Indian Journal of Orthopaedics Surgery

227-228

Authors: Subbarayan Elankumar, Ravi Kumar Chittoria.

Topical application and infiltration of bone marrow is used in the treatment of various types of chronic/non-healing wounds. Currently available methods for application of bone marrow include injectable or irrigation by syringe but have the limitation of inadequate coverage of surface area requiring large amount of bone marrow. To improve the application over large surface of wound area with minimum amount of bone marrow we have designed indigenously made spray device. This article highlights the application of this device in one of the patient in plastic surgery. This is an easily prepared cost effective device.

234-240

Authors: Girish Sahni, Rahul Kundar, Avinash Chander Gupta.

A hip fracture represents a disturbing and potentially ominous land mark in personal health history. For the health care system and to society in general, intertrochanteric fractures represent an epidemic disease. The present study is being carried out to assess the role of bipolar arthroplasty in case of highly comminuted intertrochanteric fracture of femur. After proper preoperative assessment bipolar arthroplasty was done and results were evaluated. Materials and Method: Thirty cases of highly comminuted intertrochanteric fractures were treated with bipolar arthroplasty. Adult patients after closure of the epiphysis and all the cases of highly comminuted inter-trochanteric femur fractures were included in the study. Patients with active infection of hip joint or any other region, any unstable medical illness that would significantly increase the risk of morbidity and mortality and patients before closure of epiphysis were excluded from the study. Follow up was done at stitch removal and then at 1 month interval for 6 months and then 6 months interval for 2 years. Results: 18 cases (60%) were operated within one week of admission, 9 patients (30%) between 8-14 days and 3 patients (10%) were operated after 15 days. This delay was caused in those cases who required management of associated problems. Primary bipolar cemented arthroplasty was done in all cases. 16 patients (53.33%) were ambulated within 10-14 days and 12 patients (40%) were ambulated within 15-21 days and 2 patients (6.67%) were ambulated after 21 days, because one of the patients was having associated injury of supracondylar fracture femur for which DCS was applied before operation for ipsilateral intertrochanteric fracture femur and in 2nd patient ambulation was delayed as this patient developed DVT. 23 patients (76.67%) gave good results and 6 patients (20%) showed fair results and 1 patient (3.33%) showed poor result. Conclusion: Primary cemented bipolar arthroplasty is a viable and a suitable option for the treatment of comminuted unstable intertrochanteric fractures of femur as it lessens the duration of recumbency, permits early walking with full weight bearing, reduces the incidence of various postoperative complications of prolonged immobilization and minimizes the duration of hospital stay.

245-251

Authors: Jayaram BS, Shivananda S, Gazanfar Patel.

Introduction and Objectives: Osteoarthritis is the most common disorder associated with severe hip pain and disability in adult population. Primary total hip replacement (THR) aims for immediate and long lasting effects on pain and function in osteoarthritic hip. The intend of this study was to evaluate the clinical and functional outcome of Primary total hip replacement using Modified Harris hip score. Materials and Method: A prospective study of 50 hips (38 patients) of osteoarthritis managed by Primary total hip replacement in Kempegowda institute of medical sciences, Bangalore between June 2014 to February 2017. The patients were assessed clinically and functionally using Modified Harris Hip Score pre and post operatively.Patients were followed for a minimum period of 2 years and maximum of 2.5 years. Results: 50 hips were operated in 38 patients for avascular necrosis (38), primary osteoarthritis (8), Ankylosing spondylitis (2) and Rheumatoid Arthritis (2). The mean total pre-operative Modified Harris hip score was 30.60 which improved postoperatively to a mean score of 88.90. We had complications in 8 patients, foot drop (2), superficial infection (2), limb length discrepancy (2), and posterior dislocation (2). We had good to excellent results in 84% and fair results in 12% patients. Conclusion: Our study suggests that Primary total hip replacement provides excellent clinical and functional outcome in osteoarthritis of hip.

256-260

Authors: Jayant Sharma, Prashant Upadhyaya.

Fracture of Proximal humerus are most common humerus fracture (45%). These are more common than hip fracture. As the patient has a direct fall on the limb these fractures are mostly undisplaced (85%). These are more common in osteoporotic patients in elderly age group. Aim of the management is early mobilization. JESS is a mini external fixator invented by Dr. B. B. Joshi and it is, A simple light mini fixator with Ease of application and has Fixed angle stability. We have used this fixator in 25 cases of proximal humerus received by us, and treated with this method as, it Avoids dissection of Deltoid, Rotator Cuff and biceps due to use of small pin diameter has a Lower incidence of AVN, with Minimal blood loss. It also eliminates another Surgery for Hardware removal and is based on the principle of faster rehabilitation. We found this technique to be effective in Effective in polytrauma.

266-271

Authors: Ujjwal Kejariwal, Partap Singh, Rajesh Kapila, Jagsir Singh, Himanshu Agrahasi.

The last two decades have witnessed a significant rise in high velocity trauma and violent incidents like bomb blasts and firearm injuries. This has led to increase in severely comminuted open fractures with infection, severe soft tissue trauma, bone loss and nonunion.The incidence of non-union in the presence of an open fracture with extensive soft tissue injury, not surprisingly, reaches as high as 20%.

277-282

Authors: Varun G.B.S., Dileep Reddy, Muralidhar N., Satish Kumar C., Raj Lavadi.

Introduction: Thoracolumbar fracture can be stabilized adequately by utilizing posterior decompression by performing pedicle screw fixation. The neurological progress of such patients was analyzed by using the American Spinal Injury Association (ASIA) chart. Purpose: We aimed to assess the functional, radiological, and neurological outcomes of 31 patients who have suffered thoracolumbar fractures. Materials and Methods: 31 patients underwent posterior decompression by pedicle screw fixation in order to treat their thoracolumbar fractures at Vydehi Institute of Medical Sciences and Research Center. The American Spinal Injury Association neurological chart, Visual Analogue Score, and Kyphotic Angle were used to gauge the functional progress of the patients. Patients were followed-up regularly. Results: Upon comparing the mean preoperative, postoperative, and final follow up data of this study, the neurological improvement, as indicated by the ASIA neurological chart, was highly significant as well as successful. Only two patients had screw breakage without worsening of neurological status. Five of the 31 patients developed minor complications for which they were treated. Conclusion: Posterior decompression by pedicle screw fixation is a viable option for patients who have suffered unstable thoracolumbar fractures with any deformity or neurological dysfunction.

289-293

Authors: Arun Gopalakrishnan, Sreesobh K.V..

Introduction: Unstable distal end radius fractures are a common entity with various treatment options. The degree of instability varies with each fracture and it has a bearing on the treatment outcome. We are trying to grade the instability and its use in predicting treatment outcome. Materials and Method: 48 adult patients with unstable distal radius fractures were classified into three grades according to our instability grading. All were treated with Joshi’s external stabilizing system and their anatomical and functional results were analyzed at one year. Result: 91% had excellent or good functional results and there were statistically significant differences in functional outcome among the three grades. Conclusion: The proposed grading system is simple and will help to predict functional out come and duration of JESS fixation in unstable distal radius fractures.

301-303

Authors: Shreeharsha Patil, Prashant Bhavani.

Introduction: Vein Thrombosis is a major national health problem that takes a significant toll of lives and creates major disabilities. Objective: Incidence of Deep Vein Thrombosis in elderly fracture neck of femur patients with prophylactic anticoagulation. Materials and Method: This study was conducted in the out-patient and emergency Department of Orhtopaedics, Yashoda Superspeciality Hospital, Malakpet, Hyderabad. Aged more than 60 years, during the period from May 2010 to august 2011 was included in this study. Results: Forty patients with fracture of hip were selected. Patients in 60-70 years age group were 27(67.5%), 70-80 years age’s were 11(27.5%) and >80 years were 2(5%). Out of 40 patients 23 (57.5%) had fracture neck femur and 17(42.5%) intertrocanteric fracture. out of 40 patients who received thromboprophylaxis 8 had DVT. Conclusion: Incidence of deep vein thrombosis in hip fracture patients is high and require thromboprophylaxis.

308-313

Authors: Deepak Kaki, Chitta Ranjan Sahu, Jagdesh Gudaru, Venugopal S.M., Samuel Lenald Palaji.

Distal end radius fractures represent approximately one-sixth of all fractures treated in the emergency department. Fractures of the distal radius continue to pose a therapeutic challenge. Some of these fractures are caused by severe high energy trauma, resulting in intraarticular involvement and comminution, while some result from trivial trauma especially in the elderly. These fractures often are unstable, are difficult to reduce anatomically, and are associated with a high prevalence of complications like distal radio ulnar joint [DRUJ] instability, malunions, delayed fracture collapse, post-traumatic osteoarthritis. It is also known that extra-articular malalignment can lead to decreased grip strength and endurance as well as limited motion and carpal instability

318-322

Authors: Tushar Pisal, Prafulla Herode, Mohan Sadaria, Jeegar Patel, Saurav Jha.

Most commonly in elder patients due to trivial trauma. Especially more common in females. Osteoporosis remains the most important factor contributing to hip fractures. In the young population these fractures are result of high energy trauma. We compared outcome of intertrochanteric fracture of neck of femur type 3, 4 and 5 treated with bone graft and without bone graft. However introduction of bone grafting in patients with fracture IT failed to show any benefit in rate of union at fracture site. Bone grafting along with fixation does not have any added benefit in terms of degree of collapse when compared with the group without bone grafting.