DOES CLOSED INTRAMEDULLARY INTERLOCKING NAILING IN PATIENTS WITH HUMERAL SHAFT FRACTURES HAS ADVANTAGES: EVALUATION THROUGH A CLINICAL STUDY

Objective: Intramedullary interlocking nail fixation (IINF) for the fracture shaft humerus (FSH) offers good clinical outcome. Evaluating the functionaloutcome of IINF in FSH and assessing the complications of the technique, time taken for fracture consolidation, and union rates were the objectives.Methods: Adult patients with a clinical diagnosis of diaphyseal fracture of humerus were assessed clinically and radiologically for the functional outcome of IINF in FSH. Functional outcome of shoulder and elbow considered together was graded as excellent, moderate, and poor. Daily assessment was done along with active physiotherapy. All were followed up at monthly intervals for 6-12 months or till the union of fracture. Radiological assessment was done at immediate post-operative period, at months 1, 3, 6, 9, and 12 months.Results: 30 patients (males n=24, 80%) with a mean(±standard deviation) age of 39(±13.31) years were included. Road traffic accident was the frequent cause (n=18, 60%). Indirect injury was the cause in 66.66% patients. Middle 1/3rd of shaft of humerus was fractured in 53.33% patients. 10 (33.3%) patients each had oblique fracture and transverse fracture, respectively; comminuted fracture was seen in another 26.6% patients. Radial nerve palsy (10%) was the frequent associated injury of the total nine. The overall functional outcome was excellent in 80%, moderate in 16.6%, and poor in 3.3% patients. Postoperatively, nonunion, superficial infection and shoulder stiffness was seen in one patient each. Conclusion: IIFN is an excellent, least invasive surgical option for FHS with early fracture consolidation and better union rates.Keywords: Fracture shaft humerus, Functional outcome, Intramedullary interlocking nail fixation, Nonunion, Shoulder stiffness, Superficial infection

EVALUATION OF ARTHROSCOPIC A CRUCIATE LIGAMENT ECONSTRUCTION WITH HAMSTRINGS TENDON GRAFT

ABSTRACTObjective: Treatment of rupture of anterior cruciate ligament (ACL) aims to restore normal/near normal stability and function of the knee, preventingfurther damage to other knee structures. We studied the functional outcome of arthroscopic guided ACL reconstruction using quadrupled hamstringtendon graft (QHTG) and evaluated the complications.Methods: In this prospective study, evaluation parameters Lachman test, Pivot test, and hamstring strength were assessed pre- and post-operativelyat months 3, 6, 12, 18, and 24; Lysholm test was assessed postoperatively. Intravenous ceftriaxone+tazobactam 1 g b.d × 2 days followed by oralcefpodoxime 200 mg b.d was prescribed till suture removal. Post-operative ACL rehabilitation protocol was followed for all patients.Result: A total of sixteen male patients with a mean age of 26.5 years were evaluated. Injury due to road traffic accident (7) and sports activity (6)was a common cause. Preoperatively, all patients had positive Pivote and anterior drawer test, 4+ score of Lachman test, 4/5 muscle strength withrestriction of movement to <10°. Mean±standard deviation Lysholm score at months 3, 6, and 12 were 81.19±10.21, 83.86±12.44, and 89.17±8.32,respectively. At month 3, negative Lachman test was seen in 75% (12/16) patients, 18.75% (3/16) had 1+ laxity, and only one had 2+ laxity. None hadpivot shift test positive. At month 3, 81.25% (13/16) patients had normal range of motion of the operated knee; at month 6 and 12, 85.71% (12/14)and 91.67% (11/12), respectively, had equal range of motion compared to normal contralateral side. At months 3 and 12, 37.5% (6/16) and 100%(12/12) had a grade of 5/5 power in hamstring muscles. 12 post-operative complications were seen in 10 patients.Conclusion: Autologous ipsilateral QHTG is a good choice in arthroscopic guided ACL reconstruction and is associated with fewer complications.Focus on regaining hamstring power is essential for a successful surgery.Keywords: Anterior cruciate ligament tear, Hamstring strength, Lysholm score, Pivote test, Quadrupled hamstring tendon graft, Range of movement