Early Treatment Outcome of Humeral Shaft Fracture Non-Union in Adults: Comparative Study of Plating versus Interlocking Nailing

Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3rd of the humeral shaft (60%). Failed TBS treatment was the commonest indication for the osteosynthesis (71%). More patients had plating (53%) compared to 47% who had LIMN. Most patients (93.4%) had union between 3 to 6 months irrespective of fixation type with no significant statistical difference between the union rate of DCP and LIMN (p value 0.06) with similar functional outcome and complication rates irrespective of the type of fixation. Conclusion: This study showed that the success rates in term of fracture union, outcome functional grades and complication rates were not directly dependent on the types of the fixation: plating or locked intra-medullary nailing.

Early clinical outcome and learning curve following unilateral primary total knee arthroplasty after introduction of a novel total knee arthroplasty system

BACKGROUND New implants for total knee arthroplasty(TKA)are continuously introduced with the proposed benefit of increased performance and improved outcome.Little information exists on how the introduction of a novel arthroplasty implant affects the perioperative and surgical outcome immediately after implementation.AIM To investigate how surgery-related factors and implant positioning were affected by the introduction of a novel TKA system.METHODS A novel TKA system was introduced at our institution on 30th November 2015.Seventy-five TKAs performed with the Persona TKA immediately following its introduction by 3 different surgeons(25 TKAs/surgeon)were identified as the Introduction Group.Moreover,the latest 25 TKAs performed by each surgeon prior to introduction of the Persona TKA were identified as the Control Group.A Follow-up Group of 25 TKAs/surgeon was identified starting 1-year after the end of the introduction period.Demographics,surgery-related factors and alignment data were recorded,and intergroup differences compared.RESULTS Following introduction of the novel implant,Persona TKA was utilized in 69%(71%),53%(54%),and 45%(75%)of primary TKA procedures by the three surgeons,respectively(Follow-up Group).Mean surgery time was increased by 28%(P<0.0001)and mean intra-operative blood loss by 25%(P=0.002)in the Introduction Group,while only the mean surgery time was increased in the Follow-up Group by 18%(P<0.0001).Overall alignment was similar between the groups apart from femoral flexion(FF)and tibial slope(TS).The number of FF outliers was reduced in the Introduction Group with a more pronounced decrease in the Follow-up Group.CONCLUSION Introduction of the new TKA implant increased surgical time and intraoperative blood loss immediately after its introduction.These differences diminished one year after introduction of the new implant.Fewer outliers with respect to FF and TS were seen when using the novel TKA implant.Further studies are needed to investigate if these differences persist over time and correlate with patient reported outcomes.

Bleeding risk stratification in an era of aggressive management of acute coronary syndromes

Major bleeding is currently one of the most common non-cardiac complications observed in the treatment of patients with acute coronary syndrome(ACS). Hemorrhagic complications occur with a frequency of 1% to 10% during treatment for ACS. In fact, bleeding events are the most common extrinsic complication associated with ACS therapy. The identification of clinical characteristics and particularities of the antithrombin therapy associated with an increased risk of hemorrhagic complications would make it possible to adopt prevention strategies, especially among those exposed to greater risk. The international societies of cardiology renewed emphasis on bleeding risk stratification in order to decide strategy and therapy for patients with ACS. With this review, we performed an update about the ACS bleeding risk scores most frequently used in daily clinical practice.