Online ISSN: 2515-8260

Keywords : joint contractures

Aseptic non-union of tibia treated with ilizarov fixator: A retrospective study

Dr. Sumit Kumar, Dr. Nishith Sharma, Dr. Jashanpreet, Dr. Raj Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 145-153

Background: Nonunions of the tibia may be associated with low-density bone tissue, bone loss, adjacent
soft-tissue damage, limb shortening, limb deformities and joint contractures. There is no gold standard
for the treatment of nonunions of the tibia.
Aims and Objectives: The purpose of our study was to assess the results of treatment with the Ilizarov
method in patients with aseptic nonunions of the tibia, depending on the employed treatment strategies
and surgical techniques. To achieve union at nonunion site with correction of limb length discrepancy
and correction of deformity with early function and mobilization.
Materials and Methods: Our study has been taken place, Department of Orthopaedics, Maharaja
Agrasen Medical College, Agroha, Haryana, India. The operators used one of two treatment strategies:
neutral fixation without compression or continued compression. The following were assessed: rates of
union, ASAMI bone scores, ASAMI functional scores, treatment time, complications, duration of
hospital stay. It is prospective study of treatment of aseptic nonunion of shaft tibia. As we have taken 35
patients of tibial nonunion. All relevant pre and perioperative information and complications were
recorded. Also assessment of functional outcome was made.
Results and Observations: In our study we have evaluated the differences in time to union in the
subgroup of patients with at least one risk factor for disturbances in fracture healing. The following risk
factors were considered: diabetes mellitus, corticosteroid therapy, smoking, advanced lower extremity
vascular disease, and alcohol dependence. Sample size in our study was of 32 out of 35 cases has united,
about 91% success rate. The average duration of nonunion was about 14.5 months, average union time
(fixator removal) is about 6.2 months. Two of our patient were showing poor tolerance to Ilizarov
external fixator changed to other modality.

Evaluation of factors associated to functional outcomes of intertrochanteric fractures of femur when managed with PFNA2

Dr. Sumit Kumar, Dr. Nishith Sharma, Dr. Jashanpreet, Dr. Raj Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 154-159

Background: Aging is an undefiable process and as the population ages, the incidence of hip fracture is
anticipated to increase exponentially. Prolonged bed rest further worsens the morbidity and mortality
after a hip fracture. Intertrochanteric femur fracture management in elderly needs more attention to
reduce malunion and increase early mobilisation to reduce mortality and morbidity. Ideal choice of
treatment is internal fixation by intramedullary or extra medullary devices. Intramedullary devices
provide more stable proximal femoral anatomical fixation. Between PFN and PFNA; helical blade in
PFAN provides more stability, better compression and rotational control with lower cut-out rate.
Aims and Observations
a) To assess the factors for functional outcome of PFNA2.
b) Evaluation of effectiveness and stability of PFNA2.
Material and Methods: In our study, we have taken 32 patients with unstable Intertrochanteric femur
fracture between Nov 2020 to Oct 2021 fulfilling inclusion and exclusion criteria were included in this
study and underwent closed reduction and internal fixation by PFNA (n=32). Assessment was done in
terms of demography, preoperative and intraoperative variables, postoperative parameters mainly
functional outcome till 1 year postoperative.
Results: In our study Preoperative variables, AO fracture type were assessed preoperatively. Duration
of surgery, blood loss and fluoroscopy imaging were significantly lower in PFNA as compared to PFN.
Postoperative complications like cut-out rate, shortening, varus malalignment, return to pre-fracture state
were also lower in PFNA group than PFN. Postoperative functional assessment done by Harris Hip Score
shows better outcome in PFNA than other fixation devices.
Conclusion: PFNA reduces duration of surgery, blood loss, fluoroscopy imaging as compared to other
implants. PFNA also offers better postoperative functional outcome.