European Journal of Molecular & Clinical Medicine

Early stabilization of open fractures provides many benefits to the injured patient. It protects the soft tissues around the zone of injury by preventing further damage from mobile fracture fragments. It restores length, alignment, and rotation. All patients attending the orthopedic out-patient department and casualty of medical college and hospital with complaints of an open fracture grade II, IIIA, IIIB and meeting inclusion and exclusion criteria will be selected for the study. A written informed consent will be obtained from selected patients. Result was considered excellent in patients with full rom, and with no evidence of any complications. Result was considered good in patients with near to full rom, with no complications Result was considered fair in patients with restricted rom, with complications like infection and delayed union Result was considered poor in patients with non-union

Lumbar prolapse of intervertebral disc (PIVD) is seen in over 1% of adults with the most incidence between the 3rd to 5th decades of life. It appears to be more prevalent in the male population and predominantly affects the L4-L5 and L5-S1 levels. Over the years several surgical techniques have been developed for its management but the best technique is still debatable.
Aims: This study aims to compare both immediate and long-term functional outcome following minimally invasive spine surgery (MISS) and open discectomies for Lumbar prolapse.
Settings and Design: It is a non-randomised controlled study.
Methods and Material: The patients, diagnosed with lumbar disc prolapse, were taken for the surgery of choice following an initial assessment. The outcome is assessed in the immediate post-operative period using VAS and ODI and long-term functional outcome using Modified macnab criteria between 12 and 18 months post-surgery.
Statistical analysis used: The IBM SPSS software was used to study the correlation. One-tailed ANOVA with CI of 95% was conducted for VAS score and ODI score while Mann-Whitney U test was done on the Modified Macnab Criteria.
Results: This study was conducted on 103 subjects with 56.3% undergoing open discectomies while 43.7% underwent minimally invasive discectomies. 73 subjects were operated on the L4-L5 level and 30 on the L5-S1 level. The study revealed that the operative duration of MISS is significantly more than that of open procedure. The VAS score for the MISS procedure had a mean change of 3.067 in the immediate postoperative period versus the mean reduction of 2.603 for open procedure. The ODI of MISS has decreased from 44.27 to 13.73 and that of Open procedure has decreased from 43.19 to 17.48. The long-term outcome at 12-18 months after surgery was excellent for 75.5% of MISS patients but only 25.9% open discectomy cases
Conclusions: The MISS procedure did not produce a strongly clinical outcome compared to open discectomies in the immediate after surgery but the functional outcome of MISS procedure on the long-term was greater than that of the conventional method

Background:To compare and study the functional outcome of displaced midshaft clavicle fractures Between surgical fixation using Open reduction with internal fixation (ORIF) plating and Titanium Elastic nailing system (TENS). Methods: A total of 65 patients with displaced midshaft clavicle fractures (aged between 20-65 years) were randomly allocated to ORIF (n=34; Mean age 43.59±15.55 years; 55.9% males) or TENS (n=31; Mean age 43.36±16.08 years; 61.3% males) groups. Preoperative demographic, clinical characteristics and functional status in terms of Disabilities of Shoulder and Hand (DASH) scores were noted. Intraoperative blood loss and transfusion need were noted. Post-operative complications, duration of hospital stay and mobilization time were noted. The patients were followed up at 2 weeks, 3 months and 6 months follow-ups. At each follow-up functional outcome was noted in terms of DASH scores. Final functional status was measured at 6 months. Data was compared using chi-square and student ‘t’-tests. Results: The two groups were matched statistically for preoperative demographic, clinical and functional characteristics. Mean preoperative DASH scores were 78.47±2.85 and 78.16±3.26 respectively in ORIF and TENS groups. No significant difference in intraoperative and postoperative clinical course was seen between the two groups. Time taken for mobilization was 5.97±1.51 and 5.90±1.25 days respectively in ORIF and TENS groups whereas mean duration of hospital stay was 12.15±1.42 and 11.87±1.98 days respectively in the corresponding group. At six months DASH scores were 24.32±7.27 and 25.00±8.15 respectively in ORIF and TENS groups. An improvement of 69% and 68% in mean DASH scores was seen in the two study groups showing the difference not to be significant. Conclusion:  Both ORIF as well as TENS have comparable clinical and functional outcome in management of displaced midshaft clavicle fractures. Trial registration:Clinical Trials Registry-India (ICMR-NIMS) - CTRI/2022/12/048509
URL of the trial registry: http://www.ctri.nic.in.

Background: Aim & Objective: The purpose of the present study is to verify the
functional outcome of the internal fixation, in calcaneum fractures.
Materials and Methods: Our study included patients reporting to Osmania General
Hospital, Hyderabad from June 2017 to October 2019 treated by internal fixation using
various modalities and those who were available for follow up. All patients above
l8years of age with communitedcalcaneum fractures, Fresh fractures and Patients
should be walking prior to the fracture.
Results: Thirty patients with comminuted calcaneal fractures were operated from June
2017 till October 2019 Of the 30 patients 28 were male 2, were female with a mean age
of 37 years, 2 patients had bilateral fractures.18 had left sided fractures while 12 had
right sided fractures and mode of injury for the 23 patients was fall from a height and
RTA for 67patients.20 patients had SANDERS type 3 fracture and 10 patients had
SANDERS type 2 fractures. Days of hospital stay varied from 14 to 22 days {mean 16.04
days}. Post operatively 14 patients had swelling and 6 patients had persistent pain,2 had
superficial infection and one had deep infection. The infections have healed with
antibiotics and regular dressing. Of the 30 patients, 9 had excellent results, 15 had good
results, 4 had fair results, 2 had poor results. Hence we concluded from the above
findings the internal fixation helps in improving the functional outcome of the patients
in view of their physical and radiological findings.
Conclusion: The technique of plate fixation with a lateral approach is good with regards
to fracture union and functional outcome. It also shows that anotomical reduction in
terms of the correction in BOHLER'S and GISSANE'S angle plays an important role in
determining the good functional outcome.

The most widespread internal fixation device used today is the fixed angle extramedullary device, such as a 95-degree lag screw and side plate or blade plate. This implant includes a large lag screw positioned in the center of the femoral neck and head and a side plate alongside the lateral femur. The screw-plate interface angle is changeable and depends on the anatomy of the patient and the fracture. A total of 30 patients who were admitted with intertrochanteric fractures that fitted into the inclusion criteria and managed surgically with proximal femoral nail were included in the study. In our series, Boyd and Griffin type II and type III contributed eighteen and six cases in each group, making to 60% and 20% followed by type IV contributing 6 cases making 20%. We performed closed procedure in 26 cases (87%) and open nailing in 4 cases (13%). The average duration of radiation exposure was 120 seconds, average duration of surgery was 95 minutes and average blood loss was 140 ml with 23% intraoperative complications

Closed reduction with plaster of Paris slab immobilization has traditionally been used for supracondylar fractures, but loss of reduction and necessity of repeated manipulation likely results malunion producing varus or occasionally valgus deformity of elbow and elbow stiffness.
Because of lower percentage of good results and higher percentage of early and late complications compared with skeletal traction, percutaneous pinning and open reduction, casting is appropriate only for undisplaced fractures. The clinical material for the study consists of 30 cases of fresh supracondylar fractures of humerus in children of traumatic etiology meeting inclusion and exclusion criteria. Out of 19 patients which were treated by closed reduction, 16 patients (84.2%) showed excellent result and remaining 3 showed good results (15.8%) according to Mitchell and Adams criteria. Out of 11 patients treated by open reduction, 5 patients (45.5%) showed excellent results and 4 patients (36.4%) showed good results and 2 poor results (18.2%) were obtained with a statistically moderate significant value of p 0.045.

Background: Patients treated with bi columnar locking compression plates show a greater
functional range of motion, better restoration of articular congruity, secure bony fixation,
better bone healing, and early rehabilitation. The aim of this study to assessed whether distal
humerus fractures (AO type 13-C) treated with open reduction and internal fixation with bi
columnar plating allows early mobilization and improves functional outcomes in patients and
also to assess its associated complications.
Materials& Method: This is prospective study where in consecutive 50 cases of distal
humerus fractures (AO type 13C) admitted in orthopedic ward in SMS Medical College,
Jaipur, Rajasthan, India during one year period. Functional outcome was assessed through
The Mayo Elbow Performance Score. All the cases in the study were posttraumatic. Patients
were following u pregularly for a period of 1year post operatively.
Results: The mean age of patients was39.68 years,withthe youngest being 21years and oldest
is 80years. Male to female ratio was 2.3:1. In 32patients left side was involved and in
18patients had right side involved. 30cases were due to Road traffic accidents and 20cases
due to self-fall. 48patients had a closed type and only two patients had an open typeII
fracture. The mean arc of movement in the flexion–extension plane was 116.780 with a mean
fixed extension of 8.560. MEPS was excellent in 35 patients, good in 8 patients, fair in 5
patients and poor in 1patient at end point of follow up. Patient with poor score had severe
stiffness and experienced difficulty in performing daily routine activities.
European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 9, Issue 3, Winter 2022
10937
Conclusion: We concluded that distal humerus fractures operated with bicolumnar locking
compression plates using trans olecranon approach by chevronosteotomy has good functional
outcome with particular advantage in intra-articular typeC3 which allows early mobilization
of the patients even in fractures with comminution due to the enhanced stabilityof the
construct.

Background: Anterior cruciate ligament avulsion common in young adults and teenage
group, other mechanism of injuries includes sports injuries fall. The present study was
conductedto assess the functional outcome of arthroscopic suture pull out fixation of
displaced tibial spine avulsion fracture.
Materials&Methods: The present prospective hospital-based study was conducted over a
period of 1 year with a sample size of 40. Diagnostic arthroscopy was performed under spinal
or general anesthesia through the standard anterolateral portal. Patients who had pain and
disability resulting from tibial spine avulsion inactive patient type II, type III and type IV,
Age: < 60 years were included in the study.
Results: In the present study majority of subjects were in the age group 18 to 30 years
(60%).In the study, 85% were males and 15% were females.15% had fall from the cycle,
60% had fallen from motorbike and 25% had fall while playing.Status of Physis in 62.5%
was closed and open in 37.5%.In the study 72.5% had Type III and 37.5% had Type IV
Meyers and McKeever's classification.At 3 months, the mean Post op Lysholm score was
85.14±1.45, at 6 months was 96.83±2.03 and at 12 months was 97.14±1.35. There was a
significant increase in Post op Lysholm score at 6 months and 12 months. At 12 months when
compared to 6 months Post op Lysholm score, there was no significant increase in Post-op
Lysholm score.10% subjects had Post-op Knee Stiffness.
Conclusion: The present study concluded that Arthroscopic suture pull-out fixation for type
III and IV tibial spine avulsion shows excellent outcomes without any significant
complications.

Background: Extra-articular distal shaft humerus fractures at the junction of cylindrical and triangular portion are seen as torsion wedge fractures. Historically most shaft fractures were treated conservatively. Today’s trend is towards surgical management due to high patient demand and availability of anatomical plates. This study aims to evaluate the functional results of plating in extra-articular distal humerus fractures with duration of clinical and radiological union.
Methods: A prospective study of 20 patients with torsion wedge fractures of AO Type 12-B1 was done over a period of 3 years. Demographic data was collected and all patients underwent fixation with posterior triceps splitting approach using an extra-articular distal humerus plate (EADHP) and inter-fragmentary screws. Results were evaluated by clinical and radiographic parameters. Functional results were monitored by modified Quick DASH score.
Results: There were 12 males and 8 females with a mean age of 34.45 years. Mean time to clinical and radiographic union was 10.5 weeks and 33.9 weeks respectively. The mean modified Quick DASH score at clinical and radiographic union was 24.8% and 13.76% respectively. Two patients developed radial nerve neuropraxia recovering spontaneously. One patient having inadequate reduction went on to unite both clinically and radiographically with good functional out come without any secondary intervention.
Conclusion: AO Type 12-B1 humerus fractures treated surgically with anatomical locking plates and inter-fragmentary screws give excellent anatomical and functional results. Though time to radiographic union is prolonged, no secondary intervention in the form of bone grafting or other modalities was required in any patient.

Background: Accurate placement of tibial and femoral tunnel has significant effect on
functional outcome after anterior cruciate ligament reconstruction (ACLR). Anterior cruciate
ligament tear is one of the common sports injuries, and arthroscopic reconstruction is now a
day’s popular surgery. Its failure is rare but not uncommon. Despite advances, failure rate
after ACL reconstruction (ACLR), ranges from 0.7% to 10%1. Slight anterior placement of
femoral tunnel can lead to restriction of knee flexion and, similarly if tibial tunnel is anterior,
it leads to impingement of graft, surgical failure and also the need for a revision surgery.
Post-operative CT scan provide a reliable and valid way for the assessment of anatomical
tunnel position and obliquity after ACLR.
Materials and Methods: 31 patients with complete ACL tear with or without the meniscal
injury are treated with single bundle arthroscopic reconstruction using hamstring graft tendon.
With common post-operative rehabilitation protocol all patient are followed up clinically and
radiological for next 2 year. Femoral, tibial tunnel positions on sagittal plane. Were measured
interpreted with the clinical parameters. Radiological parameters were summarized as mean
standard deviation and proportions as applicable.
Results: Total no of patients with the age averaged 27.13± 5.89, pre op lysholm score
averaged 64.26±8.93. At 24 months follow up position of the tibial tunnel was found to be at
an average of 31.55%±4.79posterior from the anterior edge of the tibia. The femoral tunnel
was found at an average of 28.54±3.18% anterior to the posterior femoral cortex. 32.2% and
35.5% of patients showed grade 1 anterior drawer and lachman test positive respectively. And
mean lysholm score averaged to be 86.58±5.32.
Conclusion: The location of femoral tunnel in the mid sagittal section from the posterior
cortex 28.54±3.18% of anteroposterior length showed no significant correlation the lysholm
scoring. Locating the tibial tunnel positioning on the tibial plateau from the anterior cortex of
Showed significant p value with functional outcome.

Background: Tunnel expansion in anterior cruciate ligament reconstruction (ACL-R) is a
well-accepted phenomenon, still its effect on functional outcome is little known.
Purpose: To study prospectively the effect of change in the tunnel volume as observed with
computed tomography (CT) on functional outcome after ACL-R.
Materials and Methods: This study conducted for a follow up of 24 months of time period
between June 26th 2017 to 31st December of 2019, after approval from ethical committee 31
patients with complete ACL tear with or without the meniscal injury were treated with single
bundle arthroscopic reconstruction using hamstring tendon graft. With common postoperative
rehabilitation protocol, all patients were followed up clinically and radiologically
for two years. Tibial and femoral tunnel volume were measured and correlated with the
clinical parameters. Radiological parameters were summarized as mean, standard deviation
and proportions as applicable.
Results: Total number of 31 patients with the average age 27.13±5.89 and pre-operative
lysholm score average of 64.26±8.93 were included in the study. At the end of 2years follow
up of each patient, 32.2% and 35.5% of patients showed grade 1 anterior drawer and
lachman test positive respectively and mean lysholm score averaged to be 86.58±5.32.
Significant difference of tunnel volume noted at the end of 2 years with a 0.837 cm3 and
0.545 cm3of tibial and femoral tunnel volume respectively.
Conclusion: Noted a significant expansion of both tibial and femoral tunnel volume
postoperatively when compared to the intra-operative tunnel volume. Both the femoral and
tibial tunnel volume showed negative correlation with the functional outcome.

Introduction: Clavicle fracture is a common traumatic injury and account for approximately 2.6% of all fractures. The middle-third fractures (80-85%) are most common of all clavicular fractures and were conservatively treated. Several recent multicenter, randomized control studies reported that open reduction and internal fixation (ORIF) had much lower nonunion and malunion rates as well as better shoulder function compared with non-operative treatment there are few precise data on the complications and functional outcome rates of each plate based on different fracture classifications. The current study aims to understand the complications and functional outcome with various plates.
Material and Methods: A prospective study was done in 40 patients with mid clavicular fractures type B according to Robinsons classification selected by purposive sampling method, during December 2018 to May 2021 in a tertiary care teaching hospital. After obtaining institutional ethical clearance and informed consent, history was collected, findings on general, systemic and local examination were recorded. Clavicular fixation was done under general anaesthesia using plates (reconstruction plate/dynamic compression plate/locking compression plate) and cortical screws. Follow up done to note complications and functional outcomes with different plates and analyzed statistically by chi-square test with P<0.05 as significance level.
Results: Majority of the patients were in the age group of 19-29 years (20 patients/50%) with mean patient age was 32 years. Majorities were males (32 patients/80%). In 20 patients (50%) reconstruction plates were used. In 10 patients (25%) locking compression plates were used.
 
In 10 patients (25%) Dynamic compression plates were used. The functional outcome was assessed by Constant and Murley score, 29 patients (67.5%) had excellent functional outcome, good functional outcome in 5 patients (12.5%), fair functional outcome in 6 (15%) patients and poor in 2 patients (5%).
Conclusions: Functional outcome was either excellent or good (80%) and complications (45%) were less common in patients managed with non-reconstruction plate compared to reconstruction plate, which was statistically significant.

Background: Displaced mid shaft clavicular fracture can be manage conservatively and
surgically, open reduction and internal fixation with plate and screw, as primary
intervention is valid option.
Method: prospective cohort study was conducted of 18 young patients with displaced mid
shaft clavicle fracture ,these patients underwent open reduction and plate and screw
fixation, after 6 months follow up evaluation done for complication rates functional score
by DASH & ULCA score, patients satisfactions and estimation of time need for resume
job.
Results: 15/18 patients were male; those patients underwent open reduction and internal
fixation by plate and screw in time up to 40 days post injury. 50% have complications
mostly minor complications like prominent hard ware and scar or paresthesia, 2/18
patients have major complication, one infection and other implant failure ,most of patients
14/18 have fully satisfied with result ,61% resumed the job early within 3 weeks. The
mean DASH score was 34.9 ,ULCA score 28.9, factors effecting DASH score was
comorbidity, complication, range of motion, satisfaction and time to return to job, while
ULCA score effected by use of regional anesthesia, complication, range of motion,
satisfaction and time to return to job. There is no statistical relationship between age,
gender, and complications and time to fixation to satisfaction or time to resume job.
Conclusion: open reduction and internal fixation of displaced mid shaft clavicle fracture
should be offered for patient with expectation of good outcome especially with supervised
rehabilitation.