Background: Proper positioning of osseous tunnels during single bundle arthroscopic ACL reconstruction, which gives reproducibly good clinical outcome, is a matter of concern. Little evidence is there correlating tunnel position in arthroscopic ACL reconstruction with their clinical outcome in Indian population. Our aim in this study was to examine if the radiological tunnel-positions were significantly associated to the clinical outcomes. Methods: ACL reconstruction was performed in 147 young patients with an isolated ACL tear. They were followed up prospectively for the next two years. Clinical assessment of each patient was done using the International Knee Documentation Committee (IKDC) evaluation form before surgery and at two years later the surgery. At the same time, the radiological assessment was done on standard digital radiographs. Results: Considering the anterior and posterior-most points on the Blumensaat's line as 0% and 100% respectively the average position of the femoral tunnel was at 84.8%. Similarly, the tibial tunnel was at 46.8% along the tibial plateau. On the coronal plane the average position of the tibial tunnel was at 45.6% point along the tibial plateau (measured from the medial-most point towards laterally). The mean position of the femoral tunnel in the coronal plane was at 43.2% along the broadest part of the distal femur (measured from the lateral extent). The average inclination angle of the graft measured 19.6 (along the coronal plane). Conclusion: Ideal clinical outcome was significantly associated with the placement of the femoral tunnel along the sagittal plane. Placement of the femoral tunnel should not be beyond the 85% mark along the Blumensaat's line from the anterior-most point. No correlation was established between clinical results and any of the remaining radiological parameters described above.
<p class="abstract"><strong>Background:</strong> Supracondylar humerus fractures are one of the commonest fractures encountered in children. This fracture has been managed both conservatively with a long arm plaster and operatively by fixing with Kirschner wires. Debate still remains regarding the pin configuration to be used for fracture stabilisation. This study analyses the clinical and radiological parameters following fixation of supracondylar humerus fractures in paediatric patients with three lateral pins.</p><p class="abstract"><strong>Methods:</strong> It is a prospective study with 30 patients conducted between April 2016 and September 2016 conducted in Medical College and Hospital, Kolkata. All the said patients underwent closed reduction and percutaneous pinning with three laterally placed divergent kirschner wires.<strong></strong></p><p class="abstract"><strong>Results:</strong> Most of the patients in this study had clinicoradiological parameters well within normal limits, barring a few. The baumann’s angle was well within normal limits in these cases as found in subsequent follow-ups.</p><p class="abstract"><strong>Conclusions:</strong> In this study, it was found that lateral pinning can be safely employed for fixing supracondylar humerus fractures in children with lesser chances of iatrogenic ulnar nerve palsy which was encountered with crossed pin configuration.</p><p> </p>
ResumoA artroplastia total do joelho (ATJ) é uma das cirurgias mais eficazes para alívio da dor e melhora da função no estágio final da artrose (quando ocorre contato entre os ossos). As várias complicações intraoperatórias da ATJ incluem fratura, lesão em tendão ou ligamentos, e complicações nervosas ou vasculares. Neste artigo, descrevemos uma complicação incomum: a migração do pino intramedular dentro do canal femoral durante a ATJ. Um paciente do sexo masculino de 72 anos foi submetido a ATJ com sistema de estabilização posterior e sacrifício do ligamento cruzado posterior. A porção distal do fêmur foi seccionada, e o equilíbrio foi verificado em extensão. Em seguida, um bloco anteroposterior (AP) cinco em um foi utilizado para seção anterior, posterior, de chanfro, e entalhe. Por apresentar uma saliência medial, o bloco foi deslocado em sentido lateral. Ao fazê-lo, os pinos também tiveram de ser deslocados, e um deles foi inadvertidamente inserido na abertura do canal medular do fêmur criado. Como instrumentos ortopédicos usuais, como pinça reta longa e saca-bocado pituitário não conseguiram remover o pino migrado, uma pinça laparoscópica extralonga foi usada sob controle fluoroscópico para localizar, agarrar e remover o pino migrado.
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