Aim. To evaluate the clinical use of blocking screws as a supplement to stability in distal tibial metaphyseal fractures treated with statically locked intramedullary nail. Main Outcome Measurement. Alignment and reduction preoperatively, postoperatively, and at healing were the main outcome measured with an emphasis on maintenance of initial reduction on followup. Patients and Methods. This was a prospective study of 20 consecutive cases of distal tibial metaphyseal fractures treated with statically locked intramedullary nailing with supplementary blocking screw between August 2006 and September 2007 with a maximum followup of 3 years. Medullary canal diameter was measured at the levels of fracture and isthmus. Results. The mean diameter of tibia at the level of isthmus was 11.9 mm and at the fracture site was 22.9 mm. Mean length of distal fracture segment was 4.6 cm. Mean varus/valgus alignment was 10.3 degrees preoperatively and 1.7 degrees immediatly postoperatively and was maintained till union. Using Karlstrom-Olerud score the outcome was excellent to good in 90%. Conclusion. We conclude that the use of blocking screw as a supplement will aid in achieving and maintaining the reduction of distal tibial metaphyseal fractures when treated with intramedullary nailing thereby extending the indication of intramedullary nailing.
Calcaneal fracture, the most common tarsal bone fracture, occurs predominantly in manual labors and subsequently has got considerable socioeconomic implications. Treatment modality which can offer early weight bearing and early return to work is therefore needed for those patients. We have used a biplanar percutaneous external fixator for treating calcaneal fractures without operative and per operative visualization of the fractures. We have treated 17 calcaneal fractures in 16 patients, 12 intra articular and five extra articular, with our percutaneous external fixator system without preoperative X-ray control or reduction. Functional outcome was measured using the American Orthopaedic Foot and ankle society Hind foot score. All fractures united with a mean of 55 days. Partial weight bearing was possible in a mean of 1.8 days and full bearing was possible in a mean of 11.6 days. All the patients were returned to their original work within six weeks. Minor infectious complications occurred in 17.6 percent of cases. The average AOFAS score at six months follow up was 83.8. We conclude that our percutaneous external fixator technique for fracture calcaneum is an effective alternative to the currently available – surgical and conservative treatment modalities especially in lower socio economic labor population who need to return to their job as early as possible. Level of Evidence – IV Case series.
Introduction:The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) coronavirus disease-2019 (COVID-19) outbreak became a pandemic across the world after the outbreak in China in December 2019. This study aimed to determine the impact on the emergency orthopedic fixation during the COVID-19 pandemic in the Institute of Orthopaedics and Traumatology, Coimbatore. Materials and methods: This is a retrospective study done on patients of trauma admitted in the emergency orthopaedic unit, under Tamilnadu Accident and Emergency Care Initiative (TAEI), Coimbatore Medical College Hospital from April 2020 to December 2020. All the patients admitted were evaluated as per the routine protocols followed in this COVID-19 pandemic in our institution and the patients were taken up for emergency orthopedic fixation based on the COVID-19 status. Results: The total number of emergency orthopedic surgical fixation procedures done during the pandemic period from April 2020 to December 2020 was 245. Orthopedic surgical fixation done in elective theatres during this pandemic in 2020 is 245 cases. As per the results, during the COVID-19 pandemic, emergency orthopedic surgical fixation was not stopped and treated as per the COVID-19 protocol followed in our hospital. Conclusion:The SARS-CoV-2 (COVID-19) pandemic has a major impact on orthopedic surgical fixation. All the patients admitted should be evaluated for the COVID-19 infection and use of adequate personal protective equipment while treating the patients to deliver safe and effective surgical services during this COVID-19 pandemic.
A 40-year-old man sustained trauma while walking and presented three months after trauma. The attitude of left hip was flexion, neutral rotation, and neutral abduction/adduction with an arc of flexion available from 30° to 90°. No movement was possible in other planes. On roentgenogram and 3D computed tomography, the femoral head was lying inferior and medial to the acetabulum, and it was in the same coronal plane of the acetabulum, neither anterior nor posterior, within the pelvic cavity. An indentation over the superolateral half of femoral head was observed. The acetabulum was found intact except for a small defect in the inferior aspect of its medial wall. Cemented total hip replacement was done without any need to reconstruct the acetabulum, and at the two years follow-up, the patient was having a pain-free, stable hip and was able to walk unaided. We hereby report a late presentation of intrapelvic dislocation of hip in view of rarity.
Fractures of distal ulna are often associated with fracture distal radius. Isolated intra-articular fractures of ulnar head have very rarely been reported in the literature. Displaced intra-articular fractures of ulna head should be treated properly so that the distal radio ulnar joint congruence is maintained. I am reporting a case of malunited isolated intra-articular fracture of ulnar head in young girl which was treated by open reduction and internal fixation. Logan and Lindau in their review of literature and recommendations for treatment of distal ulna fractures in adults found only few case reports. All those reported cases were treated soon after the injury. This case has been presented not only for its rarity but also to recognize the importance of managing the intra-articular fractures properly even in distal ulna. How to cite this article: Sengodan MM. Malunited Isolated Intra-articular Fracture of Ulnar Head. J Orth Joint Surg 2020;2(2):74–78.
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