A comparative study of functional outcome of treatment of intra-articular fractures of distal end radius fixed with external fixator vs. volar plate

Background: Distal end radius fractures constitute 75% of all forearm fractures. Maintenance of the articular congruity is an ardent prerequisite for successful recovery, following distal end radius fractures. The available options include immobilization with plaster, external fixation, prefabricated splintage using ligamentotaxis, K-wire fixation, and open reduction internal fixation with various plates.  The aim of the study was to analyze and compare the functional outcome and possible complications associated with fixation of two different surgical modalities: External fixator and Volar Plate in the treatment of intra-articular fractures of distal end radius.Methods: A prospective comparative study was conducted in 26 patients who were admitted and operated between September 2017 to September 2018 and had fulfilled the inclusion /exclusion criteria. They were allocated into 2 groups-group A and B, 13 patients each for external fixator and open reduction and internal fixation with volar T plate, respectively.Results: The results were assessed using the modified Green O’ Brien Scoring. In Group-A of patients treated with External fixator we had 6 excellent, 3 good, 3 fair results and 1 poor results. Whereas in Group-B of ORIF with Volar plating we had 7 excellent, 3 good, 2 fair results and 1 poor results.Conclusions: In our study, volar plate fixation showed superiority as it provides better long term functional outcome owing to more adequate restoration of radio-ulnar variance and distal end radius parameters

A study of periprosthetic fractures following hemi-arthroplasty of hip in elderly population: diagnosis and management

Background: Hemi-arthroplasty of hip for intracapsular fractures of femoral neck is one of the most commonly done surgical procedures in the low mobility older Indian population. Although there are numerous complications associated with the procedure, we want to study the types and management of peri-prosthetic fractures in patients treated with hip hemi-arthroplasty.Methods: A total of 26 patients were included in the study. A retrospective analysis of the radiological cum clinical diagnosis and management of peri-prosthetic fractures was performed. All patients were followed up till 1.5 years post-operatively.Results: According to Vancouver classification of peri-prosthetic fractures, 10 fractures were classified as type A, 7 as type B1, 3 as type B2, 4 as type B3 and 2 as type C. Fractures were managed either by Open Reduction with Internal Fixation (ORIF) or Revision hemi-arthroplasty. Fractures type AG, B1 and C were managed with ORIF and type B2 and B3 fractures were managed with revision hemi-arthroplasty using longer stem.Conclusions: As evident in our study, majority of fractures occurred intra-operatively, a thorough evaluation of pre-operative x-rays of both hips should be done along with special focus on anatomical variations. Correct diagnosis based on radiological and intraoperative findings followed by appropriate treatment are of paramount importance in the management of peri-prosthetic fractures

Tumour induced osteomalacia: a diagnostic challenge and its implications in orthopaedic surgery

Tumor-induced osteomalacia (TIO) is a paraneoplastic phenomenon which encompasses a wide array of clinical features ranging from musculoskeletal pain to pathological fractures. An excess of fibroblast growth factor 23 (FGF23) is produced which is a parahormone with its target receptors in proximal convoluted tubules of glomeruli. This results in decreased blood phosphate levels and decreased hydroxylation of 25-OH vitamin-D, ultimately leading to osteomalacia. Compliance with medical treatment is unsatisfactory and tedious owing to repeated dosing schedules and overwhelming side effects. Surgical excision of the lesion is the only suitable treatment

Best technique for fixation of displaced transverse olecranon fractures: tension band wiring or plate fixation?

Background: Fractures of olecranon are common fractures in upper limb. Tension band wiring (TBW) and plate fixation (PF) are mostly used techniques but choice is based on type of fracture and surgeon’s preference.Methods:  A study assessed functional results in 28 patients that were enrolled after the clinical event of trauma has occurred. Patients were divided into two groups- Group (A) for TBW and Group (B) for PF; here gender, age and side of fracture were ignored. Post-operative functional outcome were evaluated by using the Mayo Elbow Performance (MEP) and the Disabilities of the Arm, Shoulder and Hand (DASH) score parameters.Results: Mean (SD) union time as determined by postoperative radiographs was 8.5 (1.48) weeks for group (A) and 9 (2.08) weeks for group (B). Mean (SD) MEP score at 9 months in group (A) 84.28 (7.28) and 80.71 (10.92) in group (B). Mean (SD) DASH at 9 months in group (A) 12.2 (8.8) and 11.7 (10.4) in group (B). Complications were reported in group (A) 6 patient (42.85%) out of 14 patients and in group (B) 1 patient (7.14%) out of 14 patients.Conclusions: The current study shows that there are no significant differences in functional outcome between both the study groups. Due to lesser complications, we recommend the plate fixation approach as the better choice for transverse displaced olecranon fractures. More large scale studies are required to further confirm our results