Even though fractures of the clavicle are very common but fracture of the shaft of clavicle associated with sternoclavicular joint dislocation is extremely rare. This is a case report of a 50-year old woman who met with a road accident. Radiographs revealed right mid shaft clavicle fracture with inferior angulation of fracture fragments, anterior dislocation of sternoclavicular joint. The sternoclavicular joint was stabilized with sutures whereas the midshaft fracture was managed non-operatively. In postoperative period the sternoclavicular joint was found stable whereas the shaft clavicle united completely after 6 months.
BACKGROUND: Radial head fractures are quite common with incidence 1.5-4% of all adult fractures. The treatment for these fractures depends upon age, type of injury and whether the physics is closed or not. AIM: Comparison between radial head excision versus radial head replacement based on mayo elbow scoring in comminuted radial head fractures. MATERIAL AND METHODS: We did a prospective comparative study comprising 32 patients between age 22-60 years with Mason type II/III radial head fractures at Sir J.J Group of Hospitals, Mumbai. The patients were randomised using the admission day of the week placing 17 patients in the arthroplasty group and 15 patients in the excision group. The patients were followed up for 18-24 months (average 20 months) postoperatively. Results were analysed by the Mayo’s elbow performance score at 6 months and 18 months and were statistically evaluated by unpaired t-test. RESULTS: At 6 months, radial head arthroplasty gave excellent results in 2 patients, good in 5 patients and fair in 8 patients. In excision, there were 5 patients with excellent results at 6 months, 7 with good results and 2 with fair results. At 18 months, of the 17 patients who had undergone head arthroplasty, 2 had excellent results, and the same number had poor results. 7 (46.7%) of the 15 cases who had undergone radial head excision had excellent results. Good results were obtained in 7 cases of each. There was 6 cases (35.3%) of radial head arthroplasty which fell into the fair group. As per Mayo’s score at 6 months follow up, mean and standard deviation (SD) of the scores in arthroplasty was 68.82 and 18.66 respectively & for excision, it was 85.66 and 10.66. At 18 months follow up, it was 75 and 14.89 for arthroplasty & 90.66 and 7.98 for excision. The difference between the results was statistically significant (p < 0.01). CONCLUSION: Our study shows that long and short-term results of radial head excision are better as compared to arthroplasty in comminuted radial head fractures based on mayo elbow scoring, particularly for dominant upper limbs.
Background The extraction of a femoral stem during the revision hip arthroplasty can be a daunting task and can lead to catastrophic complications for the patient. A sound technique employed intraoperatively helps in speedy recovery of the patient and reduces the risk of future surgical interventions. In this study, we present a medium-term outcome of our novel Lancaster Cortical Window technique which can be used for removal of cemented or uncemented femoral stems. Methodology The study was conducted at a specialist centre in the North-West of the UK from January 2014 to May 2019. This is a retrospective case series where patients were treated surgically using Lancaster Cortical Window technique for removal of femoral implant during a revision hip arthroplasty. Patient’s electronic notes and the radiographs were used to evaluate the functional and radiological outcome. Results In this study, 18 patients were managed surgically using Novel Lancaster Window technique. The mean age of the all the patients was 81.5 years and the male to female ratio was 10:8. Fifteen patients underwent revision surgery for aseptic loosening of the femoral and acetabular component. Rest of the three patients had revision surgery for a broken femoral stem, intraoperative femoral canal perforation while implanting a total hip replacement femoral stem and infection. Twelve femurs were replanted with uncemented long femoral stems and six with long cemented stems. The cortical window osteotomy united in all the patients in 4.2 months (mean). The mean follow up of these patients is 20.9 months, and none of them had any implant subsidence or loosening at the time of their last follow up. Conclusion We believe Lancaster cortical window technique can be safely used for removal of cemented stems during revision hip arthroplasty without the need for expensive equipment’s.
BACKGROUNDThe human hand has evolved into an organ of exceptional prehensile function, capable of highly complex movements and manipulation. Hand injury is extremely common and accounts for about 15% of the attendance at accidents and emergency departments.
Neuropathic arthropathy (Charcot joints) most frequently affect the weight-bearing joints of the body, are commonly associated with a variety of medical and neurological conditions and are notoriously difficult to treat due to the nature of the underlying pathology. We present a case of ipsilateral shoulder and thumb carpometacarpal (CMC) joint neuropathic arthropathy secondary to cervical syringomyelia. To our knowledge, this is the first reported case in the literature of this rare association.
AIM:To study average clinical and radiological union time and range of motion at knee joint in case of proximal tibia fracture treated with Minimally Invasive Percutaneous Plate Osteosynthesis. MATERIALS & METHODS: 30 patients with proximal tibial fractures were treated surgically using the Minimally Invasive Percutaneous Plate Osteosynthesis technique between June 2011 and December 2013 with a 1 year follow-up. The fractures were classified using the AO and Schatzkar classifications (Figure 1). Closed and Compound fractures, both were included in the study. Patients were followed up on 14 th post-operative day, 4 weeks, 6 weeks, and then monthly for 3 months and yearly later on. The functional outcome was evaluated using the Knee Society Score. RESULTS: Primary union was achieved by 29 of the 30 study subjects. The mean union time was 13.87 weeks. The rate and type of complication such as implant failure, wound gapping has not been observed. Acceptable range of movement with going back to activities of daily living was observed in our study. The mean Knee Society score was 88.7 at final follow-up visits, 26 patients achieved an excellent result, 2 a good result and 2 a fair result. There were 3 cases with infection, of which 2 healed uneventfully and one required implant removal after healing. Functional results were similar for primary and staged MIPO (p = 0.109). CONCLUSION: It could be hence inferred that MIPPO (Minimally Invasive Percutaneous Plate Osteosynthesis) or Biological plating preserves vascularity and hence has less complications, less union problems with early recovery in form of joint movement. KEYWORDS: Proximal Tibia, Fracture, Minimally Invasive Plate Osteosynthesis, Knee Society Score. INTRODUCTION:Among all the fractures in the body, tibia is the single largest bone that is commonly involved in injuries. Owing to the increase in vehicular accidents and industrial mishaps, high velocity trauma produces tibial fractures in increasing numbers. Fractures of the proximal tibia can be quite challenging to manage as they are difficult to reduce, align and stabilize and prone to develop wound complications and infections. 1 Preservation of soft tissue, fracture hematoma and periosteal compression are the key to good results in proximal tibial fracture management. Intramedullary nails and Open reduction with compression plating have failed to give satisfactory results. 2 Minimal Invasive Percutaneous Plate Osteosynthesis (MIPO) using a locking plate has become alternative technique for proximal tibial fractures. The preservation of periosteal blood supply allowed by MIPO offers a clear biological advantage over traditional plating, because it reduces iatrogenic damage to surrounding soft tissues. 3,4,5 The purpose of this study was to assess the results and the efficacy of MIPO for closed and open fractures of the proximal tibia.
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