Pub Date : 2016-07-01DOI: 10.4103/2319-2585.193754
K. Reddy, C. Dasaraiah, Meeravali Shaik, C. Ramesh Kumar
Background: Trochanteric fractures of femur like intertrochanteric and subtrochanteric fractures are a leading cause of hospital admissions in elderly people. Conservative methods of treatment results in malunion with shortening and limitation of hip movement as well as complications of prolonged immobilizations such as bed sores, deep vein thrombosis, and respiratory infections. This study is done to analyze the surgical management of trochanteric fractures of the femur using a proximal femoral nail (PFN). Methodology: This is a prospective study of 40 cases of trochanteric and subtrochanteric fractures admitted to Government General Hospital, Vijayawada, Andhra Pradesh. Cases were taken according to inclusion and exclusion criteria, i.e., patients with trochanteric fractures femur above the age of 20 years. Medically unsuitable, open fractures and patients not willing for surgery were excluded from the study. Results: Forty percentage of cases were admitted due to slip and fall and with a slight predominance of the right side. Out of 40 cases, 26 were trochanteric, and 14 were subtrochanteric. In trochanteric class, 37.5% were body and griffin Type 2, in subtrochanteric class 12.5% were sinsheimer Type 3a and 10% were 2b. Out of 30 remaining cases, 25 were trochanteric, and 05 were subtrochanteric. Good to excellent results are seen in 100% cases of trochanteric fractures and 90% cases in subtrochanteric fractures. Conclusion: From this sample study, we consider that PFN is an excellent implant for the treatment of pertrochanteric fractures. The terms of successful outcome include a good understanding of fracture biomechanics, proper patient selection, good preoperative planning, accurate instrumentation, good image intensifier, and exactly performed osteosynthesis.
{"title":"A study on management of extracapsular trochanteric fractures by proximal femoral nail","authors":"K. Reddy, C. Dasaraiah, Meeravali Shaik, C. Ramesh Kumar","doi":"10.4103/2319-2585.193754","DOIUrl":"https://doi.org/10.4103/2319-2585.193754","url":null,"abstract":"Background: Trochanteric fractures of femur like intertrochanteric and subtrochanteric fractures are a leading cause of hospital admissions in elderly people. Conservative methods of treatment results in malunion with shortening and limitation of hip movement as well as complications of prolonged immobilizations such as bed sores, deep vein thrombosis, and respiratory infections. This study is done to analyze the surgical management of trochanteric fractures of the femur using a proximal femoral nail (PFN). Methodology: This is a prospective study of 40 cases of trochanteric and subtrochanteric fractures admitted to Government General Hospital, Vijayawada, Andhra Pradesh. Cases were taken according to inclusion and exclusion criteria, i.e., patients with trochanteric fractures femur above the age of 20 years. Medically unsuitable, open fractures and patients not willing for surgery were excluded from the study. Results: Forty percentage of cases were admitted due to slip and fall and with a slight predominance of the right side. Out of 40 cases, 26 were trochanteric, and 14 were subtrochanteric. In trochanteric class, 37.5% were body and griffin Type 2, in subtrochanteric class 12.5% were sinsheimer Type 3a and 10% were 2b. Out of 30 remaining cases, 25 were trochanteric, and 05 were subtrochanteric. Good to excellent results are seen in 100% cases of trochanteric fractures and 90% cases in subtrochanteric fractures. Conclusion: From this sample study, we consider that PFN is an excellent implant for the treatment of pertrochanteric fractures. The terms of successful outcome include a good understanding of fracture biomechanics, proper patient selection, good preoperative planning, accurate instrumentation, good image intensifier, and exactly performed osteosynthesis.","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70435973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-01DOI: 10.4103/2319-2585.186183
A. Schicho, C. Riepl
In high-energy accidents, even exceptional multifragmentary fractures can be found in young and healthy individuals. We hereby report a case of a traumatic proximal femur fracture with dislocation of the femoral head and neck fragment to the scrotum. Although the blood supply to the fragment must have been destroyed during the displacement to the scrotum, there were no radiologic signs of femoral head necrosis. Initial open reduction and internal fixation failed within 7 weeks. The revision with a proximal femur nail was stable. A fast progressing osteoarthritis due to accompanying acetabular fracture urges for a total hip replacement.
{"title":"Peringuinal luxation of the femoral head and neck","authors":"A. Schicho, C. Riepl","doi":"10.4103/2319-2585.186183","DOIUrl":"https://doi.org/10.4103/2319-2585.186183","url":null,"abstract":"In high-energy accidents, even exceptional multifragmentary fractures can be found in young and healthy individuals. We hereby report a case of a traumatic proximal femur fracture with dislocation of the femoral head and neck fragment to the scrotum. Although the blood supply to the fragment must have been destroyed during the displacement to the scrotum, there were no radiologic signs of femoral head necrosis. Initial open reduction and internal fixation failed within 7 weeks. The revision with a proximal femur nail was stable. A fast progressing osteoarthritis due to accompanying acetabular fracture urges for a total hip replacement.","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70435659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-01DOI: 10.4103/2319-2585.193846
S. Chavre, V. Bhat, B. Chandra Sekar, M. Ram
Isolated fracture of the scaphoid with the dislocation of the proximal bony component is a rare abnormality, usually encountered in a high-energy injury. Prompt diagnosis is essential for preferentially considering open reduction and fixation. Careful image analysis is necessary to exclude more frequent injuries such as lunate dislocation and establish encroachment of carpal tunnel or injury to median nerve. This presentation presents imaging and management consideration of the patient with the scaphoid fracture with dislocation of proximal component encountered in association with polytrauma.
{"title":"Fracture dislocation of scaphoid in association with polytrauma: Diagnostic and management considerations","authors":"S. Chavre, V. Bhat, B. Chandra Sekar, M. Ram","doi":"10.4103/2319-2585.193846","DOIUrl":"https://doi.org/10.4103/2319-2585.193846","url":null,"abstract":"Isolated fracture of the scaphoid with the dislocation of the proximal bony component is a rare abnormality, usually encountered in a high-energy injury. Prompt diagnosis is essential for preferentially considering open reduction and fixation. Careful image analysis is necessary to exclude more frequent injuries such as lunate dislocation and establish encroachment of carpal tunnel or injury to median nerve. This presentation presents imaging and management consideration of the patient with the scaphoid fracture with dislocation of proximal component encountered in association with polytrauma.","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70436321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-01DOI: 10.4103/2319-2585.193751
V. Shetty
{"title":"Platelet-rich plasma therapy in orthopedic clinical practice: \"Again I ask the gentleman…\"","authors":"V. Shetty","doi":"10.4103/2319-2585.193751","DOIUrl":"https://doi.org/10.4103/2319-2585.193751","url":null,"abstract":"","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70435832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.4103/2319-2585.180692
Sohael M. Khan, N. Saxena, Shraddha Singhania, Mahendra Gudhe, S. Nikose, M. Arora, P. Singh
Background: Fracture of the distal end radius constitutes one of the most common skeletal injuries treated by the orthopedic surgeon. Wide arrays of techniques have been described including closed reduction, percutaneous fixation and open methods of reduction, and stabilization. Displaced extra- or intra-articular distal radius fractures require accurate reduction to allow a good outcome. We assessed the outcome of volar plate osteosynthesis and compared its outcome with other methods of treatment to confirm satisfactory reduction and functional outcomes. Materials and Methods: Prospective study conducted in our medical institution between 2012 and 2013. Inclusion criteria included skeletally mature patients who presented to casualty with fractures of the distal radius. Closed reduction cast application/K-wire fixation/open reduction and internal fixation with a volar plate was done under general anesthesia in 60 patients (20 cases each). During the follow-up, radiological and functional parameters were assessed and Gartland and Werley scoring was done. Results: Patients with volar plate fixation had a better outcome than the K-wire fixation and cast application. Radiological parameters were well-maintained, and functional parameters showed a significant improvement during the follow-up period. The complication rate was less and insignificant. Conclusion: Primary volar plate fixation of unstable distal radius fracture provides a stable construct that helps in early mobilization, thereby better functional outcomes and minimizes chances of delayed/malunion and, thereby is an upcoming method of choice for fracture distal end of radius. The present study comprised of 60 patients of distal radius fractures in 20 patients treated by plating, 20 by cast application and 20 by K-wire application. The minimum follow-up was 8 weeks, and the maximum was 36 weeks. This study was undertaken to assess the functional outcome of operative management of distal radial fractures and the following conclusions were drawn - male patients predominated female patients (36 males to 24 females) and average age of patients is 46.01 years. Left sided fractures were more common (61.6%). Road traffic accident was the commonest cause of the trauma (73.3%). AO 23 A-2 was the most common type of fracture, accounting for (26.6%) with Associated injuries seen in 4 patients (6.6%). Functional outcome as per Gartland and Werley was 3.75 for plating, 8.6 for cast application, and 7.55 for K-wire fixation. About 90% excellent to good results were observed in plating group as compared to 55% in cast and 65% in K-wire fixation in demerit score. Complication such as irregular articular surface, wrist pain, finger stiffness, K-wire loosening was observed. Thus, based on this study, we conclude that volar plating has relatively better outcome for distal end fractures of radius particularly volar Barton fractures, with minimum chance of loosening of implant even in highly comminuted cases a
{"title":"Volar plating in distal end radius fractures and its clinical and radiological outcome as compared to other methods of treatment","authors":"Sohael M. Khan, N. Saxena, Shraddha Singhania, Mahendra Gudhe, S. Nikose, M. Arora, P. Singh","doi":"10.4103/2319-2585.180692","DOIUrl":"https://doi.org/10.4103/2319-2585.180692","url":null,"abstract":"Background: Fracture of the distal end radius constitutes one of the most common skeletal injuries treated by the orthopedic surgeon. Wide arrays of techniques have been described including closed reduction, percutaneous fixation and open methods of reduction, and stabilization. Displaced extra- or intra-articular distal radius fractures require accurate reduction to allow a good outcome. We assessed the outcome of volar plate osteosynthesis and compared its outcome with other methods of treatment to confirm satisfactory reduction and functional outcomes. Materials and Methods: Prospective study conducted in our medical institution between 2012 and 2013. Inclusion criteria included skeletally mature patients who presented to casualty with fractures of the distal radius. Closed reduction cast application/K-wire fixation/open reduction and internal fixation with a volar plate was done under general anesthesia in 60 patients (20 cases each). During the follow-up, radiological and functional parameters were assessed and Gartland and Werley scoring was done. Results: Patients with volar plate fixation had a better outcome than the K-wire fixation and cast application. Radiological parameters were well-maintained, and functional parameters showed a significant improvement during the follow-up period. The complication rate was less and insignificant. \u2028Conclusion: Primary volar plate fixation of unstable distal radius fracture provides a stable construct that helps in early mobilization, thereby better functional outcomes and minimizes chances of delayed/malunion and, thereby is an upcoming method of choice for fracture distal end of radius. The present study comprised of 60 patients of distal radius fractures in 20 patients treated by plating, 20 by cast application and 20 by K-wire application. The minimum follow-up was 8 weeks, and the maximum was 36 weeks. This study was undertaken to assess the functional outcome of operative management of distal radial fractures and the following conclusions were drawn - male patients predominated female patients (36 males to 24 females) and average age of patients is 46.01 years. Left sided fractures were more common (61.6%). Road traffic accident was the commonest cause of the trauma (73.3%). AO 23 A-2 was the most common type of fracture, accounting for (26.6%) with Associated injuries seen in 4 patients (6.6%). Functional outcome as per Gartland and Werley was 3.75 for plating, 8.6 for cast application, and 7.55 for K-wire fixation. About 90% excellent to good results were observed in plating group as compared to 55% in cast and 65% in K-wire fixation in demerit score. Complication such as irregular articular surface, wrist pain, finger stiffness, K-wire loosening was observed. Thus, based on this study, we conclude that volar plating has relatively better outcome for distal end fractures of radius particularly volar Barton fractures, with minimum chance of loosening of implant even in highly comminuted cases a","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70435418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.4103/2319-2585.172719
A. Kawalkar, Chandrashekher Martand Badole, Ajit Phadke
Introduction: There are a variety of etiological factors that may result in arthritis of the hip in young adults. There are, therefore, not infrequent occasions when orthopedic surgeons may encounter very young patients with end-stage arthritis of the hip necessitating surgical intervention. In the past hip arthrodesis or resection arthroplasty were used to address end-stage arthritis of the hip in young patients but recently total hip arthroplasty emerged as the viable alternative to above surgical procedures. The high activity level, repetitive loading and excessive demand placed on the hip on one hand and issues of durability of the implant materials on the other lead to high failure rates of total hip arthroplasty in young patients in the past. The aim of this prospective study was to evaluate the clinical and radiographic results of these modern cementless THA in patients with end stage arthritis who were younger than 40 years of age. Materials and Methods: A prospective study was carried out in which 25 patients (28 hips) younger than 40 years with hip arthritis underwent primary cementless total hip arthroplasties participated. The Taperloc femoral component with Porous coated cementless acetabular cup and highly crossed linked polyethylene liner was used in all hips. The Harris hip score was used to determine functional outcome and activity level was evaluated by the classification of Johnston et al. Radiographic analysis consisted of antero-posterior views of the hip and pelvis, a true lateral view of the hip. Observations and Results: All 25 patients were available for both clinical and radiographic evaluation. 93% of patients had excellent to good; and none of the hips had poor clinical outcome. Radiographic assessment revealed consistent evidence of bony ingrowth. No femoral component was loose or required revision. Conclusion: Cementless total hip arthroplasty can be safely and successfully performed in young patients less than 40 years with excellent results in short to midterm follow-up.
{"title":"Midterm results of cementless total hip arthroplasty in young","authors":"A. Kawalkar, Chandrashekher Martand Badole, Ajit Phadke","doi":"10.4103/2319-2585.172719","DOIUrl":"https://doi.org/10.4103/2319-2585.172719","url":null,"abstract":"Introduction: There are a variety of etiological factors that may result in arthritis of the hip in young adults. There are, therefore, not infrequent occasions when orthopedic surgeons may encounter very young patients with end-stage arthritis of the hip necessitating surgical intervention. In the past hip arthrodesis or resection arthroplasty were used to address end-stage arthritis of the hip in young patients but recently total hip arthroplasty emerged as the viable alternative to above surgical procedures. The high activity level, repetitive loading and excessive demand placed on the hip on one hand and issues of durability of the implant materials on the other lead to high failure rates of total hip arthroplasty in young patients in the past. The aim of this prospective study was to evaluate the clinical and radiographic results of these modern cementless THA in patients with end stage arthritis who were younger than 40 years of age. Materials and Methods: A prospective study was carried out in which 25 patients (28 hips) younger than 40 years with hip arthritis underwent primary cementless total hip arthroplasties participated. The Taperloc femoral component with Porous coated cementless acetabular cup and highly crossed linked polyethylene liner was used in all hips. The Harris hip score was used to determine functional outcome and activity level was evaluated by the classification of Johnston et al. Radiographic analysis consisted of antero-posterior views of the hip and pelvis, a true lateral view of the hip. Observations and Results: All 25 patients were available for both clinical and radiographic evaluation. 93% of patients had excellent to good; and none of the hips had poor clinical outcome. Radiographic assessment revealed consistent evidence of bony ingrowth. No femoral component was loose or required revision. Conclusion: Cementless total hip arthroplasty can be safely and successfully performed in young patients less than 40 years with excellent results in short to midterm follow-up.","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70435331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.4103/2319-2585.172720
A. Ratra, J. Grimes
Tarsal tunnel syndrome is generally a subacute condition that gradually develops and worsens with time. Urgent tarsal tunnel release to treat an acute onset of symptomatic neurocompression within the tarsal tunnel following a fracture repair has not been previously reported. We present a case of a pregnant woman who developed an acute tarsal tunnel syndrome following an open reduction internal fixation of an ankle fracture. The urgent release of the tarsal tunnel resulted in resolution of her symptoms.
{"title":"Acute tarsal tunnel syndrome in a pregnant woman following surgical repair of bimalleolar fracture: A case report and review of the literature","authors":"A. Ratra, J. Grimes","doi":"10.4103/2319-2585.172720","DOIUrl":"https://doi.org/10.4103/2319-2585.172720","url":null,"abstract":"Tarsal tunnel syndrome is generally a subacute condition that gradually develops and worsens with time. Urgent tarsal tunnel release to treat an acute onset of symptomatic neurocompression within the tarsal tunnel following a fracture repair has not been previously reported. We present a case of a pregnant woman who developed an acute tarsal tunnel syndrome following an open reduction internal fixation of an ankle fracture. The urgent release of the tarsal tunnel resulted in resolution of her symptoms.","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70434879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.4103/2319-2585.180691
A. Gohiya, Pulak Sharma, R. Verma, S. Gaur
Introduction: The intertrochanteric fractures of femur are commonly fixed using dynamic hip screw using a conventional open Dynamic Hip Screw (CDHS). This is associated with a long incision, blood loss, considerable soft tissue trauma and pain. All these problems can be avoided using minimally invasive Dynamic Hip Screw (MIDHS), which has a theoretical advantage of less blood loss, soft tissue trauma, and early rehabilitation. Thus, we conducted a prospective comparative study of the two techniques. Materials and Methods: This is a prospective comparative study conducted over a period of 2 years at Department of Orthopedics GMC Bhopal. Fifty patients in the age group of 50-80 years who presented with intertrochanteric femur fracture and fulfilled inclusion criteria were divided into two groups of 25 each for fixation by CDHS or MIDHS. Patients in both the groups were matched. The data analysis was performed using SPSS package. Results: The patients in minimally invasive group had shorter operative time (45 min vs. 75 min). The average postoperative blood loss in drain in conventional group was 150 ml whereas no drain was used in minimally invasive group. Postoperatively need for analgesic was significantly lower in minimally invasive group (P < 0.05). Duration of hospital stay was significantly less with minimally invasive technique. The duration of bony union was similar in both techniques. Conclusion: Our study concludes that the minimally invasive technique of fixation of Intertrochanteric femur fractures is superior in terms of less operating time and less duration of hospital stay.
简介:股骨粗隆间骨折通常采用常规开放式动态髋螺钉(CDHS)进行动态髋螺钉固定。这与长切口、失血、相当大的软组织损伤和疼痛有关。所有这些问题都可以避免使用微创动态髋关节螺钉(MIDHS)，理论上具有出血量少、软组织损伤少、早期康复的优势。因此，我们对这两种技术进行了前瞻性比较研究。材料和方法:这是一项在博帕尔GMC骨科进行的为期2年的前瞻性比较研究。50例年龄在50-80岁之间且符合纳入标准的股骨粗隆间骨折患者分为两组，每组25例采用CDHS或MIDHS固定。两组患者都是匹配的。数据分析采用SPSS软件包。结果:微创组手术时间短(45 min vs. 75 min)。常规组术后平均引流出血量150ml，微创组术后不引流。微创组术后镇痛需求明显低于对照组(P < 0.05)。微创技术可显著缩短住院时间。两种方法的骨愈合时间相似。结论:微创固定股骨粗隆间骨折具有手术时间短、住院时间短等优点。
{"title":"A comparative study between conventional and minimally invasive dynamic hip screw fixation in management of intertrochanteric femoral fractures","authors":"A. Gohiya, Pulak Sharma, R. Verma, S. Gaur","doi":"10.4103/2319-2585.180691","DOIUrl":"https://doi.org/10.4103/2319-2585.180691","url":null,"abstract":"Introduction: The intertrochanteric fractures of femur are commonly fixed using dynamic hip screw using a conventional open Dynamic Hip Screw (CDHS). This is associated with a long incision, blood loss, considerable soft tissue trauma and pain. All these problems can be avoided using minimally invasive Dynamic Hip Screw (MIDHS), which has a theoretical advantage of less blood loss, soft tissue trauma, and early rehabilitation. Thus, we conducted a prospective comparative study of the two techniques. Materials and Methods: This is a prospective comparative study conducted over a period of 2 years at Department of Orthopedics GMC Bhopal. Fifty patients in the age group of 50-80 years who presented with intertrochanteric femur fracture and fulfilled inclusion criteria were divided into two groups of 25 each for fixation by CDHS or MIDHS. Patients in both the groups were matched. The data analysis was performed using SPSS package. Results: The patients in minimally invasive group had shorter operative time (45 min vs. 75 min). The average postoperative blood loss in drain in conventional group was 150 ml whereas no drain was used in minimally invasive group. Postoperatively need for analgesic was significantly lower in minimally invasive group (P < 0.05). Duration of hospital stay was significantly less with minimally invasive technique. The duration of bony union was similar in both techniques. Conclusion: Our study concludes that the minimally invasive technique of fixation of Intertrochanteric femur fractures is superior in terms of less operating time and less duration of hospital stay.","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70435350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.4103/2319-2585.180688
S. Shrivastava, P. Singh, Shounak Taywade
Background: The wound management is a huge complex problem consuming billions of dollars. The standard treatment includes advance therapeutics with drugs (such as antibiotics), intense local dressings (such as negative pressure/antimicrobial) and multiple surgical interventions/reconstructions. Such intervention and modalities requires experts and large resources. Still the outcomes are unpredictable and associated with morbidities at donor (otherwise normal) sites. Materials and Methods: The "Sandeep′s Technique′s for Assisted Regeneration of Skin" (STARS) is therapy for complete healing of wounds with Autologous self activated Platelet Rich Plasma (PRP), imparted as local subcutaneous infiltrate in the wound margin, on every 4 th day, till complete repair takes place and local skin regenerates. The wounds are dressed daily/alternate day with only moist saline. It is a Pilot study of patients treated with STARS Therapy treated at Acharya Vinobha Bhave Rural Hospital, J.N.Medical College, Wardha, INDIA. The different types of wounds were acute wounds with exposed deep tissues such tendons and bones; compound fractures; infected wounds; necrotising post surgical flaps and chronic non healing ulcers including diabetic and pressure ulcers. Result: All the wounds healed aby PRP infiltration not requiring any further drugs, complex dressings and surgical reconstruction. Conclusion: It is safe, effective, efficient, and easily reproducible technique with predictable results for even complex wounds in which surgical reconstructions are not possible. This method of treatment is a huge step forward in preservation of resources and prevention of morbidity.
背景:伤口管理是一个巨大而复杂的问题，耗资数十亿美元。标准治疗包括使用药物(如抗生素)、高强度局部敷料(如负压/抗菌剂)和多次手术干预/重建的先进治疗。这种干预和方式需要专家和大量资源。然而，结果是不可预测的，并且与供体(其他正常)部位的发病率有关。材料和方法:“桑迪普皮肤辅助再生技术”(STARS)是一种利用自体自体活化富血小板血浆(PRP)在创面边缘局部皮下浸润，每4天灌注一次，直至创面完全修复，局部皮肤再生。伤口每天/隔天只用湿润的生理盐水包扎。这是一项在印度瓦尔达j . n .医学院Acharya Vinobha Bhave农村医院接受STARS疗法治疗的患者的试点研究。不同类型创面均为急性创面，肌腱、骨等深层组织外露;复合骨折;感染伤口;术后皮瓣坏死和慢性不愈合溃疡，包括糖尿病和压疮。结果:PRP浸润后创面全部愈合，无需进一步用药、复杂敷料及手术重建。结论:对于无法手术重建的复杂伤口，该技术是一种安全、有效、高效、易重复的技术，其结果可预测。这种治疗方法在保护资源和预防发病率方面向前迈出了一大步。
{"title":"STARS therapy: \"Sandeep′s technique for assisted regeneration of skin\"","authors":"S. Shrivastava, P. Singh, Shounak Taywade","doi":"10.4103/2319-2585.180688","DOIUrl":"https://doi.org/10.4103/2319-2585.180688","url":null,"abstract":"Background: The wound management is a huge complex problem consuming billions of dollars. The standard treatment includes advance therapeutics with drugs (such as antibiotics), intense local dressings (such as negative pressure/antimicrobial) and multiple surgical interventions/reconstructions. Such intervention and modalities requires experts and large resources. Still the outcomes are unpredictable and associated with morbidities at donor (otherwise normal) sites. Materials and Methods: The \"Sandeep′s Technique′s for Assisted Regeneration of Skin\" (STARS) is therapy for complete healing of wounds with Autologous self activated Platelet Rich Plasma (PRP), imparted as local subcutaneous infiltrate in the wound margin, on every 4 th day, till complete repair takes place and local skin regenerates. The wounds are dressed daily/alternate day with only moist saline. It is a Pilot study of patients treated with STARS Therapy treated at Acharya Vinobha Bhave Rural Hospital, J.N.Medical College, Wardha, INDIA. The different types of wounds were acute wounds with exposed deep tissues such tendons and bones; compound fractures; infected wounds; necrotising post surgical flaps and chronic non healing ulcers including diabetic and pressure ulcers. Result: All the wounds healed aby PRP infiltration not requiring any further drugs, complex dressings and surgical reconstruction. Conclusion: It is safe, effective, efficient, and easily reproducible technique with predictable results for even complex wounds in which surgical reconstructions are not possible. This method of treatment is a huge step forward in preservation of resources and prevention of morbidity.","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70435550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.4103/2319-2585.180689
A. Schicho, F. Gebhard, P. Richter
Introduction: Sacroiliac screw placement is one standard treatment option for stabilization of posterior pelvic ring injuries encountering high intra- and inter-individual variations of bone stock quality as well as a vast variety and prevalence of sacral dysmorphism. An individual, easy-to-use preoperative bone stock quality estimation would be of high value for the surgeon. Materials and Methods: We analyzed 36 standard computed tomography datasets with the uninjured pelvic ring. Using a two-plane cross-referencing technique, we assessed the Hounsfield unit (HU) mean values as well as standard deviation and minimum/maximum values within selected region of interests (ROIs) at five key areas: os ilium left and right, massa lateralis of os sacrum left and right, and central vertebral body on levels S1 and S2. Results: Results showed no difference in mean HU at any ROI when comparing male and female data. For all ROIs set on S1 and S2, there was an age-related decline of HU with a calculated slope significantly different from zero. There was no statistical difference of slopes when comparing S1- and S2-level with respect to any distinct ROI. Comparison of levels S1 and S2 revealed differences at the vertebral body and at the right os ilium. The right and left massa lateralis of os sacrum had lower bone density than the center of the vertebral body, the right, or left os ilium on S1; right and left massa lateralis density did not differ significantly. On level S2, results were comparable with no difference of massa lateralis density. Conclusion: With our easy-to-use preoperative assessment of bone density of five key areas of sacroiliac screw anchoring we were able to find the lowest bone density in both the left and right massa lateralis on levels S1 and S2 with high inter- and intra-individual variations. Significantly lower bone density was found in the center of the vertebral bodies S2 in comparison to S1, which both are crucial for iliosacral screw placement. We thus recommend priority use of level S1 in screw placement and careful consideration of sole massa lateralis short-screw anchoring.
{"title":"CT-based bone density assessment for iliosacral screw trajectories","authors":"A. Schicho, F. Gebhard, P. Richter","doi":"10.4103/2319-2585.180689","DOIUrl":"https://doi.org/10.4103/2319-2585.180689","url":null,"abstract":"Introduction: Sacroiliac screw placement is one standard treatment option for stabilization of posterior pelvic ring injuries encountering high intra- and inter-individual variations of bone stock quality as well as a vast variety and prevalence of sacral dysmorphism. An individual, easy-to-use preoperative bone stock quality estimation would be of high value for the surgeon. Materials and Methods: We analyzed 36 standard computed tomography datasets with the uninjured pelvic ring. Using a two-plane cross-referencing technique, we assessed the Hounsfield unit (HU) mean values as well as standard deviation and minimum/maximum values within selected region of interests (ROIs) at five key areas: os ilium left and right, massa lateralis of os sacrum left and right, and central vertebral body on levels S1 and S2. Results: Results showed no difference in mean HU at any ROI when comparing male and female data. For all ROIs set on S1 and S2, there was an age-related decline of HU with a calculated slope significantly different from zero. There was no statistical difference of slopes when comparing S1- and S2-level with respect to any distinct ROI. Comparison of levels S1 and S2 revealed differences at the vertebral body and at the right os ilium. The right and left massa lateralis of os sacrum had lower bone density than the center of the vertebral body, the right, or left os ilium on S1; right and left massa lateralis density did not differ significantly. On level S2, results were comparable with no difference of massa lateralis density. Conclusion: With our easy-to-use preoperative assessment of bone density of five key areas of sacroiliac screw anchoring we were able to find the lowest bone density in both the left and right massa lateralis on levels S1 and S2 with high inter- and intra-individual variations. Significantly lower bone density was found in the center of the vertebral bodies S2 in comparison to S1, which both are crucial for iliosacral screw placement. We thus recommend priority use of level S1 in screw placement and careful consideration of sole massa lateralis short-screw anchoring.","PeriodicalId":31882,"journal":{"name":"Journal of Orthopaedics and Allied Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70435667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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