Introduction Intertrochanteric fractures are the most frequently operated fracture type and have the highest postoperative fatality rate. The most commonly used devices are the dynamic hip screw (DHS) with side plate assemblies and proximal femoral nail (PFN). The aim of this study was to determine the functional and radiological outcome of unstable intertrochanteric fracture post DHS fixation at a tertiary care hospital in Karachi, Pakistan. Methods A study was carried out in the department of orthopedics at the Jinnah Postgraduate Medical Center (JPMC), from 12th June 2016 to 8th September 2017. A total of 106 patients between 18 and 75 years of age with unstable intertrochanteric fracture were included. Those patients who had multiple injuries and open fractures, subtrochanteric fractures, intracapsular fractures neck of femur, pathological fractures and patients who were non-ambulatory prior to their injury were excluded. Functional outcomes were measured both during pain using the visual analog scale and range of motion on goniometer between 80 and 100 degrees. Satisfactory outcomes were measured after three months. Results A total of 106 patients with the radiological diagnosis of the unstable intertrochanteric fracture having post DHS fixation were included in this study. Out of which, 69.8% (74) were males and the mean age was 66.61 ± 7.79 years over the range of 50 to 80 years. Patients with type II diabetes were 22.6% (24) with a mean duration of 4.3 ± 8.37 years. At the end of three months, no pain was reported in 82.1% (87) patients and 85.8% (91) patients had normal function. The satisfactory radiological outcome was observed in 86.8% (92) patients. Overall, acceptable outcomes were observed in 81.1% (86) patients at the end of three months. Conclusion The treatment of unstable intertrochanteric fracture with dynamic hip screw (DHS) fixation results in better outcomes. In our study, we observed acceptable outcomes in a vast majority, 81.1%, of patients after three months of DHS fixation of the unstable intertrochanteric fracture.
Objectives: To assess the functional outcome of dynamic condylar screws to treat subtrochanteric fractures in adult patients. Methods: The prospective descriptive study was conducted at the department of orthopedic surgery, Dr. Ruth KM Pfau civil hospital Karachi, Pakistan, from March 2016 to October 2019. A total of 47 patients of 18 to 60 years of either gender with subtrochanteric fractures treated with dynamic condylar screw were included in the study. After consent and counseling, patients were operated on by a consultant orthopedic surgeon and fixed with a dynamic condylar screw. Postoperatively patients were regularly followed at 2nd, 6th, 12th, 16th, 20th weeks, and onwards monthly for at least one year. Functional outcomes such as infection, union, failure of fixation were observed in all patients. SPSS software version 23 was used to analyze data. Mean and SD was reported for numeric variables, whereas frequency and percentage were reported for categorical variables. A Chi-square test was used to assess the association between variables. Results: The mean age was estimated as 37.53±12.31 years. Most of the patients were male (74.5%), and 25.5% were females. About 27 patients had a fracture on the right side (57.4%) and 20 on the left side (42.6%). Out 47 cases, 3 were lost to follow, 33 patients showed excellent outcomes, 6 cases had a good outcome, 3 cases had fair outcomes, and 2 cases had poor functional outcomes. During the follow-up, 42 cases showed union, 3 lost to follow-up, 1 died, and 1 patient had implant break. About 2 patients had infections in post- operative duration because of fracture. Conclusion: Subtrochanteric femur fractures are challenging to operate, especially in our society where extensive trauma becomes more frequent. Dynamic condylar screws showed overall acceptable results. It is simple, locally made, readily available, and cheap, with almost the same result as other implants around proximal femur fractures.
Introduction: Hip fractures can occur when the femoral neck, the region between the larger and lesser trochanters, or the area below the lesser trochanter breaks. Intertrochanteric fractures are extracapsular fractures of the proximal femur that occur between the greater and lesser trochanters. A subtrochanteric hip fracture occurs when a break between the region 5 cm below the lesser trochanter. Aim: To determine the incidence of hip fractures in the study population Methodology: This study comprised a total of 670 patients. There were 315 (47%) males and 355 (53%) females. The Proforma was created to record demographic information, hip fracture complications and lab test results. Every patient who was a part of this study gave their written informed permission. Before collecting data and publishing it in a medical publication, an ethics committee’s consent was obtained. The participants were chosen using a non-probability sequential selection approach. Results: The present studies show that higher numbers of hip fractures were observed in older age (above 66 years), in which 69% of females and 57% were males. The major cause of hip fracture was fall and slippage that broke the hip bone, it was found more in females (81.6%) than males (39.7%). Complications were observed due to waiting for their operative procedures. The delay has led to pulmonary, cardiac problems, and bedsores. However, in 80% of cases, the union of hip fracture was observed. Conclusion: The present study concluded that the incidence rate of hip fracture increases with respect to age. In males, a major cause of hip fracture was accidents Hip fractures are more prevalent in females, and fall and slippage are the major causes.
Objective: Motorbike accidents contribute one of the most important factors of tibial plateau fracture among young populations in Karachi Pakistan. Most surgeons feel challenging to treatment complicated bicondylar fractures of the tibial plateau.This prospective study was designed to evaluate the functional outcomes of dual plating through a two-incisions technique for the fixation of complicated bicondylar tibial plateau fractures in young patients in Karachi Pakistan. Methods: This prospective study includes 94 cases of Type V and VI tibial plateau fractures of young patient’s age range from 15 to 45 years, operated between January 2014 and December 2016 conducted in two public sector hospital of Karachi Pakistan (Jinnah Post Graduate Medical Center, Civil Hospital Karachi). Exclusion criteria include patients with multiple fractures on the same side or same bone, age >45 years, open contaminated fracture, open fracture,and patients with head injuries. All cases were operated either by lateral locking plate fixation by anterolateral approach or dual plating through double incisions. These all cases were followed for a minimum of 24 months radiologically and clinically. The statistical analysis was performed using software SPSS 20.0 to analyze the data. Results: A total of 94 patients (45 Single Plating and 49 Dual Plating)were operated during the study period of 2 years. However, four patients (4 single plating and 0 dual plating) were lost during follow-up who could not be tracked. Both groups were somewhat similar in relation to the age, mechanism of injury, fracture pattern, and soft tissue injury. Preoperatively, there was a significant increase in surgical time with the dual plating group; however, the mean time of reduction between the two groups was not significant. The decision to put bone graft was at the choice of the operating surgeon and was an intra operative decision with 74 (78.7%) patients receiving the bone graft. Post-operatively, there was no immediate difference in between the groups considering thermal alignment and reduction. It took approximately 4–5 months for the fractures to get united. There was normal union,non union or implant failure seen among those patients. There were 10 cases with superficial infection in wounds of dual plating group which were treated with culture sensitive antibiotics for average 2 weeks, healed subsequently. There were three patients found having an incidence of deep infection in a double plating group, wherein 2 patients were positive with Staphylococcus aureus and 1 patient with Escherichia coli was isolated. Extensive wound irrigation and lavage with antibiotic cement beads were given. Repeated irrigation and lavage were done again after 2 weeks with the removal of beads followed by prolonged course of antibiotic therapy for 6 weeks after which the infection resolved.A total of 38 (77%) patients in a double plating group regained full flexion (135°) and full extension (0°) with a good alignment and no pain and instability as compared to single plating group, seen in 30 (66%) patients at follow-up. Conclusion: Dual plating by two-incision method resulted in better functional outcome regarding limb alignment and range of movements at knee joint with an acceptable soft tissue complication rate in young patients. Keywords: Complicated tibial plateau fracture, Young patients, Double incision, Dual plating.
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