Can proximal femoral nailing of unstable trochanteric fractures help to regain pre-injury functional status in Indian rural patients? A prospective study of functional outcome of unstable intertrochanteric fractures with proximal femoral nailing

Background: In view of the high incidence of implant failure and varus collapse seen in unstable inter trochanteric femur fractures treated with dynamic hip screw (DHS), proximal femoral nailing (PFN) has gained popularity.1,2 However there is limited literature regarding functional outcome following PFN especially in Indian patients. In this study, our aim was to assess functional outcome following PFN of unstable inter trochanteric femur fractures which includes the ability to sit cross leg and squat.Methods: This prospective observational study was done at the associated hospitals of KMC Mangalore, spanning a time period of around 2 years, from October 2014 to July 2016. All patients who presented with isolated closed unstable inter-trochanteric fractures were included in the study. Patients were treated with proximal femoral nailing and followed up for a minimum period of 6 months. Outcome measures included Harris hip score, walking status and ability to sit cross leg and squat.Results: 40 consecutive patients (Mean age 61 years, range 25-95) were included in the study, all fractures united within 6 months. As per Harris hip score, 25 patients (62.5%) had excellent or good results, 8 patients (20%) had fair and 7 patients (17.5%) had poor results. 74% (20 out of 27) regained their gainful working status. 80% (24 out of 30) were able to squat easily  or with some  difficulty and 74% (20 out of 27) patients were able to sit crossed leg with or without difficulty. 82% (23 out of 28) regained their unassisted walking status.Conclusions: For unstable inter trochanteric femur fracture PFN gives good results in terms of union, walking ability and majority of the patients regained their pre injury activity status including squatting and cross leg sitting.

Role of palmaris longus as a contributing factor in Carpal Tunnel Syndrome-Ultrasonographic evaluation of Median Nerve and Carpal canal diameter

Purpose: To assess the diameter of Carpal tunnel (CT) and the Median Nerve (MN) in individuals with unilateral absence of Palmaris longus (PL) and compare it with the side with presence of Palmaris longus. Materials and Methods: Volunteers (students in the age group of 18-20 years) from a medical college were enrolled over a 2-month period, October to November 2007. Twenty-five subjects with unilateral absence of PL were selected for the study. We used the wrists with PL agenesis as cases and the contra lateral side with PL as controls. Anteroposterior (AP) and transverse diameters of carpal canal and MN were measured at both proximal (pisiform) level and distal (hook of the hamate) level with wrist in neutral position. Results: Significant differences were noted in the dimensions of Carpal canal and MN on the sides with PL as compared to the sides with PL agenesis. The difference in the CT AP diameter was very highly significant at proximal and distal level (P transverse). This study supports the previously done studies on the association between the Carpal Tunnel Syndrome (CTS) and presence of PL tendon

Ultrasound evaluation of carpal tunnel and median nerve in malunited Colles′ fracture

Introduction: Colles′ fractures continue to be one of the most common skeletal injuries of middle aged and elderly population. Compressive neuropathy is one of the most important complications of Colles′ fractures and usually involves the median nerve. The objective of our study was to investigate the impact of malunion of Colles′ fracture on the anatomy and dimensions of the carpal tunnel and the median nerve. Materials and Methods: Fifty cases of Colles′ fracture were included in this study, which was conducted for a period of 2 years. Radiographic and ultrasonographic evaluation was done in all patients. Nerve conduction studies were done in four patients diagnosed with carpal tunnel syndrome (CTS). Results: From our study, it was seen that there was a significant decrease in the dimensions of the carpal tunnel and median nerve in Colles′ fracture based on ultrasonographic evaluation and the loss of radial length and volar shift were the two parameters significant in patients suffering from a CTS, based on radiographic evaluation. There was also an increase in the motor and sensory nerve conduction latency on nerve conduction studies of the median nerve. Conclusion: The loss of radial length and presence of a volar shift of the distal radius are the two deformities when left uncorrected may predispose to a CTS