Comparison outcome in management of femoral neck fracture using multiple cancellous screws with and without fibular graft

Multiple cancellous cannulated screw is preferred method in fresh cases of fracture neck of femur in young patients. Fibular strut graft is sometimes used along with multiple cancellous cannulated screws to enhance union and early restoration of function. We conducted a retrospective study to patients aged between 20-50 years old with femoral neck fracture treated with multiple cancellous screws either with or without fibular graft between the period of January 2016 to January 2018. We obtained total of six patients (five males and one female) with femoral neck fracture treated with multiple cancellous screws either with or without fibular graft. All fractures were garden type II-IV fresh femoral neck fractures. The functional outcome based on Harris hip score was excellent for all patients. The mean time of full weight bearing was 16±8 weeks in both multiple cancellous screws without fibular group and multiple cancellous screws with fibular group. The mean time of union was also 16±8 weeks in both groups. There is no complication such as non-union, avascular necrosis of femoral head and/or broken fibular graft in both the groups occurrences. Fixation with cancellous screws and fibular strut grafts for femoral neck fractures is cost effective and technically less demanding and associated with good outcomes. There is no added advantage of non-vascularized fibular grafting with multiple hip screw fixation in fresh femoral neck fractures in young adults over multiple hip screw fixation alone

Local injection of leukocyte rich platelet rich plasma produced higher radius union scoring system than local injection of pure platelet rich plasma in conservative therapy of intra-articular closed distal radius fractures

Background: Distal radius fracture often occurs both extra-articular and intra-articular, covering all ages. The use of autologous platelet rich plasma (PRP) consisting of leucocytes rich-PRP (L-PRP) and pure-PRP (P-PRP) thought can help in bone healing process. This study aimed to determine that the administration of L-PRP provides a better healing rate than P-PRP in intra-articular closed distal radius fractures after conservative treatment.Methods: This was a single-blinded experimental study with stratified randomized post-test only group design involving 51 patients with closed distal fractures undergoing closed reduction, consisting of 17 patients per study group. Group 1 received placebo, group 2 received P-PRP, and group 3 with L-PRP. Each group was then re-evaluated using x-ray at week 2, 3, and 6. RUSS score was then measured. Data was analysed using descriptive statistics and normality test, homogeneity test and inferential test were performed to determine the effect of L-PRP, P-PRP on the union rate of fracture distal radius. All obtained data was analysed using SPSS statistics 22 software.Results: Between control and P-PRP group, there was significant difference in mean RUSS with p value of 0.012. Between control and L-PRP injection group, there was a significant difference in mean RUSS with p value of 0.000. Between P-PRP and L-PRP group, there was also significant mean RUSS difference with p value of 0.003.Conclusions: There was a significant difference between the control group given placebo and the group P-PRP and L-PRP in closed fractures of the intraarticular radius after conservative therapy

Profile of total knee replacement patients and short term outcome in the sanglah public hospital 2018: a case reports

Total knee replacement (TKR) is considered to be among the most successful type of orthopedic surgery, with 15-year-survival-rate of implant exceeding 95%; furthermore, the improvement in quality of life is very significant. This study aims to describe the demographics, length of hospitalization and short-term outcome observed in patients undergoing TKR at Sanglah Hospital in 2018. All patients undergoing TKR at Sanglah Hospital in 2018 have been prospectively entered into our database. A total of 59 patients were recorded on 2018 for this study and 1 revision TKR patient and 2 patients with incomplete data were excluded. At baseline, 78.6% patients were female, 72.3% were Balinese and 84.1% were housewives. The mean age of patients was 63 years old. Authors also record that 44 (78.6%) patients are Overweight patients (BMI 25.00-29.99 kg/m2), 11 (19.6%) patients are at Obese Class I (30.00-34.99 kg/ m2) range, and only 1 (1.8%) patients have normal weight (18.50-24.99 kg/m2). As many as 51.8% patients had right TKR and 49.2% left TKR. The modus of patient’s length of stay is 7 days with 27 (48.2%) patients started to walk on the 4th day. VAS was recorded at level 4/10 on 92.9% patient. Drain was removed after 3 days on 42 (75%) patients. 15 patients (26.8%) had PRC transfusion due to anemia after operation

Comparison between the results of proximal femur nail anti-rotation and cemented bipolar hemiarthroplasty in treatment of intertrochanteric fractures in Sanglah Hospital in 2016

Background: Hemiarthroplasty is now being considered as a primary treatment for comminuted unstable type of IT fracture in elderly on the grounds that it allows early mobilization and full weight bearing. Recently popular modality is fourth generation of intramedullary nails like the Proximal Femoral Nails. The goal of treatment is restoring mobility safely and efficiently, while minimizing the risk of medical complications and technical failure.Methods: A Forty patients, having Intertrochanteric fractures treated with PFNA or cemented BH at our institution between April 2016 and April 2017. The primary outcomes measures were postoperative complication and hip function. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, postoperative haemoglobin and hospital stay.Results: Seventeen patients in PFNA group and 23 patients in BH group were included for analysis. There were no significant differences between the two group regarding to the Harris Hip Score at 6 months follow up. Significant differences were found between PFNA and BH group in comparison of intraoperative blood loss (p < 0.001), length of stay (p = 0.006), surgical time (p < 0.001), postoperative transfusion (p < 0.001), and decrease of hemoglobin (p=0.001).Conclusions: These findings indicate that PFNA has obvious advantages over the BH in treatment of intertrochanteric fractures in case of surgical trauma and postoperative complication

Comparison of mortality rate between bipolar hemiarthroplasty and proximal femoral nail anti-rotation for intertrochanteric fractures in Sanglah hospital, Bali

Introduction: Intertrochanteric fractures occur in about 50% of all hip fracture events, with a mortality rate within 1 year after fracture reaching 15 to 20%. The most common treatment nowadays is either the bipolar hemiarthroplasty procedure or proximal femoral nail anti-rotation (PFNA), although there is still no consensus regarding which is better from the two, especially on patient mortality.Method: This study was an observational study using a retrospective cohort design. A total of 102 study subjects who met the inclusion requirements were grouped into 2 groups, one with bipolar hemiarthroplasty fixation treatment and another with PFNA fixation treatment. Mortality rate was recorded by survey 2 years after surgery.Result: Chi-square test showed that 2-year mortality rate after intertrochanteric fracture treated with bipolar hemiarthroplasty (21.4%) was significantly higher than the PFNA group (10.3%) (p=0.028). Bipolar hemiarthroplasty group also had longer length of stay (LoS) (50%) than the PFNA group (32.4%), albeit statistically insignificant (p=0.13). There was no significant difference between the 2-year mortality rate and LoS (p=0.976).Conclusion: Patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty have significantly higher 2-year mortality rate than similar patients underwent fixation with PFNA, while they did not experience higher LoS than the PFNA group. Future prospective, multi-center study with larger sample size will be likely to validate similar fixation choice needed to decrease the mortality rate in intertrochanteric fractures

Higher RANK ligand/osteoprotegerin ratio results in lower callus diameter and osteocalcin expression on the healing of femur fracture between diabetic and nondiabetic rats using intramedullary wire

Background: Diabetes with uncontrolled glucose level offer a significant risk of acute or chronic complications. One of the chronic complications is a decrease in bone mineral density which is regulated by RANKL and OPG balance. Diabetes is estimated to slow the healing process of fracture. Both are related to fracture risk and fracture healing process. Fracture healing is characterized by measurement of callus diameter and osteocalcin expression. Aim: This research aimed to find out the difference in RANKL/OPG ratio, callus diameter and osteocalcin expression on the fracture healing in diabetic and nondiabetic rats. Methods: This is an experimental randomized post-test only with 32 Wistar rats. The population was divided into two groups, the control group did not get treatment and the second group was the diabetes modeling. On the 7th day, both groups were examined for their ratio of RANKL/OPG using ELISA and fracture was performed. On the 28th day, the rats were sacrificed, and the effects were assessed using histopathology examination of callus diameter and immunohistochemistry examination of osteocalcin expression at the fracture area. Result: Higher median ratio of RANKL/OPG in diabetic than nondiabetic rats with p = 0,000 (p &lt;0,05). The diameter of callus on the healing of femur fracture in the nondiabetic group was higher than the diabetic group with p = 0,000 (p &lt;0.005). Osteocalcin levels in nondiabetic group were higher than diabetic group with p = 0,000 (p &lt;0.005). There was a negative correlation between RANKL/OPG ratio with callus diameter and osteocalcin level with a correlation coefficient of -0.701 and -0.652 respectively with p = 0,000 (p &lt;0,05). Conclusions: Level of RANKL/OPG ratio has a negative correlation with callus size and osteocalcin expression on healed femur fractures in diabetic rats model.</p

The correlation of Singh index and cortical thickness index toward bone mineral density in women older than 60 years old with femoral neck fracture

Background: Femoral neck fracture is one of the most common fractures in elderly. Proximal femur fracture in elderly patients is considered a severe morbidity which has a negative impact on the life expectancy and quality of life. Aim of this study was to find the correlation of cortical thickness index (CTI) and SI toward bone density (BMD) in female patients over 60 years of age with femoral neck fracture.Methods: This is an observational cross-sectional study. Subjects were selected from Sanglah general hospital outpatient department, Denpasar, Bali during the period October 2020 to January 2021 by inclusion requirements and then randomized into two groups. Data were taken through history taking, physical examination as well as supporting investigations such as contralateral hip joint radiograph and BMD measurements. Statistical analysis was done from those data.Results: It has been obtained that there was a positive correlation of Singh index (SI) and CTI toward BMD. The correlation coefficient (r) between SI and BMD was 0.874 (p=0.000). The r between CTI and BMD was 0.854 (p=0.000). Both variables were significant.Conclusions: There were significantly strong correlations between SI and BMD (r=0.874, p=0.00), also CTI and BMD (r=0.854, p=0.00) in female patients over 60 years of age with femoral neck fracture

What can we expect from patellar denervation in knee arthroplasty? An updated systematic review and meta-analysis

Denervation by electrocauterization was proposed to be efficient in preventing anterior knee pain (AKP) following arthroplasty. The purpose of this study was to evaluate the effects of patellar denervation (PD) in primary knee arthroplasty. Systematic search was performed in PubMed, ScienceDirect, Cochrane Library, and ClinicalKey databases until July 2022 for published articles. The quantitative analyses were carried out by Review Manager 5.4 software. Twenty-one studies were included. Overall incidence of AKP, visual analog scale (VAS), and knee society score were significantly superior in PD group. Denervation also showed better outcomes in incidence of AKP at each follow-up time point, and in VAS and range of motion (ROM) at ≤3 months. Subanalyses based on depth of electrocautery showed statistically better results with 2–3 mm depth in VAS and PS compared to ≤1 mm. This study concluded that PD might contribute to lower incidence of knee pain. Patients who expect quicker recovery in pain and ROM may benefit from this procedure