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Online ISSN Number 2455-538X
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Online ISSN Number 2455-538X
Biological dynamic condylar screw fixation for management of Peritrochanteric hip fractures
/in May - Aug | volume 4 | issue 1| 2018Vol 4 | Issue 1 | May – Aug 2018 | page: 25-28 | Ninad Ashok Godghate, Neha Ninad Godghate, Krishnamohan Ananda Saindane, Shriniwas Yemul, Shivraj Suryawanshi.
doi-10.13107/ti.2018.v04i01.062
Author: Ninad Ashok Godghate [1] , Neha Ninad Godghate [1], Krishnamohan Ananda Saindane [2], Shriniwas Yemul [3], Shivraj Suryawanshi [4].
[1] Consultant Grace Ortho Clinic Rajiv Nagar T-Point Wardha Road, Nagpur.
[2] FICS, Consultant, Suyog Hospital, Sakri road, Dhule.
[3] Ashwini Rural Medical College and Research Centre, Kumbhari, Solapur
[4] Consultant Orthopaedic Surgeon, Alexis Hospital Nagpur
Address of Correspondence
Dr. Ninad Godghate,
1, Satpute Layout, Somalwada, Wardha Road, Nagpur-440025
E-mail: drninadgodghate@gmail.com
Abstract
Introduction: Inspite of routine encounters, hip fractures have the capacity to perplex even experienced orthopaedic surgeons at times. Management of these fractures has evolved with time and soft tissue preserving techniques have gained importance. Through this study we have attempted to analyse the results of traditional dynamic condylar screw plate construct used in a biological manner for treatment of peritrochanteric hip fractures.
Material & Methods: 18 patients in the age group of 22 to 78 years with post traumatic unstable intertrochanteric or subtrochanteric fractures in a pre-operative normal limb were included. All cases were operated within 5 days of trauma and were advised non weight bearing mobilisation for 6 weeks.
Results: Union was achieved in all cases with average duration of 14.6 weeks. 14 patients regained pre-fracture activities.
0.5 cm lengthening was seen in 2 cases.
Conclusion: Biological plating with dynamic condylar screw plate construct is a good modality for treatment of peritrochanteric hip fractures. There is a learning curve like any other surgical technique and results can be improved over time with proper patient selection and planning.
Keywords: Biological, Dynamic condylar screw, unstable, Peritrochanteric fractures
References
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Functional outcome of Unstable Inter-trochanteric femur fracture patients treated with Trochanteric fixation nail
/in May - Aug | volume 4 | issue 1| 2018Vol 4 | Issue 1 | May – Aug 2018 | page: 22-24 | Yashwant J. Mahale, Vikram V. Kadu.
doi-10.13107/ti.2018.v04i01.061
Author: Yashwant J. Mahale [1], Vikram V. Kadu [1].
[1] ACPM Medical College , Dhule – 424001 , Maharashtra India.
[2] Mahale Accident Hospital , Dhule, Maharashtra India.
Address of Correspondence
Dr. Vikram V Kadu,
C/O Vilas Shamrao Kadu, Plot no. 20, Kadu House, Barde layout, Katol Road, Nagpur – 440013
Email: vikram1065@gmail.com
Abstract
Introduction: Inter-trochanteric fractures are disabling injuries that most commonly affect the elderly
population. These fractures have a tremendous impact on both the health care system and society in general. These fractures can be managed by conservative methods, but mal-union and complications of prolonged immobilization is the result. Thus, surgery by internal fixation is the ideal choice. DHS was the gold standard treatment for inter trochanteric fractures before intra-medullary devices were developed. These devices have the advantage of shorter lever arm causing less tensile strain on the implant, controlled fracture impaction due to incorporation of sliding hip screw, shorter operative duration and less soft tissue dissection. In view of these considerations, present study is taken up to assess the outcome in terms of adequacy of fixation and results.
Methods: This is a retrospective study including 40 patients of unstable inter-trochanteric fracture treated with trochanteric fixation nail. Mean age group of patient was 61.78 years.
Results: Functional results were assessed in all 40 cases at follow up. Excellent results were noted in 27 cases, good in 10, fair in 3 and none had poor result. Anatomical results were assessed by presence or absence of shortening and range of movements.
Conclusion: The trochanteric fixation nail is a good minimally invasive implant for unstable inter-trochanteric fracture with less blood loss and soft tissue damage.
Keywords: Unstable inter-trochanteric fractures, shortening, trochanteric fixation nail.
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Role of Antibiotic Cement-coated Nailing in Infected Nonunion of Tibia
/in May - Aug | volume 4 | issue 1| 2018Vol 4 | Issue 1 | May – Aug 2018 | page: 18-21 | Clevio Desouza,Vinod Nair, Amit Chaudhary, Harshal Hurkat, Shiju George.
Author: Clevio Desouza [1],Vinod Nair [1], Amit Chaudhary [1], Harshal Hurkat [1], Shiju George [1].
[1] Department of Orthopaedics, Dr D.Y.Patil Hospital, Pune, Maharashtra, India.
Address of Correspondence
Dr. Clevio Desouza,
Department of Orthopaedics, Dr D.Y.Patil Hospital, Pune, Maharashtra, India.
E-mail: ceviod@gmail.com
Abstract
Introduction: The infection of long bones along with its nonunion is a chronic and debilitating disorder. It becomes difficult to deal with the situation in which the implant which is used for internal fixation itself becomes a potential media for infection because of the formation of biofilms and adhesions. Traditionally, this situation is managed by a two-stage procedure for controlling the infection first and then treating the nonunion. This study has been undertaken to explore antibiotic cement-coated nailing as a single stage treatment modality for achieving stability and treating of the infection at the same time.
Materials and Methods: 20 patients (above 18years of age) with nonunion of tibia associated with infection with bone gap <2 cm were managed using antibiotic cement-coated Kuntscher nail. Antibiotics used were a combination of vancomycin and teicoplanin.
Results: Infection was controlled in 95% of the patients. Bony union was achieved in 12 of 20 (60%) patients with antibiotic cement nailing as the only procedure with average time of union of 32 weeks. Bone grafting or exchange nailing type additional procedures were required in the remaining eight patients, and this was done in six patients, with union of the fracture. Two patients refused to undergo further procedures. The various complications encountered during this study were difficult nail removal in three cases, broken nail in two cases, and bent nail in 1 case. Recurrence of infection was observed in two patients. The average period of follow-up was 12 months.
Conclusion: Antibiotic cement impregnated nailing is a simple, economical, and effective single-stage procedure for the management of infected nonunion of the tibia. It has many advantages over external fixators, as it eliminates the complications and has good patient compliance. The method utilizes existing easily available instrumentation and is technically demanding and therefore can be performed at any hospital.
Keywords: Nonunion, infected, antibiotic, cement, nailing.
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Cannulated Schanz Pin: A Novel Concept for Intraosseous Antibiotic Delivery
/in May - Aug | volume 4 | issue 1| 2018Vol 4 | Issue 1 | May – Aug 2018 | page: 15-17 | Ninad Ashok Godghate, Neha Ninad Godghate, Ashok Shyam, Krishnamohan Ananda Saindane
Author: Ninad Ashok Godghate [1], Neha Ninad Godghate [1], Ashok Shyam [2], Krishnamohan Ananda Saindane [3].
[1] Consultant Grace Ortho Clinic Rajiv Nagar T-Point Wardha Road, Nagpur.
[2] Sancheti Institute, Pune
[3] FICS, Consultant, Suyog Hospital, Sakri road, Dhule.
Address of Correspondence
Dr. Ninad Ashok Godghate,
Consultant Grace Ortho Clinic Rajiv Nagar T-Point Wardha Road, Nagpur.
Email: drninadgodghate@gmail.com
Abstract
Infection control and prevention is the first step in any orthopaedic procedure because its treatment can be challenging and complicated. Complex bony architecture, precarious blood supply and presence of biofilm make eradicating infection a difficult task. Local antibiotic delivery in such cases has proved successful as it provides high concentration of antimicrobial agents and prevents systemic toxicity that is associated with systemic antibiotic administration. Of all the options available at present for local delivery, the most commonly used is antibiotic loaded bone cement. However only heat stable antibiotics can be used with cement and studies show that amount of drug eluted from the cement decreases with time. We have attempted to address these drawbacks and make local administration of antibiotics simpler by a novel method which could be used for treatment of established infections as well as prevention of infection in open fractures. This method could allow use of sensitive and specific antibiotic in addition to providing fracture stability.
Keywords: Infection, intraosseous antibiotic delivery, cannulated schanz pin
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Skeletal Stabilization In Open Injuries
/in May - Aug | volume 4 | issue 1| 2018Vol 4 | Issue 1 | May – Aug 2018 | page: 12-14 | Dheenadhayalan J, Raja Bhaskara Rajasekaran, Sivakumar S P, Ramesh Perumal, Arun Kamal C.
Author: Dheenadhayalan J [1], Raja Bhaskara Rajasekaran [1], Sivakumar S P [1], Ramesh Perumal [1], Arun Kamal C [1].
[1] Department of Orhtopaedics & Trauma Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam road, Coimbatore, India
Address of Correspondence
Dr. Raja Bhaskara Rajasekaran,
Ganga Hospital, Mettupalayam road,Coimbatore, India
Email: rajalibra299@gmail.com
Abstract
Skeletal Stabilization in open injuries is as important as soft tissue cover in providing a good outcome following open injuries. Unilateral external fixator forms the workhorse of open injuries of the lower limb. In fractured ends with good bone circumference, good reduction and fixation leads to primary union. Primary internal fixation was considered unacceptable even about two decades ago in open injuries. However, nowadays following refinement in techniques of debridement, the pendulum has now swung towards early internal fixation whenever indicated. Definitive internal fixation before soft tissue cover has also shown to give good results.Modern multiplanar and circular fixators are used if there is significant contamination, bone loss and multilevel fractures of the tibia.
Keywords: Skeletal stabilization, external fixator, debridement, primary internal fixation
References
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2. Carroll EA, Koman LA. External fixation and temporary stabilization of femoral and tibial trauma. J SurgOrthp Adv. 2011;20:74–81.
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Management of Open Injuries: What has changed?
/in May - Aug | volume 4 | issue 1| 2018Vol 4 | Issue 1 | May – Aug 2018 | page: 7-11 | Devendra Agraharam, Arun Kamal C, Raja Bhaskara Rajasekaran, Vel Murugesan P, Ramesh Perumal, Dheenadhayalan J.
Author: Devendra Agraharam [1], Arun Kamal C [1], Raja Bhaskara Rajasekaran [1], Vel Murugesan P [1], Ramesh Perumal [1], Dheenadhayalan J [1].
[1] Department of Orhtopaedics & Trauma Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam road, Coimbatore, India
Address of Correspondence
Dr. Raja Bhaskara Rajasekaran,
Ganga Hospital, Mettupalayam road,Coimbatore, India
Email: rajalibra299@gmail.com
Abstract
Introduction: Open injuries pose a major problem to the treating surgeon as they are prone to higher rates of infection and non-union and are usually associated with life threatening polytrauma. Nowadays, specialized trauma centres and a multimodal team approach have shown to give superior results in the outcome following open injuries. Early wound debridement, early fracture stabilization and early wound closure are important components as nowadays we focus on the ‘Era of functional restoration’. Serum Lactate is a widely used biochemical marker to assess the adequacy of tissue resuscitation and the Ganga Hospital Open Injury score (GHOIS) has a higher specificity towards limb salvage and also gives guidelines regarding timing and type of soft tissue reconstruction. A combined ‘Orthoplastic’ approach in the management of open injuries and adherence to the ‘Revised reconstruction ladder’ with regarding to wound coverage has shown to a favourable outcome.
Keywords: Open fractures, Debridement, Serum lactate, Ganga Hospital Open Injury score
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