Amit Bhasale , Satyen Joshi

Abstract

Background: Fractures of the shaft of the femur are among the most common fractures resulting mostly from high energy trauma. Objectives: To study the functional outcome of closed intramedullary interlocking nailing in Gustillo-Anderson type I and II compound fractures of femoral shaft. Methodology: In this prospective study, 20 adult patients with Gustillo Anderson Class I and II fractures were included. After undergoing closed intramedullary interlocking nailing , the functional outcome was assessed using the Harris Hip score. Results and Conclusion: Excellent or good functional outcome as per Harris Hip score was observed in 80% cases while fair results were observed in 15% cases. One case with deep wound infection and non union showed poor outcome. Interlocked intramedullary nailing system showed excellent result in both close and open fractures.

Keywords

Femur, Gustillo-Anderson type I and II, Intramedullary, Trauma

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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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Akshay Bhimrao Fuse ¹, Satyen Joshi ², Shantanu Bhardwaj ¹, Aditya Apte ¹, Adit Maniar ¹

Affiliations
1 P.G. Resident, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Adgaon, Nashik − 422003, Maharashtra, IN
2 Associate Professor, Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Adgaon, Nashik − 422003, Maharashtra, IN

Abstract

Objective: Study was done to compare results between the Proximal Femoral Nail (PFN) and 95° Dynamic Condylar Screw (DCS) in Subtrochanteric femur fracture. Hypothesis was made that outcome of PFN technique is comparable to 95° DCS. Materials and Methods: 60 patients were taken in study out of which PFN technique performed on 30 patients and on remaining 30 patients 95° DCS technique was used in a tertiary care Centre. Both technique were compared on basis of time of injury to surgery, operation time, blood loss, hospital stay, blood transfusion, implant related complication, healing time, Harris Hip score and union time. Results: There was remarkable difference in Harris Hip score, fracture union, mean operative time, blood loss, wound healing. Complications such as pressure sore, pulmonary embolism etc. were found to be higher in 95° DCS group as compared to PFN group. Conclusion: PFN is found to better internal fixation device in treatment of subtrochanteric femur fracture.

Keywords

95° Dynamic Condylar Screw (DCS), Proximal Femoral Nail (PFN), Subtrochanteric Femur Fracture.

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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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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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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

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Nitin Wagh ¹, Shrikant Vetal ², Saurabh Tidke ³, Satyen Joshi ¹

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

Abstract

Purpose: To study functional outcome for upper limb phalanx fracture treated by Joshi’s External Stabilizing System (JESS) fixator. Material and Methods: 68 patients were operated for Upper limb phalynx fracture in a tertiary health care setup with JESS fixator and were reviewed at 3 weeks, 6 weeks and 3months. After the procedure, the patients were assessed for the functional outcome using DASH (Disabilities or Arm, Shoulder and Hand) scoring scale. Results: Mean Adjusted DASH scores of the operated finger over consequent visits at 3 weeks, 6 weeks, and 3 months. We found that the mean adjusted DASH score improved in each consequent visit as compared to the first visit for all the joints (p<0.001). Out of the total 68 study participants, 63 had no complications (92.65%). Only 5 study participants had complications, out of which 2 each had joint stiffness (2.94%) and superficial pin track infection (2.94%) while 1 had pin loosening (1.47%). Conclusion: From the results, we can safely conclude that JESS is an effective alternative treatment for fractures of the phalanges. It is cheap and easily available. Technically, also it is less demanding. Also there is a good functional outcome as suggested by our study findings in terms of improvement in the range of motion as well as the mean adjusted DASH scores over a period of three follow up visits planned at 3 weeks, 6 weeks and 3 months with very few complications.

Keywords

Dash Score, Joshi’s External Stabilizing System (JESS) Fixator, Phalanx Pinning, Upper Limb Phalanx

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