The fractures of metacarpal and phalanges of the hand are the most common injury encountered in emergency department. Most often these injuries are neglected as minor injuries and later on develops a functional limit of the hand. Joshi’s external stabilizing system (JESS) fixator based on the principle of ligamentotaxis, stabilize the unstable and intraarticular fractures of metacarpal and phalangeal and also provides an environment for rapid soft tissue healing without further damaging the microvascular circulation. The study includes total number of 38 patients with a diagnosis of fracture of Metacarpal and phalanx of hand admitted in Nepal Medical college and Teaching Hospital who were treated with JESS fixator. The functional outcome after the removal of JESS fixator was assessed by calculating American Society for Surgery of Hand and Total Active flexion (ASSH TAF). Among the 38 patients, all fractures went to union with an average union period of 6 weeks. The mean period of treatment for metacarpal fractures was12 weeks and for phalangeal fractures 16 weeks by which time patients regained full functional activity of hand and returned back to their respective works. The functional outcome assessed by ASSH-TAF score was excellent in 28 patients, good in 10 patients and none of them had a poor result. The complication was seen in 9(23.68%) cases, superficial pin tract infection and K Wire Loosening. JESS fixator is cheap, easily available and less technically demanding, provides with an effective treatment for the metacarpal and phalanges fracture, as it provides adequate stability that allows early rehabilitation with soft tissue care and has got a good functional outcome
Background: Anterior Cruciate Ligament Blumensaat line angle and Anterior Cruciate Ligament Inclination angle can be measured when Anterior Cruciate Ligament is visualized on Magnetic Resonance Imaging. Both these angles can be helpful to determine the intactness of Anterior Cruciate Ligament. The aim of this study was to evaluate the diagnostic accuracy of Anterior Cruciate Ligament - Blumensaat line angle, apex of Anterior Cruciate Ligament - Blumensaat line angle and Anterior Cruciate Ligament - Inclination angle to determine the status of Anterior Cruciate Ligament in terms of tear or no tear. Methods: We conducted a prospective observational study with Magnetic Resonance Imagings of knees of 71 patients, who were divided into Anterior Cruciate Ligament tear and Anterior Cruciate Ligament intact groups based on Anterior Cruciate Ligament - Blumensaat line angle (<150- intact; ? 150 – torn Anterior Cruciate Ligament), Anterior Cruciate Ligament - Inclination angle (>450 – intact ACL; ? 450 – Anterior Cruciate Ligament tear) and apex of Anterior Cruciate Ligament - Blumensaat line angle ( apex towards femur – Intact Anterior Cruciate Ligament; apex towards tibia or parallel lines– Anterior Cruciate Ligament Tear) measured on MRI study. Diagnostic accuracy was calculated in terms of sensitivity, specificity, positive predictive value and negative predictive value of Anterior Cruciate Ligament - Blumensaat line angle, Anterior Cruciate Ligament - Inclination angle and apex of Anterior Cruciate Ligament - Blumensaat line angle.Results: The sensitivity and specificity of Anterior Cruciate Ligament - Blumensaat line angle to detect Anterior Cruciate Ligament status was 95.83% and 95.35% respectively. Similarly, the sensitivity of Anterior Cruciate Ligament - Inclination angle was 95.83% and specificity was 95.35%. The sensitivity of Apex Anterior Cruciate Ligament - Blumensaat line angle to detect Anterior Cruciate Ligament tear on MRI was calculated to be 95.74% and a specificity of 87.5% Conclusions: Anterior Cruciate Ligament - Blumensaat line angle and Anterior Cruciate Ligament - Inclination angle is highly sensitive and specific for the diagnosis of Anterior Cruciate Ligament tear. Apex of Anterior Cruciate Ligament - Blumensaat line angle is also helpful in determination of Anterior Cruciate Ligament tear. Keywords: Anterior cruciate ligament; magnetic resonance imaging; ACL blumensaat line angle; ACL inclination angle
Background Treatment of fracture distal tibia is challenging. Classic open reduction and internal plate fixation requires extensive soft tissue dissection and causes periosteal injury. The locking screw-plate interface allows fracture fixation without plate-bone adherence, thus preserving the fracture hematoma, and reduces the risk of nonunion by maintaining microvascular circulation within the cortex and its investing tissues. Material & Methods This study included 33 patients of age between 18 to 62 years with extra-articular and simple intra-articular fracture of distal tibia. All fractures were fixed by minimally invasive technique with pre-countered distal tibia locking plate under image intensifier control. The American Orthopaedic Foot and Ankle Society (AOFAS) scale was used for functional assessment. Results Out of 33 there were twelve 43-A1, five A2, five A3, five B1, three B2, two C, one C2 fractures. There were 29 closed fracture and four open fracture (three type I and one type II). The overall mean time of union was 16.3 weeks. The mean AOFAS score was 93 points. In all 30 cases there were no wound problems, whereas three cases had superficial wound infection. No any cases needed secondary procedure for healing of bone. Conclusion The short-term results shows that minimally invasive locked plating is good solution for the challenging distal tibia fracture. This technique minimizes soft tissue complication and provides good union and functional outcome.
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