to assess radiological outcomes in traumatic gap non-union of long bones after primary plate fixation failure using non-vascularised fibular strut graft augmented with corticocancellous graft. Methods: A total of 20 patients were included in study presenting with non-union of humerus. In 13 males and 7 females, age between 18-65 years (average 41 years), were operated using non-vascularized fibular strut graft taken from ipsilateral site augmented with auto corticocancellous graft. All the patients were operated by same surgeon with removal of previous plate and fixing with re-plating and intramedullary fibular grafting. The mean follow-up was 9 months (range 6-12 months). The patients were assessed for functional range of motion along with x-ray. Union was achieved after confirming on x-ray. Observations & Results:In study 20 patients there were 13 males and 7 females with average age being 41.35 yrs, average length of fibular graft was 6.3 cm and mean duration of union 21.15 weeks.1 patient was lost in follow up and none of patients showed non union or secondary intervention thus ensuring Bony union in all 20 patients treated with graft and plating Conclusion: This procedure successfully showed that union at nonunion site with adequate vascularity and good soft tissue coverage can be achieved with proper patient selection and using fibular graft in addition to traditional plating and CC graft technique. Even though procedure is lengthy but it's simplicity, reproducibility and non expensive and patient compliant outcomes makes it a valid option to achieve union in nonunion.
Background: Proximal Femoral Nail (PFN) provides tangible evidence for its usage in unstable pertrochanteric fractures. There are a veritable number of references which show that PFN by virtue of its intramedullary fixation reduces the tensile strain thereby mitigating implant failure. Ours is a prospective study done on 50 subjects to assess the outcome of PFN usage in unstable pertrochanteric fractures. Methodology: 50 patients with Jensen Michaelsen type III, IV, V intertrochanteric and reverse oblique fractures were included in the study. The reduction obtained intra operatively was assessed using the modified criteria of Baumgaertner. Follow up evaluations were done at 6, 12, 24 and 52 weeks thereafter. Clinical evaluation was done using the Mobility score of Parker and Palmer. Radiographic parameters like fracture union, screw slide and degree of varus collapse were also assessed. Statistical analysis was provided by Friedman test. Results: Jensen Michaelsen type IV was the most common pattern observed (44%). The mean pre-injury parker score was 8.4. Patients with reverse oblique fracture morphology, type V fractures and patients with osteoporosis were treated with Long PFN (19 cases). The mean operating time was 92 minutes (range 60 -180), and the mean blood loss during the surgery was 145 ml (range 100ml -320 ml). The reduction was good in 40 patients (80%) and acceptable in the rest. The average time taken for fracture union was 15 weeks. It was observed that patients reached their preoperative mobility score of Parker and Palmer by 6 months post-surgery which was statistically significant (χ2 = 217.642, p < .001). Discussion: Proximal Femoral Nailing is done through a minimally invasive approach not disturbing the fracture hematoma which is a vital in fracture consolidation. The biomechanics of intramedullary fixation in cases of destabilised medial cortex is optimised by medialization of the fulcrum point and resultant reduction of the bending moment with respect to proximal fixation. Fracture reduction was good in 80% cases and in 10 cases the reduction was acceptable with a mean varus malalignment of 13.2 degrees.The mean intraoperative blood loss of 145 ml in our series compares favourably with previously reported values in the literature. Most of the fractures in our series (66%) united by 12-14 weeks. The mean preoperative mobility score of Parker was 8.4, which was reached by patients on their 6 th postoperative month (p & lt; 0.001). Each period showed statistically significant improvement over the previous period as evident from the rank total of the scores and the critical ratio.
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