Extended use of limb reconstruction system in management of compound tibia diaphyseal fracture as primary and definitive tool

Background: The fractures of the tibia are among the most difficult fractures to treat effectively. The status of the soft tissues, the degree of comminution and level of contamination sustained at the time of injury affect the long term clinical results. The goal of operative treatment is to obtain anatomic realignment of the shaft of tibia while providing enough stability to allow early motion. This should be accomplished using techniques that minimize osseous and soft tissue devascularization in the hopes of decreasing the complications result­ing from treatment.Methods: A prospective randomized study was conducted between 2014-2016 on 20 patients admitted with compound tibia diaphyseal fracture and treated with Limb reconstruction surgery.Results: In our study, the mean time of partial weight bearing was 3.5±2.97 weeks, full weight bearing was 8.55± 4.14 weeks and bone union time was 20.22±5.22 weeks. The pin tract infection was found in 5 (25%) cases. Delayed union was observed 06 (30%) cases. Shortening of more than 2 cm were recorded in 3 (15%) patients. Joint (knee or ankle) stiffness was observed in 6 (30%) cases. Loosening of pin was observed in 3 (15%) cases. Chronic osteomyelitis was observed in 3 (15%) cases. Secondary procedures were done in 11 (55%) cases. Bone marrow aspiration was done in 5 (25%) cases, iliac bone grafting in 5 (25%) cases.Conclusions: LRS is found to be wonderful tool in management of compound tibia fractures as primary and definitive mode because of its safety, versatile nature, patient friendly and cost effectiveness

Hip fractures associated with concomitant upper limb fractures: a case series

Elderly patients are at risk of fractures of distal radius, proximal humerus, spine and hip even due to trivial low energy falls. Hip injuries are commonly associated with concomitant ipsilateral upper limb injury because of a protective reflex of shielding their body from fall using their shoulder or outstretched hand. Here we presented a case series of 3 elderly patients who came to us with hip fractures and concomitant ipsilateral upper limb fractures. The injuries were adequately managed with splintage and operative procedures. Post-operatively mobilization was challenging. But patients were successfully mobilized with the help of relatives and physiotherapists. Concomitant hip fractures with associated ipsilateral upper limb fractures are quite common in elderly and difficult to treat. Post-operatively mobilization of patient and functional outcome is hampered. Proper counselling by operating surgeon, physiotherapy and postoperative rehabilitation with the help of relatives and assisting devices provides good outcome. In cases of hip trauma in old age, one should always thoroughly examine and screen for upper limb injuries. So that early appropriate treatment and mobilization can be done with good functional outcome

Two rare cases of management of proximal phalanx spina ventosa

Tubercular dactylitis or spina ventosa is the tubercular infection of phalanges, metacarpals and metatarsals termed after cystic swelling of short tubular bones by tubercular infection. Here we presented two rare cases of spina ventosa in a 10 years old female and a 16 years old male patients. In both cases there was swelling of digits with stiffness. The radiographs were suggestive of chronic osteolytic infection with cortical destruction and diffuse sclerosis. We managed them with adequate surgical debridement, splintage and anti-tubercular therapy with good functional recovery. Spina ventosa or tubercular dactylitis is a rare condition and is often missed on diagnosis due to vague non-specific presentation, unavailability of rapid diagnostic tests and can be confused with other mimicking diseases. Any swelling over small tubular bones of hand or feet should raise the suspicion of spina ventosa, especially in endemic countries for tuberculosis. In neglected chronic infections, surgical debridement, curettage and splintage followed by anti-tubercular therapy based on histo-pathological reports is the treatment of choice with high protein diet and vitamin D supplementation ensures good outcome.

Study of the post operative outcome in orthopeadic management in cases of high HBA1c diabetic patients-a case series

Elderly diabetic patients are at risk of poor fracture healing in post-traumatic fracture seven due to trivial low energy falls and chronic pathological bone involvement. Glycated haemoglobins are haemoglobins with an attached sugar moiety. HbA1c is the predominant fraction of HbA1 and gives an estimate of the blood sugar levels of an individual over the last three months. Here we present a case series of 3 elderly patients who came to us with post traumatic fractures or chronic bone pathologies and very high HBA1C values (>10%) who required operative orthopaedics management. The injuries were adequately managed with splintage and operative procedures after proper control of the patients’ blood sugars levels. Postoperatively mobilization was challenging. Orthopaedic chronic bone pathologies and post traumatic limb fractures with uncontrolled sugar and very high HBa1c are very difficult to treat. Postoperatively patients are at a very high risk of infection, poor suture healing, risk of repeat fracture, osteoporosis, etc which often results into functional outcome being hampered. Proper counselling by operating surgeon, physiotherapy and postoperative rehabilitation with the help of relatives and assisting devices with strict preoperative and post operative sugar control provides good outcome. In cases of trauma in old age, one should always thoroughly examine and screen for comorbidities such as hypertension and diabetes using reliable markers such as HBa1c levels. So that early appropriate treatment and mobilization can be done with good functional outcome

Tibia non-union management using limb reconstruction system fixator-a case series

The management of non-unions is always the challenge to the orthopedic surgeons. It requires proper expertise in that field. Improper management leads to multiple surgeries and disability in patients. External fixation using limb reconstruction system (LRS) is one of the options in the management of these conditions. We present a series of 04 cases of non-union tibia managed with LRS fixator. All the patients had compound tibia fractures, 02 patients were managed initially with AO external fixator, one with plating and another with intramedullary nailing. Out of four cases, two cases were infected non unions and two cases were non infective non unions. All the four patients were managed secondarily with LRS fixator with less complications and good outcome. LRS fixator is one of the best options in the management of both infective and non-infective non unions of the tibia. It helps in both compression and distraction in a single frame with minimal complications. It gives good stability in the bone which helps in early weight bearing and adjacent joint range of motion

The management of complex periprosthetic femoral fractures: a case series of plating with wire augmentation, and a review of the literature

Periprosthetic fractures continue to increase in frequency. This is due, in part, to the increasing number of primary and revision arthroplasties performed annually and to the increasing age and fragility of patients with such implants. All types of periprosthetic fractures can present unique and substantial treatment challenges. Here we present a case series of 3 elderly patients who came to us with periprosthetic hip fractures in previously operated case of hip hemiarthroplasty/total hip replacement done. The injuries were managed with splintage and operative procedures. Postoperatively mobilization was challenging. But patients were successfully mobilized with the help of relatives and physiotherapists. Periprosthetic fractures are becoming quite common in elderly and difficult to treat as the number of hip joint arthroplasty operative has increased in developing countries. the correct procedure is very challenging as every case needs to be treated very individualistically. A good plan always results in much reduction in the operating time and better patient post operative outcome. Postoperatively mobilization of patient and functional outcome is hampered. Proper counselling by operating surgeon, physiotherapy and postoperative rehabilitation with the help of relatives and assisting devices provides good outcome. So that early appropriate treatment and mobilization can be done with good functional outcome

Primary tendon repair in a case of acute traumatic tibialis anterior with extensor hallucis longus tendon rupture in a young male-a case report

Tibialis anterior tendon rupture is a rare entity which can be either traumatic and non-traumatic. It often presents late due to mild clinical symptoms and signs. Acute ruptures are traumatic occurring in young individuals while chronic ruptures are due to degenerative processes occurring in elderly individuals, commonly after 45 years of age. Tibia anterior along with extensor hallucis tendon is an even rarer entity, operative management of which becomes mandatory, more so in a young active individual for better outcome. We have a 31-year-old male patient, who presented to us with an acute post traumatic tibialis anterior tendon rupture of 3 days duration which was diagnosed following an initial clinical examination, an unremarkable X-ray picture, and Ultrasonography confirming the diagnosis. The patient was managed with primary repair of the tibialis anterior tendon along with Extensor hallucis tendon (which was found intra-operatively) with 2-0 ethibond sutures using a cross-linked Bunnell technique. The patient regained full ankle range of motion at 8 weeks post operative period with ankle dorsiflexion and great toe extension back to pre-injury state.As we have seen with this case, early primary repair in a case of acute rupture at tibialis anterior and extensor hallucis longus rupture with non-absorbable suture has significant improved post operative outcome in terms of return of the affected range of motion and can be practice safely in new hands with limited resources as material of suture and technique has not significant effect in post operative outcome. Acute tibialis anterior and extensor hallucis tendon rupture, non absorbable suture, ethibond, cross linked Bunnell technique.

A case of subtrochanteric femur fracture nonunion with failed implant in situ treated with exchange nailing using interlock nail and autologous bone grafting: a case report

Subtrochanteric femur fracture accounts for 25% of all hip fracture and may land up in non-union due to the inadequate reduction and fixation tech, local muscle pull over fragments, biomechanical stress in subtrochanteric region and soft tissue interposition etc., non-union are managed with various choices of implants like exchange nailing , angle blade plate , dynamic condylar screw, augmentation of previous hardware with plate and by providing biological environments at fracture site using  bone graft. Strict adherence to principles of providing stability to fracture and providing environment for bony growth gives good clinical outcome. A 52 years old male with subtrochanteric femur fracture was operated with long PFN, later presented to us after 18 months with failure of the hardware and atrophic non-union manifesting as pain during walking and limping. Patient was operated with removal of implant and exchange nailing using femur interlock nail and autologous bone grafting from iliac crest graft. 1 year follow up showed complete bony union and abundant of callus formation. Patient is currently doing all the daily activities and have no complaints at present. At 1 year follow up there is complete union at non-union site and good clinical outcome is achieved. Exchange nailing with interlock nail and autologous bone grafting for treatment of atrophic non-union of subtrochanteric femur fractures gives good clinical outcome

Role of tibia interlocking nail in treating distal tibial metadiaphyseal fractures: study of 46 cases

Background: Distal tibial diaphyseal fractures are known for its various challenges that orthopaedicians face while treating. While performing surgery, many principles of fixations are needed to be properly addressed. This study was undertaken to know the efficiency of closed reduction, polar screws and tibia interlocking nail fixation at our Institute.Methods: The data, which were collected from the medical records and Department digitalised storage system and from the HMIS patient filing system, included age, sex, date of admission, type of admission (elective versus emergency), and AO classification of distal tibial fracture admitted in Orthopaedics Department from 2007 to 2013. Analyses of 46 cases, 34 males and 12 females, were made to find out the functional, radiological outcome, associated complications in treating distal tibia with ILN. During Analysis, association of the single event with the variables was estimated using Relative Risk, with a 95% confidence interval and P value of <0.05 was considered significant.Results: The average time to union of the closed fracture was 15.4 weeks (range: 12–28 weeks). The healing times for the primarily nailed compound Grade I averaged 17.8 weeks (range: 15-34 weeks). Complications of delayed union occurred in 3 cases, and two cases of non-union. Infection in 6 cases (5 superficial, 1 deep), screw breakage in 4 cases and 3 cases of significant malalignment. The final functional outcome of 33 patients had excellent results, 11 had good results and 2 had fair results as determined by criteria of Johner and Wruh. Conclusions: The dynamic osteosynthesis of distal tibia by interlocking nail and judicious use of poller screws is an effective alternative for the treatment of distal metaphyseal tibial fractures.

Fracture union in extra articular distal tibia fracture after definitive delta frame external fixation in COVID 19 pandemic: a case report

Distal tibia fractures account for 10% of lower limb fractures. Mode of trauma also determines the fate of soft tissue recovery. In low energy fractures soft tissue show better healing whereas fractures due to high energy trauma show high chances of soft tissue complications like poor soft tissue coverage, wound infection and necrosis. We presented a 50 years old male case of extra articular left distal tibia fibula open fracture managed by delta frame external fixator with fibular K wiring used as a definitive management with good fracture healing and range of motion 5 months postoperative. Ankle spanning external fixation is a good modality of surgical management of extra articular compound distal tibia fractures as both temporary and definitive surgical fixation