Background: Achieving reduction prior to fixation is a key aspect in successfully managing intertrochanteric fractures. In this study of proximal femoral nailing for intertrochanteric fractures, a novel technique of utilizing pre-fixation compression screw was introduced to achieve and maintain reduction of femoral neck shaft angle. Materials and Methods: The current prospective study was conducted over a period of six months between July 2018 and January 2019 among patients who underwent surgical fixation by PFN for intertrochanteric fractures of femur. Pre-fixation compression screw was used in all the cases to achieve and maintain correction of varus. Pre-operative, intra-operative and post-operative neck shaft angles were documented. Data was analysed by using Statistical Package for Social Sciences (SPSS). The results were expressed as percentages and graphs. Results: There is significant improvement in correction of varus (average increase of neck shaft angle =14.04 degrees) with the use of pre-fixation screw technique. This procedure did neither increase the blood loss (average blood loss = 34.67 ml) during the procedure nor the duration (average duration = 19.46 min) of the procedure. Conclusion: Pre-fixation compression screw can be used as an effective alternative for varus correction in cases of simple intertrochanteric fractures undergoing PFN fixation with added intra-op and post-op advantages compared to other methods of reduction.
Introduction: Massive and irreparable posterior-superior rotator cuff tears present a difficult treatment problem. Chronic rotator cuff tears can cause tendon retraction and fatty atrophy of the muscles. Fullthickness rotator cuff tears involves more than one tendon cause superior migration of the humeral head in relation to the glenoid with altered glenohumeral forces, and ultimately leading to rotator cuff arthropathy. Transfer of the latissimus dorsi muscle is considered a surgical option in the treatment of younger patients without glenohumeral arthritis and with functional deficits caused by an irreparable posterior-superior rotator cuff tear. Presentation of Case: This report presents a case of Right Supraspinatus and Infraspinatus Chronic tear with Subscapularis tear. The case was chronic with non-subsidence of symptoms in spite of conservative treatment. Our treatment in this case consisted of Right Subscapularis and Infraspinatus Repair with Lattisimus Dorsi Transfer to Greater Tubercle. Post operatively ultrasling was used to keep the shoulder in neutral with slight abduction. Rehabilitation protocol was begun after 3 weeks of immobilization. Discussion: Latissimus Dorsi Tendon Transfer has been considered to be a means of restoring function and providing pain relief in patients with irreparable tears involving the infraspinatus and supraspinatus tendons in the absence of substantial glenohumeral arthritis. The aim of this case presentation is to report an example for this case, highlight the difficulties in diagnosis and the treatment options. Conclusion:The Latissimus Dorsi Tendon Transfer for irreparable postero-superior cuff deficiency in selected patients reduce pain and improve shoulder function in the medium term.
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