the TNJ dislocates, usually medially, and the calcaneus swivels under the talus, with the calcaneocuboid joint intact. A careful assessment of initial radiograph and CT scan should be done to determine type of dislocation and associated fracture. An open reduction K-wire fixation bring a stable reduction. Talonavicular dislocations are rare injuries, occur as a result of high-energy trauma. A stable reduction and good outcome are anticipated.
Background: Tibia plateau fracture is a fracture that involves the joint surface and dramatically contributes to the early development of knee osteoarthritis, which can lead to disability. The joint narrowing is one of the most initial signs of knee osteoarthritis. Until now, the mechanism of joint narrowing is not known with certainty but is thought to be related to the configuration of the patient's fracture, malalignment, and BMI. This study aims to determine and analyze the effect of Schatzker VI fracture configuration, malalignment, and BMI > 25 kg/m2 on joint narrowing in post-operative tibia plateau fracture patients.Methods: This research is an observational study with a case-control design. Thirty-eight patients with tibia plateau fractures who had surgery with acceptable reduction were followed-up within 12-15 months post-operatively. The control group consisted of patients who did not experience joint narrowing post-operatively, while the case group are patients with joint narrowing. Schatzker classification, malalignment, and BMI were compared and statistically analyzed for significance. Data were analyzed using SPSS version 21 for Windows.Results: Sixteen patients (84,0%) had Schatzker VI with a risk of 11.56 times to experience joint narrowing (p=0.003). Malalignment were 18 samples (47,0%), with a risk of 11,56 times becoming joint narrowing (p=0.003); and 8 samples with BMI > 25 kg/m2 had a risk of 0.802 times to develop joint narrowing (p=1.000).Conclusion: Schatzker VI configuration and malalignment are risk factors for joint narrowing in patients following tibial plateau surgery, while a BMI is not a risk factor for joint narrowing. Latar Belakang: Fraktur tibia plateau merupakan fraktur yang melibatkan permukaan sendi dan sangat berkontribusi terhadap perkembangan dini osteoartritis lutut yang dapat berujung pada timbulnya disabilitas. Joint narrowing merupakan salah satu tanda awal terjadinya osteoartritis lutut. Sampai saat ini mekanisme terjadinya joint narrowing belum diketahui secara pasti namun diduga terkait dengan konfigurasi fraktur, malalignment, dan BMI pasien. Tujuan dari penelitian ini adalah untuk mengetahui pengaruh konfigurasi fraktur Schatzker VI, malalignment, dan BMI > 25 kg/m2 terhadap terjadinya joint narrowing pada pasien pasca operasi fraktur tibia plateau.Metode: Penelitian ini merupakan studi observasional dengan desain case control. Tiga puluh delapan pasien yang menjalani operasi fraktur tibia plateau diamati dalam 12-15 bulan pasca operasi. Kelompok kontrol terdiri dari pasien yang tidak mengalami joint narrowing pasca operasi sedangkan kelompok kasus terdiri dari pasien yang mengalami joint narrowing. Klasifikasi Schatzker, malalignment, dan BMI dibandingkan dan dianalisis secara statistik untuk signifikansi.Hasil: Enam belas pasien (84,0%) memiliki konfigurasi fraktur Schatzker VI berisiko 11,56 kali mengalami joint narrowing (p=0,003); malalignment dengan 18 sampel (47%), berisiko 11,56 kali menjadi joint narrowing (p=0,003); dan sampel dengan BMI> 25 kg/m2 adalah 8 sampel dan berisiko 0,802 kali untuk mengalami joint narrowing (p=1.000). Simpulan: Konfigurasi Schatzker VI fraktur tibia plateau dan malalignment adalah faktor risiko untuk terjadinya joint narrowing pada pasien yang pasca operasi fraktur tibia plateau, sementara BMI > 25kg/m2 bukan merupakan faktor risiko terjadinya joint narrowing.
The cervicothoracic junction (CTJ) is defined as the area extending from vertebral segment C7 to T2. Spinal metastases of CTJ are rare, range from 10% to less than 20%. A 47-year-old woman complained sensory and motor disturbance since 3 weeks prior to admission. History of lump on the left breast was confirmed. Neurological deficit was confirmed as ASIA C at the time of diagnosis. MRI finding suggest fracture of T1 vertebral body with kypothic angle 28° that causing anterior compression of spinal cord. The patient underwent decompression and posterior fusion from C4 to T4. A biopsy sample was also collected from the spine and left breast to confirm the diagnosis. Patient evaluation was done during discharge and at certain points of follow-up for improvement on its neurological, pain, and functional status. An MRI evaluation was performed to evaluate spinal stability and fusion. Significant improvements were observed in patient ambulatory and pain status. Cervicothoracic junction fusion procedure is a considerable choice for the management of pathological vertebral fractures with cervicothoracic junction involvement caused by spinal metastases of breast cancer.
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