A comparative study of low multidirectional locked nailing and locking compression plating in management of distal tibia fractures

Background: Ideal management for distal tibial meta-diaphyseal fracture remains controversial, due to lack of adequate evidences about implants and multiple treatment modalities. Most commonly these fractures were dealt with either locking compression plate (LCP) or by multi directional intra-medullary nail (IMIL). Aim is to compare these two implants, to understand the mechanism and find out the ideal implant for the management of distal tibia fractures.Methods: This study is prospective and comparative done at the associated hospitals of KMC Mangalore, spanning a period of around 2 years (October 2014 to July 2016). All patients presented with distal tibial meta-diaphyseal fractures were included in the study. Patients were treated with either low multi directional IMIL nail or by LCP and followed up for a minimum period of 6 months. Outcome measures included Olerud Molander Ankle Score (OMAS), wound issues, union of the fracture and patient mobility.Results: 50 consecutive patients (mean age 40 years) were included in the study, divided equally into 2 groups. Group-A treated with multi directional IMIL nail and group-B with MIPPO plating. Mean functional OMAS score for nailing is 91 and for plating is 88. All fractures treated with nailing united within 6 months and 4% patient treated by plating goes mal union and 4% infected.Conclusions: For distal tibial fracture management, intra-medullary nailing proved reliable surgical option with regards to the OMAS score, fracture union and less infection rates

Timed wake-up anaesthesia in hand: A modification to wide awake surgery of hand

Introduction: Wide awake surgery of the hand (WASH) is a well-accepted technique in hand surgery which allows the surgeon to identify and rectify on the table of some of the inadvertent shortcomings in the surgical procedures to optimise the final outcome. The advantage, however, precludes the use of tourniquet. We describe a modified method which preserves all the advantages of WASH and allows the surgeon to use tourniquet. Patients and Methods: Thirty-one cases of hand surgeries were carried out using the modified technique where a wrist block was supplemented with the ultra-short acting intravenous propofol which allowed the surgeon to use the upper arm tourniquet. The propofol infusion was stopped, and the tourniquet was released after the important surgical step. Within an average of 10 min of stoppage of the infusion, all the patients were awake for active intraoperative painless movements to aid the surgeon to identify, rectify and fine tune the procedure to optimise the results. Results: Five of the 31 patients needed correction based on the intraoperative movements. All the 31 patients were pain free at the surgical site during surgery. All the 31 patients were cooperative enough to perform full range of pain-free intraoperative movements. No patient experienced significant tourniquet pain during the procedure. Patient’s and surgeon’s satisfaction at the end of the procedure has been quite satisfactory. Conclusion: Timed wake-up anaesthesia, an improvement over the original WASH, has been suggested where the surgeon can add without subtracting the benefits of the procedure in the form of usage of the tourniquet providing the clear tissue plane and haemostasis during the surgery. However, an additional cost is incurred for the use of anaesthesia and equipment should be kept in mind