Online ISSN: 2515-8260

Keywords : Fracture


NASAL BONE FRACTURE OVERVIEW AND ITS SURGICAL OUTCOME.

Rakesh Maran, Anusha Shukla, Mritunjay Shringirishi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 763-768

Background:Nose is most prominent part of face and nasal bones are most commonly fractured during road traffic accident or accidental trauma. Many patients with nasal bone fracture do not take treatment so fracture may go undiagnosed. Nasal bone fracture leads to structural & functional abnormality of nose.
Aim & Objective:Aim of study was to evaluate operative outcome after close reduction according to type of nasal bone fracture.
Method:Study was conducted in Mahaveer Medical College, Bhopal Department of ENT. Total 157 patients were selected with fracture nasal bone, from February 2021 to 2022 (01 years), all underwent closed reduction.
Results:Post-Operative CT image showed 94 patients with excellent result, 49 with good result, 10 subject with fair result & 4 patients showed poor reduction of fracture nasal bone. 
Conclusion:Fracture nasal bone reduction immediate after CT-Scan showed better result in FI, LI, LII type than FII and C Type.
 

A prospective functional outcome study of Volar locking plates versus K-wire fixation of dorsally displaced distal radius fractures

Dr. Hem Raj, Dr. Punit Tiwari, Dr. Sandeep Singh Jaura, Dr. Gagan Khanna and Dr. RK Arora

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 11993-12002

Introduction: Fractures of the distal end radius are the most common fractures of the upper extremity, encountered in practice and constitute 17% of all fractures and 75% of all forearm fractures. The fundamental principle of fracture treatment is to obtain accurate fracture reduction and then use an immobilization method that will maintain and hold that reduction. The most common surgical treatment of closed distal radius fractures is by Kirschner-wires (K-wires) or volar locking plates, with the latter gaining popularity these days. In this study, we compared functional outcomes of K-wires with those of volar locking plates.
Methods: A prospective comparative study of 50 patients with dorsally displaced distal radius fractures treated with K-wiring and volar locking plates (25 cases in each group) was performed. An initial clinical evaluation was done pre-operatively followed by fracture fixation and was further evaluated functionally and radiologically post-operatively. Functional results were analyzed by the modified Demerit point system of Gartland and Werley, anatomical results were analyzed by Sarmiento’s modification of Lindstrom criteria, and radiological assessment was done as per criteria given by NANA et al.
Results: Radiologically and anatomically volar plate had better results as compared to k-wire, during the initial follow-up of fractures of the distal radius. The volar plate also dominated over k-wires in terms of functional results but at 6 months there was very little difference seen functionally. Both techniques provide great clinical results, without a clear superiority of either fixation method for the surgical management of distal radius fractures.
Conclusion: We conclude that locking plates offer no functional advantage over the older and economical method of Kirschner wire fixation for patients with displaced fractures of the distal radius.

Management of humeral shaft fracture: A comparative study between interlocking nail and dynamic compression plating

Dr. H. Manjunath, Dr. Vikrant Kulkarni, Dr. Punith Nanjesh, Dr. Shivaprasad A Bhat, Dr. Ullas Mahesh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 11904-11909

Introduction: There is a debate about the choice of operative intervention in humerus shaft fractures requiring surgical intervention. A prospective, comparative study of management of acute humeral shaft fractures treated by antegrade interlocking nail fixation and dynamic compression plating was undertaken over a period of three years. Twenty patients of interlocking nailing and sixteen patients of plating were included after considering the inclusion and exclusion criteria. Functional scoring criteria were used for postoperative assessment and the average follow-up period was one year. A higher rate of excellent and good results and a tendency for earlier union was seen with the plating group in our series.

Surgical management of displaced calcaneum fractures by plating

Dr. H Manjunath, Dr. Ullas Mahesh, Dr. Sharat Balemane, Dr. Anil Patil

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1558-1562

Introduction: Calcaneal fractures are comparatively rare injuries, which occur in 2% of all fractures According to the recent literature, 60% to 75% of these fractures are considered to be displaced and intraarticular, which evidences the difficulty of the treatment. This type of injury is more common in men compared to women because it commonly occurs as occupation associated.
Methodology: In this study of prospective design 40 patients with calcaneum fracture treated by ORIF with plates between JAN 2019 to DEC 2021 were reviewed at a tertiary centre. The
patients were called for a final follow up evaluation and the latest functional outcome assessed as for the AOFAS score and results were analysed.
Results: Young patients showed significantly better outcome with ORIF with plating. The timing of the surgery is the most important detriment for the outcome. The final functional outcome assessed with AOFAs score is encouraging with 77.1%.
Conclusion: Operatively treated calcaneum fractures with ORIF with plates gives a good functional outcome when surgical principle are strictly adhered to, proper patient selection, appropriate timing for surgery, strict asepsis, proper approach for rising full thickness flaps, accurate anatomic reduction and proper post-operative protocol with follow up which minimizes complications.

An analytical cross-sectional study to evaluate the diagnostic accuracy of ultrasonography in detecting nasal bone fractures compared with CT as the reference standard

Dr. Naresh Tripathi, Dr. Anchal Sharma, Dr. Govind Khatri, Dr. Sahil Chawla, Dr. Aditya Kaul, Dr. Yashaswi Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 1130-1134

Aim: To evaluate the diagnostic accuracy of ultrasonography in detecting nasal bone
fractures compared with CT as the reference standard.
Methodology: A cross-sectional study was conducted in the Department of Radiology,
Maharshi Medical College & Hospital, Kumarhatti, Dist. Solan, Himachal Pradesh, pin code
173229 for the period of 1 year. The study group consisted of 100 patients with nasal bone
fracture who were investigated by physical examination. These patients were then examined
by conventional radiography and sonography. Physical examination was considered as the
gold standard for the diagnosis of nasal bone fracture. All patients were investigated
radiographically by a lateral and a Waters view X-ray at the beginning. The results were
evaluated by a radiologist. The reports were then recorded as either “positive” or “negative”
according to the existence of nasal bone fracture. Then, patients were examined by
sonography. Soft tissue edema and subperiosteal hematoma was also examined as a possible
predictor to differentiate an acute from a chronic fracture. The negative and positive
likelihood ratios (LR- and LR+), NPV and PPV were calculated and used for determining the
diagnostic accuracy. The LR-of ultrasonography was lower than radiography. The LR+of
sonography for the diagnosis of nasal bone fracture was 65.20 [9.28-390.10] which represents
a large and conclusive increase in the likelihood of the fracture in the presence of positive
findings. Furthermore, LR of sonography was 0.14 [0.10-0.21] which proposed a large to
moderate decrease in the likelihood of the fracture, in the presence of negative findings. LR+
of radiography was 6.20 [2.87-6.27] which showed a small increase of the likelihood of
fracture in positive results and the LR¯ of x-ray was 0.36 [0.21-0.42] which proposed a small
decrease in the likelihood of the fractures when the findings were negative.
Results: In this study, 100 patients who had nasal bone fracture in their physical examination
were investigated by sonography and radiography. Of these patients, 31 were women and 69
were men. The mean age of patients was 24.7 years. 37 (37%) patients were between 20-30
years and 28 (28%) were between 30-40 years, and 5 (5%) patients were < 20 years of age
group, while 7 (7%) were > 50 yearsand 23 patients were between 40-50 years of age group.
The youngest patient included in the study was a 12 year old male child and the oldest
patientwas a male of 60 years of age. Of the 100 patients, 78 had nasal bone fracture
(according to physical examination) and 22 patients were found normal but were investigated
due to legal issues. Out of the 78 clinically proven nasal bone fracture cases, conventional
radiography showed a fracture line in 65 cases.

Role of bone mineral density to assess osteoporosis at tertiary centre

Dr Burhan Bhat, Dr Sulaiman Sath, Dr Jabreel Muzaffar, Dr Ishtiaq Abdullah, Dr Zameer Ali, 6Dr A.R Badoo

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 2000-2004

Background: Measuring the density of the bone plays a vital role in the analysis of the
human bone health. The present study was conducted to assess role of bone mineral
density in assessment of osteoporosis.
Materials & Methods: 75 patients age ranged 30-60 years of both genders were
included. The BMD estimation of these patients was done by quantitative
ultrsonography of the calcaneal bone and the analysis done on the basis of T –scores. R
Results: Age group 30-40 years had 26, 40-50 years had 30 and 50-60 years had 19
patients. clinical presentation was backache in 35%, bone pain in 48% and fracture in
17%. osteopenia was seen in 45 and osteoporosis in 30 patients.
Conclusion: osteoporosis was seen in maximum subjects. Hence there is need to look
after bone calcium and phosphate level especially in age subjects.

Plating Versus Conservative Treatment in Mid Shaft Fracture of Clavicle

Yousuf Mohamed Khira,Mohamed Abdel Fattah Mohamed , Hossam FathiMahmooud, Rabe Ali Nasar Altomi

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 3046-3056

Background: A Clavicle fracture is a common traumatic injury as it positions
directly under the skin. Both conservative and operative methods are used for the
treatment of this fracture. But there is no uniform agreement on the best choice of
treatment. So, this study aims to assess the outcome of the conservative treatment
and operative treatment by using plate and screw of midshaft fracture of clavicle
and comparing the two treatment methods. Patients and methods: This study was
done at the Department of Orthopedic Surgery of Zagazig University Hospital from
April 2020 to December 2020 on 18 patients are involved then these patients were
subdivided into two groups, Group A (9 patients) for conservative treatment and
Group B (9 patients) for operative treatment by using a plate and screw fixation.
Assessment of the outcome using the constant shoulder score. Results: The time of
union was 5.33±0.70 months in the conservative group and 4.66±0.86 months in the
operative group. Constant shoulder score was in Conservative group 4 patients had
excellent score (44.4%), 2 patients had good score (22.2%), 3 patients had poor
score (33.3%) While in Operative group 6 patients had excellent score (66.6%), 1
patient had good score (11.1%), 2 patients had poor score (22.2%). Conclusion: The
non-surgical methods still the best treatment of simple nondisplaced mid-shaft
clavicular fractures. The operative methods donate a good result in active athlete's
patient with displaced or comminuted fracture.

To study the changing pattern of bacterial flora and their sensitivity patterns in grade IIIB open fractures of long bones: a prospective study at a Tertiary Centre in North India

Dr.Gursagardeep Singh; Dr. Mandeep Singh; Dr. Anshul Dahuja; Dr.Rashmeet Kaur; Dr.Radhe Shyam; Dr.Haramritpal Kaur; Dr. Shipra

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 3245-3259

Primary goal in management of open fractures is prevention of infection of bone and soft tissue by early debridement, irrigation of wound and administration of broadspectrum antibiotics with stabilization of fractures. The pattern of organisms found in open fractures is important in the selection of antibiotics for prophylaxis and empirical treatment. In this prospective study, 50 consecutive patients of all ages, both the sexes, with open fracture of grade IIIB as per Gustilo- Anderson classification were evaluated for bacterial isolates. Higher rate of infection was found in patients with farm injuries and leg was most common site. The most common gram negative and gram positive bacteria isolated were E.coli and S.aureus respectively (19.5% each). On analysis of the predebridement, post-debridement, and third culture, positive pre-debridement culture showed maximum growth of Gram-positive bacteria. However, majority of these patients were found to have growth of different organism in their post-debridement culture reports.

PAN FACIAL FRACTURE – A CASE REPORT

Dr. Vijay Ebenezer; Dr. Rakesh mohan

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 4, Pages 1505-1508

Pan facial fractures are complex to treat and hence have to be systematically managed . Several authors have quoted several principles regarding the repair of pan facial fractures in a stepwise fashion . The most important goal is to restore the occlusal relationship at the beginning of the treatment , so that all the other structures get aligned . The folllowing is a case of a traumatic pan facial fracture and its surgical management

RECONSTRUCTION OF ORBITAL FLOOR FRACTURE– A CASE REPORT

Dr. Vijay Ebenezer; Dr. Wasim Ahamed

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 4, Pages 1614-1618

Orbit is a conical cavity in which the base lies anteriorly and the apex directed at Optic Foramen .By Age of 5 years orbital growth is 85% complete, finalized between 7 years of age. Orbit is formed from 7 bones (Maxillary, Zygomatic, Frontal, Ethmoid, Larimal, Palatine, and Sphenoid ). It consists of Four Walls – roof, lateral, medial, floor .Medial wall and floor are thin ,While Lateral wall and Roof are Stronger. Floor of orbit is weakened due to infraorbtal Canal passing through it. In Pure blowout fracture one orbit wall is affected, without involving orbital rims. The inferior and medial walls are affected most frequently. Clinical features are diplopia, infraorbital nerve paresthesia , entrapment of soft tissue within the maxillary sinus, restriction of ocular movements and enophthalmos. CT scan is most helpful method for diagnosis of orbital fracture. For orbit reconstruction, natural and synthetic materials are available. We report a case of 21 years old man, diagnosed with orbital floor fracture after slip and fall from his two wheeler The surgical treatment involved orbital floor reconstruction with titanium mesh under general anesthesia. The outcome was satisfactory and during followup visual disturbances or paresthesia was not present.

MANAGEMENT OF LE FORT II FRACTURE FRACTURE – A CASE REPORT

Dr. Vijay Ebenezer; Dr. Shanmuga priyan

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 4, Pages 1559-1564

Lefort classification is the historic classification which is widely used to classify mid facial fractures. The lefort classification was given by Rene Lefort ,who classified mid facial fracture into Lefort I , II and III. Lefort 2 fracture is referred as ‘ PYRAMIDAL or SUBZYGOMATIC FRACTURE .’ Lefort 2 is a floating maxilla which runs from the thin middle area of the nasal bones down either side , crossing the frontal processes of the maxilla into the medial wall of each orbit . Within the orbit , the fracture line runs across the lacrimal bone behind the lacrimal sac to cross the infra orbital margin medial to or through the infra orbital foramen . Extends downwards & backwards across the lateral wall of the antrum below the zygomaticomaxillary suture & divides the ptyergyoid laminae .Le fort fractures are blunt trauma facial fractures which involves specific pattern of facial bones injury. Pterygoid process of sphenoid bones is involved in all Le fort fractures. Lefort fractures are classified further depending upon the involvement of zygomatic, nasal and maxillary bones. Blunt facial traumas due to motor vehicle collision, assault, falls or sports injury are the most common causes. In our case, Le fort 2 fracture resulted from motor vehicle collision.