Indian Journal of Orthopaedics Surgery

132-137

Authors: Sachin Jain, Dinesh Sonkar, Sunil Rajan

Objective: To assess short-term functional results in 2 types of syndesmotic fixation, comparing the traditional rigid quadricortical syndesmotic screw fixation with a more dynamic tricortical screw fixation. Method: PATIENTS: Thirty nine patients (Age group: 20 to 50 yr) with closed ankle fractures in which the syndesmosis was found to be unstable clinically, radiographic and confirmed intra operatively. INTERVENTION: The unstable syndesmoses were fixed with either one cortical screw through both tibial cortices (n = 18) QSF or two cortical screws engaging only 1 cortex of the tibia (n = 21) TSF. The quadricortical and the tricortical screws were removed only in the case of discomfort. However, all quadricortical screws were removed at 6 month follow up. Rehabilitation was the same in both groups. DESIGN: Prospective, randomized single blinded clinical study. SETTING: Department of orthopaedics and traumatology MGM Medical College & M Y Hospital Indore. And G.R. Medical College & Jayarogya Hospital, Gwalior. Results: At the end of three months mean OM score was 65.35 (55 to75) For TSF group as compared to59.58 (55 to65) in QSF group. Mean values were similar between the two groups with respect to pain, swelling, support, running and jumping. The overall difference noted in two groups was due to difference in Mean value for functional parameter like stair climbing, Squatting and activities of daily living. At six months there was no significant difference in any parameter of OM score. Hence the overall scores were with non-significant difference {TSF76.42 (70 To 80) and QSF72.42 (65 to 80). A three months DID was 12.07 (9to17) in TSF and 9.75 (6to13) in QSF with significant difference in two groups. At six months difference was non significant 4.75 for TSF and 4.42 for QSF Group. The one set of tricortical screws and two Quadricortical were removed in patients due to infection. Quadricortical group was re-operated in 3 (16.66 %) cases for screw removal in case of screw breakage before 6 month follow up. While one set of tricortical screws were removed due to loosening. All removal was done after 4 months as all fractures shown clinical and radiological union at 3 months. Conclusions: In this study confirmed that Syndesmosis fixation with 2 tricortical screws is safe and improves early function. After 6 months, however, there were no significant differences between the 2 groups in functional score, pain, and dorsiflexion.

146-148

Authors: Ganesan Ganesan Ram, V. C. Anil Chander, Srinivasan Rajappa

Background: Trauma to the extremities represents one of the most common injury patterns seen in emergency medical and surgical practice. As extremity injuries are evaluated, each of four functional components (nerves, vessels, bones, and soft tissues) must be considered individually and together. If three of these four elements are injured, the patient has a “mangled extremity”. In this article we are going to assess the quality of life of patients who had crush injury to the leg. Methods: Both retrospective and prospective study of 60 patients who had Grade III b and Grade IIIc open fractures of the lower limb. Study was done in Sri Ramachandra Medical College between Jan 2012 and Jan 2015. Patients who had crush injury to their lower limbs with Mangled Extremity Severity Score of seven and above were included. We followed Gustillo and Anderson classification system for fractures classification. Mangled Extremity Severity Score for all the patients were calculated. SF12 quality of life questionnaire was used to assess the patients during follow-ups. Results: The Mean PCS (physical component summary) score in SF 12 quality of life questionnaire for Amputation group and Limb Salvage group were 39.05 and 29.91. The Mean MCS (mental composite summary) score for Amputation group and Limb Salvage group were 43.10 and 36.05. Conclusion: The quality of life of patients who underwent amputations was statistically significant when compared to patients who had their limb salvaged.

153-158

Authors: SPS Gill, Manish Raj, Pulkesh Singh, Dinesh Kumar, Jasveer Singh, Prateek Rastogi

Introduction: Compound fracture of the tibia is the one of the most common injury encountered by orthopaedic surgeon these days. Diaphyseal compound fractures are well managed by primary interlocking nails with good to excellent results. Metaphyseal juxtraarticular and intraarticular compound fractures of upper and lower end of tibia are not good indication for intramedullary nails due to limitation of short proximal and distal fragment and marked communition at these areas, also mostly intra articular extensions. Till now these fractures were mostly managed by External fixators or rind fixators. Primary conventional open plating in compound fracture is not a preferred method of management till now due to fear of infection and soft tissue complications and risk of plate exposure. We managed these fractures by minimally invasive plating using locked plate and result evaluated. Material and Method: In this study we have taken compound metaphyseal fractures of the tibia for primary plating using locked anatomical plate using minimally invasive technique. Ninety four (94) cases of tibia out of which 50 cases of proximal tibia and 44 cases of distal tibia compound fracture up to grade IIIA were taken for study. In all cases primary skeleton traction were applied followed by wound management using through irrigation using low pressure pulse levage and debridement. Plating was done using MIPPO method within 7 days of injury. Cases were followed up at regular interval and functional outcome assessed by using knee society score for proximal fractures and foot and ankle score for distal tibia fractures. Results: Primary bone was achieved in 88 of 94 cases within usual duration. Low grade infection at fracture site seen in 8 cases and out of these 8 cases union achieved in 5 cases by continuation of same primary fixation. 3 cases required revision surgery with removal of implant and antibiotics cement beads followed by other method of fixation to achieve union. Good to excellent outcome achieved according to knee society score in 93.8% of proximal cases and again good functional outcome achieved according to Foot and ankle score in 85% of distal tibia cases. None of these cases showed any serious complications like amputation or severe life threatening infection. Conclusion: With our study we can concluded that compound fractures of proximal and distal tibia can also be well managed by primary plating using minimally invasive technique. This is single staged procedure with minimal financial burden of rural population. One has to take care in proper selection of cases, avoid further soft tissue damage and care should be taken not to leave bone and plate exposed to environment. Wound can be closed by other secondary procedure within next few days without any negative consequences.

164-167

Authors: Sriram Thanigai T, Sathik Babu M. B

Introduction: With rapid increase in day-to-day traffic, incidences of high-energy trauma are also increasing with the same speed. Open fractures of the tibial shaft are important for the reason that they are common & controversial. Our aims and objectives were to assess the time to bone union and functional outcome in cases of open fractures of the tibial shaft treated with reamed interlocking intramedullary nailing. Methods: Thirty patients who had 30 open fractures of the tibial shaft were treated with wound debridement and primary interlocking intramedullary nailing with reaming during the period from June 2012 to March 2014. The patients were followed up for a period of 6 – 14 months. Results: There were 9 (30 %) Type I fractures, 8 (27%) Type II fractures and 13 (43%) Type IIIA fractures. Mean time to union was 20.25 weeks for Grade I fracture, 22.5 weeks for Grade II, 24.71 weeks for Grade IIIA fractures. Deep infection occurred in 2 patients. Aseptic nonunion occurred in one patient. Malunion was noted in one patient. Interpretation and Conclusion: The results in the current study and other data support the view that reamed locked intramedullary nailing is a safe and effective technique for the management of open tibial fractures.

171-175

Authors: Jayant Sharma, Avinash Jain, Pooja Gupta Jain, Prashant Upadhyaya

Introduction: Anterior bridge plating with minimally invasive technique in shaft humeral fractures is reported as an acceptable less traumatic and reproducible procedure by several authors. We have evaluated the clinical, radiological, and functional outcome of such fractures in eleven patients, all of which were managed with dynamic compression plate over an average follow-up period of 22 months. Though open reduction and plating technique of humerus shaft fracture is prevailing, this technique also gives favorable outcome. Materials and Methods: Eleven patients with humerus shaft fractures were managed by anterior bridge plating using MIPO technique between Jan 2013 and April 2015 were included in this series. All cases were treated with closed reduction and 10-12 hole 4.5mm dynamic compression plate fixation over anterolateral aspect in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, radiation exposure, and fracture union time, and complications were noted. The UCLA shoulder and Mayo elbow performance scores were used for assessing the shoulder and elbow function. Results: Of the Eleven patients in the study, eight were males and three were females. The mean age was 34.3 years (range 20 to 53 years). Eight out of eleven patients (72.7%) had the dominant side fractured. Mean surgical time in minutes was 79.5 (range: 60–100 minutes) and mean radiation exposure, in terms of one sec for each c-arm exposure was 95 seconds (range: 70–160 seconds).The mean fracture union (radiological) time was 13.7 weeks (range: 10–18 weeks). One patient (9.1%) develops infection for which premature plate removal and debridement was done at 5 months and managed then conservatively. However Shoulder function was excellent to good in 9 cases (81.8%) and fair in 1 case (9.1%) on the UCLA score. Conclusion: This study confirmed a high overall rate of union and excellent functional outcomes. Mini incision anterior bridge technique for fracture shaft humerus gives good functional results and should be considered as an effective, cosmetically advanced surgical option in the treatment of humeral shaft fractures. It is a safe and less time consuming method for simple types of humeral shaft fractures when the surgeon is experienced in the technique.

183-185

Authors: Ganesh Singh Dharmshaktu

The Lisfranc’s joint fracture dislocation involves the articulation between medial cuneiform and base of second metatarsal, which is considered as keystone to the mid foot integrity. The articulation has stabilization effect on longitudinal and transverse arches of the mid foot. Non operative or suboptimal treatment has grave complications and aftermath. Lisfranc’s joint includes tarsometatarsal complex and injury to the region is a rare occurrence. Neglected or undertreated injury to Lisfranc joint complex leads to secondary arthritis and significant morbidity and disability. This uncommon pattern of injury is often missed on initial or poorly done radiographs. We present a report of six weeks old neglected Lisfranc’s joint injury with surgical management and satisfactory functional outcome.

194-196

Authors: Rajendra Kumar Ahire, Harshal sakale, Vinit K Jain

Penetrating injuries are dangerous and deserve emergency treatment due to the risk of injuring vital structures. We present an unusual case of a young male patient who sustained piercing injury of thigh with a tree branch due to fall from the tree. Careful planning, proper evaluation of such patient is required before extracting such foreign bodies.