Satyen Joshi ¹, Nikhil Challawar ², Nitish Agrawal ³, Bhalchandra Prabhakar Bhalerao ³, Ameya Kulkarni ³, Yogesh Rathod ³

Affiliations
1 Associate Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Adgaon, Nashik − 422003, Maharashtra, IN
2 Assistant Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Adgaon, Nashik − 422003, Maharashtra, IN
3 P.G. Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Adgaon, Nashik − 422003, Maharashtra, IN

Abstract

Background: Posterior Cruciate Ligament (PCL) is the main posterior stabilizer of the knee. Injuries of the PCL are rare. Isolated PCL disruption most commonly occurs as avulsion at its tibial insertion as compared with its femoral origin or as a mid-substance tear. In PCL bony avulsion, fixation of the avulsed fragment with cancellous screw is a recommended procedure. Objective: To evaluate efficacy of Burk Schaffer’s approach in treatment of PCL tibial avulsion fracture with cancellous screw and evaluation of functional results according to Tegner Lysholm score. Material and Methods: We included 30 patients (Male 26 and Female 4) operated for isolated PCL avulsion from tibia during the period from 2015 to 2017. Patients were evaluated clinically by posterior drawer test, radiologically by X-ray and using functional scale of Tegner-Lysholm. MRI was advised for suspected other ligaments and meniscal injuries. All cases were operated with 4mm cannulated screw fixation by Burk and Schaffer approach. Results: Mean Tegner Lysholm score of 30 patients was 95.37 after 6 months of surgery, which was excellent. After 3 months 75% has grade 0 posterior drawer test, 12.5% has grade 1 and 12.5% has grade 2 laxity. Conclusion: Approach by Burk and Schaffer is safer and easier than the classical one. Open reduction and fixation with cannulated screw for tibial avulsion of PCL gives good functional outcome.

Keywords

Burk and Schaffer’s Approach, Posterior Cruciate Ligament (PCL) Avulsion Fractures, Tegner Lysholm Score.

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Sandeep Pangavane ¹, Nikhil Challawar ², Ameya Kulkarni ³, Nimesh Nebhani ³, Nitish Agrawal ³, Bhalchandra Bhalerao ³

Affiliations
1 Professor and HOD, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik − 422003, Maharashtra, IN
2 Assistant Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik − 422003, Maharashtra, IN
3 Post-Graduate Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik − 422003, Maharashtra, IN

Abstract

Introduction: Intertrochanteric fractures are one of the most common fractures in elderly population and have a huge impact on the health care system of the society. Objectives: The objective of our study was to compare functional outcome and complication rates of bipolar hemiarthroplasty to dynamic hip screw which is a established procedure for unstable intertrochanteric fracture femur. Materials and Methods: The present study included 50 patients over the age of 55 years, 25 undergoing bipolar hemiarthroplasty and 25 undergoing dynamic hip screw for unstable intertrochanteric fracture femur and their functional outcomes were compared with Harris hip score. Results: We found that the average Harris hip score was better for the bipolar hemiarthroplasty group than for the dynamic hip screw group at 6 months. Conclusion: Bipolar hemiarthroplasty is an effective alternative to dynamic hip screw for unstable intertrochanteric fractures in elderly patients as it has a good function outcome and lower complication rate. A larger randomized control trial has to be conducted to arrive at a conclusion.

Keywords

Dynamic Hip Screw, Primary Bipolar Hemiarthroplasty, Unstable Inter-trochanteric Fractures.

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Satyen Joshi ¹, Sameer Ramdas Shelar ², Nitin Wagh ¹, Nikhil Challawar ³, Chinmay Salunkhe ²

Affiliations
1 Associate Professor, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
2 Former PG Resident, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
3 Assistant Professor, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN

Abstract

Introduction: Distal Tibia fractures are considered as a surgeon’s nightmare as it is difficult to treat due to less muscle cover, precarious blood supply and its proximity to ankle joint. Here we compare two surgical procedures Open Reduction Internal Fixation (ORIF) and Minimally Invasive Plate Osteosynthesis (MIPO) methods. Aims and Objectives: Study was done to compare results between surgical approaches ORIF vs. MIPO in treatment of lower third tibia fractures. Methodology: The study included 64 patients out of which 32 were treated by ORIF and remaining 32 by MIPO. Outcome was evaluated on the basis of length of incision, duration of surgery, blood loss, duration of stay, mobilization with partial and full weight bearing, AOFAS grading. Results: Length of incision, blood loss, mobilization at full weight bearing was significantly higher in ORIF group as compared to MIPO and was statistically significant. Results and Conclusion: MIPO offers biological advantages over conventional plating techniques in terms of low surgical trauma, preservation of the blood supply, lesser evacuation of osteogenic fracture hematoma and stable construct.

Keywords

Fracture, Distal Tibia, Internal Fixation, Plate Osteosynthesis

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