INTRODUCTIONCofield's summary of treatment of proximal humeral fractures is an indication of the difficulty of treating these injuries, from first evaluation to final outcome much controversy and confusion still exist, and no single treatment protocol or algorithm has been proved to be universally effective.1 As indicated by Cofield areas still in question include radiographic diagnosis, operative, non-operative treatment, consideration of patient age in treatment decision making, surgical approach, fracture fixation or hemiarthroplasty, type of internal fixation, and rehabilitation protocol.Fractures of proximal humerus are still an unsolved problem in many ways. Disagreement exists regarding reliability of classification system. The indication for surgical management continues to be modified. Fixation techniques are myriad and none is ideal for all cases. Fractures of proximal humerus are not uncommon especially in older age group. They represent no more than 3% of all upper extremity fractures.3 Their overall incidence has been reported to be73 cases per 100, 000 individuals per year. 4 About 85% fractures are minimally displaced and are effectively treated symptomatically with immobilization followed by early motion. The remaining 15% of fractures are displaced, unstable and ABSTRACT Background: Fractures of proximal humerus are still an unsolved problem in many ways. Locked plating is becoming more common; precise knowledge of and experience with the surgical technique is required to maximize clinical outcomes. However the goal of proximal humerus fracture fixation should be stable reduction allowing early mobilization. This study is conducted to study the results and complications of proximal humeral fractures treated by anatomic locking compression plate (PHILOS-proximal humerus interlocking system) and PHLP-Pro. Methods: This is a 4 year prospective study, conducted in the department of Orthopaedics in Shri B M Patil Medical College & Hospital, Vijaypur. Displaced two part, three part and four part fractures of proximal humerus with or without shoulder dislocation including fractures involving osteopenic bone were included. The functional assessment was done according to constant Murley score and DASH score at the end of 6 months. Results: Out of 60 patients, 56 were available for follow-up: 24 patients having excellent results (4 are 2 part, 20 are 3 part fractures), 32 patients having good results (22 are 3 part, 10 are 4 part fractures). None of the patients had fair or poor results. Conclusions: In conclusion, the internal fixation of proximal humeral fractures with the use of anatomic locking compression plates yields reliable results when utilized correctly. We believe that, provided the correct surgical technique is used by competent surgeon, the anatomic locking compression plate is suitable for the stabilization of proximal humeral fractures and can lead to a good functional outcome.
Fractures of distal end radius are common fractures of the upper limb, and constitute 17% of all fractures and 75% of all forearm fractures 1. This fracture shows bimodal distribution of age with the fracture more commonly seen in children and elderly. The objectives of management for a distal end radius fracture should be restoration of range of motion and grip strength while facilitating the patient's early reinstation to normal daily activities and minimizing the chances of post traumatic arthritis. The treating orthopedician has an armada of treatment options to select from to accomplish this. Regardless of these fractures being common, there is no clear consensus on their treatment as there is no clear clinical-based evidence in the literature. For several decades, closed reduction and bridging external fixator for 4-6 weeks has been a well-established treatment of distal end radius fracture7. To reduce fracture fragments and maintain alignment, principle of ligamentotaxis is used by external fixation. This study aims to assess the functional outcome and duration for union in intraarticular distal radius fractures treated with external fixator using ligamentotaxis. The present study was carried out from 1ST December 2015 to 31ST January 2017 at Orthopaedic Department in Shri B. M. Patil Medical College Hospital and Research Center, Vijayapur. During this period 100 patients of intraarticular communited distal end radius fractures were treated surgically. We found 78% Excellent to Good results. 14 patients had Fair results while 8 patients had Poor results. Most common complication seen in our study were Pin Tract Infection (12%) and Restricted Wrist Motion (5%). It was concluded that external fixation offers good mode of treatment in communited fractures as they allow gradual distraction providing better functional and anatomical results in communited intraarticular wrist injuries.
Introduction: Tremendous advance in mechanization and fastness of travel have been accompanied by steep increase in number and severity of fractures and those of tibial plateau are no exception. Knee being one of the major weight bearing joints of the body, fractures around it will be of paramount importance. Materials and Methods: A 4 year prospective study was conducted, to know the functional outcome in operatively treated tibial plateau fractures in adults were included from blde university Vijayapura. The total number 60 patients. Results: Out of 60 cases treated with surgical procedure, 39 cases gave excellent result, 12 cases came out with good result, fair in 3 case and 3 case had poor result, mainly due to the severity of the injury and infections. It was found that high velocity injuries (type IV -VI) have poor outcome than low velocity injuries (type I-III) 4. All fractures united within expected time. Not a single case of nonunion was noted in our series. Average time for union was 14 weeks (range 10-22 weeks). The three cases had wound infection two had stiffness of the knee joint and one case had malunion. Conclusion: We conclude that the functional outcome is good in operatively treated tibial plateau fractures in adults. The surgical management of tibial plateau fractures is challenging and gives excellent anatomical reduction & rigid fixation to restore articular congruity, fascilitate early knee motion by reducing post-traumatic osteoarthritis and thus achieving optimal knee function.
Introduction: Perkins warranted that Colles' fracture however skill fully treated may leave behind a deformed wrist [1] . As the disability has been attributed to the deformity, therefore obtaining the anatomical reduction has been emphasised. Aim of the study was to evaluate the results of conservative treatments of Colles' fracture, in terms of radiological and functional outcome, their relationship with each other, and to found out the acceptable measurements of radiological parameters for better functional results. Material & Methods: This prospective study included 50 patients of extra articular Colles' fracture, was carried out in the Department of Orthopaedic from May 2017 to May 2019. All patients were immbolized with a below elbow cast for 4 weeks and followed up at 3 months and 6 months. Radiological assessment was done by measuring dorsal angulation, loss of radial inclination and loss of radial height as per Stewart et al. and functional assessment was done by criteria by Mayo wrist scores. Results: Excellent and good results was obtained in 72.5% anatomically and 82.5% functionally at 6 months, with a statistically significant association between them. Out of the three anatomical parameter as criteria led by Stewart et al. dorsal angulation < 10 degrees and loss of radial inclination < 9 degrees showed statistically significant association with functional results. But loss radial height < 6 mm did not show statistically significant association. Conclusion:As there was a statistically significant association between the radiological and functional results, therefore obtaining a acceptable anatomical reduction of the fracture is emphasised, and acceptable radiological parameters were, dorsal angulation was < 10 degrees, loss of radial inclination < 9 degrees and loss of radial height was < 4 mm for obtaining excellent or good functional results.
Aims and objective 1. To evaluate the results 2 year after the management of Achilles tendon rupture, using standardized, validated assessment methods for symptoms and function in patients treated with percutaneous surgical repair augmented with ss wire. 2. To evaluate the recovery of function 2 year after injury and to study how function relates to patient-reported outcomes, with regard to lower limb function, as well as general health and quality of life. Material and method:This was an Prospective Cohort study of 50 patients of acute ruptured Tendo Achilles who were treated with percutaneous repair. Cases were taken up according to inclusion and exclusion criteria. All patients underwent a rehabilitation program. Cases were followed and evaluated at 3 weeks, 6 weeks, 12 weeks, 6 month and 1 year interval. The results were evaluated clinically and functionally by Leppilahti scoring method. Results: All the patients were followed up at 3 weeks, 6 weeks, 12 weeks, 6 months and 1 year interval. Mean time to return to work was 4 months in patients treated with percutaneous repair of acute ruptured Tendo Achilles. Lippelahti scores was excellent in 92%, good in 6%and fair in 2%. Conclusion: the results of our study shows that complications associated with Percutaneous repair with modification included in this study of Tendo Achilles were significantly low with. Percutaneous repair provides excellent function, with a better cosmetic appearance, a lower rate of wound complications, re rupture rate and is also cost effective.
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