Surgical fixation of a fracture of the shaft of humerus can be achieved by Plating or Nailing. Plating provides satisfactory result, but requires extensive dissection, and meticulous radial nerve protection. The theoretical advantage of intramedullary nailing included less invasive surgery, an undisturbed fracture hematoma and use of a load sharing device support. This study compares the two more commonly used interventions: locking/dynamic compression plating and locked intramedullary nailing. Patients admitted were randomly assigned to either ILN group (Group A) or DCP group (Group B). In group a, internal fixation with interlocking nail done. In the plating group (Group B), fixation was done with 4.5 mm dynamic/locking compression plates using either anterolateral or posterior approach. All the cases were regularly followed up. Functional outcome is determined on the basis of disability arm shoulder and hand score (DASH). Union was present in 18 (90%) patients in the ILN group whereas in the DCP group, union was present in the 17 (85%) patients. Average union time is 7.83 with standard deviation of 1.54 weeks in the ILN group and 8.64 with standard deviation of 1.96 weeks in the DCP group. DASH score for the ILN group is 33.74 with standard deviation of 14.18 whereas it is 27.66 with standard deviation of 10.32 in the DCP group. The DASH score of the two groups is statistically insignificant (p>.05). Both the modalities of treatment are good as far as union of the fracture is concerned, but considering the rate of complications we concluded that dynamic compression plating offers better result than interlocking nailing with respect to pain and function of the shoulder joint.
<p class="abstract"><strong>Background:</strong> There is no consensus on treatment of closed femoral-shaft fractures in children. We compared hip spica cast with titanium elastic nailing (TEN) in the treatment of femoral-shaft fractures in children.</p><p class="abstract"><strong>Methods:</strong> Study was conducted at SMS Medical College, Jaipur (Rajasthan). Out of 90 Patients of diaphyseal fracture femur, 45were treated conservatively by spica cast and 45 were treated with TEN. Follow up done regularly up to twelve months of injury with taking into account, various parameters.<strong></strong></p><p class="abstract"><strong>Results:</strong> All diaphyseal fractures of femur healed, whether treated conservatively by spica cast or treated operatively with TEN. The time of union and weight bearing was less in operative group as comparative to spica cast group. Ten patients (22.22%) in spica group compared to three patients (6.66%) in operative group had malunion and two patients (4.4%) in spica group compared none in operative group had delayed union.</p><p><strong>Conclusions:</strong> Results of TEN turned out to be far superior to traction and spica cast treatment in paediatric femoral fractures. Rate of complications was far low with operative than conservative Treatment.</p>
Fracture distal radius is the most common fracture approximately 25% of all fractures treated at an emergency department, which constitutes 17% of all fractures and 75% of all forearm fractures. Conventional method of reduction and cast treatment for distal radius fracture has resulted in unsatisfactory anatomical and functional results, varying degrees of deformity and disability with secondary loss of reduction during ongoing treatment. Fixed angle volar plating and k wiring represents a valuable treatment modality for the most frequent types of unstable fractures of the distal radius. Patients admitted were randomly assigned to either k wiring group (Group A) or Volar plating group (Group B).In group A, percutaneous k wiring done after closed reduction under image intensifier whereas in group B, volar plating done after open reduction through modified Henry approach. All the patients were regularly followed up. Functional outcome is determined on the basis of disability arm, shoulder and hand score (DASH). The overall mean age of the patients was 44.5±11.94 years. The age group 41-50 years comprised the highest number of patients (37.09%). AO Type A fracture constituted the highest number of patients (45.2%) followed by type C fractures (37.1%). The mean time to operation from the date since injury for all fractures was 5.09±2.82 days. The duration taken for surgery for k wire group was 20.194.88 days and for volar plate group was 49.83±7.0 days. The average blood loss was higher for volar plating group. For k wire group average blood loss was 8.09±3.59ml and for volar plate was 155.48±18.76ml.Duration of fracture union in k wire group and volar plate group was seen by 7.38±1.02 and 6.67±0.83 weeks respectively. The mean DASH score at the end of follow up was 6.03±1.87 for volar plate group and 7.00±2.38 for the k wire group. At 12 weeks from the procedure, clinical results seem to favour patients treated with plating, but there were no significant difference between the two types of treatment at long term follow up. Unstable intra-articular radius fractures that cannot be reduced or held reduced with pinning should be treated with locking volar plate, however k wiring remains a simple and inexpensive option for simple fracture patterns.
<p class="abstract"><strong>Background:</strong> Dynamic hip screw (DHS) has been the standard treatment for stable trochanteric fracture patterns. However, primary stabilization with dynamic/sliding hip screw is not always successful, especially in osteoporotic fractures. Internal fixation in such a situation may achieve a satisfactory initial fracture site reduction, but late fracture collapse into varus during weight bearing, can lead to a high failure rate. Since 1975, polymethylmethacrylate (PMMA) cement-augmented DHS have been used as a solution in unstable ITFs by adding an anchoring ability to the lag screw.</p><p class="abstract"><strong>Methods:</strong> A series of 33 osteoporotic intertrochanteric fractures were operated with cement augmented dynamic hip screw. One patient lost to follow up. All patients were then allowed partial weight bearing walker aided ambulation under the guidance of physiotherapist on the second or third postoperative day. The patients were followed radio logically and clinically at regular intervals (1st month, than at 3rd month and then at 6th month interval after surgery). Results were graded as excellent (score >31), good (score 24-31), fair (score 16-23), and poor (score <16). Clinical result was given according to Salvati and Wilson scoring.<strong></strong></p><p class="abstract"><strong>Results:</strong> Total 33 patients were taken for the study they were followed for minimum 6 months and at 6 months the clinical outcome was rated as per the Salvati and Wilson scoring system. One patient lost to follow-up. Final clinical results as evaluated by Salvati and Wilson scoring were; excellent in 24 cases (75%), good in 7 cases (21.88%), fair in 1 case (3.12%) and poor in 0 cases (0%). There were no non-union, AVN, implant failure and screw cut-out in our study.</p><p><strong>Conclusions:</strong> The surgical management of intertrochanteric fractures with PMMA augmented DHS provide a stable fixation with moderate pain free early mobilisation and better outcome in osteoporotic patients without the complications of superior screw cut-out, sliding collapse, and with the appropriate placement of bone cement along with proper amount (4-5 ml) of cement we can also reduce the cement related complications such as delayed healing, nonunion, heat necrosis and avascular necrosis.</p>
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