Morphometric Comparison of Distal Hamate Articular Surface with the Proximal Articular Surface of Middle Phalanges of Index, Middle, Ring and Little Fingers for Hemi-Hamate Arthroplasty

Vol 8 | Issue 2 | July-December 2022 | page: 13-16 | B Jagannath Kamath, Manesh Jain, Monish N

DOI: https://doi.org/10.13107/ti.2022.v08i02.028


Authors: B Jagannath Kamath [1], Manesh Jain [1], Monish N [1]

[1] Department of Orthopedic, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Address of Correspondence

Dr. Monish N

Department of Orthopedic, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.

E-mail: monish1994n@gmail.com


Abstract

PURPOSE: The study is focused to compare the Distal Hamate articular Surface to the morphology of the base of middle phalanges of Index, Middle, Ring & little fingers.

METHODOLOGY: A Observational Paired T study was conducted. Patients with fractures of forearm or hand excluding any fractures in hamate and middle phalanges of Index , Middle, Ring & Little finger of both the upper limbs are subjected to Computed Tomography (CT) of hand and a 3D reconstructed image is obtained. Once the scans are collected, the below parameters will be determined using Radiant software.

RESULTS: At the end of this study ,we found that Majority of the patients who underwent CT Scans were noted to be between 31 and 50 years of age. Gender wise, males considered for the study were 24 (52%) and females were 25 (49%). The average hamate axial ridge angle was 69.18 and that of the ring finger middle phalangeal base was 80.23 (P < .05) Out of 50 patients the axial ridge angle of hamate was comparable with ring finger middle phalangeal base. The average distal hamate surface area was 1.04 and that of the middle phalangeal base was 1.00 (P < .05) The distal hamate articular surface area was comparable with the middle finger’s middle phalangeal base. The average sagittal inclination of distal hamate surface was 48.64 and that of the ring finger middle phalangeal base was 49.08 (P < .05) . The sagittal inclination of hamate was comparable with ring finger middle phalangeal base .

CONCLUSION: In literature very few radiological studies comparing the hamate and middle phalanx articular surfaces are reported. This study helps us in understanding the digit which is similar to hamate for undergoing Hemi Hamate Arthroplasty and usefulness of pre operative CT scan in further management of chronic proximal interphalangeal joint fracture dislocations. According to the results obtained from our study, we conclude that the Axial ridge angle and sagittal inclination of Middle Phalanx of Ring finger is in close approximation with Hamate . Articular Surface Area of Middle Finger is in close approximation with Hamate distal articular surface area.

Keywords: PIPJ- Proximal Interphalangeal Joint, ORIF- Open Reduction, Interal Fixation, CT- Computed Tomography, HHA- Hemi Hamate Arthroplasty


References

1.Drain J, Mehta S, Goyal KS. An analysis of hamate morphology relevant to Hemi-hamate arthroplasty. J Hand Surg Am [Internet]. 2020;45(7):657.e1-657.e6

2. Sollaccio DR, Navo P, Ghiassi A, Orr CM, Patel BA, Lewton KL. Evaluation of articular surface similarity of Hemi-hamate grafts and proximal middle phalanx morphology: A 3D geometric morphometric approach. J Hand Surg Am [Internet]. 2019;44(2):121–8.

3. Calva, D., Calotta, N., Lopez, J., Christopher, A., Magid, D., Demehri, S., & Lifchez, S. D. (2016). A simple pre-operative imaging method to assess donor and recipient anatomy in hemi-hamate arthroplasty for proximal interphalangeal joint reconstruction. Surgical and Radiologic Anatomy, 38(6), 699-704.

4. Ten Berg P, Ring D. Quantitative 3D-CT anatomy of hamate osteoarticular autograft for reconstruction of the middle phalanx base. Clin Orthop Relat Res [Internet]. 2012;470(12):3492–8.

5. McAuliffe JA. Hemi-hamate autograft for the treatment of unstable dorsal fracture dislocation of the proximal interphalangeal joint. J Hand Surg Am [Internet]. 2009;34(10):1890–4.

6. Calfee, R. P., Kiefhaber, T. R., Sommerkamp, T. G., & Stern, P. J. (2009). Hemi-hamate arthroplasty provides functional reconstruction of acute and chronic proximal interphalangeal fracture–dislocations. The Journal of hand surgery, 34(7), 1232-1241.

7. Capo JT, Hastings H 2nd, Choung E, Kinchelow T, Rossy W, Steinberg B. Hemicondylar hamate replacement arthroplasty for proximal interphalangeal joint fracture dislocations: an assessment of graft suitability. J Hand Surg Am [Internet]. 2008;33(5):733–9.

8. Barksfield RC, Bowden B, Chojnowski AJ. Hemi-hamate arthroplasty versus transarticular Kirschner wire fixation for unstable dorsal fracture-dislocation of the proximal interphalangeal joint in the hand. Hand Surg [Internet]. 2015;20(1):115–9.

9. Korambayil PM, Francis A. Hemi-hamate arthroplasty for pilon fractures of finger. Indian J Plast Surg [Internet]. 2011;44(3):458–66.

10. Podolsky DJ, Mainprize J, McMillan C, Binhammer P. Suitability of using the hamate for reconstruction of the finger middle phalanx base: An assessment of cartilage thickness. Plast Surg (Oakv) [Internet]. 2019;27(3):211–6.

11. Williams RMM, Kiefhaber TR, Sommerkamp TG, Stern PJ. Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft. J Hand Surg Am [Internet]. 2003;28(5):856–65.

12. Janssen, S. J., Ter Meulen, D. P., Hageman, M. G., Earp, B. E., & Ring, D. (2015). Quantitative 3-dimensional CT analyses of fractures of the middle phalanx base. HAND, 10(2), 210-214.


How to Cite this article: Kamath BJ, Jain M, Monish N | Morphometric Comparison of Distal Hamate Articular Surface with the Proximal Articular Surface of Middle Phalanges of Index, Middle, Ring and Little Fingers for Hemi-Hamate Arthroplasty | July-December 2022; 8(2): 13-16.  https://doi.org/10.13107/ti.2022.v08i02.028

 


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A Comparative Study showing Elbow Kinematics in Radial Head Replacement Versus Radial Head Excision Versus Radial Head Fixation

Vol 8 | Issue 2 | July-December 2022 | page: 01-05 | Amit Yadav, Sagar Bansal, Mrinal Kambli, Shaswat Mishra, Devenshu Gupta

DOI: https://doi.org/10.13107/ti.2022.v08i02.026


Authors: Amit Yadav [1], Sagar Bansal [1], Mrinal Kambli [1], Shaswat Mishra [1], Devenshu Gupta [1]

[1] Department of Orthopaedics, Grant Medical College and Sir J. J. Group of Hospitals, Byculla, Mumbai, Maharashtra, India.

Address of Correspondence
Dr Sagar Bansal,
Senior Resident, Department of Orthopaedics, Grant Medical College and Sir J. J. Group of Hospitals, Byculla, Mumbai, Maharashtra, India.

E-mail: sagarbansal59@gmail.com


Abstract

Background: Radial head fractures are quite common with incidence 1.5-4% of all adult fractures. The management of these fractures depends upon age and type of injury

Aim: To compare the outcome in comminuted radial head fractures(Mason type III) based on mayo elbow scoring and handgrip strength test when managed with radial head excision, radial head fixation or radial head replacement

Material and Methods: We did a prospective comparative study comprising 60 patients between age 20-60 years with Mason type III radial head fractures. The patients were randomised using the admission day of the week placing 20 patients each in arthroplasty , excision and in the fixation group. The patients were followed up for 18-24 months postoperatively. Results were evaluated by the Mayo’s elbow performance and Handgrip strength score at 6 months and 18 months and were statistically evaluated by one-way ANOVA test.

Results: As per Mayo’s score at 6 months follow up, mean and standard deviation (SD) of the scores in arthroplasty was 83.25 and 11.50, for excision it was 76.25 and 11.38 & for fixation, it was 68.75 and 17.83 respectively. At 18 months follow up, mean and standard deviation was 90 and 12.56 for arthroplasty, 83 and 9.92 for excision & 76.25 and 21.69 for fixation respectively. As per handgrip strength score at 6 months follow up, mean and standard deviation of the scores in arthroplasty was 31.1 and 4.37, for excision it was 28.75 and 4.27 & for fixation, it was 27.15 and 5.94 respectively. At 18 months follow up, mean and standard deviation was 32.95 and 4.006 for arthroplasty, 30.7 and 4.06 for excision & 28 and 6.75 for fixation respectively. The difference between the results according to both Mayo’s score as well as Handgrip strength test was statistically significant (p < 0.05).

Conclusion: Our study shows that long and short-term results of radial head replacement are better than radial head excision and radial head fixation in comminuted radial head fractures based on mayo elbow scoring and hand grip strength score.

Keywords: Radial head fracture, Radial head replacement, Mason classification


References

1. Duckworth AD, Clement ND, Jenkins PJ, Aitken SA, Court-Brown CM, McQueen MM (2012) The epidemiology of radial head and neck fractures. J Hand Surg Am 37(5):112–119.

2. Broberg MA, Morrey BF. Results of treatment of fracture-dislocations of the elbow. Clin Orthop. 1987;216:109-19.

3. Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg. 1954;42:123-32.

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7. Ring, David MD; Psychoyios, Vasilis N. MD; Chin, Kingsley R. MD; Jupiter, Jesse B. MD Nonunion of Nonoperatively Treated Fractures of the Radial Head, Clinical Orthopaedics and Related Research: May 2002 – Volume 398 – Issue – p 235-238.

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9. Singh AK, Jidge A, Ramteke U, Venkateswaran N, Rokade H, Mulje SM, Mukherjee S, Kotian A. Functional Outcome of Elbow Kinematics in Radial Head Excision Versus Radial Head Replacement: A Comparative Study. Open Access Maced J Med Sci. 2019 May 15;7(9):1505-1508.

10. Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ. The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg Am. 2004 Aug;86(8):1730-9.

11. Ikeda M, Sugiyama K, Kang C, Takagaki T, Oka Y. Comminuted fractures of the radial head: comparison of resection and internal fixation. Surgical technique. J Bone Joint Surg Am. 2006 Mar;88 Suppl 1 Pt 1:11-23.

12. Swensen SJ, Tyagi V, Uquillas C, Shakked RJ, Yoon RS, Liporace FA. Maximizing outcomes in the treatment of radial head fractures. J Orthop Traumatol. 2019 Mar 23;20(1):15.

13. Sun H, Duan J, Li F. Comparison between radial head arthroplasty and open reduction and internal fixation in patients with radial head fractures (modified Mason type III and IV): a meta-analysis. Eur J Orthop Surg Traumatol. 2016 Apr;26(3):283-91.

14. Sinha S, Sarkar S, Singh A, Saraf SK, Rastogi A, Singh T. Radial Head Arthroplasty, Excision and Osteosynthesis in Complex Elbow Fracture-Dislocations in Young Adults: What is Preferred? Indian J Orthop. 2020 May 18;54(Suppl 2):260-269.

15. Heim U.[Combined fractures of the radius and the ulna at the elbow level in the adult. Analysis of 120 cases after more than 1 year]. Rev Chir Orthop Reparatrice Appar Mot. 1998 Apr;84(2):142-53.

16. Ring D, Quintero J, Jupiter JB. Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am. 2002 Oct;84(10):1811-5.

17. Herbertsson P, Josefsson PO, Hasserius R, Besjakov J, Nyqvist F, Karlsson MK. Fractures of the radial head and neck treated with radial head excision. J Bone Joint Surg Am. 2004 Sep;86(9):1925-30.

18. Shetty SK, Shetty A, Balan B, Ballal A, Rai HR, Hegde A. Excision Versus Fixation of the Radial Head: A Comparative Study of the Functional Outcomes of the Two Techniques. J Clin Diagn Res. 2017 Feb;11(2):RC01-RC03.

19. Bain GI, Ashwood N, Baird R, Unni R. Management of Mason type-III radial head fractures with a titanium prosthesis, ligament repair, and early mobilization. Surgical technique. J Bone Joint Surg Am. 2005 Mar;87 Suppl 1(Pt 1):136-47.


How to Cite this article: Yadav A, Bansal S, Kambli M, Mishra S, Gupta D | A Comparative Study showing Elbow Kinematics in Radial Head Replacement Versus Radial Head Excision Versus Radial Head Fixation | July-December 2022; 8(2): 01-05. https://doi.org/10.13107/ti.2022.v08i02.026

 


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Efficacy and Safety of Tranexamic Acid Administration in Patients with Acute Traumatic Brain Injury: A Review of Current Literature

Vol 8 | Issue 2 | July-December 2022 | page: 06-12 | Kenzie Kao, Mohammed Alsabri

DOI: https://doi.org/10.13107/ti.2022.v08i02.027


Authors: Kenzie Kao [1], Mohammed Alsabri [2]

[1] Saba University School of Medicine, Saba, Dutch Caribbean, Netherlands. [2] Department of Emergency Medicine, Al-Thawra Modern General Teaching Hospital, Sana’a City, Yemen.

Address of Correspondence

Dr. Mohammed Alsabri,

Department of Emergency Medicine, Al-Thawra Modern General Teaching Hospital, Sana’a City, Yemen.

E-mail: alsabri5000@gmail.com


Abstract

Hypothesis: Early administration of tranexamic acid (TXA) reduces mortality in patients suffering from acute traumatic brain injury (TBI).

Methods: A structured search of PubMed and CENTRAL from inception until July 1st, 2022 was carried out seeking RCTs comparing the effects of TXA administration to placebo in patients suffering from TBI. The primary outcome tested was 28-day all-cause mortality. Secondary outcomes included intracranial hemorrhage growth and thromboembolic events.

Results: Eight RCTs involving a total of 14,714 patients met the inclusion criteria; 7573 patients received TXA while 7141 patients received a placebo. There were 1415 patient deaths (18.7%) in the TXA group and 1410 patient deaths (19.7%) in the placebo group. None of the included studies reported a significant reduction in 28-day all-cause mortality, however, they all shared positive trends toward superior outcomes in the intervention arms. Two of the included studies reported significant reductions in intracranial hemorrhage expansion in those patients treated with TXA, with four more studies reporting trends toward superior outcomes in the TXA groups. There was no evidence of increased incidence of thromboembolic events in the TXA groups in four of the five studies that reported relevant data, with one study representing 1.2% of total patients reporting an increased incidence of pulmonary emboli in the intervention group.

Conclusions: In patients suffering from acute TBI, early administration of TXA reduces intracranial hemorrhage growth and may have positive effects on mortality with no corresponding increase in thromboembolic events. Given these results, early administration of TXA in patients experiencing TBI is recommended in initial care.

Keywords: Tranexamic acid, Traumatic brain injury, Intracranial hemorrhage, Mortality, Disability


References

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3) Zhang, J., Zhang, F., & Dong, J. F. (2018). Coagulopathy induced by traumatic brain injury: systemic manifestation of a localized injury. Blood, 131(18), 2001–2006. 

4) Nakae, R., Takayama, Y., Kuwamoto, K., Naoe, Y., Sato, H., & Yokota, H. (2016). Time Course of Coagulation and Fibrinolytic Parameters in Patients with Traumatic Brain Injury. Journal of neurotrauma, 33(7), 688–695. 

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16) Fakharian, E., Abedzadeh-Kalahroudi, M., & Atoof, F. (2018). Effect of Tranexamic Acid on Prevention of Hemorrhagic Mass Growth in Patients with Traumatic Brain Injury. World neurosurgery, 109, e748–e753. 

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26) Lawati, K. A., Sharif, S., Maqbali, S. A., Rimawi, H. A., Petrosoniak, A., Belley-Cote, E. P., Sharma, S. V., Morgenstern, J., Fernando, S. M., Owen, J. J., Zeller, M., Quinlan, D., Alhazzani, W., & Rochwerg, B. (2021). Efficacy and safety of tranexamic acid in acute traumatic brain injury: a systematic review and meta-analysis of randomized-controlled trials. Intensive care medicine, 47(1), 14–27. 

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28) Brenner, A., Belli, A., Chaudhri, R., Coats, T., Frimley, L., Jamaluddin, S. F., Jooma, R., Mansukhani, R., Sandercock, P., Shakur-Still, H., Shokunbi, T., Roberts, I., & CRASH-3 trial collaborators (2020). Understanding the neuroprotective effect of tranexamic acid: an exploratory analysis of the CRASH-3 randomised trial. Critical care (London, England), 24(1), 560. 

29) Yokobori, S., Yatabe, T., Kondo, Y., Kinoshita, K., & Japan Resuscitation Council (JRC) Neuroresuscitation Task Force and the Guidelines Editorial Committee (2020). Efficacy and safety of tranexamic acid administration in traumatic brain injury patients: a systematic review and meta-analysis. Journal of intensive care, 8, 46. 

30) Du, C. N., Liu, B. X., Ma, Q. F., & Yang, M. F. (2020). The effect of tranexamic acid in patients with TBI: a systematic review and meta-analysis of randomized controlled trials. Chinese neurosurgical journal, 6, 14. 

31) CRASH-3 Intracranial Bleeding Mechanistic Study Collaborators (2021). Tranexamic acid in traumatic brain injury: an explanatory study nested within the CRASH-3 trial. European journal of trauma and emergency surgery : official publication of the European Trauma Society, 47(1), 261–268. 

32) Taam, J., Yang, Q. J., Pang, K. S., Karanicolas, P., Choi, S., Wasowicz, M., & Jerath, A. (2020). Current Evidence and Future Directions of Tranexamic Acid Use, Efficacy, and Dosing for Major Surgical Procedures. Journal of cardiothoracic and vascular anesthesia, 34(3), 782–790. 

33) Guerriero, C., Cairns, J., Perel, P., Shakur, H., Roberts, I., & CRASH 2 trial collaborators (2011). Cost-effectiveness analysis of administering tranexamic acid to bleeding trauma patients using evidence from the CRASH-2 trial. PloS one, 6(5), e18987. 

34) Williams, J., Roberts, I., Shakur-Still, H., Lecky, F. E., Chaudhri, R., & Miners, A. (2020). Cost-effectiveness analysis of tranexamic acid for the treatment of traumatic brain injury, based on the results of the CRASH-3 randomised trial: a decision modelling approach. BMJ global health, 5(9), e002716. https://doi.org/10.1136/bmjgh-2020-002716


How to Cite this article: Kao K, Alsabri M | Efficacy and Safety of Tranexamic Acid Administration in Patients with Acute Traumatic Brain Injury: A Review of Current Literature | July-December 2022; 8(2): 06-12. https://doi.org/10.13107/ti.2022.v08i02.027

 


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Management of a Polytrauma Case In a Resource-Constrained Hospital

Vol 8 | Issue 2 | July-December 2022 | page: 21-25 | Daniel Mossalbaye Adendjingue, S. Pascal Chigblo, Oswald Goukodadja, Adebola Padonou, Iréti Fiacre Tidjani, Aristote Hans-Moevi Akue

DOI: https://doi.org/10.13107/ti.2022.v08i02.0230


Authors: Daniel Mossalbaye Adendjingue [1], S. Pascal Chigblo [2], Oswald Goukodadja [2], Adebola Padonou [2], Iréti Fiacre Tidjani [2], Aristote Hans-Moevi Akue [2]

[1] Department of Orthopedic-Traumatology, National Teaching Hospital CHU-RN, N’Djamena-Chad. [2] Department of Orthopedic-Traumatology, National Teaching Hospital CNHU-HKM, Cotonou, Benin.

Address of Correspondence

Dr. Daniel Mossalbaye Adendjingue,

Department of Orthopedic-Traumatology, National Teaching Hospital CHU-RN, N’Djamena-Chad.

E-mail: dendjinguedaniel@gmail.com / adendjingue@yahoo.fr


Abstract

Introduction: The management of polytrauma patient should be beforehand and always in keeping in mind the damage control. the surgical treatment is secondary to the stabilization of the patient.

Clinical Case: we are reporting a 34 years old polytrauma patient from a motor vehicle accident. On physical examination, we noted : a severe brain injury, a closed articular fracture of right distal radius associated to a dislocation of distal radius and ulna distal joint, a closed bilateral fracture of both trochanters, an open communitive tibial fracture of proximal epiphysis methaphysis and diaphysis. The last one was classified as type IIIB of Gustilo and Anderson and associated to a closed fracture of the head and the neck of right fibula, a closed fracture of the right lateral malleolus. After patient stabilization, the head injury improves to normal Glasgow score on 8th day of admission. Necrosis of soft tissus and exposition of the tibia was noted. The surgical treatment was done on 2 stages due to financial issues. A bone synthesis of the trochanteric fracture was done only on the left and external frame as well as a muscle flap was done for the right tibial fracture on the 18th day. On the 42nd day a PAPINEAU technic associated to a proximal inter tibiofibular graft was done. The functional outcome of the orthopaedic treatment of the wrist was bad (malunion). That last complication was managed by a SAUVE KAPANDJI surgery (at 6 months) and the contracture (pronation and supination) at 12 months post trauma. The outcome was fair good despite patient financial issue and local complications that compromise an optimal surgical management and a delay. He resumes normal professional activities at about 2 years. At 5 years follow up, functional and anatomical results were satisfactory.

Conclusion: In a limited ressources’ setting, the management of lesions including a multiple fractures is a challenge for the practitioner and the injuried patient. A management taking into account social and economic ressources is mandatory to minimise sequelae. Keywords: Management, Polytrauma, Limited ressources.


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How to Cite this article: Adendjingue DM, Chigblo SP, Goukodadja O, Padonou A, Tidjani IF, Akue AHM | Management of a Polytrauma Case In a Resource-Constrained Hospital | July-December 2022; 8(2): 21-25 |  https://doi.org/10.13107/ti.2022.v08i02.030

 


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Tens Nailing in Fracture Clavicle – A Case Series

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


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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

 


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