The human hand architected to show an exceptional movements and is often a most vulnerable to various degree of injuries caused often by road traffic accidents and industrial accidents. Treatment of hand injuries involves in joint range improvement and redevelopment of coordinative movements. Joshi's external stabilizing system (JESS) provides a stable skeletal environment with early tissue healing and immediate active and passive mobilization of the uninjured adjacent joints. This study designed to assess the efficacy of JESS in management of Hand injuries. Study includes 50 patients of both sexes and all age groups with open or close type of hand injuries. All the patients were allowed to complete clinical and radiological assessment before and after surgical procedure along with subsequent follow up. Various types of distractors (30%) were applied because majority fractures were intra-articular and in 18% cases basic and extended hand frames were used. Fixators was removed within 6 weeks and in 68% wounds were healed at that time of fixator removal. Swelling was commonly associated complications in 32% cases. The incidence of non-union and delayed union of fractures was 8%, 10% respectively. At the time of final follow up 62.8% metacarpophalangeal joints, 64% of interphalangeal joints, 63% of proximal metacarpophalangeal joints, 63.5% of distal metacarpophalangeal joints and 62% of wrist joints regained their normal movements. In 74% cases grip strength was remains normal. JESS is simple, modular and low expensive. It assists the surgeon in obtaining tissue stabilization, spontaneous revascularization and tissue expansion by gradual and controlled distraction.
Management of infected nonunion of fractures is a difficult task for orthopedic surgeons in a manner to create bony stability, in recovery of soft tissue and fracture union. Several surgical treatment modalities have been available like bone grafting, antibiotic treatment, ilizarov methods and free soft tissue transfer. This study was conducted to assess the role of monolateral external fixators in infected nonunion of fractures. A total 40 infected nonunion cases were recruited based on AO classification. Patients with wounds of minimum 3 months were considered as non-draining cases. Blood investigations, microbiological investigation and radiological investigation were done. Special attention was focused on limb length measurements, range of motion of the joints, neuromuscular status and distal vascularity. The final surgical outcome was assessed asper ASAMI'S criteria with grade system. Among the cases, 65% nonunion fractures were observed in femur, 22.5% in tibia and 12.5% in humerus. Superficial pin tract infections was noticed in 48% cases and are responded to oral antibiotics. The final surgical outcome indicates that 90% cases had grade-I & II (excellent and good) recovery from infected nonunion fractures in bony and functional recovery. The monolateral external fixation system is effective and convenient method for the treatment of infected nonunion of long bones and is most reliable to rectify the limb length discrepancies.
The incidence of femoral fractures at hip region is increasing with advancement of age in population, globally. Surgical treatment with stable fixation reduces fracture associated complications and helps in regaining of mobility. Dynamic hip screw (DHS) and proximal femoral nail (PFN) are main types of fixations for trochanteric fractures. This study was designed to assess the efficacy of DHS and PFN in trochanteric fractures of femur. A total 50 patients with type I, II, III intertrochanteric and subtrochanteric fractures of femur as per Boyd and Griffin's classification, Seinsheimer's classification and Evans classification were included and were managed operatively by internal fixation with dynamic hip screw (DHS) and proximal femoral nail (PFN). 48% cases in DHS and 44% cases in PFN undergone with surgery within 5 days after injury. In PFN, the range of lag screw length was between 70mm to 95mm whereas in DHS, range was in between 65mm to 100mm. In intra operative complications of this study, there was ill fitting jig in 24% cases of PFN and in DHS method includes shattering of lateral cortex (8%) and difficulty in reduction (8%). Average time for fracture union in this study was between 14-17 weeks. In 12% cases varus deformity was observed in both groups and on an average 82% cases had good range of movement at hip joint in PFN and DHS groups. It was concluded that proximal femoral nail and dynamic hip screw were ideal treatment modalities to treat inter trochanteric and sub trochanteric fractures of the femur.
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