INTRODUCTIONThe stability of the trochanteric fracture depends on the amount of contact between the proximal and distal main fragments. Trochanteric fractures with comminution of posteromedial buttress exceeding simple lesser trochanteric fragment or with subtrochanteric extension are termed as unstable. In 3-part fractures stability is inversely proportional to the size of the lesser trochanteric fragment. Instability occurs when more than 50% of the calcar is affected allowing the proximal fragment to collapse into varus with shortening. Reverse obliquity fracture is unstable fracture in which major fracture line extends outward and downward from the lesser trochanter.Unstable trochanteric fractures are technically much more challenging than stable fractures. Stable reduction of an intertrochanteric fracture requires providing medial and posterior cortical contact between the major proximal and distal fragment to resist varus and posterior displacing forces. For unstable fractures intramedullary implants are (biomechanically) superior.1 Lag screw cut-out failure following fixation of unstable intertrochanteric fractures in osteoporotic bone remains an unsolved challenge. 2 ABSTRACTBackground: Treatment of unstable trochanteric fracture is much more challenging than stable fracture. These fractures require stable fixation to minimize the fracture and implant related complications. Need of this study is to assess the suitable implant for stable fixation of unstable trochanteric fracture with less intra and postoperative complications and good functional outcome. Methods: In this prospective randomized comparative study, 64 patients were distributed into two groups. Group A consisted of patients treated by proximal femoral nail (PFN) (n=32) and group B treated by dynamic hip screw (DHS) (n=32). All the patients were evaluated preoperatively and surgery was done according to the group they were allotted. Post-operative follow up was done at 6 weeks, 3, 6 and 12 months. Results: Average age of the patients in this study was 51.26±10.24 year. In this study patients were followed up for an average of 10.87±2.61 month. The duration of surgery was shorter in PFN group. Weight bearing was earlier in PFN group than DHS group. Mean functional ability score was better in PFN group with significant gain in function earlier as compared to DHS group. Conclusions: PFN is a better implant for internal fixation of unstable trochanteric fractures which allows early mobilization and has got better functional outcome score in early postoperative period than DHS.
Background: Tennis elbow is a common clinical problem familiar to orthopaedic surgeons. Its etiology and management remains controversial, reflected by the fact that more often it runs a chronic course. This study was designed to know the effectiveness of a local corticosteroid injection in its management. Materials and Methods: sixty-eight patients (median age, 38 to 41 years), presenting with pain on the lateral side of the elbow for a duration of more than six weeks were enrolled for the study. Patients were consecutively allotted to treatment with corticosteroid injections (Group I, n = 34) or oral analgesics and physiotherapy (Group II, n = 34). Injection of 1 ml of triamcinolone acetonide (10 mg) mixed with 1 ml of 2% lidocaine were given at the site of maximum tenderness for patients in group I. Oral Acetaminophen (1000-2000 mg/day), Ibuprofen (800-1200 mg/day), Diclofenac (100-150 mg/day) or Physiotherapy and an exercise program were given to patients in group II. Results were evaluated based on severity of the elbow complaints, tenderness and cozen's test at six weeks follow-up and compared to the baseline clinical features at presentation. Results: The incidence was more in the third decade 35.3% (n=24), with female preponderance 64.7% (n=44) and the dominant arm being more commonly involved 55.9% (n=38). Excellent results were found in group I in n=19 (55.9%) whereas poor results were more in group II in n=20 (58.8%). Group I had poor result only in n=04 (11.8%) of patients who later underwent further surgical intervention. Conclusion: Local corticosteroid injections are the most effective treatment for tennis elbow at six weeks and cause early resolution of symptoms.
<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Injuries around ankle and distal third of tibial shaft are among common paediatric bone trauma. Some of these cases are associated with soft tissue injury over the lower third of leg or around the ankle joint as tibia is subcutaneous on the anteromedial aspect. This study was conducted to know the outcome of these injuries with minimal invasive external fixation.</span></p><p class="abstract"><strong>Methods:</strong> Eleven patients in the age group of 4-14 years were included in this study. All patients had closed fracture of distal third tibial shaft or injury of distal tibial physis with associated soft tissue injury. Joshi’s external stabilization system was used to retain the reduction of fracture and appropriate wound care was taken. JESS was removed after radiological signs of fracture union.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Patients were followed up for mean period of 8.9 month. After JESS fixation healing of wound occurred at an average of 12.45 day and external fixator was removed at 6-8 weeks period. Three patients had grade 1 pin tract infection which was controlled by local dressing. No patient had stiffness of ankle at the time of JESS removal. No limb length discrepancy was seen in any of the patients in this study at their final follow up. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">JESS gives good results in fractures of distal tibial with associated soft tissue injury. It helps in better management of wound and fracture stabilization.</span></p><p> </p>
Background: In India the estimated geriatric population is going to rise from 8% of total population in 2010 to 19% by 2050. Incidence of osteoporosis and associated fractures will rise in coming years with increasing elderly population. Management of fracture neck of femur and unstable intertrochanteric fractures in osteoporotic bone is challenging in elderly as they are more prone for fracture associated complications like pressure sore, deep vein thrombosis and pneumonia. Aim: The purpose of this study is to evaluate the role of cemented bipolar hemiarthroplasty in management of osteoporotic proximal femoral fractures in elderly people. Patients and Methods: In this prospective study twenty patients with osteoporosis having proximal femoral fractures (fracture neck of femur/unstable intertrochanteric fracture) were treated by cemented bipolar hemiarthroplasty. Patients were followed up at 3 weeks, 3, 6, and 12 months to evaluate the function outcome. Mean age of the patients in this study was 73.84 years. Results: Average duration follow up in this study was 14.63 month. Mean Harris Hip Score in the postoperative period was 42.73 ± 8.78 which improved to 81.57 ± 9.11 at 6 months. Average post-operative mobilization duration was 3.84 day and average hospital stay was 11.31 day. At 1 year follow up 85% patients had excellent to fair outcome and 10% had poor outcome. Conclusion: Treatment of osteoporotic proximal femoral fractures with cemented bipolar hemiarthroplasty gives better functional outcome.
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