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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
Fractures of the distal end of humerus treated with joshi external stabilizing system
/in Volume 3 | Issue 2 | Sep-DecVol 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
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To study the efficacy and safety of Rivaroxaban in the prevention of venous thromboembolism after Total Hip and Knee Arthroplasty
/in Volume 3 | Issue 2 | Sep-DecVol 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.
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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
/in Volume 3 | Issue 2 | Sep-DecVol 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
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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.
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New Comprehensive Classification Systems for Peri-trochanteric Femur Fractures
/in Volume 3 | Issue 2 | Sep-DecVol 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.
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Percutaneous Release of Trigger Finger: A Safe And Cost effective Procedure
/in Volume 3 | Issue 2 | Sep-DecVol 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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18. Sahu R, Gupta P. Experience of percutaneous trigger finger release under local anesthesia in the medical college of Mullana, Ambala, Haryana. Ann Med Health Sci Res 2014;4(5):806-809.
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20. Eastwood DM, Gupta KJ, Johnson DP. Percutaneous release of the trigger finger: An office procedure. J Hand Surg Am 1992;17(1):114-117.
21. Elsayed MM. Percutaneous release of trigger finger. Egypt Orthop J. 2013; 48(3): 277.
22. Diab RA. Percutaneous release of trigger finger. J Orthop Surg (Hong Kong). 2015; 23(2): 241-242.
23. Pope DF, Wolfe SW. Safety and efficacy of percutaneous trigger finger release. J Hand Surg Am 1995;20(2):280-283.
24. Guler F, Kose O, Ercan EC, Turan A, Canbora K. Open versus percutaneous release for the treatment of trigger thumb. Orthopedics 2013;36(10):e1290-e1294.
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Evaluation of Radiological and Functional Outcome of Calcaneum Fractures using Essex-Lopresti Technique of Reduction
/in Volume 3 | Issue 2 | Sep-DecVol 3 | Issue 2 | Sep -Dec 2017 | page: 28-30 | Atul A Kharat, Sandeep R Biraris, Pramod P Chikhalikar, Sheran Ali, G Krishna Naresh Goud
Author: Atul A Kharat [1], Sandeep R Biraris [2], Pramod P Chikhalikar [3], Sheran Ali [1], G Krishna Naresh Goud [2].
[1]Department of Orthopaedics, Pad. Dr D Y Patil Medical College & Hospital, Nerul, Navi Mumbai.
[2]Department of Orthopaedics, Mumbai Port Trust Hospital, Wadala (E), Mumbai.
[3]Department of Orthopaedics, Pad. Dr D Y Patil Medical College, Pune.
Address of Correspondence
Dr. Sandeep R Biraris,
Department of Orthopaedics, Mumbai Port Trust Hospital, Wadala (E), Mumbai, Maharashtra-400037.
Email: drsandeeprb@gmail.com
Learning Points for this Article: This articles states about various treatment modalities about management of the calcaneum fractures, it shows that non-displaced fractures can be treated conservatively and also Bohler’s and Gissane’s angles should be maintained post-operatively to have a good functional outcome.
Abstract
Background: Calcaneum fractures account for approximately 2% of all fractures, with displaced intra-articular fractures comprising 60-75% of these injuries of which 10% have associated spine fractures and 26% are associated with other extremity injuries. Several authors have reported that patients may be totally incapacitated for up to 3 years and partially impaired for up to 5 years post injury, Although modern surgical techniques have improved the outcome, controversy still exists regarding classification, treatment, operative technique, and post-operative management.
Materials and Methods: 28 out of 31 cases were analyzed prospectively and retrospectively from July 2011 to August 2013 after local ethical and scientific clearance. Three patients had lost to follow-up. All patients with calcaneum fractures above age of 18 with either simple or open injuries were included in the study, excluding pediatric and complex injuries. All patients were clinically evaluated and Bohler’s, Gissane’s angles were calculated preoperatively. All patients were treated with one of the modalities, which include conservative, Steinmann pinning, and Calcaneum plate fixation. All patients were followed up in outpatient basis fortnightly for 3 months and on 6th month and 1 year respectively, to check signs of union of fracture, subtalar movements, and complications if any. After radiological evaluation, functional outcome assessment was done using American Orthopaedic Foot and Ankle Society
Results: Mean age was 35.1 with range 20-52 years, male to female ratio of 9:1. 85% were due to high-velocity trauma. The most common type of injury was tongue type. Preoperative mean Bohler’s and Gissane’s angles which were about 14.87 and 121.5 degrees respectively, the improved angles postoperatively were 25.68 and 104.37 degrees. One patient had heel pain, one patient had residual edema, one patient developed subtalar and ankle stiffness, there was one case of tendocalcaneus weakness, one with broadening of heel, and one case of wound infection.
Conclusion: Undisplaced or minimally displaced calcaneum fractures are best-treated conservatively with cast immobilization for 6 weeks. Essex-Lopresti technique of reduction was superior technique for displaced fractures and achievement of Bohler’s and Gissane’s angle to the after reduction was judgemental for optimal functional outcome.
Keywords: Calcaneum, Essex-Lopresti, functional outcome.
References
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