Study of functional outcome of muller type C distal femur fracture treated with locking compression plate

Background: To evaluate the functional outcome of Muller type C distal femur fracture treated with locking compression plate (LCP). Methods: This prospective study was carried out at Al-Ameen medical college and hospital, Vijayapura. Forty patients (24 males and 16 females) with Muller type C distal femur fractures were enrolled in our study. Patients were treated with open reduction and internal fixation with LCP. They were followed up for 9 months with clinical examination and serial x-rays. The functional outcome was evaluated using Neer’s scoring system. Results: Forty patients who completed follow up of 9 months were included. There were 18 muller type C1, 14 muller type C2 and 8 Muller type C3 fractures. The functional evaluation with Neer’s scoring system was excellent in 8 patients, good in 20 patients, fair in 8 patients and poor in 4 patients. Complications observed were difficulty in reduction, superficial infections, knee stiffness and limb length discrepancy. Conclusions: The LCP is a safe and effective tool to manage these difficult fractures as we had no incidence of implant failure, delayed union, non-union and revision surgery except that we had knee stiffness as commonest complication which can be tackled by early surgery, surgical expertise, meticulous soft tissue handling and vigorous early knee mobilisation.

A prospective study on operative management of displaced fracture of midshaft of clavicle

Background: Clavicle fractures had been traditionally treated non-operatively which resulted in high rates of non-union. The present study has been undertaken to study the role of precontoured locking compression plate in the fixation of mid-third clavicle fractures.Methods: We reviewed the results of 25 cases of displaced middle third clavicle fractures (Robinson type 2B) which were treated with open reduction and internal fixation with pre-contoured locking compression plate at Al-Ameen Medical College and Hospital.Results: Out of 25 patients operated with precontoured LCP, 21 were male and 4 were female patients. One patient had hypertrophic scar, one patient had plate prominence, two patients had delayed union and one patient had implant failure, none of them developed non-union. Constant Murley score was excellent in 19, good in 4 and fair in 1 patient and poor in 1 patient. Conclusions: Precontoured locking compression plate fixation has better functional outcome, immediate pain relief, early return to function and avoids complications of conservative methods

Status of oxidants and antioxidants in rheumatoid arthritis patients of north Karnataka

Background: Oxidant stress as a result of increased production of reactive oxygen species (ROS) or a reduction in the body’s endogenous antioxidant defense system is a hallmark of chronic inflammatory diseases including rheumatoid arthritis (RA). The objective of the study was to establish the status of oxidative/nitrosative stress in RA patients of north Karnataka.Methods: Thirty RA patients and equal number of healthy individuals (controls) were included in the study. The morning stiffness (MS) and disease activity score 28 (DAS28) of RA patients were examined. Erythrocyte sedimentation rate (ESR) and hemoglobin (Hb) levels were estimated. Biochemical parameters uric acid, lipid peroxide (LPO), nitric oxide (NOx), vitamin C & E, erythrocyte superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were measured.Results: Significant increased ESR (11.20 mm/hr vs. 40.97 mm/hr, 265.80%), uric acid (3.85 mg/dL vs. 6.73 mg/dL, 74.81%), LPO (1.12 μmol/L vs. 2.35 μmol/L, 109.82%) and NOx (16.19 μmol/L vs. 45.43 μmol/L, 180.61%) levels with significant decreased of the levels of Hb (12.59 g/dL vs. 10.16 g/dL, 19.30%), vitamin C & E (11.20.mg/L vs. 3.87.mg/dL, 65.45% and 13.01 mg/L vs. 7.05 mg/dL, 45.81%), SOD (3757.90 U/g Hb vs. 2201.20 U/g Hb, 41.42%) and GSH-Px (1.81 U/g Hb vs. 0.92 U/g Hb, 49.17%) were observed in RA. There was direct correlation found between MS, DAS-28 and ESR with serum LPO and NOx in RA patients. A significant negative correlation was detected between activity parameters with biochemical parameters in RA patients.Conclusions: Increased oxidants level and decreased non-enzymatic/enzymatic antioxidants level in RA patients of north Karnataka confirm an association between oxidative/nitrosative stress and rheumatoid arthritis.

A clinical study to evaluate the effectiveness of the short proximal femoral nail in the management of unstable intertrochanteric fractures

Background: The objective was to study the effectiveness and drawbacks of short proximal femoral nail in the management of unstable intertrochanteric fractures.Methods: This prospective study was conducted in the department of orthopaedics Al-Ameen medical college, Vijayapura, Karnataka, India from July 2010 to June 2017. Total 175 patients (130 males and 45 females) aged between 41 to 80 years with unstable Intertrochantreric fracture (155 had type IV and 20 had type III according to Boyd and Griffin classification). All patients were operated using Short proximal femoral nail and followed at least for a minimum period of 6 months and were evaluated radiologically and clinically by Kyle’s Criteria.Results: Anatomical reduction was achieved in 125 patients, 105 (60%) had no complications post operatively. Complications included 5 cases of avascular necrosis and screw cut out, 5 cases of delayed union, 5 cases of Z-effect, 20 cases of varus malunion, 10 cases of antirotation screw breakage, 5 cases of distal bolt breakage and 15 cases with lateral thigh discomfort. 125 patients had No shortening and the average shortening was 0.34 cm, average time of union was 19.26 weeks (15-30 weeks) in 170 cases. At the end of 6 months, good to excellent results were seen in 71.5% of cases, 57% patients returned to their pre injury functional level.Conclusions: Short proximal femoral nail provides good fixation for unstable intertrochanteric fractures, if proper pre-operative planning, good reduction and surgical techniques are followed leading to high rate of bone union and minimal soft tissues damage especially for Asian patients with relatively small femora