Comparison of tunnel widening between interference screw and suture disc fixation after ACL reconstruction using CT scan

Background: It is important to study the cause of tunnel widening which occurs after anterior cruciate ligament (ACL) reconstruction as it may affect tendon to bone healing. Amount of tunnel enlargement that happens after different fixation methods like interference screw or suture discs needs to be compared.The objective of the study was to test the hypothesis that aperture fixation (interference screw) reduces tunnel enlargement compared to suspensory fixation (suture disc) due to reduced graft tunnel motion.Methods: 24 bone tunnel diameters in 12 patients were evaluated by CT scan postoperatively after ACL reconstruction to measure tunnel widening. Two groups were formed, one consisting of 14 tunnels fixed by interference screws (IFS) and other consisting of 10 tunnels fixed with suture disc (SD). The difference between the two groups was compared by unpaired student’s t test.Results: The mean tunnel widening in IFS group was 0.414mm while that in the SD group was 1.23mm. The difference between the means of the two groups was statistically significant (p<0.001). Conclusions: Tunnel widening phenomenon was significantly less with anatomic IFS fixation as compared to suture disc fixation probably due to reduced motion of graft within the walls of bony tunnel and consequently better graft healing

Evaluation of volar locking plate fixation for management of intra-articular fractures of distal end of radius

Background: With the increase in high velocity trauma, the incidence of intra-articular fractures of distal end of radius, particularly in adults- the working class of society is increasing. Normal functioning of wrist is of paramount importance for all activities of daily living and working. The present study was undertaken to evaluate the results of using volar locking plate for fixation of intra-articular fractures of distal end radius, with emphasis on return to pre-injury employment assessment.Methods: It is a combined prospective and retrospective study from January 2013 to June 2016. Twenty patients of intra-articular fractures of distal end of radius (AO type B2 and B3) were treated with volar locking plate through volar approach. The patients were regularly followed up for one year. The assessment of pain, range of motion, activity and grip strength were scored by Green and O’Brien’s system.Results: According to scoring system of Green and O’Brien the patients were assessed at 1 year follow up. 17 patients (85%) showed excellent results (scores 90-100). 2 patients (10%) showed good result (scores 80-89) while 1 patient (5%) had fair outcome (score 65-79). No patient had poor result (score less than 65). 19 patients (95%) returned to their pre-injury employment at 1 year.Conclusions: Open reduction and internal fixation with volar locking plate is reliable and excellent methods of management of intra-articular fracture of distal end of radius especially shear type of injury (AO type B2 and B3) in adults.

Chronic insertional achilles tendon ruptures treated by suture anchor repair and augmentation with flexor hallucis longus tendon transfer

Background: Different surgical procedures have been used for treatment of chronic ruptures of the Achilles tendon with varying results. This study assesses the functional outcomes and complications of chronic insertional tears of Achilles tendon.Methods: 10 patients with chronic ruptures of the Achilles tendon were followed for a mean period of 10.3 months. Only ruptures at or near (within 1 cm) insertion were included. They were treated by direct repair of tendon to calcaneum by suture anchor. Flexor hallucis longus (FHL) tendon transfer fixed to calcaneal tunnel with an interference screw was used to augment the repair.Results: Outcome was assessed by AOFAS Ankle-Hindfoot (AHS) score. The mean preoperative score of 41.2 improved to 85.4 at final follow-up out of a total 100 points. We achieved excellent results in 80% and good outcome in 20% cases. No re-ruptures were noted. Conclusions: In insertional chronic ruptures of Achilles tendon, FHL transfer to calcaneum with interference screw fixation and repair of Achilles tendon with suture anchor is a reliable technique with good outcome and is recommended

Comparison of tunnel widening between interference screw and suture disc fixation after ACL reconstruction using CT scan

Background: It is important to study the cause of tunnel widening which occurs after anterior cruciate ligament (ACL) reconstruction as it may affect tendon to bone healing. Amount of tunnel enlargement that happens after different fixation methods like interference screw or suture discs needs to be compared.The objective of the study was to test the hypothesis that aperture fixation (interference screw) reduces tunnel enlargement compared to suspensory fixation (suture disc) due to reduced graft tunnel motion.Methods: 24 bone tunnel diameters in 12 patients were evaluated by CT scan postoperatively after ACL reconstruction to measure tunnel widening. Two groups were formed, one consisting of 14 tunnels fixed by interference screws (IFS) and other consisting of 10 tunnels fixed with suture disc (SD). The difference between the two groups was compared by unpaired student’s t test.Results: The mean tunnel widening in IFS group was 0.414mm while that in the SD group was 1.23mm. The difference between the means of the two groups was statistically significant (p<0.001). Conclusions: Tunnel widening phenomenon was significantly less with anatomic IFS fixation as compared to suture disc fixation probably due to reduced motion of graft within the walls of bony tunnel and consequently better graft healing

Evaluation of volar locking plate fixation for management of intra-articular fractures of distal end of radius

Background: With the increase in high velocity trauma, the incidence of intra-articular fractures of distal end of radius, particularly in adults- the working class of society is increasing. Normal functioning of wrist is of paramount importance for all activities of daily living and working. The present study was undertaken to evaluate the results of using volar locking plate for fixation of intra-articular fractures of distal end radius, with emphasis on return to pre-injury employment assessment.Methods: It is a combined prospective and retrospective study from January 2013 to June 2016. Twenty patients of intra-articular fractures of distal end of radius (AO type B2 and B3) were treated with volar locking plate through volar approach. The patients were regularly followed up for one year. The assessment of pain, range of motion, activity and grip strength were scored by Green and O’Brien’s system.Results: According to scoring system of Green and O’Brien the patients were assessed at 1 year follow up. 17 patients (85%) showed excellent results (scores 90-100). 2 patients (10%) showed good result (scores 80-89) while 1 patient (5%) had fair outcome (score 65-79). No patient had poor result (score less than 65). 19 patients (95%) returned to their pre-injury employment at 1 year.Conclusions: Open reduction and internal fixation with volar locking plate is reliable and excellent methods of management of intra-articular fracture of distal end of radius especially shear type of injury (AO type B2 and B3) in adults.