Background: Combined external fixation and internal fixation of distal radiusfractures is used most commonly to treat injuries with joint surface ormetaphysealcomminution. External fixation aids reduction intraoperatively and facilitates percutaneous or intraoperative manipulation of fracture. Internal fixation maintains precise reduction in critical anatomy, principally the contour and orientation of the articular surface. Postoperatively, the external fixator functions as a neutralization device, preventing fracture collapse and decreasing the biomechanical demands on the internal fixation hardware. Purpose of study: The aim of this study is to see short-term functional and radiological outcome analysis in patients with unstable intraarticular distal radius fracture treated with combined external fixation and open reduction and internal fixation by volar plating. Materials and methods: A total of 25 cases of unstable intra-articular distal radius fracture (AO Type C group) were treated by combined transarticular external fixator and internal fixation by volar plating with supplementary procedures such as primary bone grafting and K-wire fixation if necessary. The abovementioned study was conducted in Government Royapettah Hospital, Chennai-14, from June 2010 to May 2012. The Modified Gartland and Werley Demerit Scoring system was used to evaluate the functional outcome. In most cases, external fixator was left for a period of 6 weeks. Results: There were 25 patients ranging from 20 to 70 years with 16 males and 9 females. The follow-up period was from 12 to 18 months. Accordingly, there were 14 (56%) excellent, 8 (32%) good, 2 (8%) fair, and 1 (4%) poor results. There were very few complications such as one malunion, two superficial radial nerve palsy, and two secondary fracture collapse noted in our series. Conclusion:We conclude that unstable intra-articular fractures of distal radius treated by combined external fixation and internal fixation by volar plating provides high rate of fracture union and high level of patient satisfaction with early return to work.
Osteochondromas are the most common tumour of proximal fibula. Resection of the tumour is fraught with complications due to proximity of neurovascular structures and ligaments. We present a case report of two cases of hereditary multiple exostoses in siblings with symptomatic proximal fibula exostoses, which were managed by modified resection technique for proximal fibula tumours. The benefit of this technique is preservation of proximal tibiofibular joint and its associated ligaments. One case developed transient common peroneal nerve palsy, which completely recovered in the follow-up period. Both patients at one year follow-up had full range of motion of knee without any motor weakness and neurodeficit and without any signs or symptoms of instability of knee joint or recurrence.
Nowadays, the use of DHS in unstable trochanteric fractures has been associated with significant medial displacement of the shaft resulting from excessive sliding of screw within the barrel and a higher incidence of screw cut out. To emphasise the importance of the modular Trochanter Stabilizing Plate (TSP) in addition to the Dynamic Hip Screw (DHS) prevents excessive telescoping/varus malposition and limb shortening in all unstable trochanteric fractures with lateral wall communitions. MATERIAL AND METHODTwenty five consecutive patients with unstable intertrochanteric fractures were treated with an additional TSP superimposed on the regular DHS at our institution between October 2013 and November 2015. Three patients migrated to other states, one patient was lost to follow-up and another patient refused follow-up. Thus, twenty patients were followed for at least mean of 19 months (Range 6 to 28 months). RESULTSLateralization of the greater trochanter was successfully prevented in all fractures. Functional results were excellent and good in 87 percent of patients and fair in 13 percent according to the Harris Hip score. CONCLUSIONTSP with DHS is a biomechanically stable construct allowing reconstruction of lateral wall to maintain adequate lever arm and abductor strength (Power arm) in unstable intertrochanteric fractures with lateral wall comminution. Two point fixation provides additional rotational stability. Superior functional and radiological outcome favours its use in unstable intertrochanteric fracture.
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