In our series 12 cases had complications such as wound infection, nonunion and malunion. Superficial infection (27%) with skin necrosis was the commonest complication we encountered. Skin necrosis was very much less when plate and screws of 3.5 mm system is used. Miller et al noted infection rate of 2.2% in his series of bimalleolarfractures, and he suggested that the skin incision should be carried straight down to the level of bone, without undermining the skin or subcutaneous tissue and skin necrosis was very much less when plate and screws of 3.5 mm system is used. Nonunion of medial malleolus was seen in two cases due to early removal of implant due to deep infection.
This is to certify that this dissertation in “PROSPECTIVESTUDY OF FUNCTIONALOUTCOME OF CLOSED SCHATZKER TYPE V AND TYPE VI TIBIAL PLATEAU FRACTURES MANAGED BY OPEN REDUCTION AND INTERNAL FIXATION” 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.
This is to certify that this dissertation titled “A Retrospective and ProspectiveStudy on FunctionalOutcome of Distal Tibiofibular Syndesmotic Injuries Associated with Ankle Injuries Treated by Open Reduction and Internal Fixation and Syndesmotic Screws” is a bonafide record of work done by Dr.M.Suresh, during the period of his Post graduate study from June 2015 to April 2018 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.
I declare that the dissertation entitled "A PROSPECTIVESTUDY OF FUNCTIONALOUTCOME OF TIBIAL METAPHYSEAL FRACTURES TREATED WITH INTRAMEDULLARY NAILING WITH BLOCKING SCREWS (POLLER SCREWS)" submitted by me for the degree of M.S Orthopaedics is the record work carried out by me during the period of May 2016 to September 2018under the guidance of Prof.Dr.D.R.RAM PRASATH M.S.Orth., D.Orth., Associate Professor, Institute of Orthopaedics and traumatology, Coimbatore Medical College & Hospital, Coimbatore. This dissertation is submitted to the Tamilnadu Dr.M.G.R. Medical University, Chennai, in partial fulfillment of the University regulations for the award of degree of M.S.ORTHOPAEDIC SURGERY examination to be held in May 2019.
This is to certify that Dr.PRASOBH. C, Postgraduate student (2011-2014) in the department of Orthopaedics, Government Mohan Kumaramangalam Medical College, Salem has done this dissertation “A ProspectiveStudy of FUNCTIONALOUTCOME OF DISPLACED MIDDLE THIRD CLAVICULAR FRACTURES TREATED BY PLATE OSTEOSYNTHESIS”under my supervision in partial fulfillment of the regulation laid down by the Tamilnadu Dr. M.G.R Medical University, Chennai for M.S. (Orthopaedics) degree examination to be held during April 2014.
This prospectivestudy on ‘Functionaloutcome of intra articular distal radius fractures managed by fragment specific fracture fixation’ was conducted in the Department of Orthopaedic Surgery, Govt. Kilpauk Medical College and Hospital, Chennai from September 2014 to July 2016 after ethical committee clearance was obtained.
This is to certify that Dr. T.C. PREM KUMAR, Postgraduate student (2006-2008) in the department of Orthopaedics, Government Kilpauk Medical College, Chennai has done this dissertation on “PROSPECTIVESTUDY ON FUNCTIONALOUTCOME OF DIAPHYSEAL FRACTURES OF SHAFT OF HUMERUS TREATED SURGICALLY WITH LOCKING COMPRESSION PLATES IN OSTEOPOROTIC BONES” under my guidance and supervision in partial fulfillment of the regulation laid down by the Tamilnadu Dr. M.G.R Medical University, Chennai for MS (Orthopaedics) degree examination to be held on March 2008.
I, Dr.G.Kaliraj, solemnly declare that the dissertation titled “PROSPECTIVESTUDY ON FUNCTIONALOUTCOME OF COMMINUTED AND SEGMENTAL FRACTURES OF SHAFT OF HUMERUS TREATED SURGICALLY WITH THE GOLD STANDARD MANAGEMENT PLATE OSTEOSYNTHESIS” is a bonafide work done by me, at Government Kilpauk Medical College between 2007-2009, under the guidance and supervision of my unit chief Prof. Dr.K.NAGAPPAN M.S Ortho., D. Ortho., Professor of orthopaedic surgery. This dissertation is submitted to the Tamilnadu Dr. M.G.R Medical University, towards partial fulfillment of regulation for the award of M.S.Degree Branch-II) in Orthopaedic surgery.
Fixation with the 3.5 mm Medial Distal tibial LCP has many similarities to the traditional plate fixation methods, with a few important improvements. The technical innovation of locking screws provides the ability to create a fixed angle construct while using familiar AO plating techniques. Locking capability is important for fixed angle constructs in osteopenic bone or multifragmentary fractures where screw purchase is compromised. These screws do not rely on plate to bone compression to resist patient load, but function similarly to multiple, small, angled blade plates. The fixation of this implant can be done in both MIPPO or routine open reduction technique.
Dynamic loading tests have shown that, with an effective increase in the length of bone bridged, this leads to premature failure of the implant. It is recommended that in simple fractures with bone contact, one or two combination holes be left unused on each side of the fracture space, while in complex fractures with an extensive fragmented zone and resultant lack of bone, contact the holes closest to the fracture should be used. An aiming device (sleeve) should be used in all cases while drilling for the locking head screws as axial deviation of the direction of drilling by more than 5° causes impaired stability. In case of metaepiphyseal fractures, combination holes in the area of the joint allow anatomical realignment and internal fixation; the metaphyseal region can be served by a bridging osteosynthesis. The number of screws in the area of the joint depends solely on the object of refixation with interfragmentary compression.
thrombosis, pulmonary embolism and so on (5) . In senior citizens, these morbidities cause loss of independence and reduced daily activities leading to social isolation and depression (6) . The fractured osteoporotic vertebrae may also progress to collapse and may lead to progressive burst fractures leading to kyphosis with variable degrees of cord compressions and further complications. So the need to stabilize the fractures besides the medical treatment and braces is mandatory. Vertebroplasty a type of vertebral
injuries are not as desired [1,2] . The injuries of midfoot can be broadly grouped into lisfranc joint injuries (Includes all injuries of Tarsometatarsal Joints) and Tarsal Bone injuries [3,4] . Usually, these midfoot injuries are the result of an axial load or twisting force exerted on a foot in plantarflexion, and also by crush injuries or direct injuries  . Treatment choices for both Lisfranc Joint and Tarsal Bone injuries range from conservative therapy to Open reduction and internal fixation (ORIF), Closed reduction and internal fixation (CRIF) to Primary arthrodesis. In case of operative management, controversy remains whether primary ORIF or arthrodesis should be favored [5–7] especially in cases of neglected injuries. Usually, in studies on functional outcomes of midfoot injuries, crush injuries and polytrauma patients are often excluded [6,8,9] . But midfoot injuries can very well be present in such patients [10,11] . This study aims to evaluate functional outcomes after operative and conservative management for various midfoot injuries at a rural secondary level trauma center. Factors associated with variation in functional outcomes were assessed.
Mean AOFAS score among patients treated by operative methods was 68.5 while in those treated conservatively was 78.8.Mean AOFAS score among patients with Lisfranc joint injuries was 67.6 while in those with tarsal bone injuries was 74.2. Mean AOFAS score was 72.22 (Range 51 - 85).Functionaloutcome was graded according to AOFAS scores as Excellent (Scores 85-100), Good (Scores 70-84), Fair (Scores 50-69), Poor (Scores<50). Thus, ‘Excellent’ outcome was seen in 9 patients (n=9),’Good’ outcome was noted in 19 patients (n=19), ’Fair’ outcome was noted in 12 patients (n=12) while none of the patients had ‘Poor’ outcome (n=0). There was no significant difference between outcome of closed and open fractures and patients managed with closed and open reduction. Secondary arthrodesis was not performed on any patients. Table 3 describes the treatment characteristics.
High energy distal femoral fractures are frequently associated with articular fracture and metaphyseal communication 1,2,3 .Coronal plane fractures and extensive distal comminution generally preclude the use of traditional fixed – angle devices or retrograde nails 11 . Earlier, fixation of these fractures with a lateral plate alone has historically been associated with non-union and/or malunion with varus collapse. Prior to advent of locking plates, these problems were addressed with dual plating methods 5 .
Three and four part fractures represent 13% to 16% of Proximal Humeral Fractures. Open reduction & internal fixation is the treatment of choice for displaced three part fracture of Proximal Humerus. It is important to avoid extensive exposure and soft tissue dissection of fragments which may compromise blood supply. Intramedullary nails is usually not adequate to neutralise deforming forces. The AO buttress plate gives good results but may require extensive soft tissue stripping.
All patients were admitted in casualty department and were resuscitated. If there were any major associated injuries they were treated accordingly at first. After the general condition of the patient improved, radiographs – anteroposterior and oblique views were taken. Fracture reduced in closed manner at first under sedation and volar below elbow slab was applied. Unstable fractures were taken up for surgery – open reduction and internal fixation with plate osteosynthesis.
femur is not sufficient by itself. Hence it must be supplemented, atleast with one screw passed through the plate portion into the proximal fragment. Condylar plate do not require radiographic control for insertion but are inserted under direct visual control, using only bony land marks and appropriate templates and guide wires as directional guides. This permits the surgery that can be carried out in on ordinary operating table. Full manipulation of leg facilitates the reduction and fixation of spiral and oblique fractures and their butterfly fragments. However placement of the 95 degree blade plate is a technically demanding procedure because the surgeon is required to place the blade in three planes simultaneously. Sanders and Regiazzori (1989) reported a 28 – 39 per cent complication rate.
Another factor which closely correlated with the outcome was the time interval between injury and fracture fixation 7,21 . 85.7% of the patients who had earlier surgery had good anatomical reduction and functionaloutcome. The age of the patient which was strongly related to the outcome in Matta’s 7, study did not have any effect on the outcome in our study. This may be due to reason that the number of patients in our study was much lower.
A total of 72 patients were studied retrospectively by Jan –Magnus Bjorkenheim. The patients were followed for a period of 12 months. All of them had fracture of the proximal humerus treated surgically with locking compression plate between February 2002 to January 2003. Constant Score was used and it was inferred that the final functionaloutcome was better even in geriatric patients. 2 patients had non union and 3 patients developed humeral head avascular necrosis. Two patients had failure of implants. The final interpretation was made that the PHILOS method was safe and can be advised for the treatment of these fractures in patients with reduced mineral density of bone 25 .
It is proved that the lateral shift can decrease tibiotalar contact area necessitating proper and perfect anatomic reduction . Operative method restores the anatomy and contact-loading characteristic of the ankle. Surgical intervention can be either closed reduction or open reduction with internal fixation (ORIF). Conservative technique of closed reduction in stable injury yields satisfactory outcome while unstable, displaced, and open fractures need ORIF. The superiority of ORIF over closed treatment has been thoroughly demonstrated in the literature . Additional advantages include easier rehabilitation without a cast, early mobilization and earlier weight bearing . However, the outcome in bimolecular fractures varies. Hence, we assessed the functionaloutcome and results of surgical treatment of bimalleolarfractures.