Objective: Intramedullary interlocking nail fixation (IINF) for the fracture shaft humerus (FSH) offers good clinical outcome. Evaluating the functional outcome of IINF in FSH and assessing the complications of the technique, time taken for fracture consolidation, and union rates were the objectives.Methods: Adult patients with a clinical diagnosis of diaphyseal fracture of humerus were assessed clinically and radiologically for the functional outcome of IINF in FSH. Functional outcome of shoulder and elbow considered together was graded as excellent, moderate, and poor. Daily assessment was done along with active physiotherapy. All were followed up at monthly intervals for 6-12 months or till the union of fracture. Radiological assessment was done at immediate post-operative period, at months 1, 3, 6, 9, and 12 months.Results: 30 patients (males n=24, 80%) with a mean(±standard deviation) age of 39(±13.31) years were included. Road traffic accident was the frequent cause (n=18, 60%). Indirect injury was the cause in 66.66% patients. Middle 1/3 rd of shaft of humerus was fractured in 53.33% patients. 10 (33.3%) patients each had oblique fracture and transverse fracture, respectively; comminuted fracture was seen in another 26.6% patients. Radial nerve palsy (10%) was the frequent associated injury of the total nine. The overall functional outcome was excellent in 80%, moderate in 16.6%, and poor in 3.3% patients. Postoperatively, nonunion, superficial infection and shoulder stiffness was seen in one patient each. Conclusion:IIFN is an excellent, least invasive surgical option for FHS with early fracture consolidation and better union rates.
Objectives: Appropriate management of malleolar injuries is crucial as ankle is an important weight-bearing joint, and locomotion is determined by and dependent on joint stability. We studied the functional outcome of surgically managed bimalleolar fractures of the ankle. Methods:Fractures were classified anatomically and as per Lauge-Hansen, arbeitsgemeinschaft für osteosynthesefragen (AO)/orthopedic trauma association classification. The stability of the structures at the fracture site, the extent of damage, mechanism of injury was assessed. Radiologically, tibiofibular clear space of >6 mm and widening of the medial clear space of >4 mm were indicators of syndesmotic instability.All underwent open reduction and internal fixation (ORIF) under spinal and/epidural anesthesia. We used tension band wiring, malleolar screw, Kirschner wires (K-wires), cancellous screws for fixing medial malleolus; one-third tubular plate and K-wires for lateral malleolus. Patients were followed up at 6 weeks for 6 months, evaluated using Biard and Jackson's ankle scoring system. Results:Of 30 patients, 25 (83.3%) were men. Right ankle was involved in 56.6%. Road traffic accident was the cause in 83.3%. 14 (46.6%) had supination external rotation injuries. The AO Type B was the most common (66.6%). All had a complete union, with a mean time for union 10.6 weeks (8-14 weeks). Functional scores were categorized into excellent (60%), good (26.6%), fair and poor (n=02 each). Superficial and deep infection (n=02 each), delayed union (n=01) were the complications. Conclusion:ORIF restores the articular congruity of the ankle joint. Cancellous or malleolar screws are better for fixation of the medial malleolus and lateral plating for fibular fractures.
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