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Two-Staged Management of Proximal Tibial Fractures with Impending Compartment Syndrome By Temporary External Stabilization and Fasciotomy and Delayed Definitive Fixation

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Vol 3 | Issue 2 | Sep – Dec 2017 | page: 16-20 | M. Shoaib Qureshi, Mangesh Panat, Pratik Israni

Author: M. Shoaib Qureshi [1], Mangesh Panat [1], Pratik Israni[1].

[1]Department Of Orthopedics, Mgm Hospital & Research Centre, Aurangabad, India

Address of Correspondence
Dr.  Mangesh Panat,
Dept. of orthopedics, mgm medical college and hospital.
Email: mangeshpanat@yahoo.co.in

Learning Points for this Article: This article will focus on successful management of proximal tibia fractures with impending compartment syndrome in two stages supporting the practice of delayed internal fixation until the soft-tissue envelope allows for definitive fixation.

Abstract

Introduction: High energy proximal tibia fractures with soft tissue involvement presenting with dicolored patches over the leg and severe swelling, compound wounds, blisters with tight compartments and absent or feeble dorsalis pedis or posterior tibial arteries warrant to go in for a staged procedure. In patients with multiple injuries, an external fixator can be applied quickly with minimal blood loss for unstable periarticular fractures around the knee. Two-stage procedures involve (1) early joint spanning external fixators with fasciotomy for the medial and posterior compartments, (2) and late definitive fixation with plates or nails and with skin grafting.
Materials and Methods: In our study, we present a short series of 15 proximal tibial fractures with impending compartment syndrome. Patients selected for this study were (1) closed proximal tibia fracture intra- and peri-articular and metaphysis diaphysis junction communited and noncommunited fractures (2) impending compartment syndrome evaluated based on excessive swelling, tight compartments, blisters over skin, feeble or absent dorsalis pedis or posterior tibial pulsations, color Doppler suggestive of severe subcutaneous edema associated with monophasic or absent flow over distal arteries.
Exclusion criteria: (1) Low energy proximal tibia fracture without soft tissue insult and compound wounds over the proximal tibia fractures, (2) associated popliteal artery injuries.
Conclusion: With the initial application of a bridging external fixator followed by delayed internal fixation protocol for pilon fractures has been successful in reducing the historically high rates of wound complications associated with these high-energy injuries. As well this protocol allows the use of minimally invasive plate osteosynthesis technique which is based on a combination of the principles of stability, restoration of anatomy and early motion while eliminating the need for excessive soft tissue dissection.
Keywords: Proximal Tibial fractures, External fixators, Fasciotomy, Definitive fixation.

References

1. Dougherty PJ, Silverton C, Yeni Y, Tashman S, Weir R. Conversion from temporary external fixation to definitive fixation: Shaft fractures. J Am Acad Orthop Surg 2006;14:S124-S127.
2. Chan PS, Klimkiewicz JJ, Luchetti WT, Esterhai JL, Kneeland JB, Dalinka MK, et al. Impact of CT scan on treatment plan and fracture classification of tibial plateau fractures. J Orthop Trauma 1997;11(7):484-489.
3. Weigel DP, Marsh JL. High-energy fractures of the tibial plateau. Knee function after longer follow-up. J Bone Joint Surg Am 2002;84(9):1541-1551.
4. Ricci WM, Rudzki JR, Borrelli J Jr. Treatment of complex proximal tibia fractures with the less invasive skeletal stabilization system. J Orthop Trauma 2004;18(8):521-527.
5. Gosling T, Schandelmaier P, Muller M, Hankemeier S, Wagner M, Krettek C. Single lateral locked screw plating of bicondylar tibial plateau fractures. Clin Orthop Relat Res 2005;439:207-214.
6. Egol KA, Tejwani NC, Capla EL, Wolinsky PL, Koval KJ. Staged management of high-energy proximal tibia fractures (OTA types 41): The results of a prospective, standardized protocol. J Orthop Trauma 2005;19(7):448-455.
7. Watson JT, Moed BR, Karges DE, Cramer KE. Pilon fractures. Treatment protocol based on severity of soft tissue injury. Clin Orthop Relat Res 2000;78-90.
8. Haidukewych GJ, Collinge CA. Conversion of Temporary External Fixation to Formal Internal Fixation for Complex per Articular Injuries of the Lower Extremity: Is there an Infection risk? Presented at the American Academy of Orthopaedic Surgeons Annual Meeting, Dallas, Texas; 2002.

How to Cite this article:  Qureshi MS, Panat M, Israni P. Two-Staged Management of Proximal Tibial Fractures with Impending Compartment Syndrome By Temporary External Stabilization and Fasciotomy and Delayed Definitive Fixation. Trauma International Sep-Dec 2017;3(2):16-20.

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Fractures of the distal end of humerus treated with joshi external stabilizing system

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Vol 3 | Issue 2 | Sep – Dec 2017 | page: 8-11 | Meganath Pawar, Mohammed Ibrahim

Author: Meganath Pawar [1], Mohammed Ibrahim [2].

[1]Department of Orthopaedics, ESIC Medical College, Gulbarga, Karnataka, India,
[2]Department of Orthopaedics, GIMS Medical College, Gulbarga, Karnataka, India.

Address of Correspondence
Dr. Mohammed Ibrahim
Department of Orthopaedics, GIMS Medical College, Gulbarga, Karnataka, India.
Email: dribrahimparvez@gmail.com

Learning Points for this Article: Application of simple and easy method for treated of complex fractures at peripheral level

Abstract

Fracture of the distal humerus is a common and debilitating injury and accounts for 2% of all adult fractures. Patients with displaced, unstable distal humeral fractures may have improved outcomes if managed operatively.
Objectives: The objectives were aimed to study the results of using Joshi’s external stabilizing system (JESS) for the management of fractures of distal humerus.
Materials and Methods: This prospective study was conducted in GGHGulbarga on 15 subjects with distal humerus fractures. As per AO classification,C typefractures were included and prepared for JESS fixation. The results of the treatment were evaluated as per Cassebaum functional criteria. Patients were followed up for 12 months.
Results: Among15 patients, 9 males and 6 females, 6 hadC1, 6 had C2, and 3 had C3. Mean duration of JESS application was 8 weeks. Among 15 patients,10 had excellent, 3 had satisfactory result, and 2 had unsatisfactory result.
Conclusion: JESS is an alternativesimple and easyoption for the treatment of distal humerus fractures, showing excellent to good results in cases of AO C1, C2, and C3 fracture.
Keywords: Distal humerus intracondylar, Joshi’s external stabilizing system.

 References

1. Babhulkar S, Babhulkar S. Controversies in the management of intra-articular fractures of distal humerus in adults. Indian J Orthop2011;45(3):216-225.
2. Galano GJ, Ahmad CS, Levine WN. Current treatment strategies for bicolumnar distal humerus fractures. J Am AcadOrthopSurg2010;18(1):20-30.
3. Safoury YA, Atteya MR. Treatment of post-infection nonunion of the supracondylar humerus with Ilizarov external fixator. J Shoulder Elbow Surg2011;20(6):873-879.
4. Zlotolow DN, Catalano LW, Barron OA,Glickel SZ. Surgical exposure of the humerus. J Am AcadOrthopSurg2006;14(13):754-765.
5. Qureshi KK, Sabir MR, Yasin G. Assessment of elbow function after stable fixation of AO Type C fracture of the distal humerus in adults. Prof Med J 2005;12:331-335.
6. Cheung EV, Steinmann SP. Surgical approaches to the elbow. J Am AcadOrthopSurg2009;17(5):325-333.
7. O’Driscoll SW, Sanchez-Sotelo J, Torchia ME. Management of the smashed distal humerus. OrthopClin North Am2002;33:19-33, vii.
8. Sanchez-Sotelo J, Torchia ME, O’Driscoll SW. Complex distal humeral fractures: Internal fixation with a principle-based parallel-plate technique. Surgical technique. J Bone Joint Surg Am2008;90Suppl 2:31-46.

How to Cite this article:  Pawar M, Ibrahim M. Fractures of the Distal End of Humerus Treated with Joshi External Stabilizing System. Trauma International Sep-Dec 2017;3(2):8-11.

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To study the efficacy and safety of Rivaroxaban in the prevention of venous thromboembolism after Total Hip and Knee Arthroplasty

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Vol 3 | Issue 2 | Sep-Dec 2017 | page: 3-7 | S. K. Rai, V. P. Raman, Naveen Shejale, S. S. Wani, Rohit Varma

Author: S. K. Rai [1], V. P. Raman [2], Naveen Shejale[3], S. S. Wani [1], Rohit Varma [1].

[1]Department of Orthopaedics, Indian Naval Hospital Ship Asvini, Colaba, Mumbai, 400005, India.
[2]Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad, 500055, India.
[3]Department of Orthopaedics, Indian Naval Hospital Ship Kalyani, Visakhapatnam, 530005, India.

Address of Correspondence
Dr. SK Rai
Department of Orthopaedics, Indian Naval Hospital Ship Asvini, Colaba, Mumbai, 400005, India.
Email: skrai47@yahoo.com

Learning Points for this Article: To prevent of venous thromboembolism after total Hip and Knee Arthroplasty there is parenteral low molecular weight heparin is available and being used in many centers but it has to be given my trained paramedic or nurse however oral drug like Rivaroxaban in once daily doses and it is patients friendly and can be taken at home after discharge. It is safe and as effective as parenteral low molecular weight heparin.

Abstract

Objective: Development of venous thrombo-embolism (VTE) including deep venous thrombosis (DVT) is a common complication after total hip and total knee Arthroplasty, pelvic fracture or long bone fractures especially in the lower limb. Currently used drugs for DVT prophylaxis after these procedures have important limitations, including parenteral administration, and unpredictable plasma levels requiring frequent monitoring and dose adjustment leading to decreased patient compliance. In our study we used oral rivaroxaban, which is one of the newer oral anticoagulants and is a direct factor Xa inhibitor that has demonstrated superior efficacy, compared to that of enoxaparin or any parenteral low molecular weight heparin (LMWH).
Materials and Methods: In our study, 180 patients who underwent Total knee replacement (TKR) or Total hip replacement (THR) in our center were included. They were put on oral rivaroxaban, 10 mg once daily, started 6 h after surgery and continued for 3 weeks in case of TKR and 6 weeks in case of THR.
Results: VTE and DVT are common complications after THR and TKR and cause a substantial burden to patients, healthcare providers, increase costs to the patients and increase both morbidity and mortality, if not addressed promptly. Currently available anticoagulants in the form of subcutaneous injection have limitations that lead to decreased compliance with DVT prophylaxis guidelines. Rivaroxaban which is oral 10 mg once daily has superior efficacy compared to enoxaparin or any parenteral LMWH for the prevention of the same and the patient compliance is also very good. There were no incidences of increased bleeding or wound infection in our study as compared to control group which were given subcutaneous enoxaparin.
Keywords: Venous thrombo-embolism, deep vein thrombosis, Total knee replacement, Total hip replacement, Rivaroxaban, deep venous thrombosis prophylaxis.

References

1. Kucher N. Clinical practice. Deep-vein thrombosis of the upper extremities. N Engl J Med. 2011;364:861–869. [PubMed]
2. Ciccone WJ, II, Fox PS, Neumyer M, Rubens D, Parrish WM, Pellegrini VD., Jr Ultrasound surveillance for asymptomatic deep venous thrombosis after total joint replacement. J Bone Joint Surg Am. 1998;80:1167–74. [PubMed].
3. Selby R, Borah BJ, McDonald HP, Henk HJ, Crowther M, Wells PS. Impact of thrombo-prophylaxis guidelines on clinical outcomes following total hip and total knee replacement. Thromb Res. 2012;130(2):166–72. [PubMed].
4. Prevention of venous thrombosis and pulmonary embolism. NIH Consensus Development. JAMA. 1986;256:744–749. [PubMed].
5. Cohen AT. Asia-Pacific Thrombosis Advisory Board. Asia-Pacific Thrombosis Advisory Board consensus paper on prevention of venous thromboembolism after major orthopaedic surgery. Thromb Haemost. 2010;104:919–930. [PubMed].
6. Piovella F, Wang CJ, Lu H, Lee K, Lee LH, Lee WC, et al. Deep-vein thrombosis rates after major orthopedic surgery in Asia. An epidemiological study based on postoperative screening with centrally adjudicated bilateral venography. J Thromb Haemost. 2005;3:2664–2670. [PubMed]
7. Januel JM, Chen G, Ruffieux C, Quan H, Douketis JD, Crowther MA, et al. Symptomatic in-hospital deep vein thrombosis and pulmonary embolism following hip and knee arthroplasty among patients receiving recommended prophylaxis: a systematic review. JAMA. 2012;307:294–303. [PubMed]
8. Eikelboom JW, Karthikeyan G, Fagel N, Hirsh J. American Association of Orthopedic Surgeons and American College of Chest Physicians guidelines for venous thromboembolism prevention in hip and knee arthroplasty differ: what are the implications for clinicians and patients? Chest. 2009;135:513–520. [PubMed]
9. D. Kubitza, M. Becka, W. Mueck et al., “Effects of renal impairment on the pharmacokinetics, pharmacodynamics and safety of rivaroxaban, an oral, direct Factor Xa inhibitor,” British Journal of Clinical Pharmacology, vol. 70, no. 5, pp. 703–712, 2010.
10. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th Edition) Chest. 2008;133(6 Suppl):381S–453S. doi: 10.1378/chest.08-0656 . [PubMed]
11. Kim YH, Oh SH, Kim JS. Incidence and natural history of deep-vein thrombosis after total hip arthroplasty. A prospective and randomised clinical study. J Bone Joint Surg Br. 2003;85(5):661–665.[PubMed]
12. Stringer MD, Steadman CA, Hedges AR, Thomas EM, Morley TR, Kakkar VV. Deep vein thrombosis after elective knee surgery. An incidence study in 312 patients. J Bone Joint Surg Br. 1989;71(3):492–497.[PubMed]
13. Fisher CG, Blachut PA, Salvian AJ, Meek RN, O’Brien PJ. Effectiveness of pneumatic leg compression devices for the prevention of thromboembolic disease in orthopaedic trauma patients: a prospective, randomized study of compression alone versus no prophylaxis. J Orthop Trauma. 1995;9(1):1–7. [PubMed]
14. Lachiewicz PF, Kelley SS, Haden LR. Two mechanical devices for prophylaxis of thromboembolism after total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg Br. 2004;86(8):1137–1141.[PubMed]
15. Hull R, Raskob G, Pineo G, Rosenbloom D, Evans W, Mallory T, et al. A comparison of subcutaneous low-molecular-weight heparin with warfarin sodium for prophylaxis against deep-vein thrombosis after hip or knee implantation. N Engl J Med. 1993;329(19):1370–1376. [PubMed]
16. Hull RD, Pineo GF, Francis C, Bergqvist D, Fellenius C, Soderberg K, et al. Low-molecular-weight heparin prophylaxis using dalteparin extended out-ofhospital vs in-hospital warfarin/out-of-hospital placebo in hip arthroplasty patients: a doubleblind, randomized comparison. North American Fragmin Trial Investigators. Arch Intern Med. 2000;160(14):2208–2215. [PubMed]
17. Stewart DW, Freshour JE. Aspirin for the prophylaxis of venous thromboembolic events in orthopedic surgery patients: a comparison of the AAOS and ACCP guidelines with review of the evidence. Ann Pharmacother. 2013;47(1):63–74. [PubMed]
18. Palmer AJ, Koppenhagen K, Kirchhof B, Weber U, Bergemann R. Efficacy and safety of low molecular weight heparin, unfractionated heparin and warfarin for thrombo-embolism prophylaxis in orthopaedic surgery: a meta-analysis of randomised clinical trials. Haemostasis. 1997;27(2):75–84. [PubMed]
19. Mont MA, Jacobs JJ. AAOS clinical practice guideline: preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. [[cited 2014 Jan 19]];J Am Acad Orthop Surg. 2011 Dec 19(12):777–8. [Internet] Available from: http://www.ncbi.nlm.nih.gov/pubmed/22134210 . [PubMed]
20. Lassen MR, Gallus A, Raskob GE, Pineo G, Chen D, Ramirez LM. Apixaban versus enoxaparin for thromboprophylaxis after hip replacement. N Engl J Med. 2010;363(26):2487–2498. [PubMed]
21. Eriksson BI, Dahl OE, Rosencher N, Kurth AA, van Dijk CN, Frostick SP, et al. Oral dabigatran etexilate vs. subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the RE-MODEL randomized trial. J Thromb Haemost. 2007;5(11):2178–2185. [PubMed]
22. Eriksson BI, Borris LC, Friedman RJ, Haas S, Huisman MV, Kakkar AK, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med. 2008;358(26):2765–2775.[PubMed].
23. Jameson SS, Rymaszewska M, Hui ACW, James P, Serrano-Pedraza I, Muller SD. Wound complications following rivaroxaban administration: a multicenter comparison with low-molecular-weight heparins for thromboprophylaxis in lower limb arthroplasty. J Bone Joint Surg Am. 2012;94(17):1554–1558. [PubMed].

How to Cite this article: Rai S K, Raman V P, Shejale N, Wani S S, Varma R. To study the efficacy and safety of Rivaroxaban in the prevention of venous thromboembolism after Total Hip and Knee Arthroplasty. Trauma International Sep – Dec 2017;3(2):3-7.

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Acute Complete Acromioclavicular Dislocations: A Prospective Multicenter Therapeutic Study Comparing Combined Intra-articular and Extra-articular Fixation with Intra-articular K-wire Fixation

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Vol 3 | Issue 2 | Sep – Dec 2017 | page: 21-24 | Biswajit Sahu, Ranajit Panigrahi, Nishit Palo, Ashok Priyadarshi, Saswat Samant

Author: Biswajit Sahu [1], Ranajit Panigrahi [2], Nishit Palo [3], Ashok Priyadarshi [4], Saswat Samant [5].

[1] Department of Orthopaedics, VSS Medical College.
[2] Department of orthopedics, Hi-Tech Medical College
[3] Department of Orthopaedics, Santosh Medical College,Ghaziabad, UP.
[4] Department of orthopedics, Hi-Tech Medical College, Bhubaneswar

Address of Correspondence
Dr Saswat Samant
Department of Orthopaedics, Hi-tech Medical College
Bhubaneswar.
Email: Saswatsamant135@gmail.com

Learning Points for this Article: Isolated intra-articular K-wire fixation also fails to provide the required stability to the injured joint, especially in developing countries, where patients fail to adhere to the rehabilitation protocol. Thus, combining both, the intra-articular and coracoclavicular fixations seem to be a promising modality in terms of stability and secure fixation. Combining the intra- and extra-articular techniques significantly decreases the complication rates as seen with the isolated fixation techniques.

Abstract

The AC joint is commonly involved in traumatic injuries that affect the shoulder.Treatment of these injuries has been controversial and continues to evolve to this day ranging from conservative management and k-wire fixations to screw fixation, and more recently, arthroscopically assisted ligament reconstructions with no definite consensus about the ideal method of treatment.Each modality has its own advantages and disadvantages. In this prospective therapeutic multicenter study, we compared combined intra-articular fixation and screw coracoclavicular repair versus the intra-articular fixation with k-wires alone to assess the stability, failure rates, and outcomes of combining the two methods of fixation versus isolated intra-articular fixation.combining both, the intra-articular and coracoclavicular fixations seem to be a promising modality in terms of stability and secure fixation. Combining the intra- and extra-articular techniques significantly decreases the complication rates as seen with the isolated fixation techniques.
Keywords: Acromioclavicular dislocations, intra-articular, multicenter.

References

1. Simovitch R, Sanders B, Ozbaydar M, Lavery K, Warner JJ. Acromioclavicular joint injuries: Diagnosis and management. J Am Acad Orthop Surg 2009;17(4):207-219.
2. Galatz LM, Hollis Jr RF, Williams Jr GR. Acromioclavicular Joint Injuries. Rockwood and Green’s Fractures in Adults. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 1210-1242.
3. De Carli A, Lanzetti RM, Ciompi A, Lupariello D, Rota P, Ferretti A. Acromioclavicular third degree dislocation: Surgical treatment in acute cases. J Orthop Surg Res 2015;10(1):13.
4. Saccomanno MF, Fodale M, Capasso L, Cazzato G, Milano G. Reconstruction of the coracoclavicular and acromioclavicular ligaments with semitendinosus tendon graft: A pilot study. Joints 2014;2(1):6-14.
5. Steinbacher G, Sallent A, Seijas R, Boffa JM, Espinosa W, Cugat R. Clavicular hook platefor grade-III acromioclavicular dislocation. J Orthop Surg (Hong Kong) 2014;22(3):329-332.
6. Zhu YY, Cui HY, Jiang PQ, Wang JL. Complications of treatment of acromioclavicular joint dislocation and unstable distal clavicular fracture with clavicular hook plate. Zhongguo Gu Shang 2013;26(11):927-931.
7. Virtanen KJ, Savolainen V, Tulikoura I, Remes V, Haapamäki V, Pajarinen J, et al. Surgical treatment of chronic acromioclavicular joint dislocation with autogenous tendongrafts. Springerplus 2014;3:420.
8. Stucken C, Cohen SB. Management of acromioclavicular joint injuries. Orthop Clin North Am 2015;46(1):57-66.
9. Tidwell JE, Kennedy PM, McDonough EB. Concurrent treatment of a middle-third clavicle fracture and Type IV acromioclavicular dislocation. Am J Orthop (Belle Mead NJ) 2014;43(11):E275-E278.
10. Pan Z, Zhang H, Sun C, Qu L, Cui Y. Arthroscopy-assisted reconstruction of coracoclavicular ligament by Endobutton fixation for treatment of acromioclavicular joint dislocation. Arch Orthop Trauma Surg 2015;135(1):9-16.
11. Williams GR, Nguyen VD, Rockwood CR. Classification and radiographic analysis of acromioclavicular dislocations. Appl Radiol 1989;12:29-34.
12. Tossy JD, Mead NC, Sigmond HM. Acromioclavicular separations: Useful and practical classification for treatment. Clin Orthop Relat Res 1963;28:111-119.
13. Adams FL. The Genuine Works of Hippocrates. Vol. 1-2. New York: William Wood &Company; 1886.
14. Bearn JG. Direct observations on the function of the capsule of the sternoclavicular joint in clavicular support. J Anat 1967;101(Pt 1):159-170.
15. Cadenat FM. The treatment of dislocations and fractures of the outer end of the clavicle. Int Clin 1917;1:145-169.
16. Weaver JK, Dunn HK. Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am 1972;54(6):1187-1194.
17. Wolf EM, Pennington WT. Arthroscopic reconstruction for acromioclavicular joint dislocation. Arthroscopy 2001;17(5):558-563.
18. Lancourt JE. Acromioclavicular dislocation with adjacent clavicular fracture in a horseback rider. A case report. Am J Sports Med 1990;18(3):321-322.

How to Cite this article: Sahu B, Panigrahi R, Palo N, Priyadarshi A, Samant S. Acute Complete Acromioclavicular Dislocations: A Prospective Multicenter Therapeutic Study Comparing Combined Intra-articular and Extra-articular Fixation With Intra-articular K-wire FixationTrauma International Sep-Dec 2017;3(2):21-24.

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New Comprehensive Classification Systems for Peri-trochanteric Femur Fractures

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Vol 3 | Issue 2 | Sep – Dec 2017 | page: 31-34 | Aditya K. Agrawal

Author: Aditya K. Agrawal [1].

[1]Dept of Orthopaedics, Dhiraj Hospital, SBKS MIRC, SumandeepVidyapeeth, Waghodia, Vadodara, Gujarat, 391760 India.

Address of Correspondence
Dr. Aditya K. Agrawal
Dept of Orthopaedics, Dhiraj Hospital,
SBKS MIRC, SumandeepVidyapeeth, Waghodia,
Vadodara, Gujarat, 391760 India.
Email: adityagrawal83@gmail.com

Abstract

Purpose: A classification is considered as good classification if it describes the particularregion of bone, type of fracture, personality of fracture in either planes and helps in selectionof implant and most importantly easy to understand by an orthopedic surgeon. Classification becomes more complicated when there is double region involvement with comminution,or distal fracture is in shaft leading to segmental fracture.
Materials and Methods: There are numerous classification systems available in the presentliterature for peri-trochanteric femur fractures. These include Evan’s, Tronzo, and Boyd andGriffin, OTA classifications for peri-trochanteric region, Seinsheimer’s and Fieldingclassifications for sub-trochanteric region. AO classification which is widely acceptedcritically defines peri-trochanteric, head and neck region of fracture femur.
Results: Drawbacks of existing classifications are that they are based on fractureconfiguration in sagittal plane only except Seinsheimer’s classification which is based oncoronal plane fracture morphology. Furthermore, double regions/ multiple regions arenot properly defined in these classification systems. If the proper classification system is not followed, it will lead to the selection of wrong implants which thereby leads to complications.
Discussion: Advantages of our new classification system are that it is easy to understand; allregions of peri-trochanteric femur are covered, and in the selection of proper implant.Hence, intra-operative complications can be avoided with proper pre-operative planning.
Conclusion: Thus, we hope that our new comprehensive classification of peri-trochantericfemur may help to solve the mysteries surrounding the understanding, classifying, and treating the fractures of peri-trochanteric femur.
Keywords: Classification, comprehensive, femur, fracture, peri-trochanteric.

References

1. Marks R. Hip fracture epidemiological trends, outcomes, and risk factors, 1970-2009. Int J Gen Med 2010;3:1-17.
2. Chang KP, Center JR, NguyenTV, Eisman JA. Incidence of hip and other osteoporotic fractures in elderly men andwomen: Dubbo osteoporosis epidemiology study. J Bone Miner Res 2004;19:532-6.
3. Saudan M, Lubbeke A, Sadowskil C, Riand N, Stern R, Hoffmeyer P,.“Per-trochanteric fractures: Is there an advantage to an intramedullary nail: A randomized prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail,”. JOrthopTrauma, 2002; 16,386-93.
4. Pajarinen J,Lindahl J, Michelsson O, Savolainen V, Hirvensalo E. Pertrochanteric femoralfractures treated with a dynamic hip screw or a proximal femoral nail. A randomised study comparing post-operative rehabilitation. J Bone Joint Surg Br 2005;87:76-81.
5. Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin OrthopRelat Res 1998;348:87-94.
6. DavisTR, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG. Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br 1990;72:26-31.
7. Adams C.I, Robinson C. M, Court-Brown C.M, and Mcqueen M.M. “Prospective randomized controlled trail of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur,.” JOrthopTrauma, 2001; 15, 394-400.
8. Gadegone WM, Salphale YS. Proximal femoral nail-an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year. IntOrthop 2007;31:403-8.
9. Ballal MS, Emms N,Thomas G. Proximal femoral nail failures in extracapsular fractures of the hip. JOrthopSurg (Hong Kong) 2008;16:146-9.
10. Flores LA, Harrington IJ, Heller M.The stability of intertrochanteric fractures treated with a sliding screw-plate. J BoneJoint Surg Br 1990;72:37-40.
11. Bridle S.H, Patel A.D, Bircher M,. (1991) “Fixation of intertrochantericfractures of the femur: A randomized prospective comparison of the gamma nail anddynamic hip screw,”.J Bone Joint Surg, 1991; 73,330-4.
12. Halder SC.The Gamma nail for peritrochanteric fractures. J Bone Joint Surg Br 1992;74:340-4.
13. Schipper IB, Steyerberg EW, Castelein RM, van der HeijdenFH, den Hoed PT, Kerver AJ, et al. Treatment of unstable trochanteric fractures.Randomised comparison of the gamma nail and the proximal femoral nail. J BoneJoint Surg Br 2004;86:86-94.
14. Morihara T, Arai Y,Tokugawa S, Fujita S, Chatani K, Kubo T. Proximal femoral nail for treatment oftrochanteric femoral fractures. J OrthopSurg (Hong Kong) 2007;15:273-7.

How to Cite this article:  Agrawal A. K. New Comprehensive Classification Systems for Peri-trochanteric Femur Fractures. Trauma International Sep-Dec 2017;3(2):31-34.

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Percutaneous Release of Trigger Finger: A Safe And Cost effective Procedure

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Vol 3 | Issue 2 | Sep – Dec 2017 | page: 25-27 | Vinod Nair, Amit Chaudhary, Clevio Desouza, Harshal Hurkat, Shiju George

Author: Vinod Nair [1], Amit Chaudhary [1], Clevio Desouza [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
D. Y. Patil Medical College, Pimpri, Pune ,Maharashtra

Email: cleviod@yahoo.com

Learning Points for this Article: This articles shows us that although in its initial stages percutaneous release of trigger finger is a safe and cost effective procedure.

Abstract

Introduction: Trigger finger is a common cause of pain and disability of the hand. Trigger finger (or thumb) arises either from thickening of the flexor tendon sheath (which occurs following tenosynovitis of infective, traumatic or rheumatolgical origin) or from nodular thickening of the flexor tendon itself which may be congenital. Percutaneous release results in earlier functional recovery and patient satisfaction. This is a cost-effective and rapid method which saves a surgical procedure and results in a better functional outcome.
KeyWords: Trigger finger, percutaneous release, outpatient treatment, cost-benefit analysis.

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How to Cite this article:  Nair V, Chaudhary A , Desouz C, Hurkat H, George S. Percutaneous Release of Trigger Finger: A Safe and Cost effective Procedure. Trauma International Sep-Dec 2017;3(2):25-27.

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