Background: Distal femur fractures are complex injuries producing long term disability and present considerable challenges in management. These fractures poses challenges to the treating surgeon because of thin cortex of the femoral condyles, wide medullary canal, relative osteopenia, short condylar fragment and comminution involving articular surface. Distal femur fracture disrupts normal knee joint functioning, hence needed anatomical reduction and stable internal fixation to prevent crippling disabilities and hardware failure. Objective: To evaluate the functional and radiological outcome of comminuted metaphyseal fracture of distal femur treated by Lateral locking compression plate and medial TENS nail using NEER'S score. Methods: In this study, 20 cases of comminuted metaphyseal fracture of distal femur were operated between November 2018 to April 2020 with distal femur lateral locking compression plate and medial augmentation with tens nail. Patients were selected based on inclusion and exclusion criteria and were followed up for 12 months. The results were analysed with NEER'S score. Results: Out of 20 patients with comminuted metaphseal distal femur fractures AO-Muller type A3subtypes 15 and C2 subtypes 5 patients were studied. Mean age of the patients was 45.5 years with age ranging from 20 years to 80 years. Right sided fractures were predominant. In 65% cases mode of injury was road traffic accident and rest were self-fall. 2 cases were operated under MIPPO technique and rest all were operated on with standard open lateral approach. Average surgical procedure timing was 119.5 minutes in our study. Average duration of radiological union was 18.6 weeks and average duration of weight bearing was 20.5 weeks. Complications such as superficial wound infection, knee pain and stiffness were observed in 9 patients. The NEER'S score was excellent in 45%, good-fair in 50% and 5% poor outcome. Conclusion: Comminuted distal femur fracture needs dual column fixation to achieve bone healing and restore function of the affected limb in shortest time without compromising stability. The advantage medial augmentation with TENS is active range of motion can be started earlier, stable internal fixation that does not allow varus collapse, mal-union and further implant failure.
Background: Acetabular fractures remain one of the most difficult Orthopaedic injuries to treat successfully. 80% of the acetabular fractures result from high-energy trauma like motor vehicle accidents and 10% falls from a significant height. Posterior wall fracture with or without dislocation are the most common type acetabular fracture accounting for a quarter to a third of all acetabular fractures. Unsatisfactory clinical results occur in more than 80% of patients treated non-surgically. Recently it has become obvious that accurate reduction of fracture is an important factor in achieving satisfactory outcome and open reduction is better than closed reduction Operative management usually offers the best chance of preserving long-term joint function and early mobilization but only if an anatomically reconstructed acetabulum is achieved. Material and Methods: This is a Prospective Study of 20 Patients with posterior wall or posterior column acetabular fracture treated surgically with open reduction and internal fixation with plates and screws by Kocher Langhenbeck approach. The present study was conducted in the department of Orthopaedics at Sanjay Gandhi Institute of Trauma and Orthopaedic and followed up for a period of 18 months. Results: The mean follow up period ranged from 6 weeks to 18 months. All the fractures were united at an average of 16 weeks and mean Harris hip score at the end of 1 year was 85.8. There was 1 superficial wound infections which was treated with intravenous antibiotic and wound healed with secondary intention and 1 case had foot drop post-operatively treated with foot drop splint recovery occurred after 6 month postoperatively. Conclusion: Good to excellent results were achieved in 75% of total cases. Hence we conclude that management of posterior wall or posterior column of Acetabular fracture is best achieved by means surgical approach by open reduction internal fixation with plates and screws.
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