Percutaneous screw fixation for trapezium fracture

Isolated trapezial fracture is a rare diagnosis which can lead to long term symptoms if missed. We report a case of vertical intra-articular displaced trapezial fracture treated with percutaneous cancellous screw fixation with good functional outcome

A study on outcome of medial open wedge osteotomy using puddu plate for Unicompartmental Osteoarthritis of Knee

INTRODUCTION: Osteotomies around the knee have had a significant complication rate in the past and many surgeons abandoned these procedures although the favourable long term results were well known. The main problems were the intraoperative choice of the correction angle and the risk of a postoperative loss of correction. After many years of closed-wedge osteotomy, open wedge valgization osteotomy has become popular. The experience and the development of new techniques for axis correction around the knee have led to its revival. 90% of all osteotomies around the knee are for valgization of tibia (high-tibial osteotomy = HTO). Whereas in the past closed-wedge osteotomy from the lateral side with fibula osteotomy was the gold standard in many countries; and in 1990s fixation plate by Puddu came to vogue. This procedure looked very attractive to many surgeons because of the small incision and the simple surgical steps.Open-wedge osteotomy of the tibia can be performed without bone grafting or bone substitution in most cases. In this study we analyse the outcome of open wedge osteotomy in patients having unicompartmental osteoarthritis with genu varum using the puddu plate. AIM & OBJECTIVES: AIM : The aim of the study is to analyse the effectiveness of Medial open wedge osteotomy using puddu plate in patients with Unicompartmental Osteoarthritis. OBJECTIVES : (a) To study the effectiveness of medial open wedge osteotomy using puddu plate in relieving knee pain in patients with Unicompartmental Osteoarthritis. (b) To study the functional outcome in these patients. (c) To show that bone grafting is not necessary. MATERIALS AND METHODS: This is a prospective study of patients who attended the orthopaedic out pateint clinic in our hospital between September 2010 to October 2012. The patients were evaluated by clinical examination and weight bearing radiographs. The patients who were found to have unicompartmental osteoarthritis with knee pain not relieved by conservative management and who satisfy the inclusion criteria were selected. INDICATIONS : 1. Pain and disability resulting from osteoarthritis that interfere with high-demand employment or recreation. 2. Evidence on weight bearing radiographs of degenerative arthritis that is confined to one compartment with a corresponding varus deformity. 3. The ability of the patient to use crutches after the operation and the possession of sufficient muscle strength and motivation to carry out a suitable rehabilitation program. 4. Good vascular status without serious arterial insufficiency or large varicosities. 5. Age < 60 years. RESULTS: We have observed results in 13 knees with patients‘ age ranging between 35 to 54 years. Female patients outnumber the male patients by few percentage. Left sided knee gets involved in 69 % of the patients and for unkown reasons is symptomatic earlier in most of the patients. On an average the Body mass index was 27.8 which is in overweight category. Two of the three obese patients had fair and poor results. The relation of body weight to poor outcome could be attributed to the weight which the joint has to sustain and the poorer active rehabilitation by these patients. Pain relief were found in Nine patients but for the 3 patients with complications of superficial infection in two and under correction in one. The outcome was excellent in 15%, good in 62%, fair in 15%, poor in 8% by ‗Knee society‘ knee score and excellent in 31%, good in 38%, fair in 31% , no poor results by ‗Knee society‘ function score. The outcome was excellent in 31%, good in 38%, fair in 15% and poor in 15% by JOA knee rating scale. CONCLUSION: From our prospective study with thirteen knees we arrive at the following conclusions. Medial open wedge osteotomy is a useful option in unicompartmental osteoarthritis and definitely relieves pain and improves functional outcome in patients. The results are evident and maximal at 1 year. Bone grafting is not necessary for this procedure. No hazardous complications occur in these patients. Future Total knee replacement will not be a problem as the bone stock is preserved