Parth Vinod Agrawal ¹, Nitin Wagh ¹, Sandeep Pangavane ¹

Affiliations
1 Department of Orthopaedics, Nashik, Maharshtra − 400610, IN

Abstract

Aims and Objectives: To evaluate the results with regard to function, to restoring proper limb length after surgery and to study the associated complications in intertrochanteric fractures treated by cemented bipolar hemiarthroplasty in elderly. Methodology: This is a prospective study of 25 cases of Intertrochanteric fractures admitted to a tertiary care center between August 2013 and November 2015 treated with Cemented Bipolar Hemiarthroplasty for intertrochanteric fractures. Cases were taken according to inclusion and exclusion criteria. Results: In our study of 25 cases, there were 14 male and 11 female patients with mean age of 72.8 years. 80% of the cases admitted were due to trivial trauma, 20% due to RTA with left side being more common side affected. According to OTA classification Type 31A2.2 fractures accounted for 60% of cases & Type 31A2.3 accounted for 40 %.. Mean duration of hospital stay was 13.2 days and mean time of full weight bearing was 4.7days in our patients. Excellent was seen in 24% cases Fair to Good results were seen in 72% of cases in our study according to Harris Hip Score. Conclusion: From our study we conclude that Cemented Bipolar Hemiarthroplasty for intertrochanteric fractures in elderly reduced the complications of prolonged immobilisation, prolonged rehabilitation, marked residual deformities and need for revision surgeries. The procedure offered, faster mobilization, rapid return to pre injury level, improved the quality of life.

Keywords

Hemiarthroplasty, Harris Hip Scor, Intertrochanteric Fractures.

Full Text

   

Sandeep Pangavane ¹, Sandeep Pangavane ¹

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

Abstract

Background: Management of compound tibia and femur fractures is difficult due to the presence of infection, bone loss, shortening and multiple surgeries in the past open wound of lower limb are traditionally managed by Ilizarov fixation. The disadvantages of Ilizarov are poor patient compliance, inconvenience of the frame and difficult frame construction. We conducted a study on 20 compound tibia and femur fractures treated by the limb reconstruction system (LRS). Method and Materials: A prospective analysis of compound fracture of tibia type IIIa and III was done, cases treated from jan 2012 to june 2016 were included, which were treated with LRS application. this patient who had a minimum period of 6-24 month follow up from the day of initiation of treatment. 10 cases of compound tibia IIIa and 10 cases 0f IIIb were included in study status of wound was classified by Gustello -Anderson open wound criteria, comorbidies were noted, additional procedure if any were noted. radiological union was defined as minimum of 3 cortical continuity in views of X-Ray. time duration was recorded in which knee Range of motion was assessed by ‘hand goniometry during treatment. Result: Average age of patient was 37.9 year, tibial showed total 100% fracture united. Average time tibial union was 10.2 month. Average time for tibial LRS in situ was 10.6 month. 6 patient required corticotomy with lengthening. Average lengthening was 2.5 cm in 7 no cases (1.5-5 cm range). Average knee rom is 100 degree of flexion (range 90-130) complication noted were 1) pin tract infection 2) Delayed or Non union 3) multiple surgeries 4) patients co-operation.

Keywords

Management, Open Tibia Fracture, Limb Reconstruction System.

Full Text

   

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.

Full Text

   

Mehul Sarkar ¹, Nitin Wagh ², Sandeep Pangavane ³

Affiliations
1 Senior Resident, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College and Hospital, Nashik – 422003, Maharashtra, IN
2 Associate Professor, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College and Hospital, Nashik – 422003, Maharashtra, IN
3 Professor and Head, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College and Hospital, Nashik – 422003, Maharashtra, IN

Abstract

Osteonecrosis of the femoral head is not a specific diagnostic entity, but rather the final common pathway of a series of derangements that produce a decrease in blood flow, leading to cellular death within the femoral head. It can present with a number of clinical manifestations. The most common complaint is a deep, intermittent, throbbing pain in the groin region which has an insidious onset. In the early stages, prophylactic measures are used to prevent further progression of the disease. When the patient is diagnosed in later stages, the collapse and distortion of the femoral head can be seen, for which a reconstructive procedure is the treatment of choice. The goals of total hip arthroplasty are to relieve pain, to provide motion with stability and to correct deformity so that they are able to return to their normal daily activities. Total hip arthroplasty can be the first treatment of choice. especially in the advanced stages of hip osteonecrosis, or can be reserved as a salvaging procedure when other more conservative treatments fail. Total Hip Arthroplasty is a good modality of treatment for patients with very poor pre-surgical functional scores combined with an excellent long term survival of the cement-less implants.

Keywords

Harris Hip Score, Osteonecrosis, Survival Analysis, Total Hip Arthroplasty

Full Text

   

Deepak Kumar Singh ¹, Rajesh Sonawane ², Sandeep Pangavane ³, Nitin Wagh ⁴, Satyen Joshi ⁴, Pranit Sonawane ⁵, Ashutosh Ushir ², Ajit Jangle ⁵, Tanay Goyal ¹

Affiliations
1 Former PG Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN
2 Assistant Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN
3 Professor and Head, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN
4 Associate Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN
5 Senior Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN

Abstract

Background: This study was conducted to assess the functional outcome of Proximal Femoral Nailing in fixation of Intertrochanteric fractures of Femur. Methods: After obtaining written consent, this prospective study was conducted among 127 patients (age group>18 years) who had inter-trochanteric fracture with or without subtrochanteric extension fixed using proximal femoral nail. Mobilisation was started between first week to 6th week of fracture fixation depending on the rigidity of fixation and pain tolerance of the patient. Patients were followed up at 6th week, 3rd month and 6th month after operative fixation. Functional outcome was assessed using a physician based scoring system i.e. Harris Hip Score at every follow up. Scores were tabulated and assessment was done. Results: The present study included, 54 females (42.5%) and 73 males (57.5%) in the age group of 28 years to 94 years with the mean age of 67.7 years. Unstable inter-trochanteric fractures were seen in 106 cases (83.5%) ‘Fair’ results were seen in 17(13.4%), ‘Good’ results seen in 61(48.0%), ‘Excellent’ results were seen in 37(29.1%) patients at the end of 6 months follow up. Intraoperative complications were seen in 4 patients and late complications seen in 13 patients. Conclusion: From this study, we consider that PFN is an excellent implant for the treatment of intertrochanteric fractures. With a proper technique, PFN gives excellent clinical results with fewer failure rates and complications.

Keywords

Harris Hip Score, Intertrochanteric Fractures, Proximal Femur Nail

Full Text

   

Mukesh Agarwal ¹, Sandeep Pangavane ², Nimesh Nebhani ³, Ameya Kulkarni ³, Nitish Agarwal ³, Yogesh Rathod ³

Affiliations
1 Associate Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN
2 Professor and Head, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN
3 Former PG Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN

Abstract

Background: Primary lumbar vertebral instability or “spondylolisthesis” is perhaps one of the commonest radiological sign associated with lumbo-sacral pain after the third decade of life. Aims and Objectives: To find out the functional outcome in terms of clinical improvement in cases of single level lumbar spondylolisthesis by bone grafting and interbody cage fusion and pedicle screw fixation after decompression of neural elements. Materials and Methods: All the patients were evaluated by anteroposterior and lateral radiographs of the lumbosacral spine centered at the appropriate level. In all cases flexion and extension views were taken to assess the instability. More than 4 to 5 mm of sagittal translation and 10 degrees of rotation were considered as instability. All cases were evaluated further by MRI to evaluate facet joint pathology, sacralization/lumbarisation and to find the associated disc changes and the nerve root involvement. All patients were treated by decompression and interbody fusion with cage and bone graft by either Transforaminal or Posterior approach and instrumentation done with pedicle screws. Post operatively all patients were assessed for the functional outcome using the Oswestry Disability Index at 1 month, 3 month and 6 months Results: There is statistically significant difference in ODI Scores (Oswestry Disability Index) post operatively at 1 month, 3 month and 6 months. Conclusion: In agreement with good results, found in our study, we strongly believe that this technique of fusion and instrumentation is very useful in management of lumbar spondylolisthesis. However, this study should further be extended to a wider sample of patients with a longer follow-up.

Keywords

Back Pain, Interbody Cage fusion, ODI Score, Spondylolisthesis

Full Text

   

Tanay Goyal ¹, Mukesh Agrawal ², Sandeep Pangavane ³, Ketan Gandhi ⁴

Affiliations
1 Former PG Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon Nashik, Nashik – 422003, IN
2 Associate Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon Nashik, Nashik – 422003, IN
3 Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon Nashik, Nashik – 422003, IN
4 Assistant Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon Nashik, Nashik – 422003, IN

Abstract

Background: Proximal humerus fractures account for 4-5% of all fractures. The treatment options for fractures of proximal humerus includes transosseous suture fixation, intramedullary nailing, open reduction and internal fixation using plate and percutaneous pinning. The ideal treatment of displaced proximal humeral fracture is still the centre of scientific debate. Various minimally invasive modalities have been on the rise for the past 10/15 years. This minimally invasive fixation method allows preservation of blood supply of the humeral head. The smaller K-wires used in JESS have lesser risk of soft tissue, neural, and vascular injury. Aim and Objective: To find the functional Outcome of JESS fixation for proximal humerus fracture in 33 patients. Materials and Methods: 33 patients with proximal humerus fracture were treated by JESS fixator and their functional outcome was studied. Results and Conclusion: The mean Constant Murley Score preoperatively was 29.09 which raise to 60.39 at 4 weeks post operatively, 69.97 at 8 weeks post operatively and 79.64 at 12 weeks post-operative. Thus JESS fixator is an affordable, cost effective alternative treatment option for proximal humerus fracture with minimal complications.

Keywords

Constant Murley Score, Functional Outcome, Joshi’s External Stablisation System (JESS)

Full Text

   

Shantanu Hari Bhardwaj ¹, Sandeep Aware ², Sandeep Pangavane ³, Aditya Apte ¹, Adit Maniar ¹, Akshay Fuse ¹

Affiliations
1 Former PG Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN
2 Assistant Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN
3 Professor and Head, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN

Abstract

Background: Meniscal repair is performed in an attempt to prevent post-traumatic arthritis resulting from meniscal dysfunction after meniscal tears. The socio-economic implications of premature arthritis are significant in the young patient population. Investigations and techniques focusing on meniscus preservation and healing are now at the forefront of orthopaedic sports medicine. Methods: All unilateral primary ACL reconstructions in a prospective cohort who had meniscal repair at the time of ACLR were evaluated. Validated patient oriented outcome instruments were completed preoperatively and then again at follow up. Results: 65 unilateral primary ACL reconstructions were performed concomitant meniscal repairs during the study period. Patient follow-up was obtained, allowing confirmation of meniscal repair success (defined as no repeat arthroscopic procedure) or failure. Conclusions: Meniscal repair is a successful procedure in conjunction with ACL reconstruction. When confronted with a “repairable” meniscal tear at the time of ACL reconstruction, orthopaedic surgeons can expect an estimated >90% clinical success rate using a variety of methods as shown in our study.

Keywords

Anterior Cruciate Ligament, Meniscal Repair, Reconstruction, Meniscal Tear

Full Text

   

Shubham Siddheshwar Zade ¹, Rajesh Sonawane2 ², Sandeep Pangavane ³, Vishal Harkar ¹, Kaustubh Devasthali ¹, Vishwesh D. Chudasama ¹

Affiliations
1 Former PG Resident, 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
3 Professor and Head, Department of Orthopedics, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra, IN

Abstract

Background: Distal femur fractures represent 4-6% of all the femoral fractures and they occur within the 9 terminal centimeters. Most distal femur fractures are the result of a severe axial load with a varus, valgus or rotational force. Though various treatment options are available for the management of these injuries with their own advantages and disadvantages, treatment of these fractures with the angle stable constructs using Locking compression plating remains the most desirable treatment option. Objectives: To study the functional outcomes and complications of intra-articular distal end femur fractures treated with Locking Compression Plating. Materials and Methods: A prospective observational study was conducted over a period of 3 years on 47 patients requiring operational intervention for distal end femur fractures. Results: We studied different parameters like age of the patients, mode of injury, type of injury according to AO classification, duration of hospitalization, movement of knee after operation, Neer’s score results, union or non-union and compared our studies with other studies we find satisfactory results in our study in outcome of the patient As per the Neer’s knee score, excellent and good outcome was seen in 48.9% and 38.3% cases while fair and poor outcome was seen in 8.5% and 4.3% cases respectively. Conclusion: From our study we concluded that Distal femoral-LCP, the “internal fixator” was a safe and reliable implant although careful preoperative planning and case selection were important factors which determine the final outcome.

Keywords

Distal Femur Fracture, Locking Plate

Full Text

   

Vishwesh Devendrasinh Chudsasama ¹, Sandeep Pangavane ², Kaustubh Satish Devasthali ¹, Sameer Nandkumar Shelavale ³, Shubham Zade ¹, Vishal Harkar ¹

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

Abstract

Background: The proportion of humeral shaft fractures being treated conservatively reportedly varies from 33% to 95%. Nonsurgical treatment results in higher incidence of union and fewer complications than open reduction and internal fixation. Aims and Objectives: To study and compare the functional outcome of Dynamic Compression Plating and Interlock Nailing for humeral shaft fractures. Material and Methods: After taking approval of ethics committee of our institute, we studied a total of sixty cases over a span of 36 months – October 2018 to December 2020. Study was carried out on cases of humeral shaft fractures requiring operational intervention in department of orthopaedics of tertiary care centre in Maharashtra. Results: A total of 76.7% cases in plating group had excellent outcome as compared to 56.7% in nailing group. Also poor to fair outcome was noted more in nailing group (13.4% vs 10%). Conclusion: Statistically comparable results have been observed for patients undergoing surgical intervention for humeral shaft fractures among locking plating and intramedullary nailing. Both provide excellent and favourable results in terms of union and function, however a higher rate of excellent results and tendency for union was seen with dynamic compression plating group

Keywords

Dynamic Compression Plating, Humeral Shaft Fracture, Intramedullary Nailing, Open Reduction Internal Fixation

Full Text

   

Sandeep Pangavane ¹, Mayur Pekhale ², Akshaj Sharma ³

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

Abstract

Background: The treatment of complex fractures of Tibial plateau is challenging even for the most experienced surgeons. These injuries, affecting mainly the younger population during their most productive years causes a socioeconomic impact. A retrospective study was performed to evaluate the of Schatzker type V and VI, functional outcome, managed through internal fixation and open reduction was thus evaluated in this retrospective study. Materials and Methods: In our study, we used Rasmussen et al., score to evaluate patients. A simple and valid score, it helps the patient’s to access their own perspective regarding surgical outcome. We have attempted to present Type V/VI Schatzker’s proximal tibia fractures in our tertiary care centre. With the increase in population, intern giving rise to increase in automobiles, has resulted in more vehicle accidents. Results: The study was conducted on 30 cases of surgically treated closed proximal tibia fractures and was analysed under the criterias of - sex, age, cause of injury, fracture type, range of motion, time taken for union, and occurrence of complications. Conclusions: The results of this study thus show an excellent functional outcome, with the open reduction and internal fixation surgery as there is minimal soft tissue complication with it. The rigid fixation with bicondylar plating helps in stability for early mobilisation and the range of motion thus ensuring optimal functional recovery and patient satisfaction.

Keywords

Plateau Tibial Fractures, Rasmussen et al. Score, Schatzker Type V and VI, Soft Tissue Injury

Full Text