Satyen Joshi ¹, Brijbhushan Mahajan ¹, Arpit Gajjar ¹

Affiliations
1 Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik - 422003, IN

Abstract

Background and Objective: Bimalleolar fractures are one of the most common fractures in orthopaedic traumatology. As with all intra articular fracture, malleolar fracture necessitate accurate reduction and stable internal fixation. When malleolar fractures are not reduced accurately they may lead to post traumatic painful restriction of motion or osteoarthritis or both. To study the functional outcome and result of surgical treatment of bimalleolar fractures and to know the complication of open reduction internal fixation in bimalleolar fractures. Materials and Methods: A prospective study of thirty patients of age group of 18-60 years of acute bimalleollar fractures irrespective of gender, done at medical college and research centre. Fractures were classified on basis of danis-weber classification system. They were treated with open reduction and internal fixation with canulatedcancellous screws for medial malleoli and plates for lateral malleoli. Post operatively sequential radiographs at 0, 2 and 6 months are taken and functional evaluation is done by olerud and molander ankle score. Result: Olerudmolander ankle score was used to assess the functional outcome of the fracture fixation at 2, 3 and 6 months of follow up. At 2 months majority of patients were showing poor result at 3 months majority of patients showing fair result. And at 6 months majority of patients were showing excellent and good result. Conclusion: Understanding the mechanism of injury is essential for good reduction and internal fixation. The fibular length has to be maintained for lateral stability of the ankle. Anatomical reduction is essential in all intra articular fractures more so if a weight bearing joint like ankle joint is involved.

Keywords

Bimalleolar Fracture, Olerud and Molander Ankle Score, Open Reduction and Internal Fixation.

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Nitin Wagh ¹, Brijbhushan Mahajan ², Bhalchandra Prabhakar Bhalerao ³, Nitish Agrawal ³, Nimesh Nebhani ³, Yogesh Rathod ³

Affiliations
1 Associate Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Nashik – 422003, Maharashtra, IN
2 Assistant Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Nashik – 422003, Maharashtra, IN
3 Former PG Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Nashik – 422003, Maharashtra, IN

Abstract

Background: Most commonly reconstructed ligament of knee is Anterior Cruciate Ligament that aims to halt or minimise the number of instability episodes 1. Testing with biomechanical parameters has shown that there is correlation between graft cross-sectional area and maximum load to failure 2. This study attempts to analyse the functional outcome of ACL reconstruction with 5 strands of hamstring autograft. Aims and Objectives: This study is based on hypothesis that larger graft will be stronger, stiffer providing better functional outcome. Materials & Methods: 35 Patients having ACL injury were treated at a tertiary care hospital; using a 5-strand hamstring graft, fixed with suspensory fixation at femoral side and aperture fixation at the tibial side. Cases were diagnosed with ACL on clinical examination & MRI. Tegner-lyshom score and International Knee Documentation Committee - Orthopaedic Scores (IKDC) is used post-operatively to grade the functional outcome of an ACL reconstruction. Results: Male predominance was observed in study subjects than female with left side slightly more commonly involved than right. Laterality didn’t influenced outcome. Graft diameter observed is 9mm in 68.6%, 8 mm and 10 mm was observed in 11.4% and 20% respectively. Lysholm score at baseline was 41.63 which increased progressively to 93.45 at the end of 9 months. The IKDC score at baseline was 32.5 which increased progressively to 83.45 at the end of 12 months. Superficial infections was seen in 8.6% while complaint of knee pain was given by 2.9% cases. Lachman test was positive in 2 (5.7%) cases. Conclusion: Five-strand graft offers very high strength and more length than the 4ST. It is useful in patients with ligamentous laxity, small tendons, or other stability risk factors.

Keywords

ACL, Autograft, Graft Diameter, 5 Strand

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Suyog Baliram Chavhan ¹, Bharat Kelkar ², Brijbhushan Mahajan ³

Affiliations
1 Former PG Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422203, Maharashtra, IN
2 Former Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422203, Maharashtra, IN
3 Associate Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422203, Maharashtra, IN

Abstract

Background: Fractures of proximal humerus are very common. Many options are available for its management including non-operative management. Reconstruction of the articular surfaces including restoration of the anatomy and a stable fixation with minimal soft tissue damage is the main principle of this procedure. Percutaneous pinning is the less invasive, less time consuming and reliable procedure and avoids complications such as avascular necrosis, infections and heavy weight bearing implants. Aims and Objectives: 1. To study the clinical profile of adult patients with proximal humeral fractures. 2. To study the functional outcome of closed reduction and percutaneous pinning of proximal humeral fractures. 3. To study the factors affecting functional outcome of proximal humeral fractures. Materials and Methods: This is a prospective study among 32 patients on whom percutaneous pinning was done after closed reduction for the fractures of proximal humerus. This study was conducted from August 2014 to December 2016. Results: According to Neer's functional assessment score the functional outcome was excellent in 18 (56.3%) patients, satisfactory in 6 (18.8%) patients, unsatisfactory in 7 (21.9%) patients and failure in 1 (3.1%) patient. Conclusion: Percutaneous pinning is simple, less invasive, reliable and effective procedure. It reduces risk of heavy implant bearing, infection and avascular necrosis.

Keywords

Neer's Functional Assessment Score, Percutaneous Pinning, Proximal Humerus Fractures

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Nitin Wagh ¹, Chinmay Salunkhe ², Sandip Pangavane ³, Brijbhushan Mahajan ⁴, Sameer Shelar ²

Affiliations
1 Professor, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra, India ., IN
2 Former PG Student, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra, India., IN
3 Professor, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra, India ., IN
4 Associate Professor, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital and Research, Centre, Nashik – 422003, Maharashtra, India ., IN

Abstract

Background: Anterior Cruciate Ligament (ACL) tear is the one of the common among ligamentous injury to the knee joint. Various surgical methods have been advised for the anterior cruciate ligament reconstruction with different kinds of grafts which have own merits and demerits. Bone patellar tendon bone is one of the commonly used autograft for ACL reconstruction. Aim of this study was to analyze the functional outcome following arthroscopic ACL reconstruction using Bone patellar Tendon Bone graft (BTB). Materials and Methods: Between 2017 and 2019, 32 patients with an average age of 27 years (range: 19-51 years) participated in a prospective study. The patients were arthroscopically treated with a bone-patellar tendon-bone graft. Physiotherapy and appropriate post-operative care were provided. The patient’s functional status was assessed at three-month, six-month, and one-year intervals. We assess knee joint stability and normal knee function using clinical tests. To evaluate the findings, we used the Tegner Lysholm knee score as well as the VAS score. Results: In terms of clinical outcomes, 93 percent of patients had normal or near-normal knee function. According to the Tegner-Lysholm knee rating system, 88 percent of the patients received an excellent score. At the end of one year, 27 out of 32 patients have no pain on the VAS score. Anterior knee discomfort (10%) and numbness above the graft donor site were the most common consequences (8 percent). Conclusion: Based on objective and subjective assessments, ACL reconstruction employing the bone-patellar tendon-bone approach could produce a very satisfactory functional outcome. Improved knee stability and function allow for a quicker return to everyday activities.

Keywords

Anterior Cruciate Ligament (ACL), Arthroscopic Repair, Bone Patellar Tendon Bone graft (BTB)

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