INTRODUCTIONSurgical treatment of high-energy tibial plateau fractures remains a challenge due to problems encountered which include wound complications, infection, varus collapse, knee stiffness, and articular malreductions.1-3 High energy tibial fractures usually affect the younger age group in productive life years and have significant socioeconomic impact due to late recovery time and subsequent requirement of early total knee replacement in some complicated cases. 4 Schatzker classified fractures of tibial plateau radiologically from type I to VI.5 Schatzker type V and VI fractures are high-energy fractures often accompanied by other injuries and complications. The complexity of the fracture pattern and the associated soft tissue disruption of these types of fractures contribute to high rate of failure and unsatisfactory results which follow both operative and non-operative management.6,7Several fixation methods could be used for tibial plateau fractures including unilateral fixation with a single plate, dual-plate, a hybrid external fixator or a less invasive stabilizing system. [8][9][10] There is a considerable debate regarding the best method for treating proximal tibia fractures and there is no clear consensus on which leads ABSTRACT Background: Complex tibial plateau fractures remain a challenge to even the most experienced surgeons. These injuries usually affect the young population in their productive years thereby causing socioeconomic impact. We performed a retrospective study to evaluate the functional outcome of of Schatzker type V and VI managed through open reduction and internal fixation. Methods: 26 patients with Schatzker type V and type VI tibial plateau fractures treated with open reduction and internal fixation using plates were included in the study. Three patients were lost to follow up, 23 patients were evaluated in the final analysis. The preoperative, intraoperative data was noted from the indoor files.The final evaluation was done using Oxford knee score and VAS score. Results: There were nine Schatzker type V fractures and 14 patients with Schatzker type VI fractures. The mean duration of follow-up was 68.32 months ranging from 41 months to 126 months. The mean Oxford knee score was 39.78. Patients with Schatzker type VI had mean OKS of 37.7.The mean MPTA and mean PPTA were 88.75 degrees and 7.35 degrees respectively. Average VAS Score was 2.8 ranging from 1 to 3.9. All patients returned to their preinjury level of activity and employment. There were no patients of deep infection. Conclusions:We conclude that open reduction and internal fixation of high-energy tibial plateau fractures gives excellent to good functional outcome with minimal soft tissue complications. The complications can be minimized with proper patient selection and soft tissue dissection.
INTRODUCTIONFractures of the distal radius are common fractures seen in orthopedics outpatient and trauma care. Data suggests that around 6% of women by age of 80 years will sustain such fracture and 9% women by age of 90.1 As the population continues to age, these figures are likely to increase still further. Its growing incidence may be attributed to a parallel rise of osteoporosis and high energy accidents.2,3 The epidemiology has changed from the times of Colle's fracture to present date due to increased life expectancy and increased in high energy trauma. Various authors have stated the age specific incidence, that ranged from 9 to 100 per 10,000 per year. [4][5][6] Various operative and non-operative treatment options are available, without there being a consensus as to an optimal method according to the patients demographics and fracture pattern. 7,8 Despite this being a topic of discussion there have been very few studies focusing on the functional outcomes following percutaneous K wiring and volar plating in extra articular fractures. Each having their own merits and demerits.Percutaneous wire fixation being a relatively quick and minimally invasive procedure that could be carried out in limited operative environment. However, since the ABSTRACT Background: As fractures of the distal radius are the most common fractures of the upper extremity with no clear guidelines for mode of intervention it was decided to compare two of the most common methods of treatment. The aim of this study was to review a group of patients sustaining extra articular lower end radius fracture treated with percutaneous wiring and volar plating and compare their functional outcome at a significant follow up time. Methods: A prospective study was conducted at tertiary care center. A sample of 45 patients who had a displaced extra articular distal radius fracture and were subjected to treatment with either a plate (n =24) or k wiring (n =21). Outcome assessments were conducted at 6 months. Outcomes were measured on the basis of scores on the DASH questionnaire, wrist range of motion, and radiographic parameters. Results: Patients in the plate group had significantly better DASH scores (p=0.0431) and range of motion at six months compared with patients in the k wiring group. Collapse in radial length was observed in 2 patients with percutaneous wiring which led to suboptimal range of motion and increased DASH scores. Significance arc of motion at 6months in dorsiflexion and palmar flexion were p=0.0038 and when compared with opposite limb were significant in all three planes p=0.0217, p=0.0126 and p=0.0029. Conclusions: Based on our observation we found that treatment of dorsally displaced, unstable extra articular radius fractures across all age groups, volar-locked plates achieve a superior radiological and functional outcome with minimal complications.
<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Complex forearm injuries are often associated with contamination, crushing, loss of tissues and patient arrives at odd hours when specialists are not available. These injuries can lead to complications like infective non-union, stiffness, disabilities and secondary amputations.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">23 patients having complex forearm injuries treated primarily at tertiary care center by single surgeon were included in the study. Pinch strength, grip strength, residual deformity and DASH score was assessed at final follow-up. In 23 patients treated, 16 patients underwent primary internal fixation of both bone, primary external fixator was done in 4 patient, delayed fixations in 6patients, primary bone grafting in 3 patients and in 1 patient delayed bone grafting was done Skin grafting was performed in 6 cases, and flaps in 13 patients. Vascular repair was done in four patients</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">All 23 patients came for follow-up. An average number of surgery performed per patient was 3.81 and mean hospital stay of 28.2 days. The mean duration of follow up was 47.2 months. The average DASH score was 10.24 with average key and tip pinch and grip strength of 62.24%, 58.48% and 54.75% respectively. 3 patients had superficial infection and two patient deep infections. Superficial infections were managed with IV antibiotics. The patients with nerve and vascular injuries had higher DASH score. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Early wound coverage can improve functional outcomes. Training in plastic coverage of wounds using pedicle flaps and skin grafting, microsurgical nerve and vessel repairs for orthopedic surgeon can be of great help for the patients.</span></p>
Context: Distal end radius fractures are among the commonest fractures encountered in public health care. These injuries are associated with osteoporosis, articular damage, comminution and complex fracture pattern. These fractures should be managed according to fracture configuration and functional demand of patient. Material and Methods: 110 patients with distal end radius fractures were managed with different surgical fixation. Out of them 58 were operated by locking plates, 44 were operated by percutaneous k wire pinning and external fixation was done in 8 patients. Mean age of study population was 46.4 year (range 20-75year) with slight male dominance. All patients were assessed post operatively by clinical and radiological methods in forms of DASH score, VAS pain score, range of motion at wrist joint, operative complication of each treatment modality, pinch and grip strength of both hands. Results: Patients managed with plating had significantly better function, strength and range of motion as compared with patients operated with K-wiring or distractor in all 8 types of fractures (p<0.05). Mean DASH score, VAS pain score, range of motion and grip strengths were much better in locking plate group compared to k wire pinning and external fixation. Locking plate was also found better at restoring radiological parameters (radial tilt, radial inclination and radial height) as compared to other methods. Collapse in radial height was more in k-wiring group in patients with osteoporotic bones. Conclusion: Improved understanding of fracture pattern and bone quality by various radiological examination demands proper fixation to get better functional outcomes. Locking plate has superior outcome for osteoporotic bone, articular damage and complex injuries while k wire pinning should be used for good quality bone with less functional demand and external fixation should be reserved for open injuries and poor skin texture.
<p><strong>Background:</strong> Thumb carpometacarpal osteoarthritis is a common disease, affecting up to 11% and 53% of men and women in their 50s respectively, which leads to pain, stiffness, weakness of the CMC joint. Patients with advanced disease have multiple surgical options including ligament reconstruction with tendon interposition, resection arthroplasty, silicone implantation, or total joint arthroplasty. The aim of study was to evaluate results of LRTI for CMC joint arthritis.<strong><em> </em></strong></p><p><strong>Methods:</strong> This is a series of 29 patients operated in a tertiary care hospital. All patients included in the study were seen in the outpatient and identified to have basal joint arthritis according to their clinical presentation and classified on the basis of radiologic appearance. Trapeziectomy with ligament reconstruction with tendon interposition was done for patients with advanced disease. All the patients were followed up and assessed for function and disability using DASH score.</p><p><strong>Results:</strong> Average duration of follow up was 36 months with average tip pinch strength gain was 75%, key pinch strength gain 80% , grip strength gain 80 % of other limb. Significant Improvement in active 1<sup>st</sup> web space angle was seen with average of 19.5 degree. Average DASH score was 4.14. Nobody had extreme pain, 3 had mild pain and 2 had moderate pain.<strong> </strong></p><p><strong>Conclusions</strong>: Based on our observation of DASH scores, the results have remained encouraging in most of the cases with restoration of normal anatomy to provide a stable and functional thumb. The success of LRTI in treating trapeziometacarpal arthritis has withstood the test of time.<strong></strong></p>
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