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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Online ISSN Number 2455-538X
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.
References
1. Robert W Bucholz, James D Heckman, Charles M Court-Brown, Rockwood and Greens volume 2, 6th edition; pages 1827-44
2. GS kulkarni, Rajiv Limaye, Milind Kulkarni, ‘ intertrochanteric fractures- Current concept review’ Ind J Orth, 2006, vol 40, 16-23
3. Boldin, Christia, Seibert, Franz J, Fankhauser, Wolfgang, Szyszkowitz, Rudolf (2003) et al. Acta Orthopaedics, 74:1, 53-58
4. Ganz R, Thomas R.J, Hammerle CP. Clin Orthop 1979; 138:30-40
5. Cleveland, m. Bosworth, D. M and Thompson, F.R. JBJS, 29:1049-67, 1947
6. Mulley G and Espley, A. J. Postgrad Med. J, 55:264-265, 1979
7. Evans EM. JBJS 1949; 31B: 190-203
8. Wolfgang GL. Clinical Orthopaedics and related research 1982; 163: 148-158
9. Sarmeinto, A. Clin.Orthop, 53:47-59, 1967.
10. Wei-Chao Sheng, Jia-Zhen Li, Sheng-Hua Chen and Shi-Zen Zhong. International orthopaedics, vol 33, number 2, 537-42
11. Patil Suresh S, Panghate Atul. J orthopaedics 2008, 5(3) E7.
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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.
References
1. Toh CL, Jupiter JB. The infected nonunion of the tibia. ClinOrthopRelat Res 1995;315:176-191.
2. Patzakis MJ, Zalavras CG. Chronic posttraumatic osteomyelitis and infected nonunion of the tibia: Current management concepts. J Am AcadOrthopSurg 2005;13(6):417-427.
3. Stoodley P, Ehrlich GD, Sedghizadeh PP, Stoodley LH, Baratz ME, Altman DT, et al. Orthopaedic biofilm infections. CurrOrthopPract2011;22(6):558-563.
4. Nelson CL. The current status of material used for depot delivery of drugs. ClinOrthopRelat Res 2004;427:72-78.
5. Cierny G, Mader J. The surgical treatment of adult osteomyelitis. In: CMC Evarts, editor. Surgery of the Musculoskeletal System. New York, USA: Churchill Livingstone; 1983. p. 4814-4834.
6. Court-Brown CM. Fractures of the tibia and fibula. In: Bucholz RW, Heckman JD, Court-Brown CM, editors. Rockwood and Green’s Fractures in Adults. 6th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2006. p. 2080-2146.
7. Beals RK, Bryant RE. The treatment of chronic open osteomyelitis of the tibia in adults. ClinOrthopRelat Res 2005;433:212-217.
8. Ueng SW, Chuang DC, Cheng SL, Shih CH. Management of large infected tibial defects with radical debridement and staged double-rib composite free transfer. J Trauma 1996;40(3):345-350.
9. Chen CE, Ko JY, Wang JW, Wang CJ. Infection after intramedullary nailing of the femur. J Trauma 2003;55(2):338-344.
10. Wu CC, Shih CH. Distal tibial nonunion treated by intramedullary reaming with external immobilization. J Orthop Trauma 1996;10(1):45-49.
11. Paley D, Herzenberg JE. Intramedullary infections treated with antibiotic cement rods: Preliminary results in nine cases. J Orthop Trauma 2002;16(10):723-729.
12. Qiang Z, Jun PZ, Jie XJ, Hang L, Bing LJ, Cai LF. Use of antibiotic cement rod to treat intramedullary infection after nailing: Preliminary study in 19 patients. Arch Orthop Trauma Surg 2007;127(10):945-951.
13. Madanagopal SG, Seligson D, Roberts CS. The antibiotic cement nail for infection after tibial nailing. Orthopedics 2004;27(7):709-712.
14. Thonse R, Conway J. Antibiotic cement-coated interlocking nail for the treatment of infected nonunions and segmental bone defects. J Orthop Trauma 2007;21(4):258-268.
15. Sancineto CF, Barla JD. Treatment of long bone osteomyelitis with a mechanically stable intramedullar antibiotic dispenser: Nineteen consecutive cases with a minimum of 12 months follow-up. J Trauma 2008;65(6):1416-1420.
16. Nelson CL, Hickmon SG, Harrison BH. Elution characteristics of gentamicin-PMMA beads after implantation in humans. Orthopedics 1994;17(5):415-416.
17. Nizegorodcew T, Palmieri G, Marzetti E. Antibiotic-coated nails in orthopedic and trauma surgery: State of the art. Int J ImmunopatholPharmacol 2011;24 1 Suppl 2:125-128.
18. Riel RU, Gladden PB. A simple method for fashioning an antibiotic cement-coated interlocking intramedullary nail. Am J Orthop (Belle Mead NJ) 2010;39(1):18-21.
19. Dhanasekhar R, Jacob P, Francis J. Antibiotic cement impregnated nailing in the management of infected nonunion of femur and tibia. Kerala J Orthop2013;26(2):93-97.
20. Kim JW, Cuellar DO, Hao J, Seligson D, Mauffrey C. Custom-made antibiotic cement nails: A comparative study of different fabrication techniques. Injury 2014;45(8):1179-1184.
21. Akinyoola AL, Adegbehingbe OO, Aboderin AO. Therapeutic decision in chronic osteomyelitis: Sinus track culture versus intraoperative bone culture. Arch Orthop Trauma Surg 2009;129(4):449-453.
22. Beals RK, Bryant RE. The treatment of chronic open osteomyelitis of the tibia in adults. ClinOrthopRelat Res 2005;433:212-217.
23. Henry SL, Ostermann PA, Seligson D. The prophylactic use of antibiotic impregnated beads in open fractures. J Trauma 1990;30(10):1231-1238.
24. Chen CE, Ko JY, Wang JW, Wang CJ. Infection after intramedullary nailing of the femur. J Trauma 2003;55(2):338-344.
25. Tunney MM, Ramage G, Patrick S, Nixon JR, Murphy PG, Gorman SP. Antimicrobial susceptibility of bacteria isolated from orthopedic implants following revision hip surgery. Antimicrob Agents Chemother 1998;42(11):3002-3005.
26. Chang Y, Chen WC, Hsieh PH, Chen DW, Lee MS, Shih HN, et al.In vitro activities of daptomycin-vancomycin-and teicoplanin-loaded polymethylmethacrylate against methicillin-susceptible, methicillin-resistant, and vancomycin-intermediate strains of Staphylococcus aureus. Antimicrob Agents Chemother 2011;55(12):5480-5484.
27. Öztemür Z, Sümer Z, Tunç T, Pazarcé Ö, Bulut O. The effect of low dose teicoplanin-loaded acrylic bone cement on biocompatibility of bone cement. ActaMicrobiolImmunol Hung 2013;60(2):117-125.
28. Green SA. Complications of external skeletal fixation. ClinOrthopRelat Res 1983;180:109-116.
29. Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. ClinOrthopRelat Res 1990;250:81-104.
30. Shyam AK, Sancheti PK, Patel SK, Rocha S, Pradhan C, Patil A. Use of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of long bones. Indian J Orthop 2009;43(4):396-402.
31. Pradhan C, Patil A, Puram C, Attarde D, Sancheti P, Shyam A. Can antibiotic impregnated cement nail achieve both infection control and bony union in infected diaphyseal femoral non-unions? Injury. 2017 Aug;48 Suppl 2:S66-S71
32. Selhi HS, Mahindra P, Yamin M, Jain D, De Long WG Jr, Singh J. Outcome in patients with an infected nonunion of the long bones treated with a reinforced antibiotic bone cement rod. J Orthop Trauma 2012;26(3):184-188.
33. Kendall RW, Duncan CP, Smith JA, Ngui-Yen JH. Persistence of bacteria on antibiotic loaded acrylic depots. A reason for caution. ClinOrthopRelat Res 1996;329:273-280.
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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
References
1. Winkler H. treatment of chronic orthopaedic infection. EFFORT open reviews. 2017; Vol. 2: 110-116
2. James M, Khan W, Nannaparaju M, Bhamra J, Morgan-Jones R. Current evidence for the use of laminar flow in reducing infection rates in total joint arthroplasty. The open prthopaedic journal 2015; 9, Supple. 2: 495-498
3. Electricwala A, Dasgupta R, Rajshekharan S, Mody B, Sancheti K. Laminar air flow and air handling unit. Manual of infection control in orthopaedic surgery: operation theatre protocols and patient optimization. Jaypee. Pg. 40-49
4. Cook G, Markel D, Ren W, Webb L, McKee M, Schemitsch E. infection in orthopaedics. J. Orthop Trauma 2015; 29: S19- S23
5. Patzakis MJ, Zalavras CG. Chronic posttraumatic osteomyelitis and infected nonunion of the tibia: current management concepts. J Am Acad. Orthop Surg. 2005; 13:417–427.
6. Beenken KE, Bradney L, Bellamy W, et al. Use of xylitol to enhance the therapeutic efficacy of polymethylmethacrylate-based antibiotic therapy in treatment of chronic osteomyelitis. Antimicrob Agents Chemother. 2012; 56:5839–5844.
7. Hanssen AD. Local antibiotic delivery vehicles in the treatment of musculoskeletal infection. Clin Orthop Relat Res. 2005; 437:91–96.
8. McKee MD, Wild LM, Schemitsch EH, et al. The use of an antibiotic impregnated, osteoconductive, bioabsorbable bone substitute in the treatment of infected long bone defects: early results of a prospective trial. J Orthop Trauma. 2002; 16:622–627.
9. Ateschrang A, Albrecht D, Schroter S, Hirt B, Weise K, Dolderer J. Septic arthritis of the knee: presentation of a novel irrigation suction system tested in a cadaver study. BMC Musculoskeletal disorders. 2011; 12: 180
10. Schanz A. Ueber die nach Schenkelhalsbruchen Zuruckbleibenden geshtorungen. Munch Med Wochenschr. 1925; 51: 730-732
11. Mehta S., Humphrey JS, Dchenkmann DI, Seaber AV, Vail TP. Gentamycin distribution from collagen carrier. Journal Orthopaedic Research. 1996; 40: 749-754
12. Cierny III G. Infected tibial non-unions. The evolution of change. Clinical Orthopaedics related research, 1999; 360: 97-105
13. Mouton JW, Vinks AA: Pharmacokinetic/ pharmacodynamics modelling of antimicrobial drug effects. J Pharmacokinet Pharmacodyn 2007; 34: 727-751
14. Tsourvakas S. Local antibiotic therapy in the treatment of bone and soft tissue infections. In Stefan Danilla, editor. Selected topics in plastic reconstructive surgery. InTech ; 2012: 17-44
15. McLaren AC, Gutierrez FN, Martin M, McLemore R. Local antimicrobial treatment. In Cierny III G, McLaren AC, Wongworawat MD, editors. Orthopaedic knowledge update: Musculoskeletal infection. AAOS. Vol. 2; 2009: 95-116
16. Wahlig H, Dingeldein E, Bergmann R, Reuss K. The release of gentamycin from polymethyl methacrylate beads: an experimental and pharmacokinetic study. J Bone Joint Surgery Br 1978;60:270-275
17. Nelson CL, Hickmon SG, Skinner RA. Treatment of experimental osteomyelitis by surgical debridement and the implantation of bioerodable, polyanhydridegentamycin beads. J Orthop Res 1997; 15: 249-255
18. McLaren AC. Alternative materials to acrylic bone cement for delivery of depot antibiotics in orthopaedic infections. Clin Orthop Relat Res 2004; 427:101-106.
19. Tam VH, Kabbara S, Vo G, Schilling AN, Coyle EA. Comparative pharmacodynamics of gentamycin against staphylococcus aureus and pseudomonas aeruginosa. Antimicrob Agents Chemother 2006; 50: 2626-2631
20. Pesenti S, Blondel B, Peltier E, Adetchessi T, Dufour H, Fuentes S. Percutaneous cement-augmented screws fixation in the fractures of the aging spine: is it the solution? BioMed research international volume. 2014; 1-5
21. Buck M, Wiggins BS, Sesler JM. Intraosseous drug administration in children and adults during cardiopulmonary resuscitation. The annals of Pharmacotherapy 2007;41: 1679-1686
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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
1. Giannoudis PV, Papakostidis C, Roberts C. A review of the management of open fractures of the tibia and femur. J Bone Joint Surg Br. 2006;88:281–289
2. Carroll EA, Koman LA. External fixation and temporary stabilization of femoral and tibial trauma. J SurgOrthp Adv. 2011;20:74–81.
3. Initial Management of Open Fractures. (Book Chapter) S. Rajasekaran et al. Rockwood and Green’s Fractures in Adults. Eigth Edition. Vol1 :353-396.
4. BAPRAS Guidelines: Standards for management of open fractures of the lower limb. 2009.
5. Hyman J, Moore T. Anatomy of the distal knee joint and pyarthrosis following external fixation. J Orthop Trauma. 1999;13:241–246
6. Lethaby A, Temple J, Santy J. Pin site care for preventing infections associated with external bone fixators and pins. Cochrane Database Syst Reviews. 2008;(4).
7. Schmidt AH, Swiontkowski MF. Pathophysiology of infections after internal fixation of fractures. J Am AcadOrthop Surg. 2000;8:285–291.
8. Clifford RP, Beauchamp CG, Kellam JF, et al. Plate fixation of open fractures of the tibia. J Bone Joint Surg Br. 1988;70:644–648.
9. Giannoudis PV, Furlong AJ, MacDonald DA, et al. Reamed against unreamed nailing of the femoral diaphysis: A retrospective study of healing time. Injury. 1997;28:15–18.
10. Kakar S, Tornetta P 3rd. Open fractures of the tibia treated by immediate intramedullary tibial nail insertion without reaming: A prospective study. J Orthop Trauma. 2007;21:153–157.
11. Bhandari M, Guyatt GH, Swiontkowski MF, et al. Treatment of open fractures of the shaft of the tibia. J Bone Joint Surg Br. 2001;83:62–68.
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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
References
1. Dabezies EJ and D’Ambrosia RD. Treatment of the multiply injured patient: plans for treatment and problems of major trauma. Instructional course lectures 1984; 33: 242-52.
2. Hoff WS, Reilly PM, Rotondo MF, DiGiacomo JC, and Schwab CW. The importance of the command-physician in trauma resuscitation. The Journal of trauma 1997; 43: 772-7.
3. Lu WH, Kolkman K, Seger M, and Sugrue M. An evaluation of trauma team response in a major trauma hospital in 100 patients with predominantly minor injuries. The Australian and New Zealand journal of surgery 2000; 70: 329-32.
4. Simons R, Eliopoulos V, Laflamme D, and Brown DR. Impact on process of trauma care delivery 1 year after the introduction of a trauma program in a provincial trauma center. The Journal of trauma 1999; 46: 811-5
5. Initial Management of Open Fractures .(Book Chapter) S. Rajasekaran et al. Rockwood and Green’s Fractures in Adults. Eigth Edition . Vol 1 :353-396.
6. Pollak AN. Timing of debridement of open fractures. The Journal of the American Academy of Orthopaedic Surgeons 2006; 14: S48-51.
7. Carsenti-Etesse H, Doyon F, Desplaces N, and et al. Epidemiology of bacterial infection during management of open leg fractures. Eur J Clin Microbiol Infect Dis 1999; 18: 315-323.
8. Kreder HJ and Armstrong P. The significance of perioperative cultures in open pediatric lower-extremity fractures. Clinical orthopaedics and related research 1994: 206-12.
9. Lee J. Efficacy of cultures in the management of open fractures. Clinical orthopaedics and related research 1997: 71-5.
10. Patzakis MJ. Orthopedics-epitomes of progress: The use of antibiotics in open fractures. The Western journal of medicine 1979; 130: 62.
11. Edwards CC, Simmons SC, Browner BD, and Weigel MC. Severe open tibial fractures. Results treating 202 injuries with external fixation. Clinical orthopaedics and related research 1988: 98-115.
12. Emami A, Mjoberg B, Ragnarsson B, and Larsson S. Changing epidemiology of tibial shaft fractures. 513 cases compared between 1971-1975 and 1986-1990. Acta Orthop Scand 1996; 67: 557-561
13. Rajasekaran S and Giannoudis PV. Open injuries of the lower extremity: issues and unknown frontiers. Injury 2012; 43: 1783-4
14. Gustilo RB. Management of infected fractures. Instructional course lectures 1982; 31: 18-29.
15. Rajasekaran S, Naresh Babu J, Dheenadhayalan J, Shetty AP, Sundararajan SR, Kumar M, and Rajasabapathy S. A score for predicting salvage and outcome in Gustilo type-IIIA and type-IIIB open tibial fractures. The Journal of bone and joint surgery. British volume 2006; 88: 1351-60.
16. Rajasekaran S and Sabapathy SR. A philosophy of care of open injuries based on the Ganga hospital score. Injury 2007; 38: 137-46.
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Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) using Locking Compression Plate (LCP) in Distal Tibial Fractures: A Prospective Study of 50 Cases.
/in May - Aug | volume 4 | issue 1| 2018Vol 4 | Issue 1 | May – Aug 2018 | page: 34-37 | Rakesh Sharma, Rajesh Kapila, Sarika Kapila, Dharam Singh, Jagsir Mann
doi-10.13107/ti.2018.v04i01.064
Author: Rakesh Sharma [1], Rajesh Kapila[1], Sarika Kapila [2], Dharam Singh [1], Jagsir Mann [1] .
[1] Department of Orthopaedics, Govt. Medical College, Amritsar – 143001 (Punjab). India
[2] Dept. Of Oral and Maxillofacial Surgery, SGRD institute of dental sciences. Amritsar
Address of Correspondence
Dr. Rajesh Kapila
2-B , circular road, Amritsar-143001
Email: kapila.rajesh@ yahoo.com
Abstract
Background: The limited soft tissue, subcutaneous location of large portion of tibia and precarious blood supply renders the treatment of distal tibial fracture very challenging. The main treatment of this type of fracture is reinstatement of the normal alignment and articular congruity. Conventional osteosynthesis is not suitable because distal tibia is subcutaneous bone with poor vascularity. Closed Reduction and MIPPO with locking compression plate (LCP) has emerged as an alternative treatment option because it respects biology of distal tibia, maintains fracture haematoma and provides biomechanically stable construct, early mobilization, less complications and relatively higher rates of union. The aim of this study was to evaluate the functional and clinical outcomes of distal tibia fracture of patients, treated by internal fixation by minimally invasive plating osteosynthesis (MIPPO) technique with locking compression plate (LCP).
Methods: 50 patients with distal tibia fracture with or without intra articular extension were treated in our department, with MIPO with LCP and were prospectively followed for average duration of 6 months. The outcome was evaluated using American Orthopedic Foot and Ankle Society (AOFAS) score ( Ankle – Hindfoot Scale )
Results: There were 50 patients (36 males and 14 female) with mean age of 38.4 years. The mean follow up period of our patients was 6 months. All fractures united at an average of 19.13 weeks (range- 16-24 to weeks) except two cases of non- union. There were 8 superficial wound infections which were treated with oral antibiotics and progressed to union and there were no failures of implants. According to AOFAS score at 6 months, 6 cases had score of 31 to 70 and 44 cases had score of 71 to 100.
Conclusions: Minimally invasive plating osteosynthesis (MIPPO) is an effective method of treatment for distal tibial fractures. The use of indirect reduction techniques and small incision is technically demanding and it is effective, minimally invasive, optimises the operation time, promotes early healing and reduces the incidence of infections and complications associated with conventional method of open reduction and internal fixation.
Keywords: Distal tibia, LCP, MIPPO, Osteosynthesis, Plating.
References
1. Ruedi T, Algower M. Fractures of the lower end of tibia into the ankle joint. Injury 1969; 1:92-9.
2. Orthopaedic Trauma Associated Committee for Coding and Classification. Fracture and Dislocation compendium. J Orthop Trauma 1996;10(1):1.
3. Smith WR, Ziran BH, Anglen JO, Stahel PF. Locking plates: tips and tricks. J Bone Joint Surg Am. 2007 Oct 1;89(10):2298-307.
4. Gustilo open fracture classification. OrthopaedicsOne Articles. In: OrthopaedicsOne – The Orthopaedic Knowledge Network. Created Mar 01, 2009 16:47. Last modified May 09, 2012 08:33 ver.246. Retrieved 2017-03-15, from http://www.orthopaedicsone.com/x/r4EqAQ.
5. American Orthopaedic Foot and Ankle Society
http://www.afoas.org/14a/pages/index.cfm?pageid=3494
6. Hazarika S, Chakravarthy J, Cooper J. Minimaly invasive locking plate osteosynthesis for fractures of distal tibia-results in 20 patients. Injury 2006; 37(9): 877-87.
7. Mushtaq A, Shahid R, Asif M. distaltibial fracture fixation with locking compression plate (LCP) using minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Eur J Trauma Emerg Surg 2009; 35: 159-64.
8. Gupta RK, Rohilla RK, Sangwan K, Singh V, Walia S. Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients. Int Orthop 2009; 33: 120-3.
9. Leung FK, Law TW. Application of minimally invasive locking compression plate in treatment of distal tibial fractures. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2009; 23: 1323-5.
10. Ronga M, Longo UG, Maffulli N. Minimally invasive locked plating of distal tibia fractures is safe and effective. Clin Orthop Relat Res 2009; 468: 110-4.
11. Bahari S, Lenehan B, Khan H, McElwain JP. Minimally invasive percutaneous plate fixationof distal tibia fractures. Acta Orthop Belg 2007; 73: 635-40.
12. Zha G, Chen Z, Qi X. Minimally invasive percutaneous locking compression plate internal fixation in the treatment of tibial fractures. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2008; 22: 1448-50.
13. Protzman R, Collinge C. Outcomes of Minimally Invasive Plate Osteosynthesis for Metaphyseal Distal Tibia Fractures. J Orthop Trauma 2010; 24: 24-9.
14. Collinge C, Kuper M, Protzman R. Minimally invasive plating of high-energy metaphyseal distal tibia fractures. J Orthop Trauma 2007; 21(6): 355-61.
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