Background:Extraarticular distal tibial fractures are among the most challenging fractures encountered by an orthopedician for treatment because of its subcutaneous location, poor blood supply and decreased muscular cover anteriorly, complications such as delayed union, nonunion, wound infection, and wound dehiscence are often seen as a great challenge to the surgeon. Minimally invasive plate osteosynthesis (MIPO) and intramedullary interlocking nail (IMLN) are two well-accepted and effective methods, but each has been historically related to complications. This study compares clinical and radiological outcome in extraarticular distal tibia fractures treated by intramedullary interlocking nail (IMLN) and minimally invasive plate osteosynthesis (MIPO).Materials and Methods:42 patients included in this study, 21 underwent IMLN and 21 were treated with MIPO who met the inclusion criteria and operated between June 2014 and May 2015. Patients were followed up for clinical and radiological evaluation.Results:In IMLN group, average union time was 18.26 weeks compared to 21.70 weeks in plating group which was significant (P < 0.0001). Average time required for partial and full weight bearing in the nailing group was 4.95 weeks and 10.09 weeks respectively which was significantly less (P < 0.0001) as compared to 6.90 weeks and 13.38 weeks in the plating group. Lesser complications in terms of implant irritation, ankle stiffness, and infection, were seen in interlocking group as compared to plating group. Average functional outcome according to American Orthopedic Foot and Ankle Society score was measured which came out to be 96.67.Conclusion:IMLN group was associated with lesser duration of surgery, earlier weight bearing and union rate, lesser incidence of infection and implant irritation which makes it a preferable choice for fixation of extra-articular distal tibial fractures. However, larger randomized controlled trials are required for confirming the results.
Introduction: Prediction of Re-displacement of pediatric forearm fractures would be a boon for orthopaedic surgeons treating them conservatively. Cast index (CI), described by Chess et al. is calculated by measuring the internal antero-posterior (AP) diameter of the cast (excluding padding) at the level of the fracture and dividing it by the internal lateral diameter of the cast (excluding padding) which could be used as a tool to predict the re-displacement of fracture if it is maintao <0.8. Aims: The aim of the present study is to evaluate the role of cast index in predicting the re-displacement in pediatric forearm fracture. Materials and Methods: A hospital based prospective study was conducted in the Department of Orthopaedics, Silchar Medical College and Hospital, Assam. 83 paediatric patients ranging from 0 to 16 yrs with forearm fractures who met the inclusion criteria were recruited in our study. Patients with open fractures and with distal neurovascular deficit were excluded from our study. The fractures were treated with closed reduction with above elbow casts after manipulation. The cast index was measured immediately following casting on x-ray and patient was followed up weekly to check for redisplacement. Results: Out of 83 patients, proximal and distal fractures were 14 (18.07%) and 69 (81.92%) respectively. Mean cast index in proximal fractures and distal fractures which were displaced was 0.85 and 0.75 respectively. Out of 69 distal forearm fractures 7 were re-displaced and were re-manipulated, on the other hand only 1 out of 14 proximal forearm fracture was re-displaced and re-manipulated. Conclusion: Distal forearm fractures with cast index >0.8 were more likely toget re-displaced than with <0.8. It is difficult to achieve a cast index <0.8 in proximal forearm fractures, cast index < or > 0.8 does not predict the risk of re-displacement and re-manipulation in proximal forearm fractures. So, its use to predict the re-displacement should be discouraged in proximal fractures. It should be used to predict redisplacement in distal forearm fractures.
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