Management of Pauwels Type 3 Femur Neck Fracture by Open Reduction Internal Fixation with DHS System and Intertrochanteric Valgus Osteotomy: A Case Series

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Vol 7 | Issue 2 | July-December 2021 | page: 18-21 | Neetin P. Mahajan, Pranay P. Kondewar, Lalkar Gadod, Akshay K. S

DOI-10.13107/ti.2021.v07i02.020

Author: Neetin P. Mahajan [1], Pranay P. Kondewar [1], Lalkar Gadod [1], Akshay K. S [1]

[1] Department of Orthopedics, Grant Government Medical College and Sir J.J Group of Hospital, Mumbai, Maharashtra, India. Address of Correspondence Dr. Pranay Pravin Kondewar, Grant Government Medical College and Sir J. J Group of Hospital, Mumbai, Maharashtra, India. E-mail: pranaypk1@gmail.com

Abstract

Femur neck is anatomically weaker and prone for fractures in all age groups of population.trauma is major cause of fracture in young individuals. Neck of femur fracture are classified based on anatomical location of fracture , pauwels classification system using orientation of fracture line and gardens system based on trabecular alignment in femur head and acetabulum. In young patients open reduction and internal fixation is preferred choice but in elderly we perform arthroplasty. When fracture is more vertical there are chances of non-union due to shear forces across fracture site.In this case series all the patients are having neck of femur fracture pauwels type 3 and are managed with lateral closing wedge valgus osteotomy at level of lesser trochanter to convert shear forces into compression forces which promotes healing of fracture And fixation is done using DHS system and CC screws .all patients were mobilised with Walker by nil weight bearing initially and followed up at 2 weekly interval later gradually weight bearing started as tolerated and all shows union of fracture and osteotomy site at 12 weeks post op. Keywords: Neck of femur fracture, Pauwels type 3, Pauwels angle, DHS system, Valgus osteotomy, Compression forces

References

1.Koval KJ, Zuckerman JD. Hip Fractures: I. Overview and Evaluation and Treatment of Femoral-Neck Fractures. J Am Acad Orthop Surg. 1994 May;2(3):141-149. 2. Barney J, Piuzzi NS, Akhondi H. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 6, 2021. Femoral Head Avascular Necrosis. 3.M.H. Meyers, J.P. Harvey Jr., T.M. Moore Treatment of displaced subcapital and transcervical fractures of the femoral neck by muscle-pedicle-bone graft and internal fixation. A preliminary report on one hundred and fifty cases .J Bone Joint Surg Am, 55 (1973), pp. 257-274 4.Pauwels F. Biomechanics of the normal and diseased hip. Springer Science and Business Media: 1976. 5.Muller ME. Intertrochanteric osteotomy: indications, preoperative planning, technique. Berlin: Springer-Verlag; 1984. pp. 25–66. 6.Chen Z, Wang G, Lin J, Yang T, Fang Y, Liu L, Zhang H. [Efficacy comparison between dynamic hip screw combined with anti-rotation screw and cannulated screw in treating femoral neck fractures]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Jan;25(1):26-9. Chinese. PMID: 21351604. 7.Bachiller, Fernando Gómez-Castresana MD, PhD*; Caballer, Antonio Perez MD, PhD**; Portal, Luis Ferrández MD, PhD* Avascular Necrosis of the Femoral Head After Femoral Neck Fracture, Clinical Orthopaedics and Related Research: June 2002 – Volume 399 – Issue – p 87-109 8.Calandruccio RA, Anderson WE 3rd. Post-fracture avascular necrosis of the femoral head: correlation of experimental and clinical studies. Clin Orthop Relat Res. 1980 Oct;(152):49-84. PMID: 7438624. 9.N.K. Magu, R. Singh, R. Mittal, et al.Osteosynthesis and primary valgus intertrochanteric osteotomy in displaced intracapsular fracture neck of femur with osteoporosis in adults Injury, 36 (2005), pp. 110-122, 10.1016/j.injury.2004.02.017

How to Cite this article: Kondewar PP, Lalkar G Management of Pauwels | Type 3 Femur Neck Fracture by Open Reduction Internal Fixation with DHS System and Intertrochanteric Valgus Osteotomy: A Case Series | July-December 2021; 7(2): 18-21.

 

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Adult Traumatic Eight Days Old Anterior Dislocation of the Hip with Ipsilateral Fracture Upper Third Shaft Femur: An Atypical Case Report

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Vol 7 | Issue 2 | July-December 2021 | page: 15-17 | Brijesh Sharma, Yajuvendra Kumar Sharma, Rohit Yadav, Chandra Prakash Pal

DOI-10.13107/ti.2021.v07i02.019

Author: Brijesh Sharma [1], Yajuvendra Kumar Sharma [1], Rohit Yadav [1], Chandra Prakash Pal [1]

[1] Department of Orthopaedics, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India.

Address of Correspondence
Dr. Chandra Prakash Pal,
Professor and Head, Department of Orthopaedics, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India.
E-mail: drcportho@gmail.com

Abstract

Introduction: Anterior or posterior dislocation of hip are usually associated with fracture head of femur but dislocations associated with femoral neck, trochanter and shaft are very rare and among this anterior dislocation of hip with ipsilateral fracture of shaft femur is an extremely rare injury. We reported a case of anterior dislocation of hip associated with ipsilateral fracture shaft femur upper third in adult male.
Case presentation: A 25 yrs male, low socioeconomic status was brought to our emergency department was conscious but unable to mobilize his right lower limb and external rotation deformity was present with some shortening. No neurovascular compromise and was found fracture shaft femur along with anterior dislocation of right hip on x-ray and treated by close reduction of femoral head and internal fixation of fracture shaft femur by intramedullary nail.
Conclusion: Early diagnosis of hip dislocation is essential to prevent avascular necrosis of femur head in future. We concluded that there is no need of open reduction for anterior hip dislocation in every such case. Close reduction of anterior dislocation of hip followed by femur interlocking for femoral shaft fracture is good option for management for such type of injuries.
Keywords: Hip dislocation, Close reduction, Avascular necrosis, Fracture dislocation

References

1. Sahin V, Karaks ES; Aksu S, Atlihan D et al (2003) Traumatic dislocation and fracture-dislocation of the hip: a long term follow-up study. J Trauma 54:520–529
2. Alexa O, Puha B, Veliceasa B, Paduraru D. Posterior dislocation of the hip associated with ipsilateral trochanteric fracture-a very rare case.Chirurgia (Bucharest, Romania : 1990) [01 Nov 2009, 104(6):761-764].
3. K Yamamoto, M Ko, T Masaoka, T Shishido, A Imakiire traumatic anterior dislocation of hip associated with ipsilateral femoral shaft fracture in a child: A case report. Journal of Orthopaedic Surgery 2004;12(1):126–132
4. Malkawi H. Traumatic anterior dislocation of hip with fracture of shaft of the ipsilateral femur in children: case report and review of the literature. J Pediatrorthop. 1982 Aug;2(3):307-11.
5. Barquet A. Traumatic hip dislocation with fracture of ipsilateral femoral shaft in childhood.Report of a case and review of literature.ArchOrthop Trauma Surg. 1981;98(1):69-72.
6. Chirag TN et al., Traumatic dislocation of hip with ipsilateral femur shaft fracture – A case report. Journal of Orthopaedics and Rehabilitation / January 2011/ vol.1/issue 1.
7. Helal and X. Skevis. Unrecognized dislocation of the hip in fractures of the femoral shaft. Vol. 49B. 2, may1967.
8. sidhasimbandan, obturator dislocation of hip associated with fracture shaft of femur Singapore: case report; medical journal volume 23, NO 5, October 1986.
9. Watson – jones R: Fracture and joint injuries. 4th ed. Baltimore: The Williams and Wilkins Co, 1955;2:678-81.

How to Cite this article: Sharma B, Sharma YK, Yadav R, Pal CP | Adult Traumatic Eight Days Old Anterior Dislocation of the Hip with Ipsilateral Fracture Upper Third Shaft Femur: An Atypical Case Report | July-December 2021; 7(2): 15-17.

 

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Sideswipe Injury to the Leg – A Hefty Price for an Autorickshaw Ride: A Case Report

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Vol 7 | Issue 2 | July-December 2021 | page: 12-14 | Devender Kasotya, Nishant Bhatia, Rajeev Yadav, Dhananjay Sabat

DOI-10.13107/ti.2021.v07i02.018

Author: Devender Kasotya [1], Nishant Bhatia [1], Rajeev Yadav [1], Dhananjay Sabat [1]

[1] Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.

Address of Correspondence
Dr. Nishant Bhatia,
Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.
E-mail: bhatianishant1111@gmail.com

Abstract

Introduction: Sideswipe injury is often described as a complex elbow injury occurring when the elbow rests on a side bar of the window of a vehicle and is then impacted by another vehicle travelling in the same or opposite direction. Side swipe injury to the leg is uncommon. Although the term side swipe is mostly used for elbow injuries, we came across a case of open comminuted fibular fracture of right leg resulting from side swipe while travelling in a tricycle.
Case Presentation: A 27-year-old male presented to us after sustaining an injury to his right leg while he was travelling in a tricycle with his right leg protruding out. There was an open wound of size 20 cm x 10 cm on lateral aspect of the middle one-third of his right leg and x-rays revealed a comminuted fracture of mid shaft of fibula. He was managed with debridement, vacuum assisted closure (VAC) dressing, split thickness skin grafting and plaster immobilization. At one year follow-up, the patient had excellent function in the leg with no activity limitation and just a minor loss of power in eversion.
Conclusion: Sideswipe injury of the leg is an infrequently reported entity and can occur if the leg is protruding out while riding in a tricycle (autorickshaw).
Keywords: Leg, Sideswipe injury, Tricycle related injury.

References

1. Sharma M, Singh K, Kumar L, Kharbanda Y. Sideswipe injuries around the elbow: Management and functional evaluation. Indian J Orthop. 2013;47:382-387. https://doi.org/10.4103/0019-5413.114923.
2. Highsmith LS, Phalen GS. Sideswipe fractures. Arch Surg. 1946;52:513-522. https://doi.org/10.1001/archsurg.1946.01230050521001. 3. Bain GI. A review of complex trauma to the elbow. Aust N Z J Surg. 1999;69:578-581. https://doi.org/10.1046/j.1440-1622.1999.01635.x.
4. Simpson NS, Jupiter JB. Complex fracture patterns of the upper extremity. Clin Orthop Relat Res. 1995;318:43-53.
5. Schmucker U, Dandona R, Kumar GA, Dandona L. Crashes involving motorized rickshaws in Urban India: Characteristics and injury patterns. Injury. 2011;42:104-111. https://doi.org/10.1016/j.injury.2009.10.049.
6. Oyewole OA, Oladiran AB, Ogunrewo TO, Omoyeni RA. Sideswipe injury of the knee: The new face of an old foe? Niger Med J. 2020;61:288-290. https://doi.org/10.4103/nmj.nmj_156_19.
7. Jalihal SA, Reddy TS. CNG: An alternative fuel for public transport. J Sci Ind Res. 2006;65(5):426-431.
8. Majumdar D, Jash T. Merits and challenges of e-rickshaw as an alternative form of public road transport system: a case study in the state of West Bengal in India. Energy Procedia. 2015;79:307-314. https://doi.org/10.1016/j.egypro.2015.11.492.
9. Dandona R, Mishra A. Deaths due to road traffic crashed in Hyderabad city in India: Need for strengthening surveillance. Natl Med J India. 2004;17:67-72.
10. Dandona R, Kumar GA, Dandona L. Traffic law enforcement in Hyderabad, India. Int J Inj Contr Saf Promot. 2005;12(3):167-176. https://doi.org/10.1080/17457300500088840.

How to Cite this article: Kasotya D, Bhatia N, Yadav R, Sabat D Side Swipe | Injury to the Leg – A Hefty Price for an Autorickshaw Ride: A Case Report | July-December 2021; 7(2): 12-14.

 

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Radiological Assessment and Functional Outcomes of Hand and Wrist in Patients with Distal End Radius Fractures

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Vol 7 | Issue 2 | July-December 2021 | page: 04-08 | Yogesh Pethapara, Vishwajeet Singh, Ronak Patel

DOI-10.13107/ti.2021.v07i02.016

Author: Yogesh Pethapara [1], Vishwajeet Singh [1], Ronak Patel [1]

[1] Department of Orthopedics, Maruti Superspeciality Orthopaedic Hospital, Morbi, Gujarat, India.


Address of Correspondence
Dr. Yogesh Pethapara, Maruti Superspeciality Orthopaedic Hospital, Morbi, Gujarat, India. 363641.
E-mail: matrixyp1@gmail.com

Abstract

Background: Fractures of distal end of radius are the most common fractures among the patients treated at emergency rooms. Despite a considerable progress in medical field over the last several years, distal end of radial fracture outcomes seem to be unsatisfactory in fairly large number of cases. The aim of this study was to determine the functional outcome of hand and wrist after distal end of radius fractures managed by different treatment modalities, to determine the complications of each methods used for treatment of distal end of radius fractures, to compare anatomical outcome with functional outcome after management of fracture distal end of radius.
Methods: A clinical, observational, prospective type of study was carried out on 40 cases with fractures of distal end of radius. The fractures were classified according to AO classification. After initial evaluation patients were taken up for either conservative or operative treatment. All the cases were followed up and assessed for minimum of 6 months. Patients with complications were followed up more frequently. Results: Anatomical results were evaluated according to Sarmiento’s modification of Lindstrom Criteria. Clinical and functional results were evaluated according to demerit point system of Gartland and Werley with Sarmiento modification
Conclusions: There is direct relationship between anatomical result and functional outcome. Therefore, every effort should be made to restore normal length and alignment, as well as articular surface congruency of distal radius.
Keywords: Distal end of radius, Demerit point system of Gartland and Werley with Sarmiento modification, Sarmiento’s modification of Lindstrom Criteria, Functional evaluation

References

1. Sarmiento A, Pratt GW, Berry NC, Sinclair WF. Colles’ fractures, functional bracing in supination. J Bone Joint Surg Am. 1975 apr;57(3)311–7.

2. Gartland JJ, Jr, Werley CW. Evaluation of healed Colles’ fracture. J Bone Joint Surg Am. 1951;oct 33-a(4)895–907.

3. Jupiter JB. Fractures of the distal end of the radius. J Bone Joint Surg [Am] 1991 mar;73-A:461-9.

4. Van Der Linden W, Ericson R. Colles‟ fracture: how should its displacement be measured and how should it be immobilized? J Bone Joint Surg [Am] 1981;63-A:1285-8.

5. Porter M, Stockley I. Fractures of the distal radius: intermediate and end results in relation to radiologic parameters. ClinOrthop 1987;220:241-52.

6. Cooney WP 3rd, Lindscheid R, Dobyns J. External pin fixation for unstable Colles‟ fracture. J Bone Joint Surg [Br] 1979; 61-B:840-5.

7. Solgaard S. Function after distal radius fracture. ActaOrthopaedicaScandinavica. 1988;59(1):39-42.

8. altissimi m, antenucci r, fiacca c, mancini g. Long-term Results of Conservative Treatment of Fractures of the Distal Radius. Clinical Orthopaedics and Related Research. 1986;&NA;(206):202-210.

9. Baruah R, Islam M, Haque R. Immobilisation of extra-articular distal radius fractures (Colles type) in dorsiflexion. The functional and anatomical outcome. Journal of Clinical Orthopaedics and Trauma. 2015;6(3):167-172.

10. Arora R, Gabl M, Erhart S, Schmidle G, Dallapozza C, Lutz M. Aspects of Current Management of Distal Radius Fractures in the Elderly Individuals. Geriatric Orthopaedic Surgery & Rehabilitation. 2011;2(5-6):187-194.

11. Ayhan KILIC, Yavuz KABUKCUOGLU, Ufuk OZKAYA, Murat GUL, Sami SOKUCU, Umit OZDOGAN. Volar locking plate fixation of unstable distal radius fracturesActaOrthopTraumatolTurc 2009;43(4):303-308

12. Chung, Kevin C, Watt, Andrws, Kotsis, Sandra VMPH, Margaliot, ZVI, Hase, Steven, Kim H. Myra. Treatment of unstable distal radius fractures with volar loking compression plate. The J Bone & Joint Surg 2006 Dec; 88-A(12): 2687-2694.

13. RE Anakwe, LAK Khan,RE Cook, and JE McEachan Locked volar plating for complex distal radius fractures: Patient reported outcomes and satisfaction J OrthopSurg Res. 2010; 5: 51.

14. Sanjay Meena, Pankaj Sharma, Abhishek Kumar Sambharia,1 and Ashok Dawar2 Fractures of Distal Radius: An Overview J Family Med Prim Care. 2014 Oct-Dec; 3(4): 325–332. doi: 10.4103/2249-4863.148101

How to Cite this article: Pethapara Y, Singh V, Patel R | Radiological Assessment and Functional Outcomes of Hand and Wrist in Patients with Distal End Radius Fractures | July-December 2021; 7(2): 04-08.

 

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Comparison of Functional Outcome Between Trans– 2nd Metacarpal Fixation and Trans-Trapezius Fixation with K-Wire for Bennett Fracture

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Vol 7 | Issue 2 | July-December 2021 | page: 01-03 | Vishal V. Navale, Manasee Gulati

DOI-10.13107/ti.2021.v07i02.015

Author: Vishal V. Navale [1], Manasee Gulati [2]

[1] Department of Orthopaedics, Mysore Medical College and Research Institute, Mysore, Karnataka, India.
[2]Department of Physical Therapy, Manipal Academy of Higher Education, Manipal Hospitals, Bengaluru, Karnataka, India.

Address of Correspondence
Dr. Vishal V. Navale, Department of Orthopaedics, Mysore Medical College and Research Institute, Mysore, Karnataka, India.
E-mail: nvvishal2010@gmail.com

Abstract

Introduction: An articular fracture of the base of the thumb metacarpal consisting of a single, variable-sized, volar-ulnar fracture fragment is termed Bennett fracture. In the studies conducted so far there has been paucity in the knowledge about the methods of k wire fixation for the Bennett fracture and hence the purpose of this study is to compare functional outcome between the trans – 2nd metacarpal fixation and trans – trapezius fixation with K wire for Bennett fracture.
Methods: Patients were 18 years and above with no previous injury on the 1st metacarpal . Final assessment was performed from six months to nine months after the treatment with the DASH Score, VAS scale for pain, Hand Grip strength by Dynamometer. Radiographic images were taken at 6 months post-op in two separate views to evaluate post-traumatic arthritis of the first CMC joint.
Results: Statistical analysis showed a correlation between Pain and DASH score to be 0.946 in TTZ group and 0.966 in T2MC group and hence signifies that patients in T2MC group had a better functional outcome with lower DASH score and lower pain score. Significant correlation was seen between Pain and Grip strength, with -0.587 in TTZ group and -0.482 in T2MC group. Higher pain score correlated with higher DASH score and lower Grip strength and hence we can conclude that T2MC had a better functional outcome post-surgery than TTZ technique of fixation. Post op radiographs showed that T2MC group of patients had a better outcome with less arthritic complications and less pain and better grip strength.
Conclusion: This study gives us the overview about the two fixation methods of Bennett fracture , and that when trans 2nd metacarpal fixation is done , there are less chances of arthritis of the CMC joint as well as better functional outcomes post operatively as compared to trans trapezial fixation and hence guides a surgeon to make a decision about the technique of fixation to be employed during fixing such fracture.
Keywords: Bennett fracture, Trans-trapezial, Trans- 2nd metacarpal, Functional outcome

References

1. Drelich M, Godlewski P. Metacarpal fractures. Orthop Traumatol Rehabil 2004;6:331–335. 2. Kahler DM. Fractures and dislocations of the base of the thumb.J South Orthop Assoc 1995;4:69 –76. 3. Gedda KO, Moberg E. Open reduction and osteosynthesis of the so-called Bennett fracture in the carpo-metacarpal joint of the thumb. Acta Orthop Scand 1952;22:249–57. 4. Yin Y, Wang Y, Wang Z, Qu W, Tian W, Chen S. Accuracy of fluoroscopic examination in the treatment of Bennett fracture. BMC Musculoskelet Disord. 2021 Jan 4;22(1):3. doi: 10.1186/s12891-020-03867-1. PMID: 33397336; PMCID: PMC7783999. 5. Fractures of the Metacarpals and Phalanges: Charles S. Day. Greens Operative Hand surgery –Elsevier, 7th edition 2016, pg 272. 6. Fischborn T, Beckenbauer D, Held M, Daigeler A, Medved F. Analysis of operative techniques of fractures of the first metacarpal base. Ann Plast Surg 2018;80:507–14. 7. Hand – surgical treatment: Thomas P Ruedi. AO principles of fracture management – AO Publishing , second edition 2007, pg 683. 8. Kamphuis SJM, Greeven APA, Kleinveld S, Gosens T, Van Lieshout EMM, Verhofstad MHJ. Bennett fracture: Comparative study between open and closed surgical techniques. Hand Surg Rehabil. 2019 Apr;38(2):97-101. 9. Crosby CA, Wehbe MA, Mawr B. Hand strength: normative values. J Hand Surg Am 1994;19:665–70. 10. van Niekerk JL, Ouwens R. Fractures of the base of the first metacarpal bone: results of surgical treatment. Injury 1989;20:359–62. 11. Kamphuis SJM, Greeven APA, Kleinveld S, Gosens T, Van Lieshout EMM, Verhofstad MHJ. Bennett fracture: Comparative study between open and closed surgical techniques. Hand Surg Rehabil. 2019 Apr;38(2):97-101. doi: 10.1016/j.hansur.2018.11.003. Epub 2019 Jan 9. PMID: 30639054. 12. Greeven APA, Van Groningen J, Schep NWL, Van Lieshout EMM, Verhofstad MHJ. Open reduction and internal fixation versus closed reduction and percutaneous fixation in the treatment of Bennett fractures: A systematic review. Injury. 2019 Aug;50(8):1470-1477. doi: 10.1016/j.injury.2019.06.027. Epub 2019 Jun 28. PMID: 31288938.

How to Cite this article: Navale VV, Gulati M | Comparison of Functional Outcome Between Trans– 2nd Metacarpal Fixation and Trans-Trapezius Fixation with K-Wire for Bennett Fracture | July-December 2021; 7(2): 01-03.

 

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