Purpose:Distal tibia fractures comprise about 7%-10% of lower extremity trauma.Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of...Purpose:Distal tibia fractures comprise about 7%-10% of lower extremity trauma.Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of distal tibia fractures especially extra articular pilon fractures.Plating is fraught with complications of wound dehiscence and infection.There are limited studies which document outcomes in such cases using intramedullary interlocking nail.We intend to study the outcome and complications of extra articular distal tibial fractures treated with interlocking nailing.Methods:This is a prospective study conducted in a tertiary care orthopaedic hospital in southern India.There are 147 patients of distal tibia extra-articular fractures managed by IM nailing with follow up of more than one year were included in this study.Only cases with fresh injury (less than 1 week),fracture below the isthmus,closed and open Gustilo Anderson type 1 and 2 fractures were included in the study.Patients were reviewed at 3,6,12 and 24 weeks after surgery and thereafter at one year and were assessed for clinical and radiological signs of healing,any complications,time to union and functional outcome.Results:There were 102 males and 45 females (male/female ratio is 2.3∶1) with a mean age of 38.96 (range 23-65) years.According to AO classification,there were 78 cases (53.06%) of 43-A1,39 cases (26.53%) of 43-A2 and 30 cases of 43-A3 constituting 20.40%.The fracture united in all the patients at an average of 18 weeks (range 16-22 weeks),none of the patient in our series had a delayed or non-union.Two patients (1.47%) had the fracture united in mild valgus but it was well within the acceptable limits (<5°).The functional outcome was assessed in all the patients at final follow up using Olerud and Molander score all the patients fared an excellent to good score,there were no cases with poor score.Conclusion:Intramedullary nailing is a viable option to treat distal tibial fractures with excellent outcome.Wound complications related to plating can be avoided but meticulous surgical technique is key to avoid malunion.展开更多
Purpose:Fractures of distal radius are one of the common orthopaedic injuries.Placing the plate on volar surface requires release of underlying pronator quadratus(PQ)muscle.No consensus is present in the literature ab...Purpose:Fractures of distal radius are one of the common orthopaedic injuries.Placing the plate on volar surface requires release of underlying pronator quadratus(PQ)muscle.No consensus is present in the literature about the repair or not of the PQ.The purpose of this study was to evaluate the influence of PQ repair on functional outcome and complications.Methods:Retrospectively 83 patients of distal radius fractures managed with volar plating between 2014 and 2016 were evaluated.Demographic data,operative notes and physical therapy records were retrieved.Patients were divided into group A where PQ repair was done and group B where no repair was done.Functional data such as range of motion(ROM),grip strength,visual analogue scale(VAS)score and disabilities of arm,shoulder and hand(DASH)score at 4 weeks,3 months,6 months and finial follow-up were retrieved.Results:Totally 63 patients(n=29 in group A and n=34 in group B)with the mean age of 51.64 years were examined.Patients were followed up for a mean of 35.2 months(range 27.2-47.1 months)in group A and 38.6 months(range 28.6-51.0 months)in group B.Though functional outcome of the affected limb was not significantly different between two groups after 3 months,PQ repair did affect the recovery at an early stage.Repair group had significantly better ROM(p=0.0383)and VAS score at 4 weeks(p=0.017)while grip strength(p=0.014)was significantly better at 3 months.Conclusions:Repair of PQ may provide pain relief and increased ROM in early postoperative period and hence every attempt should be made to achieve the repair.展开更多
Purpose:Shoulder dislocation comprises 60%of all major joint dislocations worldwide and a number of reduction techniques are described in the literature w让h varying degrees of success.The description of a large numbe...Purpose:Shoulder dislocation comprises 60%of all major joint dislocations worldwide and a number of reduction techniques are described in the literature w让h varying degrees of success.The description of a large number of techniques speaks for itself that no method is effective all the times and one should be acquainted with more than one technique.An ideal method of reduction should be simple,easily reproducible,relatively painless that can be performed unassisted without sedation or anaesthesia w让h minimal or no further complications.We report our results of using a novel method of anterior shoulder reduction described recently in the literature that claims to fulfil most of the characteristics of an ideal method if not all.Methods:This prospective study was conducted in a tertiary care centre.All the cases of primary anterior shoulder dislocation presenting within three days of injury without any associated fracture or spine trauma with or without greater tuberosity fracture were included.The reduction was done using a novel method by orthopaedic residents in all cases.The need for a second reduction attempt or anaesthesia was considered a treatment failure.Time taken for reduction,pain felt during reduction and complications if any were noted.Results:There were 47(77.04%)males and 14(22.95%)females with a mean age of(37.04±12.63)years.The new technique was effective in locating a shoulder dislocation on the first attempt in 58 of the 61 dislocated shoulders(95.08%).The remaining three shoulders were reduced on second attempt by the same technique.Sedative,pre-medication or anaesthesia was not used in any case.The average time taken for the shoulder reductio n was(130.5±25.8)sec onds and con fide nee interval(95%)124-137 s.Iatrogenic complications were not seen in any of the patients.Conclusion:This relatively painless technique of shoulder reduction is easy to acquire and practice in emergency department.The advantages of this manoeuvre and its associated safety may justly lead surgeons to select it as their primary method for reduction of anterior shoulder dislocations.展开更多
文摘Purpose:Distal tibia fractures comprise about 7%-10% of lower extremity trauma.Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of distal tibia fractures especially extra articular pilon fractures.Plating is fraught with complications of wound dehiscence and infection.There are limited studies which document outcomes in such cases using intramedullary interlocking nail.We intend to study the outcome and complications of extra articular distal tibial fractures treated with interlocking nailing.Methods:This is a prospective study conducted in a tertiary care orthopaedic hospital in southern India.There are 147 patients of distal tibia extra-articular fractures managed by IM nailing with follow up of more than one year were included in this study.Only cases with fresh injury (less than 1 week),fracture below the isthmus,closed and open Gustilo Anderson type 1 and 2 fractures were included in the study.Patients were reviewed at 3,6,12 and 24 weeks after surgery and thereafter at one year and were assessed for clinical and radiological signs of healing,any complications,time to union and functional outcome.Results:There were 102 males and 45 females (male/female ratio is 2.3∶1) with a mean age of 38.96 (range 23-65) years.According to AO classification,there were 78 cases (53.06%) of 43-A1,39 cases (26.53%) of 43-A2 and 30 cases of 43-A3 constituting 20.40%.The fracture united in all the patients at an average of 18 weeks (range 16-22 weeks),none of the patient in our series had a delayed or non-union.Two patients (1.47%) had the fracture united in mild valgus but it was well within the acceptable limits (<5°).The functional outcome was assessed in all the patients at final follow up using Olerud and Molander score all the patients fared an excellent to good score,there were no cases with poor score.Conclusion:Intramedullary nailing is a viable option to treat distal tibial fractures with excellent outcome.Wound complications related to plating can be avoided but meticulous surgical technique is key to avoid malunion.
文摘Purpose:Fractures of distal radius are one of the common orthopaedic injuries.Placing the plate on volar surface requires release of underlying pronator quadratus(PQ)muscle.No consensus is present in the literature about the repair or not of the PQ.The purpose of this study was to evaluate the influence of PQ repair on functional outcome and complications.Methods:Retrospectively 83 patients of distal radius fractures managed with volar plating between 2014 and 2016 were evaluated.Demographic data,operative notes and physical therapy records were retrieved.Patients were divided into group A where PQ repair was done and group B where no repair was done.Functional data such as range of motion(ROM),grip strength,visual analogue scale(VAS)score and disabilities of arm,shoulder and hand(DASH)score at 4 weeks,3 months,6 months and finial follow-up were retrieved.Results:Totally 63 patients(n=29 in group A and n=34 in group B)with the mean age of 51.64 years were examined.Patients were followed up for a mean of 35.2 months(range 27.2-47.1 months)in group A and 38.6 months(range 28.6-51.0 months)in group B.Though functional outcome of the affected limb was not significantly different between two groups after 3 months,PQ repair did affect the recovery at an early stage.Repair group had significantly better ROM(p=0.0383)and VAS score at 4 weeks(p=0.017)while grip strength(p=0.014)was significantly better at 3 months.Conclusions:Repair of PQ may provide pain relief and increased ROM in early postoperative period and hence every attempt should be made to achieve the repair.
文摘Purpose:Shoulder dislocation comprises 60%of all major joint dislocations worldwide and a number of reduction techniques are described in the literature w让h varying degrees of success.The description of a large number of techniques speaks for itself that no method is effective all the times and one should be acquainted with more than one technique.An ideal method of reduction should be simple,easily reproducible,relatively painless that can be performed unassisted without sedation or anaesthesia w让h minimal or no further complications.We report our results of using a novel method of anterior shoulder reduction described recently in the literature that claims to fulfil most of the characteristics of an ideal method if not all.Methods:This prospective study was conducted in a tertiary care centre.All the cases of primary anterior shoulder dislocation presenting within three days of injury without any associated fracture or spine trauma with or without greater tuberosity fracture were included.The reduction was done using a novel method by orthopaedic residents in all cases.The need for a second reduction attempt or anaesthesia was considered a treatment failure.Time taken for reduction,pain felt during reduction and complications if any were noted.Results:There were 47(77.04%)males and 14(22.95%)females with a mean age of(37.04±12.63)years.The new technique was effective in locating a shoulder dislocation on the first attempt in 58 of the 61 dislocated shoulders(95.08%).The remaining three shoulders were reduced on second attempt by the same technique.Sedative,pre-medication or anaesthesia was not used in any case.The average time taken for the shoulder reductio n was(130.5±25.8)sec onds and con fide nee interval(95%)124-137 s.Iatrogenic complications were not seen in any of the patients.Conclusion:This relatively painless technique of shoulder reduction is easy to acquire and practice in emergency department.The advantages of this manoeuvre and its associated safety may justly lead surgeons to select it as their primary method for reduction of anterior shoulder dislocations.
