Posts

Tens Nailing in Fracture Clavicle – A Case Series

/in /by

Vol 8 | Issue 2 | July-December 2022 | page: 17-20 | Mohd Danish, Hemant Gupta, Ashish Sao, Ravi Kant

DOI: https://doi.org/10.13107/ti.2022.v08i02.029

Authors: Mohd Danish [1], Hemant Gupta [1], Ashish Sao [1], Ravi Kant [1]

[1] Department of Orthopaedics, Max Superspeciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India.

Address of Correspondence

Dr. Mohd Danish,

Department of Orthopaedics, Max Superspeciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India.

E-mail: danish.shan@gmail.com

Abstract

INTRODUCTION: Clavicle is one of the most commonly fractured bones accounting for 2.6 – 4 % of all the fractures. 69 – 82% of these occur in middle third of clavicle, 73 % of which are displaced midshaft clavicular fractures). Surgery has been indicated for displaced fractures of clavicle, one with NV compromise and skin tenting. Intramedullary fixation for clavicular fractures was first described by Peroni in 1950. The use of a TENS nail carries advantages of less soft tissue compromise, less operative time, better cosmetic results, load sharing fixation with relative stability that encourages copious callus formation.

MATERIAL AND METHOD: A prospective review of 20 patients who presented to our institute between January 2021 and June 2022 with displaced midshaft clavicle fractures and treated with TENS nailing was carried out. All the patients had Constant Murley score and DASH score, which were done at 6 and 12 weeks.

RESULTS: All the patients achieved clinical and radiological union at a mean of 19.6 ± 6.67.80% of the patient had excellent Constant Murley score on follow up. Based on the assessment parameters (Disability of Arm Shoulder and Hand) Score, the mean DASH score was 25.03 ± 3.36 (range 20-30), 18.56 ± 3.46 (range 14-25) at the end of 6 weeks and 12 weeks respectively.

CONCLUSION: The intramedullary fixation using TENS of midshaft clavicle fractures is a safe minimally invasive technique in indicated cases and in our hands, it provides good functional outcome and cosmetic results.

KEYWORDS: Tens, Clavicle, Fracture, Intramedullary

References

1. Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elbow Surg. 2002; 11(5):452–6. 

2. Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res. 1994; (300: ):127–32. 

3. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007; 89(1):1–10. 

4. Houwert RM, Wijdicks FJ, Steins Bisschop C, Verleisdonk EJ, Kruyt M. Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a systematic review. Int Orthop. 2012; 36 (3):579–85.

5. Assobhi JE. Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced midclavicular fractures. J Orthop Traumatol. 2011; 12(4):185–92. doi: 10.1007/s10195-011- 0158-7 PMID: 21948051

6. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. 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(7):504– 7. 

7. Kontautas E, Pijadin A, Vilkauskas A, Domeika A. Biomechanical aspects of locking reconstruction plate positioning in osteosynthesis of transverse clavicle fracture. Medicina (Kaunas). 2012; 48(2):80– 3. 

8. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD, Evidence-Based Orthopaedic Trauma Working G. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the EvidenceBased Orthopaedic Trauma Working Group. J Orthop Trauma. 2005;19(7):504-507.

9. Grassi FA, Tajana MS, D’Angelo F. Management of midclavicular fractures: comparison between nonoperative treatment and open intramedullary fixation in 80 patients. J Trauma.2001;50(6):1096-100.

10. Leppilahti J, Jalovaara P. Migration of Kirschner wires following fixation of the clavicle–a report of 2 cases. Acta Orthop Scand. 1999;70(5):517-519.

11. Lyons FA, Rockwood CA, Jr. Migration of pins used in operations on the shoulder. J Bone Joint Surg Am. 1990;72(8):1262-1267.

12. Naidoo P. Migration of a Kirschner Wire from the clavicle into the abdominal aorta. Arch Emerg Med. 1991;8(4):292-295.

How to Cite this article: Danish M, Gupta H, Sao A, Kant R | Tens Nailing in Fracture Clavicle – A Case Series | July-December 2022; 8(2): 17-20 |  https://doi.org/10.13107/ti.2022.v08i02.029

 

(Abstract Text HTML)   (Download PDF)

New Comprehensive Classification Systems for Peri-trochanteric Femur Fractures

/in /by

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.

(Abstract)      (Full Text HTML)      (Download PDF)