A prospective study of 50 cases of patella fractures treated with different modalities

Background: Fractures of patella account for 1% of all skeletal injuries. There is no universal accepted treatment for patellar fractures. After a fracture of the patella, the best results are obtained by accurate reduction and stable internal fixation. Partial or total patellectomy is generally indicated when the patella is so severely comminuted that an accurate reduction and reconstruction of the retropatellar joint surface cannot be achieved.Methods: The prospective study of 50 cases of patellar fractures was carried out at the department of orthopaedics for the period from May 2015 to December 2017. The maximum period of follow up was 18 months with a minimum period of follow up of 5 months (average 11.68 months). Operative treatment was done in patella fractures for more than 2 mm of articular displacement or 3 mm of fragment separation. Surgical options includes internal fixation with tension band wiring with k wire and partial patellectomy with extensor mechanism repair.Results: We have studied 50 patients where 7 cases were treated conservatively. In the present series 22 patients were treated with internal fixation out of which 13 patients had excellent results. 6 patients had good results. 21 patients were treated with partial patellectomy where 6 patients had excellent results, 11 patients had good and 4 patients had fair results.Conclusions: Patella should be preserved and Osteosynthesis whenever possible has better chance for excellent results. A good surgical technique, optimal operation room environment and judicious use of antibiotics will reduce the possibility of infection

A study of clinicoradiological and functional outcomes of intramedullary nailing in diaphyseal radius ulna fractures

Background: The aim of this study was to evaluate the results of intramedullary nailing in diaphyseal fractures of radius and ulna in age group of 10 to 49 years and to understand its clinicoradiological and functional results.Methods: This is a retrospective case series study of forearm bone fractures and the selected management for the same over a period of 3 years. We chose the cases in which intramedullary nailing was the treatment modality which were followed up over a period of minimum 6 months. Patients with galeazzi variety, monteggia variety, pathological fracture or non-union after previous surgery were excluded. The outcomes were then evaluated with disabilities of the arm, shoulder and hand (DASH) score, Green and O’Brien score, and Grace and Eversmann functional outcome score.Results: Of the 22 patients, 10 patients had excellent functional outcome according to Grace and Eversmann score, 7 patients had good outcome, 4 patients had acceptable while 1 was unacceptable. Green and O’Brien also had similar results, except that patients among fair category were 3 and poor category were 3. The mean DASH score was 16.2.Conclusions: This study shows that closed method for fixation by intramedullary nailing of both bone forearm fractures leads to excellent to good functional outcomes (according to DASH score, Green and O Brien, and Grace and Eversmann score) with less complications. In 6 months follow up x ray there is radiological union in all cases with no angulation, malunion or non-union.

Study of outcomes of dual plate osteosynthesis in Schatzker type 5 and 6 fractures of proximal tibia

Background: The operative treatment of complicated bicondylar fractures of the tibial plateau remains a challenge to even the most experienced surgeons. Such injuries are usually the result of high-energy trauma, and the management of such fractures is complicated by metaphyseal and articular comminution and the frequent occurrence of associated soft tissue injuries. Aims: The aim of this retrospective study was to evaluate the clinical and radiological outcomes of dual plating for treating Schatzker types 5 and 6 bicondylar tibial plateau fractures. Methods: 24 patients with bicondylar tibial plateau fractures and operatively treated in our orthopedic department with dual-plating technique between January 2006 and December 2012 were retrospectively analyzed. Inclusion criteria for this study were (1) acute and unilateral fractures and (2) displaced bicondylar tibial plateau fractures (Orthopaedic Trauma Association types C1, C2, and C3).Knee score was used for evaluation of outcome Results: At 12 months postoperatively, the knee score was 88.5 and 84.4in the double buttress plate and combination plate groups, respectively, and the difference was not significant. Out of 24 patients 19 achieved excellent knee score (>90), 4 achieved good (80-90), 1 achieved fair (70-80) and no patient had poor (<70) knee score. Mean range of knee flexion was 115 degrees for dual buttress group and 117.5 degree for combination group. Conclusion: Dual plating in Schatzker type 5 and 6 fractures results in good outcome with low complication rates