Online ISSN: 2515-8260

Keywords : Internal Fixation


A prospective study on surgical management of metacarpal shaft fractures using mini plates and screws

Dr. Shreeshail BB, Dr. Raghu YA, Dr MD Anwar

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 4, Pages 211-220

Accurate open reduction and internal fixation of metacarpal fractures are required in unstable fractures where closed treatment technique yield poor functional outcome which usually is less than 5% of hand fractures.
Mini plates and screws when used in properly selected cases provide rigid fixation allowing early mobilization of joints and hence good functional outcome.
Patients and methods: In 25 patients with closed metacarpal shaft fractures treated with mini plates and screws between December 2017 to December 2019 at Vijayanagara institute of medical sciences Ballari. The functional outcome was assessed using Disability of Arm, Shoulder and Hand (DASH) score and Visual Analog Score (VAS) over a period of two years in prospective manner.
Results: In our study of metacarpal shaft fractures treated with plate osteosynthesis all the cases showed bone union (100%). The functional result is Excellent in 84% of the patients (21 of 25 cases), good in 12% of cases (3of 25 Cases), poor in 4% of cases (1 of 25 cases). 2 patients developed superficial wound infection which settled with daily dressing and antibiotics and this does not affect the final outcome.
Conclusions: Plate and screw fixation is a good option for treating closed metacarpal shaft fractures, where other modalities of fixation are less effective, the rigid stable fixation provided by plating withstands load without failure allowed early mobilization and achieved good functional results.

Suprapatellar Versus Infrapatellar Nail In Distal Tibial Fractures

Dr. Nikhil Gupta, Dr. Sunil Kumar Sharma, Dr. Abdul Basit, Dr. Sanjeev Gupta, Dr. Rashid Anjum, Dr. Aakash Deep, Dr. Dinesh Kumar Chadgal .

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 1, Pages 2575-2580

Background: Infrapatellar (IP) and suprapatellar (SP) surgical methods were used in this study to evaluate and analyse the clinical and functional results of distal tibia fractures treated with intramedullary nailing (IMN).
Methods: 63 patients who received IMN treatment for distal fractures during June 2019-2022 were the subject of a retrospective investigation. The SP and IP procedures were used to perform IMN on a total of 27 and 36 patients, respectively. This study looked at the length of the procedure, blood loss, closed reduction rate, rate of adjuvant reduction technique, fracture healing time, and complications. The visual analogue scale was used to rate the severity of anterior knee discomfort. Clinical evaluations were conducted using the Lysholm Knee Scoring Assessment and the American Orthopaedic Foot and Ankle Society (AOFAS) scale.
Results: A total of 63 patients were assessed, with a follow-up of 12 months. Between the two groups, there were no appreciable differences in terms of the typical operating time, blood loss, rate of adjuvant reduction technique, rate of closed reduction, fracture healing time, or Lysholm Knee Scoring Scale score. But in terms of pain score, AOFAS score, and fracture deformity rate, the SP technique outperformed the IP approach (P <0.05).
Conclusions: The SP IMN technique is superior to the IP IMN technique for the treatment of distal tibia fractures in terms of functional result, reduction in knee discomfort, and reduction in fracture deformity

Surgical management of pediatric supracondylar humerus fractures with percutaneous pinning: A prospective study

Dr. Sundaresh K, Dr. Venugopal R, Dr. Albin Geo Babu, Dr. Vinay Reddy S

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 2141-2154

Background and Objectives: Supracondylar fractures of humerus is a common injury in children accounting to 60% of the fractures around the elbow. The management of displaced
supracondylar fracture of the humerus is one of the most challenging, since it requires accurate reduction and internal fixation to prevent complications. Conservative treatment results in malunion. Open reduction and internal fixation is more invasive and recovery is prolonged. Closed reduction and percutaneous pinning is preferred method of treatment for displaced supracondylar fracture of humerus in children. The objectives of this study is to report the results of closed reduction and internal fixation with percutaneous k wires in the displaced Gartland type 2 and type 3, supracondylar fracture humerus in children.
Materials and Methods: A prospective clinical study conducted at the Department of Orthopaedic Surgery, Vijayanagar Institute of Medical Sciences, Ballari. from August 2020 to August 2022. This study consists of 30 cases of displaced supracondylar fracture humerus treated by closed reduction and internal fixation with k wires. The cases were selected according to inclusion and exclusion criteria. The final results were evaluated according to Flynn et al. criteria.
Results: In our study based on Flynn et al. criteria, the following results were made. Of the 30 cases, 21 patients obtained excellent results, 5 patients had good results, 3 patients had fair results, that is 29 patients had satisfactory results and one patient had poor result, that is unsatisfactory result. The results were comparable to other studies.
Conclusion: It can be concluded from the present study that closed reduction and internal fixation with percutaneous k wires, for displaced supracondylar fracture humerus in children gives good anatomical reduction, stable fixation and good functional outcome with minimum complication.

A prospective study on Clinical and functional outcome of proximal humerus fractures treated with locking compression plate (LCP) among adults

Dr D Hanuman Singh, Dr. Boinapally vikas , Dr. B. Tej Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 5650-5663

Introduction: Proximal humerus fractures are one of the commonest fractures occurring in the skeleton representing approximately 4% of all fractures and 26% of humerus fractures. Fractures that occur in the elderly usually result from a trivial fall on an outstretched hand or the side of the shoulder. Younger patients with these injuries are more likely due to high energy trauma following road traffic accidents and present with significant associated injuries. Aim: To evaluate the outcome of open reduction and internal fixation using locking compression plate for proximal humeral fractures.

A Study of Efficacy of Internal Fixation of Calcaneum Fractures

Mrunal Chakravarthy Goutham, Anil Kumar Mettu, Mangalapuri Rajesh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1787-1794

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.

AN EVALUATION OF OUTCOME OF SURGICAL MANAGEMENT OF UNSTABLE COMMINUTED FRACTURE OF DISTAL RADIUS USING EXTERNAL AND INTERNAL FIXATION

Dr. Anilkumar T Bennur, Dr. Tulaja Prasad PV, Niraj A Bennur

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 2029-2033

Introduction: The goal of treatment of distal fracture of radius is restoration of normal function and prevention of complication like malunion, joint stiffness and deformity but achievement of desired outcome is always a challenge in fracture of distal end of radius.
Materials and Methods: Patients with unstable comminuted fracture of distal radius admitted in the department of orthopedics and enrolled for this study based on inclusion and inclusion criteria. For functional assessment of outcome, we used DASH (Disability of the Arm, shoulder and hand) Method.
Result: The mean of DASH score was16.24±4.62 in external fixation group and 14.65±3.98 in internal fixation group. Both groups are comparable to each other as it is not statistically significant (P˃ .05). There is no incidence of compressive neuropathy, Sudeck’s osteodystrophy, iatrogenic rupture and nerve injury.
Conclusion: DASH score was less in internal fixation group. Post-operative infection was high in internal fixation group. Functional outcome was better in internal fixation group.
                                           

Open Reduction and Internal Fixation of Ipsilateral Fracture of Acetabulum and Fracture Femur through One Approach

Fadhlullah Ali Mansour, Yousuf Mohamed Khira, Waleed Mohammed Nafea, Ahmed Mashhour Gaber

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 3361-3368

Background: Major and unstable pelvic fractures as ipsilateral fractures of the
femur and acetabulum are likely to cause severe pain and shock. Poly trauma
management proceeds in line with ATLS protocol and Patients may require
lifesaving surgeries. The study aimed to assess outcome of open reduction and
internal fixation of psilateral fracture of acetabulum and fracture femur through
one approach as the effect way of treatment. Patients and methods: A prospective
study included 18 patients were presented with posterior wall acetabular fracture
with ipsilateral femoral fracture. Patients admitted Orthopedic surgery Department
of Zagazig University hospitals for fracture surgical fixations. Full history, clinical
examination and radiological assessment and Majeed Score were performed for all
patients. Follow up X rays were done in the 1st day postoperative, after two weeks,
3months , 6 months. Results: the healing time of femoral fracture ranged from 14
weeks up to 33 weeks with mean of 21.78 ± 5.9 and healing time of acetabular
fracture was 17.22 ± 4.1 weeks. 55.6% of studied group gave excellent Majeed score
of hip function, while only 16.7% were fair. Conclusion: Ipsilateral fractures of the
femur and acetabulum treated simultaneousness using Kocher-Langenbeck
approach did not demonstrate an increased risk of wound complications, and not
contraindicated to antegrade femoral nailing.

Open Reduction and Internal Fixation of Capitellar Fracture through Anterolateral Approach with Headless Double Threaded Compression Screws

Ahmed Mohammed Ali Almazouq, Mohammed Othman Mohammed, Adel Abd- Elzim Ahmed Salem , Ahmed El-Sayed El-Malt

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 4097-4105

Background: Injuries to the humeral capitellum are usually a result of axial
loading of the capitellum by forces transmitted through the radial head, the lateral
trochlear ridge and the lateral half of the trochlea due to falling on an outstretched
hand or flexed elbow. The aim of this study to evaluate the results of patients
suffering from capitellar fracture treated by open reduction and internal fixation
through anterolateral approach with headless double threaded compression screws.
Patients and Methods: This study included 12 capitellar fractures; the radiological
x-ray was done for planning the fixation technique. All fractures were treated with
headless double threaded compression screws using anterolateral approach, over
the period from March 2020 to February 2021 at Zagazig university hospital, with
the mean follow up period 8 months ± 1.95 ranged from six to 11 months. Results:
The present study showed the pain score was 45 points. At end of the follow up
period 9 patient had no pain (75 %) and 3 patient had mild pain (25 %). Eight
patients had active flexion above 100º (66.7 %) and 4 patients had active flexion
from 50º to 100º (33.3 %). Eight cases were excellent score with (66.7 %), three
cases good score (25%), and only one was satisfactory score with (8.3%).
Conclusion: Headless double threaded compression screws has a good clinical
result in Capitellar fracture because these screws have the advantage of excellent
compression at the small fracture fragments, stable fixation, and non-prominence
of the implants intraarticular.