Post operatively limb elevation was maintained for 72 hours. Compressive bandage was applied over sterile dressing. Complete suture removal was done at an average of 15 days. All operated patients were kept on absolute non weight bearing for 4 weeks followed by touchdown weight bearing with active and passive movements of ankle and sub talar joints. Full weight bearing was allowed from 12 weeks. Regular clinical follow up examination was performed monthly in all cases and functionaloutcome was assessed by using Modified Rowe scale (Table 3) after following the cases over a mean period of 18 months.
This is to certify that this dissertation in “PROSPECTIVE STUDY OF FUNCTIONALOUTCOME OF CLOSED SCHATZKER TYPE V AND TYPE VI TIBIAL PLATEAU FRACTURESMANAGED BY OPENREDUCTION AND INTERNALFIXATION” is a bonafide work done by Dr. K. R. KANNAN under my guidance during the period June 2006 – November 2008. This has been submitted in partial fulfillment of the award of M.S. Degree in Orthopedic Surgery (Branch – II) by the Tamilnadu Dr. M.G.R. Medical University, Chennai.
treated with sling immobilization and physical therapy 7 [Ianotti et al 2003]. Approximately 20% of proximal humeral fractures are displaced & maybenefit from operative treatment 6 [shene et al]. Many surgical fixation techniques have been described inthe literature, but no single surgical fixation technique is considered to be the gold standard of care 8 [Robert j et al 2009]. There are various treatment options available like conservative treatment with immobilisation and gradualphysiotherapy, operative treatment including transosseous suture fixation, percutaneous k wire fixation, openreduction and internalfixation with conventional or locked-platefixation, and hemiarthroplasty 6,9 [Shene et al and Koval et al].There is a uniform agreement that when the tuberosities and medial calcar are anatomically reduced the successful outcome is most likely and the range of motion occurs early in the rehabilitation process 10 [Gallo et al 2005]. Openreductioninternalfixation offers best chance at accurate reduction and union of all fracture fragments, including the greater tuberosity and therefore, good and excellent functional results can be achieved 10 . However, this method has been limited by difficulty in obtaining adequate exposure especially if greater tuberosity is diplaced and rigid fixation without compromising soft tissue structures. There are several fixation options which have different methods & principles of maintaining reduction, however they also have specific implant related problems as well. [Gallo et al]
The treatment for distal fibular fracture depends upon the fracture pattern .The various treatment modalities available are conservative management with application of short leg cast or surgical fixation by lag screws, plates and screws, intramedullary nail or external fixation. The main goal of openreduction and internalfixation is to restore joint congruity.
There is a controversy whether the comminuted calcanealfractures should benefit more from conservative or from surgical treatment. Aiming to contribute to this unsolved clinical question we reviewed the long-term outcome (up to 96 months) of in 44 patients (mean age 35 years) with 47 calcanealfractures who were treated surgically. In these patients openreduction and internalfixation were performed using a calcaneal reconstruction plate. The functionaloutcome was measured according to the Rowe Score and the level of pain by Visual Analog Scale. The objective outcome was estimated by the current radiographs. The clinical results were good to excellent in 69% of patients. Poor outcome observed in one patient who developed Complex Regional Pain Syndrome in his foot. The radiographic evaluation showed satisfactory reconstruction (according to the Boehler angle measurements) in 35 of operated calcanei. These results indicate on the sa- tisfactory outcome of surgical treatment in the majority of the patients who were diagnosed with comminuted fracture of calcaneus.
fixation with a plate. In patients who have a three part fracture with appreciable displacement of the greater tuberosity, openreduction, limited dissection and internalfixation should be performed. Literature says anatomical neck fractures of proximal humerus account for only 0.54% of proximal humeral fractures. Displaced anatomical neck fractures cause complete disruption; of blood supply to the articular segment. The success rate of closed pinning and headless screw fixation is very less. The chance of avascular necrosis of humeral head increases by 5 times in these type of fractures, but overall functionaloutcome is good even after avascular necrosis in many cases. The preferred treatment for displaced anatomical neck fracture is primary arthroplasty. The Neer’s four part fractures and 4 part fracture dislocation are rare compared to other fractures of proximal humerus. The chance of avascular necrosis is very high. The Neer’s Primary hemiarthroplasty is preferred treatment. Early openreduction and internalfixation prevents complications like shoulder stiffness, malunion and late osteoarthritis. There is direct relationship between displaced proximal humeral fractures, between fractures severity and eventual results. Rehabilitation is the key to success. After the fracture is stabilized by whatever means, continuous active followed by passive motion should be started. On discharge, the patients must be instructed regarding physiotherapy exercises to be done several times a day. REFERENCES
31. de Boer as, Van lieshout em, den hartog d, et al. Functionaloutcome and patient satisfaction after displaced intra-articular calcanealfractures: a comparison among open, percutaneous, and nonoperative treatment. J Foot Ankle Surg 2015;54(3):298-305. 32. Wu Z, su Y, Chen W, et al. Functionaloutcome of displaced intra-articular calcanealfractures: a comparison between openreduction/internalfixation and a minimally invasive approach featured an anatomical plate and compression bolts. J Trauma Acute Care Surg 2012;73(3):743-751.
A prospective quantitative descriptive cohort study was carried out over 2 years, from January 2016 to January 2018, in all consecutive cases of closed displaced intra-articular fractures of calcaneum in skeletally mature patients that presented to the Department of Orthopaedics at Dr. R.N. Cooper muncipal general hospital, Juhu, Mumbai.. Out of total 30 cases of calcanealfractures that were managed during the study period, 25 cases were eligible for the study and 20 cases were available for final follow up. Opencalcanealfractures, patients unwilling for the operative management, skeletally immature patients, cases managedconservatively were excluded from the study. Written informed consent was obtained from all patients to be managed with ORIF with LBCP. The data were recorded in proforma including: epidemiological information, fracture details from X-rays and CT scans, preoperative, perioperative, and postoperative details including wound condition.Fractures classified using sanders classification. Routine investigations carried out to get fitness for surgery. Patients underwent Openreduction and internalfixation with locking branched calcanealplate through extensile lateral approach under spinal anaesthesia. Post- operative physiotherapy followed according to protocol. Patients will be followed up at 6 weekly interval until fracture union. Clinical evaluation done by using Maryland foot scoring system. Radiological evaluation done by using Boehlers angle and Critical angle of Gissane on Lateral radiographs of calcaneum. Functionaloutcome was recorded at every followup after 12 wks of surgery.
sions. In high-energy traumas, pelvic frac- tures should always be suspected and con- ducted together with other lesions. Pelvic fractures are challenging injuries to manage. Stabilisation of vital parameters takes pref- erence and significantly reduces mortality. Associated injuries are common and often have a substantial effect on the patient’s psychological status. Rehabilitation period is prolonged; however proper management yields a satisfactory outcome. Further analy- sis and studies including a larger number of patients are required to identify the prognos- tic factors for the late sequelae. This study should be a valid statistical analysis of out- comes in patients who treated surgically, by internalfixation. Early rigid stabilisation of both anterior and posterior pelvic ring injury with openreduction, internalfixation, which performed in our patients, has been sug- gested as a potential reason for favourable prognosis of these injuries.
Abstract: The paper aims to introduce the bridge-type plate and study the outcomes of radial head fractures of Ma- son type-II and type-III treated by openreduction and internalfixation with bridge-type plate. The bridge-type plate is reshaped from mini-plate, whose feature is that the proximal one-third of the plate is bent outward. Twenty three cases with radial head fracture consisted of 13 cases of Mason type-II and 10 cases of type-III treated operatively with bridge-type plate from March 2006 to June 2009 were followed up. Early exercise was encouraged in all pa- tients. Follow-ups assessments of the elbow function were carried out. All fractures were treated operatively with bridge-type plates successfully. Early exercise started averagely 1.9 days after operation. The patients regained full or nearly full range of motion of the elbow joint and forearm. According to Morry assessment, all patients achieved good (four 4 cases) or excellent (19 cases) functional recovery of elbow joint. The patients returned to their daily life and previous occupational work. Satisfactory elbow joint motion can be achieved in patients with radial head fractures of Mason type-II or type-III managed by openreduction and internalfixation with bridge-type plate following early exercise.
iBONE VOID FILLER, BONESUPPORT AB, Lund, Sweden) in internalfixation of calcanealfractures. Methods: The records of patients presenting with calcanealfractures type Sanders III and IV and treated with internalfixation plus BGS were reviewed. Radiographs were analyzed using different measurements (including Böhler’s angle and calcaneal facet height). The clinical outcome was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle‑Hindfoot Scale. Results: A total of 20 fractures were available for radiographic and clinical examination at a minimum follow‑up of 12 months. No decrease in Böhler’s angle was recorded in six fractures, a reduction of <5° in 6 and of more than 5° in 8 fractures. In all fractures, the BGS was completely resorbed at 12 months on radiographs. The AOFAS score was on an average 89.8 (range, 68–99) at 1‑year follow‑up and indicated an excellent outcome in 11, a good outcome in 8, and a fair outcome in 1 fracture. Conclusions: The study results support the use of an injectable, in situ hardening calcium sulfate/hydroxyapatite BGS in DIACFs. The BGS is easy and safe to use as an augment to openreduction and internalfixation.
In closed multiple metacarpal fractures, platefixation is a good option for several reasons. These fractures are highly unstable, and stable fixation is required in these fractures . Metacarpal length is very likely to be short- ened in multiple metacarpal fractures, causing instability [6, 7]. This effect is greater in internal metacarpals (third and fourth metacarpals) than in border metacarpals (second and fifth metacarpals), because the latter are anchored on both sides of the metacarpal head . Closed ipsilateral multiple metacarpal fractures are frequently associated with more soft tissue injury as compared with single fracture, making them more susceptible to stiffness and poor functional results. Osteosynthesis using miniature plates and screws in these unstable fractures produces anatomical reduction of fractures with stabilization that is rigid enough to allow early mobilization of adjacent joints without allowing loss of reduction, thereby preventing stiffness and hence good functional results.
Abstract: Objective: To compare and analyze the clinical efficacy of openreduction with internalfixation and per- cutaneous poking reductionfixation for Sanders type II calcanealfractures. Methods: A total of 57 patients with calcanealfractures were randomly divided into the poking group (27 cases, underwent percutaneous poking reduc- tion) and the incision group (30 cases, underwent openreduction with internalfixation). The operation time, drain- age volume, intraoperative blood loss, and hospitalization days were recorded. During the postoperative follow-up, fracture healing and incidence of complications were observed and recorded for both groups. At the last follow-up, Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and the MOS item short form health survey (SF-36) were used to evaluate the clinical efficacy. Results: The operation time, drainage volume, intraoperative blood loss and hospitalization days in poking group were significantly less than those in the incision group, with statistically significant differences (P<0.05). In the postoperative follow-up, it was found that there was no significant difference in fracture healing time between the two groups. The incidence of complications was 3.70% in poking group, significantly lower than 10.00% in incision group (P<0.05). The Böhler and Gissane angles were significantly improved after surgery in both groups (P<0.05), but there was no significant difference between the two groups after surgery (P>0.05). At the last follow-up, VAS and SF-36 scores in the poking group were signifi- cantly higher than those in the incision group (P<0.05). There was no significant difference in excellent and good rate between the poking group and the incision group (P>0.05). Conclusion: Percutaneous poking reductionfixation can effectively reduce the incidence of postoperative complications and significantly improve the clinical efficacy and outcomes in treatment of Sanders II calcanealfractures, so it is an efficient treatment method for calcanealfractures.
The goal of openreduction and platefixation is to re- store articular congruity and axial alignment to prevent post-traumatic osteoarthritis. Additionally, open reduc- tion and platefixation allows for early mobilisation and may theoretically lead to a more rapid recovery and bet- ter functionaloutcome [13, 14]. Especially in the young and working population, but also in the elderly patients, this could be an advantage. Moreover, redisplacement rates up to almost 60 % are encountered in patients treated with closed reduction and plaster immobilisation, especially in those with type C fractures [15–19]. How- ever, with nonsurgical treatment the standard risks for undergoing a surgical procedure and the risk of hard- ware removal, tendon rupture and neurovascular dam- age are avoided. Moreover, we know that especially patients over 65 years of age have a lower disutility for painful malunion . Though, plaster immobilisation is not without risks either. Pressure neuropathy of the superficial radial nerve, Complex Regional Pain Syn- drome and stiffness of the wrist can occur.
and anatomical fixation of the fracture and can enable primary or secondary fracture healing depending on the type of osteosynthesis and fracture pattern. Although there were no significant differences between our two groups according to the primary and secondary outcome measures, an anterior approach offers advantages. It allows supine positioning of the patient and offers safe exposure of the humerus as the radial nerve is not dir- ectly explored . To the best of our knowledge, there have been no prospective randomized studies comparing anterior and posterior platefixation in terms of the heal- ing rate and clinical outcomes. Nevertheless, the cur- rently available literature confirms our finding that an anterior surgical approach with plating is a safe and effi- cacious treatment option for humeral shaft fractures. Re- liable results have been reported in one biomechanical study  and one retrospective clinical study  for anteromedial plating for shaft fractures in the upper ex- tremities with regard to bone union and iatrogenic neu- rovascular injury. One retrospective study of 96 humeral fractures treated with anteromedial plating presented a union rate of 97%, although 20% of the fractures in- cluded were openfractures . According to the neurological status, 18 patients with primary radialis palsy and one patient with brachial plexopathy were in- cluded in this study. Of these 19 patients, twelve achieved remission after ORIF. Two patients (2.1%) were noted to have secondary palsy (hypoesthesia in the lat- eral antebrachial cutaneous nerve distribution) after sur- gery. Another retrospective study was published by Boschi et al.  investigating the outcomes of the treat- ment of 280 humeral shaft fractures with ORIF in terms of the approach and plate location. The overall healing rate was 98.2%, without a significant difference in the approach or plate location. In accordance with the find- ings reported by Boschi et al. , no significant differ- ence in the operative duration was found between the two groups in our study; however, we found a wide vari- ation in the operative duration within the groups. As a level one trauma center and a university hospital, all op- erative procedures in both groups were performed by ei- ther trainee registrars or junior consultants, which might be one reason for the wide variation in the operative duration within the groups. The fact that the number of
Background: The use of minimally invasive plate osteosynthesis (MIPO) via anterolateral deltoid splitting has good outcomes in the management of proximal humerus fractures. While using this approach has several advantages, including minimal soft tissue disruption, preservation of natural biology and minimal blood loss, there is an increased risk for axillary nerve damage. This study compared the advantages and clinical and radiological outcomes of MIPO or openreduction and internalfixation (ORIF) in patients with proximal humerus fractures. Methods: A matched-pair analysis was performed, and patient groups were matched according to age (±3 years), sex and fracture type. Forty-three pairs of patients (average age: MIPO, 63 and ORIF, 61) with a minimum follow-up of 12 months were enrolled in the study group. The patients were investigated radiographically and clinically using the Constant score.
This is to certify that this dissertation titled “Retrospective and Prospective Analysis of Functional and Radiological Outcome in Acetabular Fractures Treated with Openreduction and internalfixation” is a bonafide record of work done by DR.A.BALAKRISHNAN , during the period of his Post graduate study from May 2015 to May 2018 under guidance and supervision of PROF.A.PANDIASELVAN., M.S.ORTHO., D.Ortho., 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.
Beingessner et al. showed that the changes in elbow stability and kinematic caused by type I coronoid process fractures cannot be correct- ed with suture repair . On the other hand, fixation with 1 or 2 lag screws was performed by some surgeons recently, nevertheless the screw fixation is not only difficult to perform , but also maybe not reliable to resist the compressive forces pulling the fragment off coronoid’s base. And the internalfixation may be failed because it is difficult to position screwsin the appropriate place of the fragment. In current studies, mini-platefixation was pro- moted for achievement of stability and com- pression in type II and type III patients.Rigid fixationcould be achieved in intra-articulation fractures due to thatmini-plate could be easily shaped according to the bone configuration, fixed fragmentsintegrately and reliably, and made less impact on the motion of articulation and surrounding tissue, especially tendon ac- tivities. Moreover, functional exercise could be given earlier after surgery. In our study, we fixed all the patients by mini-plate and achieved sat- isfactory clinical outcomes. Our study has some limitations including that not only it was a retro- spective analysis, but also it has no control group inwhich the patients were treated by other fixation methods to prove the advantag- es. However, we believe that openreduction and internalfixation with mini-plate is a valid method for coronoid process fractures of ulna with the advantages of rigid internalfixation and early functional exercise.
articular calcanealfractures by openreduction and internalfixation with a calcaneal locking compression plate (LCP) from an extended lateral approach. Early post-operative complications were recorded in six patients (20.7 %). Wound dehiscence was found in two (6.9 %), necrosis of wound edges in two (6.9 %), and early superficial infection responding to antibiotic therapy also in two patients (6.9 %), Excellent Rowe scores were achieved in 10 patients (34.5 %), good in 15 (51.7 %) and satisfactory in two (6.9 %). Only two patients (6.9 %) reported poor outcome. We did not record any complications related to wound. The score obtained in our series is comparable to observed by Zeman et al. 15
This is to certify that this dissertation titled “FunctionalOutcome Analysis of Openreduction and internalfixation of complex Acetabular fractures” is a bonafide record of work done by DR.D.KAMALASEKARAN , during the period of his Post graduate study from June 2010 to May 2013 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 2013.