Management of avascular necrosis of femoral head by core decompression

Background: Avascular necrosis (AVN) is defined as cellular death of bone components due to interruption of the blood supply; the bone structures then collapse, resulting in bone destruction, pain, and loss of joint function. The head of femur is the most common bone affected by avascular necrosis. Our aim is to study results of core decompression and bone grafting in avascular necrosis of femoral head.Methods: The present study was performed at Pravara Rural Hospital, a constituent hospital of Rural Medical Collage at Village Loni, Rahta and district: Ahamadnagar. The study includes patients who underwent core decompression and bone grafting in avascular necrosis of femoral head at Department of Orthopaedics, Pravara Rural Hospital from June 2015 to June 2017.Results: In our study majority of the patients belongs to the group of 31-40 years and most of them were males. Male female ratio was 4:1. Out of 20 patients, 6 of them were unilaterally involved rest 14 had bilateral involvement. Out of 28 hips of bilateral involvement 6 were grade III and IV Ficat and Arlet. That 6 were not considered as they come in grade III & IV of FICAT & ARLET classification. So we study 28 hips only.Conclusions: The average success rate was 82.61% after core decompression and bone grafting. The patients who had less than 60 Harris hip score on presentation had poorer outcome. Patients who had less than 80 degrees of flexion had also poorer outcome.

Comparative study of functional outcome of dynamic compression plating with intramedullary interlocking nailing in close fracture shaft of humerus in adults

Background: Humeral shaft includes 1% of all fractures. The advantage of operative management is early mobilization and patients comfort. Most of the studies compare two main modalities of management, 1. dynamic compression plate 2. intramedulary interlocking nail, with respect to fracture union as major criteria. Very few studies have compared functional outcome with respect to shoulder and elbow joint. The purpose of this study is to compare the outcomes of each method of fixation. (Dynamic compression plating and interlocking nailing) for the fracture shaft of humerus and to analyse statistically significant difference in the results of these two methods.Methods: There were 58 patients of fracture shaft humerus were enrolled during 2 May 2015 to 2 January 2017 in the study. They were randomly divided into two groups, DCP group and IMILN group, each having 29 patients and compare the functional outcome of both groups with each other.Results: There were total 53 patients among them 26 (49.05%) treated with DCP and 27 (55.95%) treated with intramedullary interlocking nail (IMILN).The mean age of patient treated with DCP was 40.12 years (SD±8.51, Min-Max: 25-60) and treated with IMILN was 41.96 years (SD±11.04, Min-Max: 22-61). Road traffic accident was major mode of injury to shaft of humerus.Conclusions:Dynamic compression plating is preferable technique than interlocking nailing for fracture shaft of humerus in adults.

The distance of the centre of femoral head relative to the midline of the pelvis: a prospective X-ray study of 500 adults

Background: The mechanical axis of the femur is defined as the line joining the centre of the femoral head to the centre of the knee joint. One of the pre-requisites for a successful total knee replacement (TKR) is correct positioning of the implants, so that the mechanical axis of the limb is restored to neutral. During TKR surgery, the distal femoral anatomy can be visualized. However, to identify the mechanical axis of the femur, the location of the femoral head must be known.Methods: We prospectively measured distance of centre of femoral head relative to the midline of the pelvis in 500 adults, using x ray of pelvic with both hip anteroposterior view done for medical causes during 2-May-2015 to 1-Jan-2017 with satisfied the following inclusion and exclusion criteria. Patient gender and age were known. Both hips were clearly shown on the radiograph and not affected by any developmental or acquired condition that might deform normal anatomy. Radiographs demonstrating unacceptable pelvic tilt or rotation were excluded. Also, we excluded any cases where degenerative changes in the native hip were more severe than grade 1, based on the Tönnis classification.Results: There were total 500 patients in which 250 were male and 250 were female. The mean age of male was 52.14 year (SD ±80.80 mm, 95% CI 51.05 to 53.24 mm) and female was 52.11 years (SD ±8.82 mm, 95% CI 51.01 to 53.24 mm).The mean distance of femoral head centre from midline in male was 95.02mm (SD ±2.20 mm, 95% CI 94.75 to 95.30 mm) and in female was 91.54 mm (SD ±2.64 mm, 95% CI 91.22 to 91.87 mm).Conclusions:This study provide a useful information to determine the femoral head center relative to the midline of pelvis which useful intraoperatively. 

Various modalities of treatment of proximal tibial fractures: a prospective longitudinal study

Background: Tibial plateau fractures are one of the commonest intra-articular fractures. They result from indirect coronal or direct axial compressive forces. This makes about 1% of all fractures and 8% of the fractures in elderly. Nevertheless, tibial plateau fractures challenging remain because of their number, variety and complexity. With advancements the treatment of each fracture type is still not defined hence we have taken up this study to analyze various fracture patterns and its outcome.Methods: The study includes 40 patients having the fractures of  the proximal tibial metaphyseal; metaphyseodiaphyseal with or without intra-articular extension (including upper third fractures of tibia), closed fractures, fractures with Open grade-I wounds (Gustillo Anderson Classification).The study excludes compound fractures having grade II and III (Gustillo Anderson) and Paediatric patients. The treatment  method  was  based  on  the  type  of  fracture,  the  amount  of displacement , the amount of depression and surrounding skin condition  of the tibial plateau. We used the Schatzker classification because it is closest to describing the specific fracture type and it is easy to apply.Results: In this study there were 40 patients with mean age of 39.18 (median 38.5 and min – max 25 to 55) with 25 male (62.5%) and 15 (37.5%) female with significant male preponderance. In this study road  traffic  accident  was  the  commonest  mode  of  injury  (65%)  and produced different types of fractures, followed by fall from height (22.5%), injury while playing sports (12.5%).Conclusions: The correct method of management of tibial condylar fractures depends on good clinical judgment. If rational treatment is to be instituted the surgeon must have sound knowledge of the personality of the injury and a clear understanding of the knee examination, imaging studies and must be familiar with variety of techniques available at present for treating tibial condyle fractures