Background: Osteonecrosis, also referred to as avascular necrosis (AVN), aseptic necrosis, and ischemic necrosis, is not a specific disease but rather a condition in which a circumscribed area of bone becomes necrotic as a result of a loss of its blood supply. The femoral head is the site most often affected. A number of procedures have been described to accomplish this. Total hip replacement is a reconstructive surgical procedure that provides stability, better quality of life and mobility in patients suffering from hip disorders thus eliminates pain and restore functions of hip. In hip arthroplasty, the acetabulum, femoral head and proximal neck is replaced with metal shell, plastic liner and metal ball. Purpose: To evaluate the clinical, functional, radiological outcome and the complications of uncemented total hip replacement in avascular necrosis of femoral head in adults. Materials and Methods: This prospective study done in the Department of Orthopaedics, Post Graduate Institute of Swasthiyog Prathistan, Miraj, from February 2013 to February 2014. We included the patients of avascular necrosis of femoral head, in the age group of 30 to 60 years. Results: 36 hips of 30 patients with avascular necrosis of femur head who underwent uncemented Total Hip Replacement admitted during above period after evaluating clinically and radiologically Harris Hip Score was used to measure the functional outcome. 36.11 % of the patients were found to be in the 50 and above age group, with age ranging from 30 to 60 years and a mean age of 43.8 years. Majority, 27 (75%) were males and 9 (25%) were females. Excellent or good pain relived and function were obtained in 86.01%. The mean total preoperative score was 34.61, which improved postoperatively to a mean score of 90.83. In the scoring system ie, pain, gait, functional activity and ROM, there was a statistically significant improvement ('p' value of <0.001) in the postoperative score when compared to preoperative score. Conclusion:The outcome of uncemented total hip replacement done in cases of avascular necrosis of femoral head most of them who are in stage 3 and 4 of Ficat and Arlet classification in adults is determined by multiple factors, including the design of the component, the selection of the patients, and the operative technique.
Most common long-bone fracture is tibial shaft fracture encountered by most of the orthopaedic surgeons. Intramedullary nailing has become the treatment of choice for displaced diaphyseal fractures of the tibia in adults. There have been multiple reports to support the superiority of intramedullary nailing to other methods of treatment with respect to return to weight bearing and work. The aim of the study is to assess diaphyseal fractures of tibia with special reference to fracture anatomy, pattern and stability, to determine fracture healing and the union rates with intra-medullary interlocking nail and to study the functional outcome of intra-medullary interlocking nail. This is a retrospective cross sectional study. The present study includes 255 fractures of isolated tibia shaft surgically treated with closed intramedullary interlocking nailing during period from July 2010 to July 2016. All the patients who satisfied inclusion criteria were included in this study. Open tibia fractures were classified according to modified Gustillo and Anderson's Classification. All enrolled patients evaluated with Johner & Wruh's criteria. Functional outcome were graded into excellent, good, fair and poor and were statically analyzed. Final assessment was done at 6 weeks, 3months, 6 months and 12 months. In our present series, 168 out 240 patients had excellent results which correspond to around 70%, 48 patients had good results around 20%, 16 patient had fair results around 7%, and 8 patients had poor results around 3%. Closed intramedullary interlocking nailing is effective mode of treatment in tibial diaphyseal fractures. Immediate postoperative partial weight bearing and subsequent full weight bearing helps in fracture union. Open injuries with severe soft tissue injury further leading to postoperative infection was the main cause for nonunion, after inter locking nailing.
<p class="abstract"><strong>Background:</strong> Control of infection in open fractures is a challenge in orthopaedic surgery. The literature provides evidence that antibiotic-laden bead chains are a useful adjuvant with systemic antibiotics in the prevention of infection in open fractures.</p><p class="abstract"><strong>Methods:</strong> Between February 2018 and January 2019, sixty four patients with open type fractures admitted in emergency room were analysed for this study. In this 64 patients, 32 in Group A received antibiotic laden PMMA (Poly methyl methacrylate) beads with standard care. Another 32 in Group B received standard care.<strong></strong></p><p class="abstract"><strong>Results:</strong> There were 54 males and 10 females with a mean age of 41 and follow up 6 months. Among 64 patients 37 patients were stabilised with external fixators and remaining 17 patients underwent a definitive fixation either an intramedullary nailing (12 patients) or internal fixation with a plate (5 patients). 10 patients were stabilised with k wires. The infection rate in group A and B was 6.25% and 21.8% respectively which is statistically not significant (p=0.072).</p><p class="abstract"><strong>Conclusions:</strong> Although the final infection control rate was comparable between the bead group (30/32, 93.75%) and the non bead group (25/32, 78.12%), few complications were noted in the bead group (9.37%, 3/32) than in the group B (15.62%, 5/32). Hence the prophylactic use of antibiotic cement beads is advantageous in preventing post traumatic orthopaedic infection, lessens hospital stay as well the financial burden to the patients.</p>
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