BACKGROUND:This prospective consecutive case series was done to evaluate indications, technical pearls and pitfalls and functional outcomes of distal femoral supracondylar fractures treated with retrograde intramedullary nailing. METHODS: The surgical outcome of 80 patients (59 males and 21 females) who were treated with retrograde intramedullary nailing for. Patients were followed-up both clinically and radiologically every 6 weeks for a mean duration of 20 (12 -24) months. The patients were assessed based on Schatzker and Lambert criteria. RESULTS: The mechanism of injury was motor vehicle accident in 48 (60%) patients and fall in 32 (40%) patients. Sixty four (80%) fractures were closed and 16 (20%) fractures were compound. Average operation time was 2 hours and average blood loss was 300 ml. The mean union time was 5.6 months (5 -7 months). Knee flexion of more than 120 degree was achieved in 60 patients, 110 degree in 16 patients and 100 degree in 2 patients. Six patients had anterior knee pain of transient nature which subsided within one year after rehabilitation, full weight bearing and self exercises. By the end of 1 year, overall outcome was excellent in 59 patients (74%), good in 12 patients (15%) and fair in 8 (10%) patients. CONCLUSION: Retrograde intramedullary femoral nailing is an optimal tool in the treatment of AO/ASIF type A and type C distal femur (supracondylar) fractures. It provides rigid fixation in a region of femur where, wide canal, thin cortices and frequently poor bone stock make fracture fixation difficult. It also provides excellent results in selected comminuted fractures of the distal femur with a low complication rate.
BACKGROUND: The following prospective consecutive case series was done to evaluate indications, technical pearls and functional outcomes of minimally invasive sliding hip screw in the fixation of stable intertrochanteric fractures of femur. These fractures carry risks associated with prolonged immobilization for which, early fracture fixation and early ambulation of the patient is necessary. Sliding hip screw remains the most common method for the treatment of stable intertrochanteric fractures of femur. METHODS: A total of 80 patients (48 males, 32 females) with stable intertrochanteric fractures of femur were treated with minimally invasive sliding hip screw technique. Average age of the patients was 73 year. Average blood loss during surgery, reduction of postoperative haemoglobin, requirement of post-operative analgesics and total days of postoperative hospital stay were studied. RESULTS: Length of incision, operation time, blood loss and duration of hospital stay were significantly less. Mean operating time was 50 minutes. Mean intra-operative blood loss was 53 ml. Mean reduction of postoperative haemoglobin was 0.9 gm/dl. Average wound size was of 5 cm. The average follow-up was 17 months. The average postoperative analgesic requirement was twice daily for 5 days. Mean hospital stay after surgery was 5 days. CONCLUSION: Minimally invasive sliding hip screw is a novel and advantageous technique that can be used comfortably for the treatment of stable intertrochanteric fractures of femur, thus providing rigid fracture fixation and early mobilization of the patients. Thus, the judicial use of this technique significantly reduces the amount of blood loss, soft tissue dissection, requirement of post-operative analgesics and also the length of stay in the hospital.
BACKGROUND:This prospective consecutive case series was done to evaluate indications, technical pearls and pitfalls and functional outcomes of elastic stable intramedullary nailing of displaced mid clavicular fractures and the effectiveness of the titanium elastic stable intramedullary nails in the surgical treatment of the mid clavicular fractures in adults. MATERIALS & METHODS: A total of 80 patients (60 men, 20 female) were included in this study. Constant score and radiographs were evaluated after 1 and 6 weeks, 3 months and 6 months in 80 patients. Mean age was 28 years. RESULTS: Length of incision, operation time, blood loss and duration of hospital stay were significantly less. The average follow-up was 17 months. Mean operation time was 62 minutes. Open reduction through an additional small incision was necessary for some fractures. Mean hospital stay was 1.2 days. The Constant score averaged 81 after 1 week, 96 after 6 weeks and 98 after 6 months. Compared to the contralateral side, average shortening of the clavicle was 1.7 mm. CONCLUSION: Elastic Intramedullary Nailing provided a good restoration of the length of the clavicle allowing immediate active mobilization and early return to normal activity with excellent functional results. KEYWORDS: Clavicle fractures; Intra medullary nailing; elastic stable intramedullary nails. INTRODUCTION:Fracture of the clavicle is a frequently seen injury which represents about 10-15% of all fractures in adults. (1) In most cases a fall with a direct trauma causes the clavicle to fracture. About 80% of all clavicular fractures involve the middle third of the bone. (2) Standard treatment for this fracture pattern is non-operative, using an arm sling or figure-ofeight bandage for external fixation. For open fractures, imminent skin perforation, neurovascular involvement, floating shoulder or in combination with multiple ipsilateral rib fractures, open reduction and plating is generally accepted. (3) While fracture healing and functional outcome is generally good for non-operatively treated mid clavicular fractures, a poor cosmetic result due to shortening and angulation is not uncommon. (2) Non-unions occur in an average of 5%. (3) Furthermore decreased shoulder function due to clavicular shortening of more than 1-2 cm after non-operative fracture management has been reported. (5,12) Whereas a mild decrease in shoulder function is easily tolerated by most patients, restoration of the clavicle length and early return to full activity with unimpaired function is of great importance for every individual irrespective of the profession or socio-economic group they belong to.As non-operative treatment is successful in most cases for this fracture, relevant clinical benefit may be limited to a selected group of patients with a high demand on shoulder function.
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