The role of valgus osteotomy with DHS fixation in the management of fracture nonunion of the neck of femur

Background: Management of fracture non-union of the neck of femur is age specific and is quite demanding. There is a need to salvage the femoral headin younger individuals which demands a procedure which suits the requirements. The aim of this study was to evaluate the role of valgus osteotomy with dynamic hip screw fixation(DHS) in the management of these fractures and to compare the results with studies of other authors as available in literature.Methods: This was a prospective study of 15 patients with fracture nonunion of the femoral neck conducted between January 2012 to January 2013 with a follow up period of 3 years.Results: There were 9 males and 6 female patients in our study with the right side being more commonly affected. The mean age of the patients was 45.2 years ranging from 36 to 58 years. All fractures united at the end of 6 months. Post operatively the mean Pauwels angle was 340 while the neck shaft angle was 135.20. There was a significant increase in the Oxford score from a mean of 20.4 preoperatively to 37.9 in the postoperative period. All patients were happy with the procedure and the functional outcome. Conclusions: Valgus osteotomy with DHS fixation is a good option for the management of fracture nonunion of the neck of femur in younger patients where there is a need to salvage the femoral head and it gives good functional results

Our experience with percutaneous autologous bone marrow injection in the management of delayed and nonunion of long bone fractures

Background: Various modalities of treatment are available for the management of delayed and nonunion of long bone fractures. The aim of this study was to evaluate the role of percutaneous autologous bone marrow injection in the management of these fractures and to compare the results with studies of other authors as available in literature.Methods: 15 patients with delayed and nonunion of long bone fractures were studied between January 2013 to January 2015 and were followed up for a period of 1 year. The patients were clinically and radiologically evaluated at regular time intervals at follow up.Results: The age of the patients ranged from 28 to 60 years with the mean age being 44.2 years. There was a male preponderance in our study with the male to female ratio being 2:1. The left side was more commonly affected as compared to the right. The mean time to radiological appearance of callus was 6.4 weeks. The mean time to clinical union was 7.33 weeks while the mean time to radiologic union was 13.4 weeks. We had a union rate of 93.3% in our series with one fracture going in for failure of union. Conclusions: Percutaneous autologous bone marrow injection is a minimally invasive, safe and cost effective option in the management of delayed and nonunion of long bone fractures and gives good functional results

An analysis of functional outcome following conservative versus surgical management in fractures of the distal radius

Background: Distal radial fractures are one of the most common injuries seen in the orthopaedic department, which can be managed both conservatively and surgically. There are advantages and disadvantages in each method of management. The aim of this study was to compare the functional and radiological outcomes of intra-articular fractures of the distal end of the radius with conservative and surgical management.Methods: 80 cases of intra articular fractures of the distal radius managed by both conservative and surgical means were studied between January 2011 to January 2013 and were followed up for a minimum period of two years.Results: In our series of 80 patients, there 53 males and 27 females. Most of the patients were between 20-30 years of age with the mean age being 40.35 years. RTA was the most common mode of injury (45%). Frykman’s type 3 (41.7%) was the most common fracture type seen followed by type 8. All fractures united by the end of 6 months. Excellent results were seen in 47.5% of cases in the surgical group and 30% of cases in the conservative group. Conclusions: From this study, we conclude that surgical management is better than conservative in the treatment of intra articular fractures of the distal end of radius. Therefore, one treatment method of treatment cannot be generalized for all types of fractures and treatment should be individualized to a particular fracture in terms of age, fracture pattern, degree of displacement and amount of communition present.

The role of platelet rich plasma injection in the management of early osteoarthritis of the knee

Background: Osteoarthritis of the knee is a degenerative disorder associated with significant morbidity in the form of pain, knee stiffness and decrease in the functional capacity of the affected limb leading to a decrease in the quality of life for the patient. Various modalities of treatment are available for the management of this condition. The aim of this study was to evaluate the role of platelet rich plasma (PRP) injection in the management of early osteoarthritis of the knee and to compare the functional outcome with the studies of various authors as available in literature.Methods: 60 patients with Kellgrenn and Lawrence grade 1 and 2 osteoarthritis of the knee were studied from January 2014 to January 2015 and were followed up for a period of 1 year.Results: There were 39 males and 21 female patients in our study with the right side being more commonly affected. There was a significant decrease in the VAS score and the WOMAC score at 1, 3, 6 and 12 months follow up as compared to the pre-injection baseline scores. All patients were satisfied with the procedure in terms of functional outcome. Conclusions: PRP injection is a cost effective, safe and efficient procedure with easily reproducible results and gives good functional results in terms of pain relief, improvement of range of movements and mobility, and improves the quality of life in patients with early osteoarthritis of the knee

The role of primary cemented total hip arthroplasty in the management of fractures of the neck of femur in the elderly population

Background: Femoral neck fractures are common injuries in the elderly population and are associated with high rates of morbidity and mortality. The aim of surgical intervention in these elderly patients is to restore them to the pre-fracture status as rapidly as possible. The aim of this study was to evaluate the role of total hip arthroplasty as a primary option in the management of these fractures and to compare the results with studies of other authors as available in literature.Methods: 45 patients with femoral neck fractures treated with cemented total hip arthroplasty were studied from January 2011 to January 2013 and were followed up for a minimum period of two years.Results: There were 18 males and 27 females ranging from 60 to 75 years of age. Mean age was 64.6 years. Majority (80%) of the fractures were completely displaced, Garden type 4 fractures followed by type 3 in 20% of cases. The most common mode of injury was a simple slip and fall. Excellent results were seen in 17 patients, good results in 24 patients and fair results in 4 patients. No poor results were seen. Conclusions: Cemented total hip arthroplasty is a very useful procedure for the primary treatment of femoral neck fractures in elderly patients. This procedure markedly improves the functional status of the patients and gives good functional results

An evaluation of functional outcome following surgical management of fractures of the proximal humerus with Neer’s scoring system

Background: Fractures of the proximal humerus are complex injuries associated with significant morbidity. Various options are available for management including non-operative treatment, depending upon the pattern of the fracture, quality of the bone and the surgeon's familiarity with the techniques. The age of the patient, physical activity and the medical fitness also largely influence the treatment options. The aim of this study was to evaluate the functional outcome following surgical management of these fractures and to compare the results with studies as available in literature.Methods: 30 patients with fractures of the proximal humerus managed by surgical means were studied from January 2012 to January 2014 and were followed up for a minimum period of two years.Results: All the fractures treated united clinically by 8 weeks and radiologically by 16 weeks. There were no cases of delayed or non-union in our series. The fractures were more common in men with a gender distribution of 1.3:1 and were also more common in the age group of 50 to 65 years (53%). As per the Neer’s scoring system, 60% patients had excellent results while 33% patients had satisfactory results. They were all pain free and successfully returned to their pre-injury work. 6% patients had an unsatisfactory result. Conclusions: Surgical management of proximal humerus fractures following the principles of articular surface reconstruction, restoration of the anatomy, stable fixation, with minimal injury to the soft tissues and early mobilization, gives good functional results

An evaluation of functional outcome following minimally invasive plate osteosynthesis in fractures of the distal tibia

Background: Management of fractures of the distal tibia remains a challenging proposition due to the fact that the major part of the bone is in a subcutaneous location and the blood supply is quite precarious. Conventional forms of osteosynthesis are associated with high rates of infection and nonunion. Due to extensive soft tissue stripping, the vascularity is compromised and often results in poor wound healing and tends to compromise fracture healing as well. Closed reduction with minimally invasive plate osteosynthesis (MIPO) addresses these issues and has emerged as a viable treatment option with minimal complications. The aim of this study was to assess the functional outcome MIPO using locking compression plates (LCP).Methods: 32 patients with distal tibial fractures treated by MIPO technique with LCP fixation were studied from January 2012 to January 2014 and were followed up for a period of 2 years.Results: All the fractures in our series united well at the end of 6 months with mean time to radiological evidence of callus formation at 10 weeks and the mean time to fracture union was 20 weeks. There were 2 cases with varus angulation in our series and no cases with implant failure. There were 3 patients with superficial skin infections and no cases of deep infection.Conclusions: We conclude that MIPO with LCP is an effective treatment option for distal tibial fractures avoiding all the complications associated with other forms of internal fixation. We strongly recommend its usage in these types of complex injuries

Operative management of tibial plateau fractures: an assessment of functional and radiological outcomes with Rasmusssens scoring system

Background: Fractures of the proximal tibia involve a major weight bearing joint and are intra-articular injuries which frequently result in functional impairment. They require an accurate reduction of the articular surface with stable internal fixation. If these fractures are not managed appropriately, they often result in high rates of morbidity in the form of knee stiffness and arthritis. This study was done to assess the functional and radiological outcomes following various surgical modalities and to compare them with other studies as available in literature.Methods: 30 patients with tibial plateau fractures treated by various surgical modalities at Saveetha Medical College and Hospital were studied from January 2013 to February 2015 and were followed up for a minimum period of 6 months. Functional and radiological outcomes were assessed by the Rasmussens scoring system.Results: All 30 patients fulfilling the inclusion criteria were thoroughly evaluated and were taken up for surgery with various modalities of fixation which included cannulated cancellous screws, T and L buttress plates and locking compression plates. Articular surface elevation with bone grafting was done in depressed fractures. Early knee mobilization was started and strict non-weight bearing walking was advocated. We had a 90% acceptable functional result which was comparable with other studies.Conclusions: In our study, we conclude that accurate reduction of the articular surface with stable internal fixation and early mobilization with bone grafting in depressed fractures with protracted weight bearing till fracture union gives good functional results. Also radiological values often do not often correlate well with functional outcomes.

The role of valgus osteotomy with DHS fixation in the management of fracture nonunion of the neck of femur

Background: Management of fracture non-union of the neck of femur is age specific and is quite demanding. There is a need to salvage the femoral headin younger individuals which demands a procedure which suits the requirements. The aim of this study was to evaluate the role of valgus osteotomy with dynamic hip screw fixation(DHS) in the management of these fractures and to compare the results with studies of other authors as available in literature.Methods: This was a prospective study of 15 patients with fracture nonunion of the femoral neck conducted between January 2012 to January 2013 with a follow up period of 3 years.Results: There were 9 males and 6 female patients in our study with the right side being more commonly affected. The mean age of the patients was 45.2 years ranging from 36 to 58 years. All fractures united at the end of 6 months. Post operatively the mean Pauwels angle was 340 while the neck shaft angle was 135.20. There was a significant increase in the Oxford score from a mean of 20.4 preoperatively to 37.9 in the postoperative period. All patients were happy with the procedure and the functional outcome. Conclusions: Valgus osteotomy with DHS fixation is a good option for the management of fracture nonunion of the neck of femur in younger patients where there is a need to salvage the femoral head and it gives good functional results

Our experience with percutaneous autologous bone marrow injection in the management of delayed and nonunion of long bone fractures

Background: Various modalities of treatment are available for the management of delayed and nonunion of long bone fractures. The aim of this study was to evaluate the role of percutaneous autologous bone marrow injection in the management of these fractures and to compare the results with studies of other authors as available in literature.Methods: 15 patients with delayed and nonunion of long bone fractures were studied between January 2013 to January 2015 and were followed up for a period of 1 year. The patients were clinically and radiologically evaluated at regular time intervals at follow up.Results: The age of the patients ranged from 28 to 60 years with the mean age being 44.2 years. There was a male preponderance in our study with the male to female ratio being 2:1. The left side was more commonly affected as compared to the right. The mean time to radiological appearance of callus was 6.4 weeks. The mean time to clinical union was 7.33 weeks while the mean time to radiologic union was 13.4 weeks. We had a union rate of 93.3% in our series with one fracture going in for failure of union. Conclusions: Percutaneous autologous bone marrow injection is a minimally invasive, safe and cost effective option in the management of delayed and nonunion of long bone fractures and gives good functional results