A study on outcome of various K-wire fixations in paediatric supracondylar humerus fractures

Background: The ideal pin geometry for treatment of paediatric supracondylar humerus fracture is still debated. Various studies have been carried out comparing medial-lateral pinning (MLP) and lateral only pinning (LOP), but none have compared all three individually i.e. MLP, lateral divergent pinning and Lateral Trans olecranon fossa four cortex purchase pinning (TOF-FCP). This study aims to compare the cosmetic and functional outcome of these three pinning methods.Methods: 54 children with supracondylar humerus (Gartland type 2 or 3) meeting inclusion criteria were treated operatively and followed up till 6 months postoperatively. At 6 months the cosmetic and functional outcomes were assessed using the modified Flynn criteria.Results: All fractures united within 3 to 6 weeks duration. The mean duration of fracture union was 4.05 weeks. Functional outcome was satisfactory (i.e. excellent or good) at 6 months according to Flynn criteria in 95% of cases in cross pinning, 100% cases in TOF-FCP construct and 89% cases in lateral entry divergent pinning. cosmetic outcome was satisfactory (i.e. excellent or good) at 6 months according to Flynn criteria in 95% of cases in cross pinning, 100% cases in TOF-FCP construct and 89% cases in lateral entry divergent.Conclusions: Functional and cosmetic outcome of all three pinning geometries after operative intervention of paediatric supracondylar humerus fracture is similar in expert hands. The incidence of complications with TOF-FCP construct is less amongst the lateral only pinning

Evaluation of results of minimally invasive per cutaneous surgeries in management of calcaneal fractures

 Background: To analyze the outcome percutaneous surgeries in fractures of the calcaneum.Methods: 20 patients admitted in a tertiary care center in Ahmedabad were followed up from admission to until 2 years post operatively and functional outcomes in them following operative intervention were analyzed using AOFAS and Maryland scoring system.Results: Majority of patients have excellent or good outcome following percutaneous surgery in fractures of the calcaneum. The results were evaluated for 22 people with intraarticular calcaneum fractures using the Maryland foot score and AOFAS score. The mean AOFAS score was 86. There were 6 excellent, 12 good and 4 fair results.Conclusions: Percutaneous fixation in fractures of the calcaneum is a middle path in treatment of calcaneum fracture having the benefit of better reduction of ORIF plating and lesser soft tissue injury or chances of infection of conservative management

Functional and radiological outcome of proximal femoral nailing versus dynamic hip screw in unstable intertrochanteric femur fractures

Background: Intertrochanteric femur fractures account half of the hip fractures in elderly, the other majority being neck of femur fracture. 35-40% of intertrochanteric are unstable (Tronzo’s classification type 3, 4 and 5). The dynamic hip screw (DHS) has achieved widespread acclaim in the last few years and is currently considered to be the standard device for outcome assessment. Though, the DHS has been shown to produce good results, but complications are frequent, particularly in unstable inter-trochanteric fracture. The advantage of Proximal Femur Nailing fixation is that it provides a more biomechanically stable construct by reducing the distance between hip joint and implant. The goal of this study is to assess the clinical and radiographical outcomes of the DHS (load bearing implant) and PFN (load sharing implant) for the treatment of Intertrochanteric hip fractures.Methods: We assessed the same in 52 cases of unstable femur fracture 26 operated with DHS and 26 with PFN and followed up with sequential radiographs for radiological union and sequential interview with Harris hip score calculation for functional outcome assessment.Results: Patients operated for unstable intertrochanteric femur fracture with Proximal femoral nailing had better Harris hip scores (excellent 4, good 14) compared to dynamic hip screw group (Excellent 6, good 5) and earlier weight bearing (At 18 weeks, 100% in PFN compared to 65.5% in DHS). PFN has lesser incidence of postoperative complications (15% in PFN compared to 38% in DHS).Conclusions:The proximal femoral nail has better functional outcome in terms of Harris hip score and early radiologic union in unstable intertrochanteric fractures of femur. 

A study of comparison of tension band wiring versus plating for olecranon fractures

Background: Olecranon fractures are one of the common fractures around the elbow, comprising around 37% of all fractures occurring around the elbow. Olecranon fractures are commonly treated with either plating or tension band wiring. The purpose of current study is to compare the clinical and radiological outcome of tension band wiring and plate fixation in patients operated for olecranon fractures.Methods: Current study was conducted in a tertiary care center from May 2017-2019. Study compromises of 30 patients operated for olecranon fractures. Clinical and radiological outcome of patients treated with tension band wiring or plating and assessed using the Mayo’s elbow score at 6 months follow up.Results: Out of the 30 patients, 15 were treated with tension band wiring and 15 were treated using open reduction and plating. Out of the 15 operated with tension-band wiring (TBW) K wire on follow up 11 showed excellent score on Mayo elbow score, 2 had good results and 2 had fair results. In patients operated with Plating 12 showed excellent result on follow up and 3 showed good result. No patient had fair or poor score.Conclusions: Both tension band wiring and plate fixation are effective methods for treatment of olecranon fractures however complications regarding symptomatic metal prominence and superficial infection were higher in patients treated with tension band wiring as compared to plate fixations