<p class="abstract">There are various methods for treating fractures of the distal tibia. The purpose of this study was to introduce a modified technique of ‘pin in plaster’ in treating the distal 1/3rd tibia fractures. Fifteen patients with fractures of the distal tibia AO classification A1 and A2 were followed for one-year post-application of the cast. Patients were excluded if they had complicated fractures or grade III b fractures or crush injuries, with multiple injuries or any pathological fractures or with any nerve or vascular injuries. Range of movement and functional results were calculated periodically at the 3rd and 6th months. Three cases developed pin tract infection in the study, all of which were treated with oral antibiotics successful. The fibula was fixed with plating in selected cases There were no cases of nerve injuries and no cases of tendon injury. All the cases that were treated were successful and completely weight-bearing by the end of the 4th month. Our modified technique is simple quick and effective to restore anatomic congruity and maintain the reduction in fractures of the distal tibia.</p>
Introduction: Distal tibial fractures are commonest, often a result of high-energy trauma causing significant soft tissue injury and comminution. Being subcutaneous with tenuous soft tissue coverage it is poorly vascularized with more risk of infections, delayed union and non-union. This study is intended to know the efficacy of closed reduction with tip locking intramedullary nail, in distal extra articular metadiaphyseal tibia fractures with at least 4-5cm of intact distal fragment. Materials and Methods:This study is conducted on 18 skeletally mature patients, 14 male and 4 female, between December 2019 to December 2020 who fulfilled the inclusion criteria, using an Expert Tibial Nail System (ETNS)/tip locking IM nail. Patients were assessed clinically and radiologically at regular intervals for fracture union, functional ROM and any residual symptoms. Results: Average time of fracture union was 15.2 weeks. The functional ROM in majority of patients was as pretrauma level at end of 15.2 weeks without any complications and residual symptoms on full weight bearing. Evaluated American Orthopaedic Foot and Ankle Society (AOFAS) ankle score was 80. Conclusion: ETNS/tip locking IM nail is an excellent option in tackling distal tibia fractures. It is a minimal invasive biomechanical procedure, giving stability even in osteoporotic bone. Minimal soft tissue complications with advantage of early fracture union and ambulation.
TENS (Titanium Elastic nailing system has become the standard treatment for pediatric femoral shaft fractures in the age group 6-14 years. The other treatment options are traction plus spica casting and external fixation. In spite of excellent results described in various studies, there still exists disunity in the orthopedic fraternity with regards to its usefulness. The aim of this study is to determine the outcome of pediatric femur fractures treated with TENS nailing. Between September 2020 and November 2022, 25 children within the age group of 3-12 years with femoral shaft fractures were included in the study. Two TENS nails of precalculated size were inserted in a retrograde fashion under fluoroscopic guidance. Patients were followed up at regular intervals to assess clinical and radiological parameters. Final results were evaluated using Flynn's clinical criteria. Results: There were 14 males and 11 females with an average age of 6.8years. Fracture levels included N=6 subjects (24%) proximal third fractures. N=15 (60%) subjects with Middle third fractures. N=4 (16%) subjects presented with Lower third fractures. Open injuries were present in 6 cases and 19 cases with closed injuries. The mean injury to surgery interval was 2.37 days, mean hospital stay was 7.3 days and mean time to union was 8.16 weeks. Severe complications were severe skin irritation with bursitis requiring early nail removal in one case, delayed union in one case, Results were excellent in 13(52%) patients, satisfactory in 10 (40%) patients and poor in 2(8%) patients. Conclusion: TENS is safe, reliable and an effeciant method of fixation owing to its simplicity, minimal invasiveness, ease of insertion and removal, TENS additionally has better cosmesis, rapid union with short rehabilitation, less psychosocial stress to the patient and family.
Introduction Lumbar spine spondylolisthesis (LSS) has been surgically managed by interbody fusion using pedicle screw and rod fixation. Many surgeons advocate the use of an interbody fusion device (cage) to assist in fusion and increase the stability of the construct. Objective The aim of the study is to assess and compare the functional and radiological outcome of patients undergoing surgical fixation with or without interbody cage. Materials and Methods We performed a prospective nonrandomized study in adults aged 28 to 68 years with LSS. Enrolment was done between 2010 and 2012 at the Department of Orthopaedics and Department of Neurosurgery, Bangalore Medical College and Research Institute, Bangalore, India. Clinical follow-up at 6 weeks, 3, 6, and 12 months intervals regarding pain, fusion (AP, lateral and flexion—extension radiographs) and the functional outcome was evaluated by visual analog scale (VAS) pain rating, and Oswestry disability index (ODI), SF-36, modified Benzel Japanese Orthopaedic Association score. Results A total of 20 patients with LSS were enrolled. The mean age of patients at the time of surgery was 46.85 years (± 21.15). Mean follow-up duration 14 months (range, 12–24 months). Earliest union seen at 6 months follow-up in 30% of bone graft (BG) and 50% of cage group (CG). At end of 1 year 90% of BG and 100% of CG group showed radiological union. Average fusion rate were 10 and 8.5 months in BG and CG, respectively. Radicular improvements were seen in 70 and 90% of BG and CG, respectively. Functional outcome was significantly better at 3, 6 months, and 1 year in both the groups ( p < 0.001). Complications were seen in 60 and 20% cases of BG and CG, respectively. Patient satisfaction was 80 and 90% in BG and CG, respectively. All patients returned to preinjury status except one in BG group. Conclusion Addition of an interbody fusion device (cage) helps in greater stability, lower implant failure, higher fusion rate, and better functional outcome in surgically treated patient of lumbar Spondylolisthesis at follow-up, however no significant difference seen between two groups ( p < 0.3, 0.5, and 0.26).
Distal tibia fractures are frequently associated with an extensive soft tissue injury, leading to a higher risk of complications such as skin complications, infection, non-union, and eventually poor overall outcome. This study aims to measure the outcome of open/closed distal tibia fractures treated with minimally invasive internal fixation. We aim to propose an algorithm for the management of distal tibia fractures by evaluating the treatment options, outcomes, and risk factors present. This study is a case series study of all distal tibia fractures treated surgically in Kamineni Academy of Medical Sciences, LB Nagar from 2018 to 2022. Patient records were reviewed to analyze the outcomes of surgical treatment and the risk factors associated with it.
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