From The Editor’s Desk!!

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Vol 6 | Issue 1 | Jan-Jun 2020 | page:1 – Ashok Shyam

Author: Ashok Shyam [1,2]

[1] Indian Orthopaedic Research Group, Thane, Maharashtra, India. [2]  Sancheti Institute for Orthopaedics & Rehabilitation, Pune, Maharashtra, India. Address of Correspondence Dr. Ashok Shyam Head of Academics, Sancheti Institute for Orthopaedics & Rehabilitation, Pune, Maharashtra, India. Email: editor.trauma.international@gmail.com

We thank authors for their contribution in the January-June 2020 issue of Trauma International. This issue contains Original Articles on Fat Embolism in Long Bone Fracture, Bipolar Hemiarthroplasty by Using Cemented Calcar Replacement Stem, Injury Survey, Intramedullary Nailing (IMN) Vs Minimally Invasive Plate Osteosynthesis (MIPO), Inter-Trochanteric Fractures of Femur and a case report on Rare Atraumatic Unilateral Isolated Compartment Syndrome. We appreciate efforts of the author s and hope for more contribution in the field of orthopaedic literature in the coming years.

How to Cite this article:   Shyam A. From The Editor’s Desk. Trauma International. January-June 2020;6(1):1.

 

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A Rare Case of Atraumatic Unilateral Isolated Compartment Syndrome of the Peroneal Compartment Leading to Common Peroneal Nerve Palsy

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Vol 6 | Issue 1 | Jan-Jun 2020 | page:26-29 | Jun Guang Kendric Tan, Rajitha Gunaratne, Geoff Cooper

Author: Jun Guang Kendric Tan[1], Rajitha Gunaratne[1], Geoff Cooper[1].

[1] Department of Orthopaedics, Joondalup Health Campus, Grand Blvd &
Shenton Ave, Joondalup, WA 6027.
Address of Correspondence
Dr. Jun Guang Kendric Tan,
Resident Medical Officer, MBBS, Joondalup Health Campus, Grand Blvd &
Shenton Ave, Joondalup, WA 6027.
E-mail: junguangt@hotmail.com

Abstract

Acute Compartment syndrome (ACS) is an orthopaedic surgical emergency with very poor prognosis when left untreated. The majority of cases are preceded by trauma, but importantly there is a small percentage of patients presenting with non-traumatic causes. Although rare with only two other case reports describing non-traumatic, spontaneous compartment syndrome of the peroneal compartment, the complications are equally devastating.
We report a 67-year-old female with a history of Factor V Leiden, pulmonary embolism (PE) and deep vein thrombosis (DVT). She was seen by orthopaedic surgery six weeks after acute onset right leg pain with associated foot-drop. Her symptoms were initially managed by a medical team as she had no history of trauma and no fractures were evident on plain radiographs. This was on a background of severe bilateral knee osteoarthritis, chronic bilateral lower leg pain and neurogenic claudication for the preceding six months. Given her atypical presentation with confounding comorbidities, she was admitted under the medical team for further investigations instead of urgent fasciotomy.
As orthopaedics was not involved in the acute phase of her symptoms, a non-surgical approach was taken. MRI right knee and calf six weeks after onset of symptoms were suggestive of sequela of compartment syndrome isolated to the peroneal compartment. This scan showed myonecrosis in this compartment as well as denervation myopathy of the anterior compartment. Over the next twelve months, there was resolution of leg pain and gradual progression of a positive tinel’s sign from the fibular head to anterior shin with associated return of some ankle range of movement and power.
Given the atraumatic presentation and patient risk factors, we believe she suffered a venous thrombotic event at the popliteal trifurcation leading to a subacute compartment syndrome of the peroneal compartment.  Swelling of the compartment led to compression of the deep peroneal nerve, causing denervation of the anterior compartment. This is of interest given the rarity of such presentations, and will serve as a timely reminder for non-traumatic causes of ACS.

Keywords: Compartment syndrome, non-traumatic, Factor V Leiden, common peroneal nerve palsy.

 

References

1. DeLee JC, Stiehl JB. Open tibia fracture with compartment syndrome. Clin Orthop Relat Res. 1981(160):175-84.
2. Shadgan B, Menon M, Sanders D, Berry G, Martin C, Duffy P, et al. Current thinking about acute compartment syndrome of the lower extremity. Can J Surg. 2010;53(5):329-34.
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14. Hirmerova J, Seidlerova J, Chudacek Z. The Prevalence of Concomitant Deep Vein Thrombosis, Symptomatic or Asymptomatic, Proximal or Distal, in Patients With Symptomatic Pulmonary Embolism. Clin Appl Thromb Hemost. 2018;24(8):1352-7.
15. Wells PS, Hirsh J, Anderson DR, Lensing AW, Foster G, Kearon C, et al. Accuracy of clinical assessment of deep-vei

How to Cite this article: Tan JGK, Gunaratne R, Cooper G | A Rare Case of Atraumatic Unilateral Isolated Compartment Syndrome of the Peroneal Compartment Leading to Common Peroneal Nerve Palsy | Trauma International | January-June 2020; 6(1): 26-29.

 

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Prospective Study of Inter-Trochanteric Fractures of Femur Treated with Biaxial Plate Fixation (Hip Screw and Derotation Screw) with Indiginous Implant

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Vol 6 | Issue 1 | Jan-Jun 2020 | page:22-25 – Ajay Surwade, Yashwant Mahale, Vikram Kadu

Author: Ajay Surwade [1], Yashwant Mahale [2], Vikram Kadu [3].

[1] Department of Orthopaedics, GMCH, Gondia, Maharashtra, India.
[2] Department of Orthopaedics, ACPMMC, Dhule, Maharashtra, India.
[3] Kadu Hospital, Katol, Maharashtra, India. 

Address of Correspondence
Dr. Vikram Kadu,
Consultant Orthopaedic Surgeon, Kadu Hospital, Katol, Maharashtra, India.
E-mail: vikram1065@gmail.com

Abstract

Background: Intertrochanteric fractures remains the common type of injuries amongst hip fracture. There are different types of classifications systems and different modalities for fixation available. Surgical treatment represents the optimal strategy for managing intertrochanteric fractures. It allows early mobilization rehabilitation and functional recovery and reduces the risk of postoperative complications.
Material and methods: Our study consisted of forty two cases of intertrochanteric fracture of femur treated surgically with BIAXIAL PLATE SYSTEM at our institute between July 2012- Dec 2014. Two patients were died within six months of operation so 40 patients were available for follow up. So anatomical and functional assessment of forty patients done.
Results: Anatomical results were assessed by presence or absence of shortening, deformity and range of movement. 95 % cases had good results and 5% cases had poor results with shortening more than 1cm in one case and limited hip movement in another case. Functional assessment of 40 patients were done by Harris hip score system and we got excellent result were noted in 12 cases, good in 23 cases, fair in 05 cases and none had poor results.
Conclusion: Osteosynthesis with Biaxial Plate offers the advantage of high rotational stability of the head-neck fragment. The advantage of fixation in two axis is, Increased torsional strength 10 times than DHS. Decreases coring out and loosening. Increased axial deforming strength 3 times than DHS. Decreases posterior and superior cut out.
Keywords: Intertrochanteric fracture; Biaxial plate system; Osteosynthesis; Indiginous implant.

References

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6. Dr. Ashok Desai; Biax Hip System;
concept; http://www.biaxhip.com/#details
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10. Grisso JA, Kelsey JI, Strom BL, and Chio GY. Risk factors for falls as a cause of hip fractures in women.New England journal of medicine. 1991; 324:1326-1331.

How to Cite this article: Surwade A, Mahale Y, Kadu V | Prospective Study Of Inter-trochanteric Fractures Of Femur Treated With Biaxial Plate Fixation (hip Screw And Derotation Screw) With Indiginous Implant | Trauma International | January-June 2020; 6(1):22-25.

 

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A Comparative Study of Distal Tibia Metaphyseal Fractures in a Series of 50 Patients: Intramedullary Nailing (IMN) Vs Minimally Invasive Plate Osteosynthesis (MIPO)

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Vol 6 | Issue 1 | Jan-Jun 2020 | page:17-21 – Tejas Tribhuwan, Chetan Pradhan, Atul Patil, Chetan Puram, Dheeraj Attarde, Parag Sancheti, Ashok Shyam

Author: Tejas Tribhuwan [1], Chetan Pradhan [1], Atul Patil [1], Chetan Puram [1], Dheeraj Attarde [1], Parag Sancheti [1], Ashok Shyam [1,2].

[1] Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India.
[2] Indian Orthopaedic research group, Thane, India.

Address of Correspondence
Dr. Dheeraj Attarde,
Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India.
E-mail: dheerajattarde@yahoo.in

Abstract

Introduction: Multiple treatment modalities have been described for distal tibia metaphyseal fractures but there is no consensus regarding optimal treatment. The purpose of this study was to compare the management of these fractures by intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO) technique by assessing the functional and radiological outcomes and complications.
Methods: 50 patients having distal tibia fractures were studied and divided into two equal groups of IMN and MIPO with a follow-up period of one year. Functional assessment was done using SF-36, LEFS and VAS scores; radiological assessment was done by evaluating the union type and radiological deformity, and complications in both procedures were studied. Various fracture patterns were also considered.
Results: SF-36 showed no statistical significance with regard to treatment mode and fracture type. LEFS score reduced with increase in complexity of fracture and also indicated that both IMN and MIPO groups regained comparable functional capacity after a year. IMN cases (96%) showed better chances of primary union than MIPO cases (72%), after a year. Varus was found in 16% and valgus in 20% of plating cases. AO Type fractures 43 A1 and 43 A2 were preferably treated with nailing whereas 43 A3, with plating.
Conclusion: While union time is shorter for IMN cases, there is a greater occurrence of deformity in MIPO patients. We concluded that both the techniques can provide a similar return of functional capabilities but as the complexity of the fracture increases, nail becomes difficult to use than a plate.
Keywords: IMN; Distal tibia metaphyseal; MIPO; Distal third tibia fractures.

References

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4. Richard RD, Kubiak E, Horwitz DS. Techniques for the surgical treatment of distal tibia fractures. Orthop Clin North Am. 2014;45:295–312.
5. Nork SE, Schwartz AK, Agel J, Holt SK, Schrick BS,Winquist RA. Intramedullary nailing of distal metaphyseal tibial fractures. J Bone JtSurg Am. 2005;87-A:1213e1221.
6. Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone JtSurg Br. 2010;92-B:984e988.
7. Court-Brown CM, Gustilo T, Shaw AD. Knee pain after intramedullary tibial nailing: its incidence, etiology, and outcome. J Orthop Trauma. 1997;11:103e105.
8. Borg T, Larsson S, Lindsjö U (2004) Percutaneous plating of distal tibial fractures. Preliminary results in 21 patients. Injury 35(6):608–614
9. Hazarika S, Chakravarthy J, Cooper J (2006) Minimally invasive locking plate osteosynthesis for fractures of the distal tibia—results in 20 patients. Injury 37(9):877–887
10. Redfern DJ, Syed SU, Davies SJ (2004) Fractures of the distal tibia: minimally invasive plate osteosynthesis. Injury 35(6):615–620
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12. Feng YZ, Hong JJ, Peng L, Shui XL, Tang J, Chen LW, et al. Comparison of two minimally invasive internal fixed methods for the treatment of distal tibiofibula. Chin J Surg 2011;2:113–8.
13. Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plating versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma 2011;25:736–41.
14. Chen N, He QQ. Clinical analysis for two fixation methods in distal tibiofibular fracture. Chin Prac Med 2008;3:116–7.
15. Zhang C, Jiang Y, An ZQ. Interlocking intramedullary nailing versus percutaneous plating in osteosynthesis of metaphyseal fractures of distal tibia. Chin J Orthop Trauma 2007;9:131–4.
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How to Cite this article: Tribhuwan T, Pradhan C, Patil A, Puram C, Attarde D, Sancheti P, Shyam A | A Comparative Study of Distal Tibia Metaphyseal Fractures in a Series of 50 Patients: Intramedullary Nailing (IMN) VS Minimally Invasive Plate Osteosynthesis (MIPO)| Trauma International | January-June 2020; 6(1):17-21.

 

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Injury Survey at Chris Hani Baragwanath Academic Hospital, Soweto, South Africa

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Vol 6 | Issue 1 | Jan-Jun 2020 | page:12-16 – Nazia Khan, Mabongo M, Kolisa Y

Author: Nazia Khan[1], Mzubanzi Mabongo[1], Yoland Malele Kolisa[2]

[1] Department of Maxillo-facial and oral surgery, School of Oral Health Sciences, University of the Witwatersrand, South Africa.

[2]2Department of Community Dentistry, University of The Witwatersrand,
South Africa.

Address of Correspondence
Dr. Nazia Khan,
Department of Maxillo-facial and oral surgery, School of Oral Health Sciences, University of the Witwatersrand, South Africa
E-mail: nazia786092@gmail.com

Abstract

Introduction: Globally injuries constitute a major public health problem. In 2007, South Africa was listed as one of the most violent countries in the world, with more than 30 000 trauma-related deaths recorded annually.
Objective: Analysis of 5 371 trauma patients seen over a three-month period at Chris Hani Baragwanath Academic Hospital’s trauma unit was conducted. Objectives of the survey were to: Describe the patients socio-demographic profile ; Assess the frequency, distribution and types of injuries sustained; Determine the severity of injuries; Determine patient outcomes after initial treatment; and Determine factors related to traumatic injuries.
Methods: A cross-sectional study. Patients were admitted assessed and records were reviewed.
Results: A male to female ratio of 2:1 was recorded. Only 22.69% of the patients reported been employed. The median age was 28 years (interquartile range 14-40 years). The predominant mechanism of injury was due to falls (32.37%), followed by assault (27.44%). Transport-related injuries accounted 22.52%, while burn injuries accounted for 8.01%. Males were more likely to suffer any form of injury compared to females (p<0.05). Assault injuries were 4.23 times more likely to result in head and neck injuries compared to any other mechanism of injury (OR:4.23, CI 3.52-5.08, p <0.00). Upon initial admission to the unit, 43.04% of patients were discharged home after initial treatment, while 41.54% were transferred to the orthopedic unit.
Conclusion: Sex, employment status, age and area of residence influenced the pattern of traumatic injuries. Falls injuries and assault were the predominant mechanisms of injury. Males were more likely to suffer from any form of injury than females. Assault injuries were more than four times more likely to result in head and neck injuries than any other mechanism of injury. Therefore, ongoing surveillance and education campaigns are recommended.

Keywords: Surveillance; Trauma; Injuries.

References

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How to Cite this article: Khan N, Mabongo M, Kolisa YM | Injury Survey at Chris Hani Baragwanath Academic Hospital, Soweto, South Africa | Trauma International | January-June 2020; 6(1):12-16.

 

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Bipolar Hemiarthroplasty by Using Cemented Calcar Replacement Stem for Unstable Inter-trochanteric Fractures in Old Age

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Vol 6 | Issue 1 | Jan-Jun 2020 | page:6-11 – Shriniwas R Yemul, Rushikesh Lonikar

Author: Shriniwas R Yemul [1], Rushikesh Lonikar [1]

[1] Department of Orthopaedics, Ashwini Rural Medical College, Kumbhari, Solapur, Maharashtra, India.

Address of Correspondence
Dr. Rushikesh Lonikar,
Associate Professor, Ashwini Rural Medical College, Kumbhari, Solapur, Maharashtra, India
E-mail: rushikeshlonikar1@gmail.com

Abstract

Background: Internal fixation of unstable inter-trochanteric is challenging and most of the morbidity is associated with prolonged immobilization and implant cut outs. Aim of this study is to evaluate clinical outcomes of bipolar hemiarthroplasty in old age patients with unstable inter-trochanteric fractures by using cemented calcar replacement stem.
Methods: 80 hips of inter-trochanteric fractures (AO/OTA type 31-A2.2 and 31-A2.3) in 80 patients, 49 females and 31 male patients from Aug 2016 to Sept 2019. All the patients were operated by posterolateral approach, and hemi-replacement done using cemented modular calcar replacement stem, greater trochanter also reconstructed in all the patients. Patients were followed at 6 wks, 3 months, 6 months and 1 year. Primary outcome included Harris hip score and secondary outcome includes functional walking ability (kovals), thigh pain, dislocation, trendelenberg test and infection, mortality.
Results: No dislocation, No e/o infection, only two patients complained of anterior thigh pain. One patient developed pulmonary embolism treated and recovered, limb length discrepancy seen in 4 patients (lengthening 4, no shortening) range 0-20 mm, Perioperative mortality during hospitalization is seen in two patients due to cardiac complications. 5 patients died from discharge to within one year. 3 patients lost to follow up. Fifty five patients (78.57%) regained preinjury ambulation status at final follow up. At final follow up, Average Harris hip score (HSS) was 80 (Range 70 to 95) , poor (<70)-3, fair(70-79)-12, Good (80-89)-50, Excellent (90-100)-5.
Conclusion: Hemiarthroplasty using calcar replacement stem in unstable inter-trochanteric fracture in old age patients helps in early mobilization of patients and early regaining of preinjury ambulation status.
keyword: Unstable inter-tochanteric fracture; Cemented bipolar; Calcar stem bipolar.
Level of evidence: Therapeutic level II.

References

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How to Cite this article: Yemul SR, Lonikar R | Bipolar Hemiarthroplasty by Using Cemented Calcar Replacement Stem for Unstable Inter-trochanteric Fractures in Old Age | Trauma International | January-June 2020; 6(1):6-11.

 

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Fat Embolism in Long Bone Fracture Patients and its Complications: A Prospective Study

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Vol 6 | Issue 1 | Jan-Jun 2020 | page:2-5 – Dheeraj Attarde, Atul Patil, Chetan Pradhan, Chetan Puram, Adarsh Kota, Parag Sancheti, Ashok Shyam

Author: Dheeraj Attarde [1], Atul Patil [1], Chetan Pradhan [1], Chetan Puram [1], Adarsh Kota [1], Parag Sancheti [1], Ashok Shyam [1,2]

[1] Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India.
[2] Indian Orthopaedic research group, Thane, India.

Address of Correspondence
Dr. Dheeraj Attarde,
Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India.
E-mail: dheerajattarde@yahoo.in

Abstract

Background: Incidence of fat embolism after long bone fracture in Indian scenario is not studied much. In our study we try to analyse data over 2 years to find incidence and its complications.
Materials and Methods: Two hundred FES (fat embolism syndrome ) suspected patients secondary to long bone fractures admitted over a 1 year period included. Patients satisfying the clinical criteria proposed by Gurd and Wilson, and Schonfeld were included in the study. Clinical features, risk factors, complications and any sequelae were noted.
Results: Out of 200 patient’s majority were male patients. Maximum (85.5%) cases were used immobilizers to stabilize case. Isolated fractures (97%) were more compare to multiple fracture (3%). Associated features included features of altered sensoriam (n = 14, 7%), petechial rash (6%), tachycardia (16.5%) and fever (14.5%). Hypoxemia was demonstrable in 25.5% (51patients) cases. Fat embolism was found in 2% (4 cases) study population. Hypoxia @ 72 hours more in multiple fractures (50%) compare to isolated fractures (4.6%). This association was statistically significant. (P<0.05) No long-term sequelae were observed.
Conclusion: We conclude that in our representative population the incidence of fat embolism is slightly higher compared to other population. This amounts to 2% of people with long bone fractures of lower limb. Fat embolism was more in femur fractures compared to tibia fractures and the chance of fat embolism was more in multiple fractures when compared to isolated fractures. The incidence of fat embolism was more in closed fractures as compared to open fractures. Other salient features of the study were the increased incidence of fat embolism noted in fractures which were not immobilized.
Key Words: Accidents; ARDS; Fat embolism syndrome; Fracture.

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How to Cite this article:  Attarde D, Patil A, Pradhan C, Puram C, Kota A, Sancheti P, Shyam A | Fat Embolism in Long Bone Fracture Patients and its Complications- A Prospective Study | Trauma International | January-June 2020; 6(1):2-5.

 

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