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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
Galeazzi fracture associated with an ipsilateral fracture of ulna diaphysis and olecrane. A rare lesional association. About a case and review of literature
/in May- Dec 2019 | Volume 5 | Issue 2Vol 5 | Issue 2 | May-Dec 2019 | page: 14-16 | Akloa Komlavi Ehlissou Kolima, Bakriga Batarabadja, Kombate, Ayouba Gamal, Akpoto Menssavi Yaovi, Dellanh Yaovi Yannick, Towoezim Tchaa Hodabalo, Abalo Anani Grégoirei
DOI 10.13107/ti.2019.v05i01.094
Author: Akloa Komlavi Ehlissou Kolima [1], Bakriga Batarabadja [1], Kombate Noufanangue Kanfitine [1], Ayouba Gamal [1], Akpoto Menssavi Yaovi [1], Dellanh Yaovi Yannick [1], Towoezim Tchaa Hodabalo [1], Abalo Anani Grégoirei [1]
[1] Department of Orthopaedic and traumatology Surgery Teaching University Hospital Sylvanus Olympio. Lomé-Togo PO Box. 14148.
Address of Correspondence
Dr. Akloa Komlavi Ehlissou Kolima,
Department of Orthopaedic and traumatology Surgery Teaching University Hospital Sylvanus Olympio. Lomé-Togo PO Box. 14148
E-mail: akloakolima@yahoo.fr
Abstract
Introduction: Tripolar lesions of the thoracic limb are rare. We report a rare a Galéazzi fracture associated with an ipsilateral fracture of ulna and olecranon in a 45-year-old patient. Surgical management has been delayed due to limited resources of the patient.
Case presentation: It was a 45-year-old man admitted in our emergency after a fallen on bicycle. He presented a fracture of olecranon, shaft bone fracture of radius and ulnar, and distal radio-ulnar disjunction. The assessment at 18 months has found a consolidation of fractures. The elbow and wrist regained joint range, but we noted a limitation of prono-supination related to radioulnar synostosis. This limitation had no impact on the professional and sporting activities of the patient.
Conclusion: Apart the difficulties to describe mechanism responsible of this complex lesion, the functional prognosis of the limb depends on a correct diagnosis and adequate management. At the last follow-up, the patient was satisfied with the result obtained. Longer term follow-up will allow us to determine the issue of this complex lesion in this patient. For the moment patient is not complained so wejust wait and see.
Keywords: Galeazzi fracture, distal radioulnar disjunction, fractures, forearm, olecranon.
References
1. Sandeep JS, Kevin CC.A Historical Report on Riccardo Galeazzi and the Management of Galeazzi Fractures. Hand Surg Am. 2010; 35(11): 1870–77.
2. Nihar RP, Poonam P. Ipsilateral Combined Monteggia and Galeazzi Injuries presenting late: A case report. Injury Extra. 2005; 36 (10): 458-62.
3. Jafari D, Taheri H, Shariatzade H, Mazhar FN, Jalili A, Ghahramani MH, Bilateral combined Monteggia and Galeazzi fractures: a case report. MJIRI. 2012; 26(1): 41-4.
4. Sang BK, Youn MH, Yi JW, Le JB, Lim BG. Shaft Fractures of Both Forearm Bones: The Outcomes of Surgical Treatment with Plating Only and Combined Plating and Intramedullary Nailing. Clinics in Orthopedic Surgery. 2015; 7(3): 282-290
5. Ömer CGökhan P, Gökhan K, Deniz K, Mehmet E. Ipsilateral olecranon and distal radius fracture: A case report. IJSCR. 2015; 6: 194–197
6. Asadollahi S, Shepherd D, Hau RC. Elbow Fracture-Dislocation Combined with Galeazzi Fracture in Adult: A Case Report and Literature Review. International Journal of Surgery Case Reports. 2013 ; 4: 748-52.
7. Abalo A, Akloa KK, Dellanh YY. Elbow Dislocation with Ipsilateral Galeazzi Fracture: A Case Report. Open Journal of Orthopedics. 2016; 6: 276-82.
8. Droll KP, Perna P, Potter J, Harniman E, Schemitsch EH, McKee MD. Outcomes Following Plate Fixation of Fractures of Both Bones of the Forearm in Adults. J Bone Joint Surg. 2007; 89(12): 2619-24.
9. Mikiéla A, Abiome R, Obiang Enguié AC, Mba Angoué JM, Diawara M. Treatment of diaphyseal fractures of the forearm in the adult by pinning of the ulna and plate of the radius (A prospective study of 27 cases). Tun Orth. 2015; l7 (1): 21-24.
10. Khemiri CH, Rebhi T, Hidoussi O, Maalla R, Kanoun ML, Ben Dali N. osteosynthesis diaphyseal fractures isolated of Ulna. Intramedullar nailing or screwed plate ?Tun orthop. 2012; 5: 56-60.
11. Abalo A, Dossim A, Assiogbo A, Walla A, Ouedraogo A. intramedullary fixation using kirschner wires for forarm fractures: a developing country perspectives. J Ortho Surg. 2007; 15: 19-22.
12. ogoua RD, Traore M, Kouamé M, Mambo M, Yépié A, Anoumou M. racking centromedullary bones of the forearm in adults. J Afr Chir Orthop Traumatol. 2018; 3 (1): 15-20.
13. Ikeda M, Fukushima Y, Kobayash Y, Oka Y. Comminuted fractures of the olecranon management by bone graft from the iliac crestand multiple tension-band wiring. The journal of bone and joint surgery. 2001; 83 (6): 885-88.
14. Reckling FW. Unstable fracture-dislocations of the forearm (Monteggia anGaleazzi lesions). J Bone Joint Surg Am. 1982; 64:857–63.
15. Giannoulis FS, Sotereanos DG Galeazzi fractures and dislocations. Hand Clin. 2007; 23:153–163.
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From The Editor’s Desk!!
/in Jan. - April 2019 | Volume 5 | Issue 1Vol 5 | Issue 1 | Jan – April 2019 | page:1-2 | Dr. Ashok Shyam.
Author: Dr. Ashok Shyam [1,2].
[1] Indian Orthopaedic Research Group, Thane, India
[2] Sancheti Institute for Orthopaedics & Rehabilitation, Pune, India
Address of Correspondence
Dr. Ashok Shyam
IORG House, A-203, Manthan Apts, Shreesh, CHS, Hajuri Road, Thane, India. 400604
Email: drashokshyam@yahoo.co.uk
We thank authors for their contribution in the July-December 2020 issue of Trauma International. This issue contains articles on operative treatment of distal femur fractures using retrograde intramedullary nail versus locking plate, Relationship between Vitamin D Level and Hip Fractures, Tranexamic Acid in an Accident & Emergency Department, Chronic osteomyelitis, Cannulated Cancellous Screw and Ender’s Nail Fixation in Stable Intertrochanteric Femur Fracture, Conservative and Surgical Management of Displaced Midshaft Clavicle Fracture, Tibial Plateau Fractures. We appreciate efforts of the author s and hope for more contribution in the field of orthopaedic literature in the coming years.
Dr Ashok Shyam
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The New Age of Trauma Resuscitation – Introducing Tranexamic Acid in an Accident & Emergency Department in Karachi Pakistan
/in Jan. - April 2019 | Volume 5 | Issue 1Vol 5 | Issue 1 | Jan-April 2019 | page: 10-13 |Muhammad Muzzammil, Muhammad Saeed Minhas, Jahanzeb Effendi, Syed Jahanzeb, Muhammad Ovais, Azeem Jamil, Ayesha Mughal, Abdul Qadir
Author: Muhammad Muzzammil[1], Muhammad Saeed Minhas[2], Jahanzeb Effendi[3], Syed Jahanzeb[2], Muhammad Ovais[1], Azeem Jamil[2], Ayesha Mughal[2], Abdul Qadir[2]
1Department of Orthopedics, Dr. Ruth K M Pfau Civil Hospital , Karachi.
2Department of Orthopedics, Jinnah Post Graduate Medical Centre, Rafiqui Shaheed Road, Karachi.
3Department of surgery, MC 7742, San Antonio.
Address of Correspondence
Dr. Muhammad Muzamil,
Department of Orthopedics, Dr. Ruth K M Pfau Civil Hospital , Karachi.
Email: muzzammil_sangani@hotmail.com
Abstract
Background: In traumatic patients there is increase loss of blood and requires excessive blood transfusion as compared to other diseases. Clinical efficacy and clinical safety of tranexamic acid in decreasing blood loss assess during this study in post traumatic patients.
Method: Prospectively conducted randomized doubleblind placebo controlled study carried out. Patients were blindly randomized into two groups to receive either intravenous 1gm tranexamic acid 20 min or similar volume of 0.9% saline as placebo (P). Inclusion criteria was based on pulse rate >110 per min or systolic pressure level <90mmHg, hemorrhage or in danger of serious hemorrhage.Patients’ total blood loss was measured, needs of transfusion and hospital stay recorded. The post traumatic hemoglobin, hematocrit values, serum creatinine, activated thromboplastin time, prothombin time, platelets count and pulmonary embolism symptoms were comparatively evaluated.
Results: The total measured blood loss in tranexamic acid group (276 ± 53 mL) when comparing to control group (523 ± 74 mL) was less significantly. The requirement of blood transfusion in comparison was high in the control group and post traumatic hematocrit values were higher with in the tranexamic acid group. After administration of tranexamic acid in traumatic patients there have been no clinically relevant differences within the vital signs and no thromboembolic complications were detected in either group.
Conclusion: In traumatic patients, the prophylactic usage of tranexamic acid has effectively decreased blood loss, transfusion needs and hospital stay without any complication or adverse effects of thrombosis. Thus, TXA can be used safely and effectively in trauma subjects.
Keywords: trauma, tranexamic acid, blood loss, transfusion, hospital stay.
References
1. Astedt B. Clinical pharmacology of tranexamic acid. Scandinavian Journal of Gastroenterology. 1987; 22: 22–5.
2. Henry DA, Carless PA, Moxey AJ, O’Connell D, Stokes BJ, McClelland B, et al. Antifibrinolytic use for minimizing perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2007;4:CD001886.
3. “Lysteda (tranexamic acid) Package Insert” (PDF). (online)(Cited 2 June 2016). Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/022430s004lbl.pdf.
4. Roberts I. Tranexamic acid: a recipe for saving lives in traumatic bleeding. J Tehran Heart Cent 2011; 6:178.
5. Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs 1999; 57:1005-32.
6. CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomized, placebo-controlled trial. Lancet 2010; 376: 23–32.
7. TXA implementation pages—how to do it. (online) (Cited 2 June 2016). Available from: http://www2.le.ac.uk/departments/cardiovascular-sciences/research/population-research-and-clinical-trials/emergency-medicine-group/research/injury/txa-implementation-pages-how-to-do-it.
8. Committee on Tactical Combat Casualty Care. Tranexamic acid (TXA) in tactical combat casualty care. Guideline revision recommendation. 2011. (Online) (cited 2 June 2016). Available from: http://www.medicalsci.com/files/tranexamic_acid__txa__in_tactical_combat_casualty_care.pdf.
9. Luz L, Sankarankutty A, Passos E, Rizoli S, Fraga G, Nascimento Jr B. Tranexamic acid for traumatic hemorrhage. Rev Col Bras Cir.2012;39:77-80
10. CRASH-2 collaborators; Guerriero C, Cairns J, Perel P, Shakur H, Roberts I. Cost-effectiveness analysis of administering tranexamic acid to bleeding trauma patients using evidence from the CRASH-2 trial. PLoS One 2011; 6:e18987.
11. Ker K, Prieto-Merino D, Roberts I. Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss. British Journal of Surgery 2013; 100: 1271–9.
12. Horrow JC, Van Riper DF, Strong MD, Grunewald KE, Parmet JL. The dose-response relationship of tranexamic acid. Anesthesiology 1995; 82: 383–92.
13. Sauaia A, Moore FA, Moore EE, Moser KS, Brennan R, Read RA, et al. Epidemiology of trauma deaths: a reassessment. J Trauma. 1995;38(2):185-93.
14. Hess JR, Brohi K, Dutton RP, Hauser CJ, Holcomb JB, Kluger Y, et al. The coagulopathy of trauma: a review of mechanisms. J Trauma. 2008;65(4):748-54.
15. Mahdy AM, Webster NR. Perioperative systemic haemostatic agents. Br J Anaesth 2004;93:842-58
16. Godier A, Roberts I, Hunt B. Tranexamic acid: less bleeding and less thrombosis. Crit Care2012;16:135.
17. Jiménez J, Iribarren J, Lorente L, Rodríguez J, Hernandez D, Nassar I, et al. Tranexamic acid attenuates inflammatory response in cardiopulmonary bypass surgery through blockade of fibrinolysis: a case control study followed by a randomized double-blind controlled trial. Crit Care2007;11:R117.
18. “The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial.” The Lancet 377(9771): 1101.e1101-1101.e1102.
19. Weber, C. F., et al. “Tranexamic acid partially improves platelet function in patients treated with dual antiplatelet therapy.” European Journal of Anaesthesiology (EJA) 2011;28(1): 57-62
20. Bekassy Z, Astedt B. Treatment with the fibrinolytic inhibitor tranexamic acid-risk for thrombosis? ActaObstetGynecolScand1990;69:353-4.
21. World Health Organization. Injuries and violence: the facts 2014. (Online). Available from URL: http://apps.who.int/iris/bitstream/10665/149798/1/9789241508018_eng.pdf?ua=1&ua=1&ua=1
22. Murray C, Lopez A: The Global Burden of Disease. Volume 1. Cambridge, MA: Harvard University Press; 1996
23. Minhas MS, Khan KM, Effendi J, et al. Improvised explosive devise bombing police bus: Pattern of injuries, patho-physiology and early management [J]. J Pak Med Assoc, 2014, 64 ( 12 Suppl 2 ): S49-S53
24. Minhas M S, Mahmood K, Effendi J, Kumar R, Bhatti A . Terrorist Bomb Blasts: Emergency department management of multiple incidents. Trauma International July-Sep 2015;1(1): 36-40.)
25. Khan, A., et al. “Transfer delay and in-hospital mortality of trauma patients in Pakistan.” International Journal of Surgery 8(2): 155-158.
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A Comparative Study of Conservative and Surgical Management of Displaced Midshaft Clavicle Fracture
/in Jan. - April 2019 | Volume 5 | Issue 1Vol 5 | Issue 1 | Jan-April 2019 | page: 23-27 | Niraj Ranjan, Arvind Agarwal, Atul Garg
Author: Niraj Ranjan [1], Arvind Agarwal [1], Atul Garg [1]
[1] Department of Orthopaedics , Maharaja Agrasen Hospital, New Delhi
Address of Correspondence
Dr. Niraj Ranjan,
Department of Orthopaedics , Maharaja Agrasen Hospital, New Delhi
E-mail: niraj.ranjan333@gmail.com
Abstract
Introduction: Since long, closed midshaft clavicle fractures, whether undisplaced or displaced, have been treated conservatively with figure of “8” bandage and sling. However, in the past few decades, management trends show an uprise in surgical management of displaced midshaft clavicle fracture with rigid internal fixation providing early pain relief and avoiding deformity, non-union (NU), and sequelae.
Materials and Methods: A total of 60 patients with displaced midshaft clavicle fracture were included in the study. Patients were randomly allocated to the non-operative and operative group with 30 patients in each group. Non-operative management was performed with clavicle brace (figure of 8 bandage) while open reduction internal fixation with plate fixation was the preferred operative treatment. Patients were followed up at 2, 4, and 6 weeks and then at 3, 6, and 12 months. Outcome analysis included standard clinical follow-up, the constant shoulder (CS) score and the disabilities of the arm, shoulder, and hand (DASH) score, and plain radiographs. Statistical analysis was done using Student’s “t” test and SPSS software. The results were considered to be significant at P < 0.05.
Results: There was a statistically significant difference in functional outcome between the two groups at 3-month follow-up (CS; P = 0.0469 and DASH; P = 0.0406), though no such difference was recorded at 1-year follow-up (CS; P = 0.2731 and DASH; P = 0.4915). It implies that the patients in operative group improved functionally and returned to normal activities earlier than the non-operative group. Even patient satisfaction regarding shoulder appearance (cosmesis) was more in the operative group (100%) than in non-operative group (60%). The complications were more in the non-operative group (23), such as symptomatic malunion in 2 cases (8%), NU in 5 cases (20%), shortening in 3 cases (12%), and muscle wasting in 2 cases (8%), whereas only four complications were recorded in the operative group, of which two were implant related.
Conclusion: Surgical management of displaced midshaft clavicle fracture has definite short-term benefits with respect to functional outcome, early return to preinjury activities, and a lower rate of malunion and NU. Furthermore, due to difficulties of non-operative treatment including pain and instability at fracture site, tightness of clavicle brace, difficulties in self-hygiene, and high percentage of NU, especially in high-energy fractures; operative treatment is a good option in displaced midshaft clavicle fracture, especially in active adult patients.
Keywords: Clavicle fracture, Conservative management, Surgical management.
References
1. Neer C. Fractures of the clavicle. In: Rockwood CA Jr., Green DP, editors. Fractures in Adults. 2nd ed. Philadelphia, PA: Lippincott; 1984. p. 707-13.
2. Lenza M, Faloppa F. Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle. Cochrane Database Syst Rev 2015;5:CD007428.
3. Nordqvist A, Petersson CJ. Incidence and causes of shoulder girdle injuries in an urban population. J Shoulder Elbow Surg 1995;4:107-12.
4. Crenshaw AH. Fractures of the shoulder girdle, arm and forearm. In: Crenshaw AH, editor. Campbell’s Operative Orthopedics. 8th ed. St Louis: Mosby; 1992. p. 989-1053.
5. NEER CS 2nd. Nonunion of the clavicle. J Am Med Assoc 1960;172:1006-11.
6. Rowe CR. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res 1968;58:29-42.
7. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD, Evidence-Based Orthopaedic Trauma Working Group. et al. Treatment of acute midshaft clavicle fractures: Systematic review of 2144 fractures: On behalf of the evidence-based orthopaedic trauma working group. J Orthop Trauma 2005;19:504-7.
8. Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br 1997;79:537-9.
9. Nowak J, Holgersson M, Larsson S. Sequelae from clavicular fractures are common: A prospective study of 222 patients. Acta Orthop 2005;76:496-502.
10. Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am 2004;86-A:1359-65.
11. McKee MD, Wild LM, Schemitsch EH. Midshaft malunions of the clavicle. J Bone Joint Surg Am 2003;85-A:790-7.
12. McKee MD, Pedersen EM, Jones C, Stephen DJ, Kreder HJ, Schemitsch EH, et al. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am 2006;88:35-40.
13. Lenza M, Belloti JC, Andriolo RB, Gomes Dos Santos JB, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev 2009;2:CD007121.
14. Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 2007;89:1-0.
15. Nowak J, Holgersson M, Larsson S. Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up. J Shoulder Elbow Surg 2004;13:479-86.
16. Robinson CM, Goudie EB, Murray IR, Jenkins PJ, Ahktar MA, Read EO, et al. Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: A multicenter, randomized, controlled trial. J Bone Joint Surg Am 2013;95:1576-84.
17. Judd DB, Pallis MP, Smith E, Bottoni CR. Acute operative stabilization versus nonoperative management of clavicle fractures. Am J Orthop (Belle Mead NJ) 2009;38:341-5.
18. Smekal V, Irenberger A, Attal RE, Oberladstaetter J, Krappinger D, Kralinger F, et al. Elastic stable intramedullary nailing is best for mid-shaft clavicular fractures without comminution: Results in 60 patients. Injury 2011;42:324-9.
19. Böhme J, Bonk A, Bacher GO, Wilharm A, Hoffmann R, Josten C, et al. Current treatment concepts for mid-shaft fractures of the clavicle results of a prospective multicentre study. Z Orthop Unfall 2011;149:68-76.
20. Kulshrestha V, Roy T, Audige L. Operative versus nonoperative management of displaced midshaft clavicle fractures: A prospective cohort study. J Orthop Trauma 2011;25:31-8.
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Cannulated Cancellous Screw and Ender’s Nail Fixation in Stable Intertrochanteric Femur Fracture in Elderly Patient With Co-Morbid Condition
/in Jan. - April 2019 | Volume 5 | Issue 1Vol 5 | Issue 1 | Jan-April 2019 | page: 17-22 |Rohan R Memon, Drashtant Patel
Author: Rohan R Memon[1], Drashtant Pate[l1]
1 Department of orthopaedics, VS General hospital,NHL Medical college. Ahmedabad
Address of Correspondence
Dr. Rohan Rafik Memon,
Department of orthopaedics, VS General hospital,NHL Medical college. Ahmedabad
Email: rhnmemon222@gmail.com
Abstract
Background: Intertrochanteric Femur fracture is common in elderly patient with co-morbidity.Ender and Simon Weidner popularized the concept of closed condylocephlic nailing for intertrochanteric fractures in 1970. The clinical experience of authors revealed that Ender nailing alone cannot provide secure fixation in elderly patients with osteoporosis.
Aims and objectives; we conducted a study to evaluate the efficacy of a combined fixation procedure using Ender nails and a cannulated compression screw for intertrochanteric fractures.
Study Design: This is a prospective observational type of study
Place and duration of study: Department of orthopaedics, NHL medical college between January 2015 to June 2018
Methodology: 52 patients with intertrochanteric fractures were treated using intramedullary Ender nails and cannulated compression screw from January 2015 to june 2018. We included those patients having age ≥50 years, with multiple co- morbid conditions like diabetes, hypertension, COPD, Asthma, bleeding disorders and multiple fractures, and duration of the Intertrochanteric fracture ≤ two week. We exclude young active patients < 50 yrs age, fracture > 2 weeks duration, fracture with lateral wall comminution and open fractures. The two Ender nails of 4.5mm each were passed across the fracture site into the proximal neck. This was reinforced with a 6.5 mm cannulated compression screw passed from the sub trochanteric region, across the fracture into the head.
Results; All the fractures were united within an average period of 13 weeks with a range of 10 – 13 weeks. The functional assessment was done with modified Harris hip score(Table no 1,2) and the mean was 86.3 with a range from 73 to 95 , and 26 patients were excellent, 20 patients were good , 4 patients were fair and two patients were poor with respect to total score. The analysis of this study fulfils the objectives of good functional outcome
Conclusions: The Ender nailing combined with compression screw fixation in cases of intertrochanteric fractures in high risk elderly patients could achieve reliable fracture stability with minimal complications.
Keywords: Compression screw, Ender nails, osteoporosis, inter-trochanteric fracture
References
[1]. Rockwood and Green;s Fracture in adults, 8th edition: vol.2:2075-2130.
[2]. Hagino H, Furukawa K, Fujiwara S, et al. Recent trend in the incidence and lifetime risk of hip fractures in Tottori, Japan.Osteoporos Int. 2009;20(4):543-548.
[3]. Lawton JO, Baker MR, Dickson RA. Femoral neck fracture: two populations. Lancer 1983;2:70-72.
[4]. Atkin JM. Relavance of osteoporosis in women with fractures of the femoral neck. Br Med J 1984;288’:597-601.Pogrund H, Makin M, Robin G, et al. Osteoporosis in patients with fractured femoral neck in Jerusalem. Clin Orthop 1977;124:165-172.
[5]. Ender J, Simon-Weidner R. Die Fixierung der trochantener bruche mit runden elastischen Kondylennageln. Acta Chir Austria1970;1:40.
[6]. Bonnaire F, Weber A, Bosl O, Eckhardt C, Schweiger, Linke B. “Cutting out” in pertrochanteric fractures – problem of osteoporosis. Unfallchirurg. 2007;110:425–32.
[7]. Beidle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures femur – randomized prospective comparison of gamma nail and dynamic hip screw. JBJS Br. 1991;73:330–4.
[8]. Nordin S, Zulkifil O, Faisham WI. Mechanical failure of DHS fixation in intertochanteric fracture femur. Med J Malaysia. 2001;56:12–7.
[9]. Fogognolo F, Kfuri M, Jr, Paccola CA. Intramedullary fixation of pertrochanteric hip fractures with PFN. Arch Orthop Trauma surgery. 2004;124:31–7.
[10]. Wojcik B, Tokarowski A, Swieboda A, Kaleta M, Nowak R. Endernails in the stabilization of trochanteric fracture in elderly. Chir Narzadow Ruchu Ortop Pol. 1999;64:279–83.
[11]. Raughstad TS, Moister A, Haukeland W, Hestenes O, Olerud S. Treatment of petrochanteric and subtrochanteric fractures of the femur by the Ender metod. Clin Orthop. 1970;138:321.
[12]. Pankovich AM, Tarabiski IE. Ender nailing of intertrochanteric fractures of femur. J Bone Joint Surg. 1980;62A:635.
[13].Cobelli NJ, Sadler AH. Ender rod versus compressive screw: fixation of hip fracture. Clin Orthop. 1970;138:321
[14]. Moon MS, Woo YK, Kim ST. A clinical study of trochanteric fractures of the femur: Outcome of the treatment in regard to osteoporosis and type of the treatment. I Korean Orthop Assoc. 1991;26:1693–702.
[15]. Russian LA, Sonni A. Treatment of intertrochanteric and subtrochanteric fractures with Ender intramedullary rods. Clin Orthop. 1980;148:203–12.
[16]. Kuderna H, Bohler N, Colby AJ. Treatment of intertrochanteric and subtrochanteric fracture of the hip by the Ender method. J Bone Joint Surg. 1976;58:604–11.
[17]. Hall LG. Comparison of nail-plate fixation Ender’s nailing for intertrochanteric fractures. J Bone Joint Surg. 1981;63-B:24–8.
[18]. Parker MJ, Handoll HH, Bhonsle S, Gillespie WJ. Condylocephalic nails versus extramedullary implants for extracapsular hip fractures. Cochrane Database Syst Rev. 2000;2:CD000338.
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Cannulated Cancellous Screw and Ender’s Nail Fixation in
Stable Intertrochanteric Femur Fracture in Elderly Patient
With Co-Morbid Condition
Comparative study of operative treatment of distal femur fractures using retrograde intramedullary nail versus locking plate Retrospective study
/in Jan. - April 2019 | Volume 5 | Issue 1Vol 5 | Issue 1 | Jan-April 2019 | page:3-6 – Raviraj Shinde, Tanvi Shinde, Ajit Shinde
Author: Raviraj Shinde[1], Tanvi Shinde[1], Ajit Shinde[2]
1Department of Orthopaedics, Grant Medical College and Sir.J.J. Group of Hospitals, Mumbai.
2Shree AnnasahebShindeMhaishalkar Charitable Trust, Post Graduate Institute, Ambedkar road, civil hospital chowk, sangli
Address of Correspondence
Dr Raviraj Ajit shinde
Department of Orthopaedics, Grant Medical College and Sir.J.J. Group of Hospitals, Mumbai
Email Id : drravirajshinde@gmail.com
Abstract
Introduction: The overall incidence of distal femur fractures is approximately 37 per 100,000 person-years.1 These fractures are either caused by high energy trauma in younger group or low energy falls in elderly population typically older women. As these fractures can lead to long term disability managing them is challenging task. Operative treatment for fracture fixation is recommended for optimal outcome. Although different modes of fracture fixation has evolved and no single method is uniformly successful. In our study we have compared fixation of distal femur fracture using locking plate and intramedullary nail.
Materials and Methods: Retrospectively collected data of operated distal femur fracture of 60 patients was included. Out of these 30 patients were operated with retrograde distal femoral nail and 30 were operated with locking distal femur plate. Patients were assessed with plain radiographs and CT scan was done for complex and intra articular fractures. AO ( Muller) classification was used to classify the fracture type. Postoperative functional results were evaluated using Schatzker and Lambert critera at 1 year follow up.
Results: Mean age of the patients in the study was 45 yrs. with 73.33 % male and 26.67 % female patients. There were 41 extra articular fractures (type A) while 19 were intrarticular fractures (type C). 22 type A and 8 type C fractures were treated with retrograde nailing while 19 type A fractures and 11 type C fractures were treated with locking plate. In LCP group 28.57% cases had excellent result while 42.86% cases had good result while in retrograde supracondylar nail 13.33% had excellent result and 23.33 % had good result. There were 2 cases of infection, one in each group and 3 cases of malunion, which were managed with nail. Delayed union was encountered in 3 patients, two of them were managed with LCP.
Conclusion: Open reduction and internal fixation of distal femur has achieved excellent to good functional results with locking plate construct in all types of fractures while retrograde supracondylar nail can achieve comparable results when used in simple extraarticular fractures.For other fractures it is difficult to maintain length, alignment and rotation with retrograde nail.
Keywords: distal femur fracture, Retrograde intramedullary nail, locking distal femur plate, minimally invasive plating technique, Schatzker and Lambert criteria
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