Introduction:The study was conducted to assess for clinical and radiological outcome particularly complications and healing rate of distal tibia fractures treated by locking compression plate using minimally invasive percutaneous plate osteosynthesis technique. It preserves soft tissue with limited operative exposure. Objectives: Assess the clinical and radiological outcome of distal tibia fractures treated by locking compression plating using minimally invasive percutaneous plating. To evaluate the healing rate, radiological outcome and complications in these cases. Methodology: Study was conducted in all patients with distal tibia fractures admitted to our Al-Ameen medical college hospital, Vijayapur from November 2015 to November 2017. Twenty patients with mean age of 38 years was taken into the study. Patients were followed up at regular intervals. Clinical and radiological outcome were evaluated at the end of one year. Results: There were fourteen males and six female patients enrolled in the study. Fracture united in all twenty patients. All were extra articular fractures which were classified based on Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification. Seven patients had associated fibula fracture. Mean duration for fracture union was 18.8 weeks. Post operatively three patients had ankle stiffness, three had occasional pain and two patients developed superficial wound infection. Based on modified ankle score of Olerud and Molander, we got excellent results in five cases, good in eight, fair in five and poor in two cases. Conclusion: Locking compression plating using minimally invasive percutaneous plate osteosynthesis technique is a good treatment option for fractures of distal tibia. Accurate positioning and proper fixation of the plate with minimal dissection are essential to produce good clinical and radiological outcome. We strongly recommend this procedure for all extra articular distal tibia fractures.
Background:There is no ideal postoperative pain management. Simple surgeon-delivered local anesthetic (LA) techniques such as wound infiltration and regional nerve blocks can play a significant role in the improvement of postoperative pain relief.Settings and Design:Administered paper questionnaires to delegates attending surgical society conferences.Methods:A 15-point questionnaire was administered to surgical delegates attending general surgey, orthopedic and gynecological conferences at different locations.Results:Response rate was 65.26%. 33% of surgeons used LA regularly, 31% occasionally, and 36% never used LA for postoperative analgesia. 50% of all surgeons used lignocaine for local anesthesia (P < 0.0001) and infiltration (65% of all surgeons) was the most common method (P < 0.0001). Only 30% surgeons knew the correct duration of action of bupivacaine infiltration (P < 0.0001) and only 4% surgeons knew that LAs are antimicrobial (P < 0.0001). 53% of orthopedic surgeons used combination of lignocaine and bupivacaine, while 46% of general and 73% gynecologists surgeons used lignocaine more commonly. Only <5% of all surgeons had used long-acting liposomal bupivacaine and almost 40% more were willing to use the liposomal LA drug only if more evidence is available.Conclusions:Although majority of surgeons were aware of the benefits of LA use for postoperative pain relief, reluctance, lack of knowledge of LA drugs and methods of LA use and fear of infection and wound healing are barriers for effective use of LA drugs for postoperative pain relief. Attending anesthesiologists must develop methods in the operating room to create awareness about the effectiveness of LA use for postoperative pain relief. Single-use vials or ampules of LA must be encouraged to LA use for postoperative analgesia, especially in the third-world countries.
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