Aim. To evaluate the clinical use of blocking screws as a supplement to stability in distal tibial metaphyseal fractures treated with statically locked intramedullary nail. Main Outcome Measurement. Alignment and reduction preoperatively, postoperatively, and at healing were the main outcome measured with an emphasis on maintenance of initial reduction on followup. Patients and Methods. This was a prospective study of 20 consecutive cases of distal tibial metaphyseal fractures treated with statically locked intramedullary nailing with supplementary blocking screw between August 2006 and September 2007 with a maximum followup of 3 years. Medullary canal diameter was measured at the levels of fracture and isthmus. Results. The mean diameter of tibia at the level of isthmus was 11.9 mm and at the fracture site was 22.9 mm. Mean length of distal fracture segment was 4.6 cm. Mean varus/valgus alignment was 10.3 degrees preoperatively and 1.7 degrees immediatly postoperatively and was maintained till union. Using Karlstrom-Olerud score the outcome was excellent to good in 90%. Conclusion. We conclude that the use of blocking screw as a supplement will aid in achieving and maintaining the reduction of distal tibial metaphyseal fractures when treated with intramedullary nailing thereby extending the indication of intramedullary nailing.
Introduction: Originally described as the fender fracture tibial plateau fractures resulted primarily from low-energy pedestrian versus car bumper accidents. The majority of tibial plateau fractures reported in the recent literature have resulted from high-speed motor vehicle accidents and falls from a height. Injuries to the tibial plateau occur as a result of a force directed either medially (valgus deformity, the classic "bumper fracture") or laterally (varus deformity), an axial compressive force or both an axial force and a force from the side. Locking Compression plates have become and imminent tool in the management of these complex fractures. Method: This is a prospective study conducted in Chengalpattu Medical College and Hospital, Chengalpattu. Twenty patients who satisfied the following criteria were included in our study. Depending on the type of fracture and severity of soft tissue injury all the patients were stabilized initially and closed or open reduction of the fracture done and fracture stabilized with locking compression plate. Discussion and Conclusion: The results were analyzed both clinically and radiologically using the Knee scoring system by Hospital for Special Surgery. Results based on Knee Scoring System, Hospital for Special Surgery (HSS) we had excellent result in 10 cases, good result in 7 cases, fair result in 3 cases and we had no poor result. From our study, we conclude that, Open/closed reduction and internal fixation of closed tibial plateau fractures with locking compression plate is an effective method of treatment provided there is no extensive soft tissue injury. Locking compression plate provides good angular stability with its triangular reconstruction principle. Keywords: Tibial plateau fracture, locking compression plate, functional outcomeIntroduction A proper function of the knee is important in walking, running and in most activities. Injuries of the knee must be treated properly to maintain a good knee function. In the last few decades, rapid industrialization and the fast pace of life have brought both comforts and catastrophe like road traffic accidents crippling many lives. Fractures of the tibial plateau involve the knee, which is a major weight bearing joint, and these are serious injuries, which frequently result in functional impairment. The goals in treating fractures of the tibial plateau are to restore the joint space, mechanical alignment of the limb, to achieve optimal healing of bone, tendon and ligaments, and to allow painless full range of motion of the knee. The optimal treatment of tibial plateau fractures has been a source of controversy for a long time. They were managed both by operative and non-operative methods. In the early 1960s, there was a great reluctance towards operative management of these fractures because of high incidence of infection, non-union, malunion, inadequate fixation and lack of proper instrument, implant as well as antibiotics. Then, the traditional management of displaced fractures was along the principle of Watso...
The shoulder by virtue of its anatomy and biomechanics is one of the most unstable and frequently dislocated joints in the body, accounting for nearly 50% of all dislocations. Since the beginning of century more than 150 surgical procedures were described in treating recurrent dislocation of the shoulder with varying results and success. Most of the operative techniques described for the treatment of recurrent anterior dislocation or subluxation of the shoulder have 2 distinct disadvantages; need to immobilize the shoulder for several weeks and Loss of external rotation. These can be overcome by Bristow-Laterjet procedure. We analysed Bristow-Laterjet procedure in the treatment of recurrent traumatic anterior dislocation of shoulder at the Department of Orthopaedics, Chengalpattu Medical College Hospital, Chengalpattu, Tamilnadu, India. We came across 20 patients (1 patient had bilateral dislocation) during February 2015 to February 2017. All the patients were followed up periodically both clinically and radiologically till their shoulder regained full range of movements and radiological bony union of the coracoid graft. All the patients were thoroughly examined and evaluated subjectively and objectively and outcome was assessed by Rowe's scoring system. We found all the patients were satisfied with surgery and were able to return to their pre dislocation level activity and none had further episodes of shoulder instability. Radiologically there was good bony union of the coracoid graft and there was no screw loosening.
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