Background: Distal femoral fractures are one of the common type of fractures seen after motor vehicular accidents. The optimal management of these fractures requires open reduction and internal fixation by plates and screws. Various studies have shown that open reduction and internal fixation by plates and screws result in early post-operative knee mobilization which is essential for good union and better functional outcome. Aims and Objective: The current study was conducted to evaluate the results of fracture lower end of femur treated by open reduction and internal fixation using locking compression plate. Materials and Methods: This was a prospective clinical study in which the cases with fracture lower end of femur were included on the basis of a predefined inclusion and exclusion criteria. Fractures were categorised by Mullers classification. All patients were treated by distal femoral locking compression plates and screws. The cases were followed up for radiological union and functional outcome (Neer’s scoring). The statistical analysis was done using SSPS 21.0 software. P value less than 0.05 was taken as statistically significant. Results: Out of the 20 studied cases there were 13 (65%) males and 7 (35%) females with a M:F ratio of 1:0.53. Road traffic accidents were the most common cause (75%) of distal femoral fractures. The most common type of fracture seen in studied cases was found to be Mullers C2 type of fracture (45%) followed by Mullers C3 (20%) and Mullers C1 (15%). All patients were treated by open reduction and internal fixation. Mean Injury to surgery interval was found to be 4.25 days in studied cases. Postoperatively desirable knee flexion (1100) was achieved in 10 (50%) cases whereas in 8 patients 910-1090knee flexion was achieved. In 2 (10%) patients less than 900 knee flexion could be achieved. The functional outcome (as assessed by Neer’s score) showed that Good and fair results were seen in 13 (65 %) and 6 (30 %) patients. Poor functional outcome was seen in only 1 (5 %) patient. Conclusion: Locking compression plate is found to have good results in patients with traumatic distal femoral fractures in terms of early mobilization and functional outcome. Particularly in intra-articular fractures it provides good angular stability by its triangular reconstruction principle.
Background: Common benign bone lesions around elbow joint include giant cell tumors, chondroblastoma, simple bone cysts, fibrous dysplasia and osteoid osteoma. These lesions can be managed either by observation and follow up, curettage with bone-grafting or combined bone grafting and cementing (sandwich technique). In some cases wide excision is indicated. We conducted this prospective study to find out the functional outcomes after curettage and reconstruction using bone graft sandwich technique with or without internal fixation. Materials and Methods: After obtaining approval from institutional ethical committee we conducted a prospective study of 25 patients diagnosed with benign osseous lesions around the elbow joint and who were managed with extended curettage and reconstruction using either bone grafting or sandwich technique. Patients having any exclusion criteria were excluded from the study. Patients were followed up at least for 1 year. Functional Outcomes were assessed according to Mayo Elbow Performance Score (MEPS) and Quick DASH scores. The data was tabulated and analyzed using SPSS 16.0 version software. Results: Out of 25 studied cases there were 16 males and 9 females with a M: F ratio of 1:0.56. The benign lesions in the studied cases included Giant cell tumors (80%), chondroblastoma (12%) and simple bone cysts (8%). All patients were treated by curettage and reconstruction with bone grafting or combined bone graft and cement. Postoperatively patients were followed up at 1month, 6moths and 1 year. Majority of the patients (92%) were found to have either excellent or good outcome. the Mayo Elbow Performance Score (MEPS) was found to have improved statistically significantly. Quick Disabilities of Arm, Shoulder and Hand (Quick DASH) score was also found to have improved in all the patients and majority of the patients had either no or mild difficulty with a mean Quick Dash Score of 14. Conclusion: Treatment of benign epiphyseal bone tumors by curettage with bone grafting or combined bone grafting and cementing (sandwich technique) was found to have good to excellent functional outcome. There were no patients with significant functional disability at the end of 1 year postoperatively.
Background: Osteopetrosis is a relatively rare disease with an incidence of approximately 1 case per 2,00,000 to 5,00,000 population. The clinical features of osteopetrosis includes pathological fractures, severe anemia due to defective erythropoiesis, bone marrow failure, coagulation defects, propensity for developing severe infections. Common fractures seen in these patients include hip and femoral fractures. Management of fractures in these patients is technically difficult and postoperative complications are common. We conducted a retrospective study of 20 patients with osteopetrosis who presented with femoral fractures and were treated in our institute. Materials and Methods:This was a multicentric retrospective study of 20 patients with osteopetrosis who presented with femoral fractures. The patients were included in this study on the basis of predefined inclusion and exclusion criteria. The diagnosis was based upon imaging studies (X-Rays in all the patients and CT in selected cases). The operative procedure post-operative complications, functional outcome and complications during follow up were studied from case papers. The data was tabulated and analyzed using Minitab 17 version software. Results: Out of 20 studied cases there were 16 (80%) males and 4 (20%) females with a M:F ratio of 1: 0.25. The most common affected age group was found to be between 30 -35 years (35%). Majority of patient sustained fracture following motor vehicular accidents (65%) followed by fall from height (20%) and direct blow or assault (15%). 13 patients were found to be having co-morbidities including anemia, carpal tunnel syndrome and visual disturbances. Open reduction and internal fixation was done in all the cases. Technical difficulties seen during operative procedures included difficult because of obliterated canal, sclerosed medulla and dense swarf. Common complications in these patients included wound infection, hematoma formation and arthritis of hip joint (5%). Repeat surgeries were required in 3 (15%) patients and 1 (5%) patient developed non-union of the fracture ends. Conclusion: Management of femoral fracture in patients with osteopetrosis is challenging for operating orthopedic surgeon. Common problems encountered during open reduction and internal fixation include overheating during drilling, smoke production and increased temperature of both bone and drill bits and production of dense bone swarf. Orthopedic surgeon should be aware of these technical difficulties encountered during operative interventions.
Variations in the arterial pattern of the upper limb are very common as observed in many cadaveric and angiographic studies. Knowledge of variations in the origin and course of the radial artery is important because they are used for many diagnostic procedures as well as vascular and reconstructive surgeries like coronary angiography, percutaneous coronary intervention and coronary artery bypass surgery. During routine dissection in our institute, we observed a case of high origin of the radial artery in a 33 year old male cadaver. It was found to be unilateral; on left side, radial artery was taking origin from 3 rd part of the axillary artery at the lower border of pectoralis minor before the origin of subscapular artery and anterior circumflex humeral artery. It had a superficial course in the arm crossing the median nerve from medial to lateral side. The further course of this superficial radial artery in the forearm was normal and it terminated by forming a deep Palmar arch in hand. These variations may be of great clinical implications for vascular and plastic surgeons and radiologists. Superficial course of radial artery makes it vulnerable to accidental injuries and elevates the risk of bleeding.
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