<p class="abstract"><strong>Background:</strong> Proximal humerus fracture treatment is still an issue with lot of controversies and various treatment modalities had yielded mixed results. Our aim is to study percutaneous K-wires fixation as a modality of treatment, does not need extensive soft tissue dissection, so small fracture fragments & retains periosteal muscle & ligament attachments which held the fracture fragments together. Complications of open reduction are avoided.</p><p class="abstract"><strong>Methods:</strong> Fractures were classified according to Neer’s Classification system and were treated with closed reduction and K-wire Fixation. They were 16 males and 09 females, with a mean age of 40.5 years. Mean follow-up was of 20.5 months (range 9-24 months). Post-operative mean VAS score and Constant Score of patients was 2.1 (±0.73) and 78.1 (±9.61) at an average follow up of 6 months. Mean duration for union was 6.5 (±1.18) weeks. Patients were followed up at 4, 8, 12 weeks and 3, 6, 9 & 12 months interval.<strong></strong></p><p class="abstract"><strong>Results:</strong> Radiological and functional outcome assessed according to Constant-Murley Shoulder assessment. Complications treated accordingly. Percutaneous K-wire fixation is safe, limited invasive technique and following basic principles of anatomical reduction has excellent results & functional outcome.</p><p><strong>Conclusions:</strong> We concluded that the soft-tissue bridging of the fracture fragments was crucial for the reduction to benefit from the ligamentotaxis effect. This technique worked well for valgus-impacted or three-part fractures. The rate of osteonecrosis was low, and rehabilitation was easier. Overall, the results from these series are quite encouraging.</p>
Background: Tibia is a most common subcutaneous long bone which is highly vulnerable for injury. Infected ILN tibia and non-union of tibia is much common in clinical practice which calls for challenging management protocols to control intramedullary infection. Considerable judgment is required to treat an infection in fracture with implant in situ. Mechanical stability and control of infections are two main factors in management of infected tibia with implant in situ. To remove infected material and bio-film by serial reaming of medullary canal, thorough lavage and local debridement of infected fracture site and sinuses is essential and must before inserting antibiotic impregnated nail. According to pharmacokinetic studies, antibiotic delivery from antibiotic impregnated bone cement is 200 times higher concentration than systemic administration without any systemic side effects. Local high antibiotic concentration not only prevents bacterial growth but also prevents bio-film formation by bacteria. The study was conducted to evaluate the efficacy of antibiotic-impregnated PMMA cemented v-nails in managing infected IL Nailing tibia without any bony defects. Methods: They were 10 males and 02 females, with a mean age of 38.5 years. Mean follow-up was of 24 months (range 15-30 months). Mean duration for union was patients were followed up at 4, 8, 12 weeks and 3, 6, 9 and 12 months interval. Functional results were evaluated with regards to control of infection, bony union, deformity, limb length discrepancy and complications (intra and post-operative). Results: Radiological and functional outcome assessed according to complications treated accordingly. Conclusions: IL nail tibia with infection can be treated effectively if control of infection by debridement and mechanical stability (by v-nail), prevention of bacterial growth by antibiotic impregnated V-nail. Control of infection after debridement is addressed by antibiotic impregnated v-nail is the main crux of treatment. After control of infection cemented V-nail is exchanged with standard IL-nail. Bone grafting is optional, if after exchange nailing there is no sign of union by 8 weeks. Insertion of antibiotic impregnated cemented V-nails combined with adequate debridement; lavage and systemic antibiotic administration significantly contribute to infection control after intramedullary nailing.
Background Malleolar fractures of ankle are usually complex injuries, as they are associated with significant ligament and soft tissue injury—injury to syndesmosis and injury to medial and lateral collateral ligaments. The open reduction and internal fixation is not feasible until recovery of significant soft tissue injury and subsidence of edema. Malleolar fractures are articular fractures and have associated subluxation and dislocation of talus. The aims of treatment are to restore normal anatomy and provide sufficient stability for early movements. Malleolar fractures more often require open reduction. Our study aimed to know efficacy and outcome of operative management of them. Materials and methods From January 2013 to March 2015, 35 patients with syndesmotic ankle injury and trimalleolar ankle fractures admitted to the Government Medical College, Latur, India, were operated and followed up prospectively. Results Mean age of patients is 35 years (25–60 years). Fracture union was seen radiologically in 3 to 4 months depending on fracture geometry. We achieved good to excellent results of 90%. Conclusion We conclude that malleolar fractures encountered in clinical practice need thorough assessment and meticulous surgical intervention, as they are associated with injury to ligament complex, i.e., ligament is a key structure in the stability of ankle mortise. Abduction and external rotation types of injuries are the most common types to be seen. We achieved stable fixation and performed early mobilization of the ankle joint, which limits the complications of mainly ankle stiffness. Each malleolus has got its inherent associated complications and calls for special attention for identifying associated conditions, such as syndesmotic injury, talus dislocation in posterior malleolar fractures, irreducible ankle dislocation with trimalleolar fracture, and entrapped fibula behind tibia with irreducible dislocation. How to cite this article Gawali SR, Kukale SB, Nirvane PV, Toshniwal RO. Management of Fracture of Posterior Malleolus, Trimalleolar Fracture, Fracture Dislocations, and Syndesmosis Injury of Ankle Joint. J Foot Ankle Surg (Asia-Pacific) 2017;4(2):90-96.
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