Background: Open fractures of tibial shaft are important for the reason that they are most commonly fractured long bone in the body & subcutaneous location of the anteromedial surface of the tibia makes their management controversial. The precarious blood supply and lack of soft tissue cover of the shaft of the tibia make these fractures vulnerable to delayed union, nonunion, malunion and infection. The treatment of tibial fractures has developed from a strictly non-operative to a variety of operative techniques. While reamed Intramedullary nailing offer improved stability of the fracture, their use carries a theoretical risk of infection and nonunion as a consequence of disturbing endosteal blood supply. Recent reports suggest that the reaming is safe for grade I, II and IIIA open fractures of tibia. Material & Method: A total of 25 patients presented to Father Muller Hospital, Mangalore from Jan'06 to July'07 with type I and II open tibial shaft fractures were included in the study and all cases underwent debridement within 6 hours of admission and treated with reamed intramedullary interlocking nailing. They were reviewed at every 2 weeks for 6 weeks and then monthly post operatively and x-rays were repeated at 6,12,24 weeks to check for fracture healing. The average duration of follow-up was 32 weeks. Functional results were graded according to criteria by klemm & borner. Result:The average time to union was 19.68 weeks. Type I united in 18.86 weeks as compared to 20.5 weeks for Type II fractures. The average range of motion in the knee joint was 135.6 degrees. Full ankle motion was observed in 19 patients. One patient showed a loss >25° of motion at ankle compared to normal side while 5 patients showed < 25 0 loss of joint motion. 92% patients achieved good or excellent results, fair results were obtained in one patient & in one patient functional results were poor. Conclusion: Anatomical & functional outcome of open tibial fractures type I and type II treated with reamed intramedullary interlocking nailing is excellent to good and it is safe and effective technique for the management of Gustilo type I and type II.
Introduction: Lumbar Canal Stenosis is developmental or congenital narrowing of the spinal canal that produces compression of the neural elements before their exit from the neural foramen. The narrowing may be limited to a single motion segment or it may be more diffuse spanning two motion segments or more. The spinal canal demonstrates narrowing, attributed most frequently to acquired degenerative or arthritic changes such as hypertrophy of the articulations surrounding the canal, intervertebral disc herniation or bulges, hypertrophy of the ligamentum flavum, osteophytes formation and degenerative spondylolisthesis. The classic presentation of Lumbar Canal Stenosis is neurogenic claudication. Aims and Objectives: To study the outcome of microdecompression by unilateral laminotomy in lumbar canal stenosis Methodology: This is institutional based prospective study of 36 patients, aged 20 to 80 years, with diagnosed lumbar canal stenosis treated with bilateral microdecompression of lumbar canal stenosis by unilateral laminotomy using microscope, surgical magnifying loops and microsurgery tools at Dr. Shankarrao Chavan Govt. Medical College Vishnupuri, Nanded. Statistical analysis done by chi-square test. Result: There was an rapid decrease in the leg pain scores from 8.94 In the pre-operative period to 1.36(SD±1.13) one month after operation. At 1 month follow up patients with no pain (VAS + 0) were 9 (25.00%). Conclusion: Unilateral laminotomy with bilateral micro decompression method is one of the excellent method for decompression of lumbar canal stenosis with early functional outcome as unilateral laminotomy preserves posterior midline structures with sparing of spinous process, opposite side lamina and paraspinal muscles.
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