Top PDF Comparision of functional outcome between traditional and lateral crossed pinning in supra condylar humerus fractures of children

Comparision of functional outcome between traditional and lateral crossed pinning in supra condylar humerus fractures of children

Comparision of functional outcome between traditional and lateral crossed pinning in supra condylar humerus fractures of children

This is to certify that this dissertation “COMPARISION OF FUNCTIONAL OUTCOME BETWEEN TRADITIONAL AND LATERAL CROSSED PINNING IN SUPRA CONDYLAR HUMERUS FRACTURES OF CHILDREN” is a bonafide record of work done by DR.K.NIKHIL RAJ, during the period of his Post graduate study from June 2015 to August 2017 under guidance and supervision in the INSTITUTE OF ORTHOPAEDICS AND TRAUMATOLOGY, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai-600003, in partial fulfilment of the requirement for M.S.ORTHOPAEDIC SURGERY degree Examination of The Tamilnadu Dr.M.G.R. Medical University to be held in April 2018.
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CROSSED PINNING VERSUS TWO LATERAL WIRES IN THE MANAGEMENT OF DISPLACED SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN

CROSSED PINNING VERSUS TWO LATERAL WIRES IN THE MANAGEMENT OF DISPLACED SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN

Ethical Committee approval was obtained from all the patients enrolled in the study. Regular three weekly follow-ups were done till radiological union followed by long- term follow-up at one and two years respectively. The final results were analysed using the Flynn criteria [12]. This criteria is divided into two components, the functional and the cosmetic component and both are further sub-divided as excellent, good, moderate and poor at an interval of five degrees. The functional component consists of measuring the arc of motion in sagittal plane which includes flexion and extension, whereas the cosmetic further measures the carrying angle which indicates the coronal movements at the elbow joint. Greater loss of movements in both, the sagittal as well as coronal plane indicates unsatisfactory outcome.
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Comparision of functional and cosmetic outcome of supracondylar fractures in children treated by percutaneous pinning and open reduction and internal fixation with K-wires

Comparision of functional and cosmetic outcome of supracondylar fractures in children treated by percutaneous pinning and open reduction and internal fixation with K-wires

From the structural and functional stand points the distal humerus is divided into separate medial and lateral components each containing an articular and non-articulating portion. Included in the non-articulating portion are the epicondyle which are the terminal points of the supracondylar ridges. The lateral epicondyle contains a roughened anterolateral surface from which the superficial forearm extensor muscles arise. The medial epicondyle is larger than the lateral counter part and serves as the origin of forearm flexor muscles.
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Comparative analysis of functional outcome of distal femur fractures treated with Locking Compression Plate fixation and Dynamic Condylar Screw fixation

Comparative analysis of functional outcome of distal femur fractures treated with Locking Compression Plate fixation and Dynamic Condylar Screw fixation

Our study is short term prospective and retrospective study conducted in Institute of orthopedics and traumatology, Madras medical college, Rajiv Gandhi Govt. General Hospital. Chennai. Tamil Nadu. Patients admitted with distal femur fractures are selected on the basis of inclusion and exclusion criteria. We have followed Muller Classification for distal femur fractures, based on which treatment modalities determined. Adult age group with Type A and C Muller included and Type B and skeletal immature patients and Gr III compound excluded in this study. Our study sample size is 25 patients, of which 10 patients treated with dynamic condylar screw and 15 patients with distal femur locking compression plate. They were processed as per protocol, traction of extremity till the patient get fit for surgery. We have used Extensile Lateral approach to fix the fracture with patient supine with sand bag underneath knee. Fractures treated with either LCP and DCS followed in standard protocol and evaluated in serial follow up. Functional outcome analyzed using standard scoring system called Hospital for Special Surgery.
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Prospective study on the outcome analysis of internal fixation of proximal humerus fractures

Prospective study on the outcome analysis of internal fixation of proximal humerus fractures

Hippocrates first documented a proximal humerus fracture in 460 BC and treated it with traction. In 1869, to improve treatment, Krocher classified fractures of the proximal humerus. In 1934, Codman developed a classification that divided the proximal humerus into 4 parts, based on epiphyseal lines. In 1970, Neer‘s classification expanded on the 4-part concept and included anatomic, biomechanical, and treatment principles, providing clinicians with a useful framework to diagnose and treat patients with these fracture (7). Treatment initially consisted of closed reduction, traction, casting, and abduction splints.
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Supracondylar condylar Fractures of the Femur

Supracondylar condylar Fractures of the Femur

Supracondylar condylar Fractures of the Femur Med J Malaysia Vol 41 No 3 September 1986 SUPRACONDYLAR CONDYLAR FRACTURES OF THE FEMUR * TEH PENG HOOI S KRISHNAMOORTY SUMMARY A retrospective study of 3[.]

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Functional Outcome of Diaphyseal Fractures of Shaft of Humerus Treated Surgically with Locking Compression Plates in Osteoporotic Bones: A Prospective study

Functional Outcome of Diaphyseal Fractures of Shaft of Humerus Treated Surgically with Locking Compression Plates in Osteoporotic Bones: A Prospective study

The operative treatment of bone fractures using plates and screws is a standard successful technique. Internal fixation with plates and screws leads to additional trauma and disturbance of the bone blood supply, which increases the risk of delayed union and infection. However, problems also are encountered in the fixation of osteoporotic bone. The locked internal fixator technique is an approach to optimize internal fixation. It aims at flexible elastic fixation to imitate spontaneous healing, including induction of callus formation. The technology supports what is currently called "minimally invasive plate osteosynthesis" (MIPO), which provides priority to biology over mechanics. An implant system called "Locking Compression Plate (LCP)" was developed, 7 based on many years
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Analysis of functional outcome of Muller's Type A and C fractures distal femur using locking compression condylar plate: A Prospective study

Analysis of functional outcome of Muller's Type A and C fractures distal femur using locking compression condylar plate: A Prospective study

This prospective study is an analysis of functional of 20 cases of displaced distal femoral fractures, internally fixed using locking compression condylar plates, which was undertaken at the department of orthopedics and traumatology at Government Royapettah Hospital, Chennai from July 2008 to October 2009.The Government Royapettah Hospital, is a multi specialty tertiary care referral and trauma centre with an average bed strength of about 700 and 110 beds allotted for orthopaedics and is situated in the heart of the city. We have a 24 hours emergency casualty, running all 365 days a year and fully equipped to take both medical and surgical emergencies, with emergency operation theatre.
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A clinical study of outcome of management of proximal humerus fractures by conservatives and surgical modalities

A clinical study of outcome of management of proximal humerus fractures by conservatives and surgical modalities

Percutaneous Reduction and K wire Fixation: For surgical neck fracture under the guidance of image intensifier, reduction was achieved and fixation was done using two 2mm K wires inserted from lateral aspect of distal fragment, parallel to each other, starting above level of deltoid insertion and directed towards the head of humerus until subchondral purchase was obtained. Further, one more k wire was inserted from anterior aspect of distal fragment further into the proximal fragment superiorly and posteriorly. For fixation of greater tuberosity percutaneously up to the head of humerus. All K wires ends were bent outside the skin and regular dressing was done under aseptic condition. Whenever required the above mentioned procedure was done and k wire were replaced with 4mm cannulated cancellous screws for additional stability. Regular dressing of k-wire was done and was removed after callus was seen on Xray, usually at 4 to 8 weeks. Rehabilitation protocol included initial elbow and wrist motion with pendulum exercise. After 3-4 weeks, gentle passive assisted forward elevation was carried out. Later, active abduction and external rotation was allowed at 6-8 weeks. At 3 months strengthening exercises were allowed. All patients were called for follow up at 1 month, 3 month, 6 months, 9 months and 1 year and evaluation using Constant Murley Scoring system along with radiological assessment was done. Open reduction And Internal Fixation: For isolated greater tuberosity fracture and surgical neck fracture (i.e 2 part, 3 part and 4 part) not amiable to closed reduction and percutaneous fixation were treated with open reduction and internal fixation. For greater tuberosity fracture trans deltoid approach was used, whereas for 3 and 4
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A comparative study of two percutaneous pinning techniques (lateral vs medial–lateral) for Gartland type III pediatric supracondylar fracture of the humerus

A comparative study of two percutaneous pinning techniques (lateral vs medial–lateral) for Gartland type III pediatric supracondylar fracture of the humerus

We conducted a prospective, single-blinded randomized control trial in the Department of Orthopaedics, Gauhati Medical College and Hospital, Guwahati, Assam, India for a period of one year, after obtaining ethical committee approval. Full written informed consent was taken from parents/legal guardian before participating in this study. Inclusion criteria for this study were aged between 3 and 12 years, closed Gartland type III supracondylar humeral fracture [13], duration of injury \ 4 days, and competent neurological and vascular status of the affected limb. Exclusion criteria were duration of injury [ 4 days, inability to take part in postoperative rehabilitation, open fractures, medical contraindications to surgery, fracture requiring open reduction or neurovascular exploration, previous ipsilateral elbow fracture, and floating elbow injury.
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A two-stage retrospective analysis to determine the effect of entry point on higher exit of proximal pins in lateral pinning of supracondylar humerus fracture in children

A two-stage retrospective analysis to determine the effect of entry point on higher exit of proximal pins in lateral pinning of supracondylar humerus fracture in children

for observation. Entry points of the proximal lateral pins (the most proximal lateral pin in case of more than two lateral pins) were recorded in reference to the ossific nu- cleus of the capitellum (ONC) on both views. To deter- mine the exit point of the proximal lateral pin, we first determined and marked the upper border of the distal metaphyseal-diaphyseal junction (MDJ) region by draw- ing two perpendicular and tangential lines along the shaft of the humerus on the AP radiograph. A horizontal line (line AB) passing through the more proximal point of the two points where the two parallel lines intersected the humeral shaft was regarded as the upper border of the MDJ region (Fig. 1). The regions below and above
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A Prospective Analysis of Functional outcome of Displaced Distal Femoral Fractures Internally Fixed using Locking Compression Condylar Plates

A Prospective Analysis of Functional outcome of Displaced Distal Femoral Fractures Internally Fixed using Locking Compression Condylar Plates

Mr.G, 22 years old college student, was admitted at our hospital following a fall from a motorcycle. He was diagnosed to have gustilo grade 2 open fracture 21,22 , Muller’s type C2 # of distal femur. Patient was hemodynamically stabilised and thorough wound wash and debridement was carried out in minor theatre. There was no other associated injury. Patient was put under intravenous antibiotics and a second look of wound was made after 48 hours, wound swab taken for culture and sensitivity reported negative. Patient was taken up for definitive surgery on 5 th day. We did open reduction, internal fixation with LCP condylar plate and K wires with ipsilateral fibular strut graft with corticocancellous iliac bone graft. Intravenous antibiotics were continued for two weeks, except for superficial wound infection overall postoperative period was uneventful.
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Outcome of proximal humerus locking plate fixation for proximal humerus fractures using the neer shoulder score

Outcome of proximal humerus locking plate fixation for proximal humerus fractures using the neer shoulder score

humerus has been fraught with complications, with malunion and nonunion caused by poor fixation in the humeral head. In addition, extensive soft tissue dissection increases the possibility of osteonecrosis of the humeral head, leading to a painful and functionally limited shoulder joint. The development of locked proximal humeral plates was expected to improve treatment of these complex injuries greatly. Numerous outcome studies are now available because the locked proximal humeral plate has been widely used for more than 10 years; however, as was pointed out in a Cochrane review, there is little level I or II evidence. A recent randomized controlled trial comparing locked plating to conservative treatment of three- and four-part fractures in elderly patients found no difference in outcomes at 1-year follow-up. Despite the lack of a large body of supporting literature, the locked proximal humeral plate is considered by most fracture surgeons to be a great improvement in the management of proximal humeral fractures, and it has become the implant of choice for these fractures. Some issues with open reduction and locked plating include the extensive exposure required for plate application that carries a risk of damage to neurovascular structures, especially the ascending branch of the lateral circumflex artery. The complication and reoperation rates do remain high with this technique. Screw perforation through the humeral head is the most frequently reported complication. Perforation can occur as cutout from fracture settlement or from poor initial technique. Other complications include arthrofibrosis, impingement, malunion, nonunion, osteonecrosis, infection, and hardware failure. Poor outcomes are associated with initial varus displacement of three- and four part fractures.
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A Prospective and Retrospective Analysis of Functional
Outcome of Proximal Humeral Fractures Treated with Proximal Humerus Internal Locking Osteosynthesis System.(PHILOS)

A Prospective and Retrospective Analysis of Functional Outcome of Proximal Humeral Fractures Treated with Proximal Humerus Internal Locking Osteosynthesis System.(PHILOS)

Aim is to establish ideal humeral head version and proper myofascial sleeve tension within the rotator cuff and deltoid musculature11. The prosthesis has two head sizes 15 & 22 mm in thickness. The larger size gives better leverage and mechanical advantage for forward elevation but the smaller size may be required for coverage by the rotator cuff. There are three stem sizes 7, 9.5 and 12mm and two stem length 125 and 150mm. Longer stem length are available, if needed to bridge a shaft fracture21. Recently modular hemiarthroplasty has been used in management of complex fractures of Proximal Humerus. The modular humerus design offers greater flexibility in head sizes, perhaps allowing more precise tensioning of soft tissues.
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Comparative Study of Cross and Lateral Fixations on Supracondylar Humerus Fracture among Children

Comparative Study of Cross and Lateral Fixations on Supracondylar Humerus Fracture among Children

There was no significant difference of patients’ clinical function result which was measured by using Flynn criteria between crossed and lateral fixation technique groups. Configurations, fixation insertion techniques, the size of K-Wire for fixation, post-surgical rehabilitation, patients’ compliance were fac- tors that supported the accomplishment of therapy. Patients’ compliance means all pa- tients visits orthopedic polyclinic after the surgery, perform programs from the poly- clinics, and obtain adequate rehabilitation therapy.
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Functional Outcome of Internal Fixation of Lisfranc Fractures

Functional Outcome of Internal Fixation of Lisfranc Fractures

All the patients who came with Lisfranc fractures were admitted to the ward, clinical, hematological and radiological workups were done. Fracture was fixed with screws and kirchner wires. Patients were discharged after suture removal around post op day10 and regularly followed up for 6 months. Non-weight bearing was adviced before discharge from the hospital on below knee cast. Partial weight bearing was started after onset of radiological union and full weight bearing was started after achieving radiological union.

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Review Article Open or closed reduction and percutaneous pinning for pediatric displaced supracondylar humerus fractures: a meta-analysis and system review

Review Article Open or closed reduction and percutaneous pinning for pediatric displaced supracondylar humerus fractures: a meta-analysis and system review

Nowadays, the preferred approach on the tre- atment of displaced pediatric SHF is closed reduction and percutaneous pinning; then in- ternal fixation following an open reduction will be preferred, if not possible [25]. Controversy exists regarding treatment strategies of SHF in Children between CRPP and ORPP, especially for the extra-articular and intra-articular frac- ture. Someone believed that even displaced intra-articular fractures can be treated with CRPP, while others recommend that ORPP is the best choice [26, 27]. The treatment of OR- PP for extra-articular fractures was associ- ated with poorer outcomes when compared with CRPP, while the patients with intra-articu- lar fracture preferred ORPP. Current studies showed that the number of patients adopting ORPP for failed closed treatment increases rap- idly [19]. The data shows that the patients of successful closed reduction and percutaneous fixation of intra-articular fractures in skeletally mature adolescents does not own higher com- plication rate, such as nerve injuries, pin tract infection and cubitus varus [28]. Moreover, a concern about open reduction is prolongation of anesthesia, soft-tissue injury and radiation exposure through the repetitive closed reduc- tion efforts. An obvious disadvantage of percu- taneous pinning is the reduction loss, which may result in deformity and bone union. The choice of the best treatment for SHF in Children depends on variation in skeletal maturity and patient size relative to age as well as the varia- tion in injury characteristics [19]. The surgeon should take several points into consideration, including the best balance of accurate reduc- tion, stable fixation, and minimal iatrogenic injury. The treatment of ORPP can also be used for the open fracture which was associated with vascular or nerve injury, or functional re- duction cannot be ensured by CRPP. An study reported that the rate of case, who had to pre- ferred open reduction for their first choices for SHF, is no more than 46% [29].
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A prospective study on functional outcome of Bimalleolar Ankle Fractures

A prospective study on functional outcome of Bimalleolar Ankle Fractures

Most common fracture pattern .Fracture pattern is identified by the level of fibula fracture at the level of ankle mortise running from anteroinferior to posterosuperior fracture lines in lateral radiograph. Syndesmotic breakage occurs in 50% of our cases. simple SER fracture pattern are treated by posterior plating of fibula. Fibula is first reduced and fixed with anteroposterior lag screw. This fixation is supplemented with a well contoured neutralisation plate and screws on lateral aspect of fibula. Exact reduction of the lateral malleolus results in reduction of the displaced posterior malleolus by the pull of posteroinferior tibiofibular ligaments. Fractures involving less than 25% of the articular surface may not need fixation 5,10 . If more than 25% of articular surface is involved fracture site is approched through posteromedial incision, reduced and fixed with cancellous screws. Medial malleolus is fixed by means of malleolar screws or tension band wiring technique.
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Functional Outcome of Unstable Pelvic Fractures: A Retrospective study

Functional Outcome of Unstable Pelvic Fractures: A Retrospective study

The patient in the fair group includes one male who had undergone Valgus osteotomy of the femur for neck of femur non union, he is started on full weight bearing crutch walking now and is advised against squatting or sitting crossed leg. The others include a male who has chronic osteomyelitis of the femur and a lady of 51 years age who has low back pain on stooping. The former is disabled because he cannot bend his knee due to quadriceps fibrosis and the latter is able to do all activities but limited in household work like sweeping the floor and washing clothes, which she perceives as her major disability.
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Functional outcome of comminuted and segmental fractures of shaft of humerus treated surgically with the gold standard management plate osteosynthesis: A Prospective study

Functional outcome of comminuted and segmental fractures of shaft of humerus treated surgically with the gold standard management plate osteosynthesis: A Prospective study

Advantages are high union rate , low complication rate and rapid return to function.It can be used for fractures with proximal and distal extention.It is safe and effective and no shoulder or elbow morbidity and stable enough to allow early upper limb weight bearing in polytrauma.(17,34)

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