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  Most popular articles (Since June 15, 2013)

 
 
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ORIGINAL ARTICLES
Magnetic resonance imaging in the diagnosis of lumbar canal stenosis in Indian patients
Inder Pawar, Supreethi Kohli, Vipin Dalal, Vinod Kumar, Seema Narang, Anu Singhal
January-June 2014, 2(1):3-7
DOI:10.4103/2319-2585.134200  
Introduction: Magnetic resonance imaging (MRI) has become the choice of imaging modality for lumbar canal stenosis (LCS) due to limitations and radiation risks of computed tomography (CT) and spinal radiography. The radiological criteria for diagnosis of LCS are still ambiguous. Aim of this study is to find out the radiological dimensions on MRI of lumbar spinal canal in Indian patients and the critical dimensions at which the symptoms occur. Materials and Methods: A cross-sectional study was conducted in ESI Hospital, New Delhi from July 2011 to 2013. Two study groups were studied, the symptomatic LCS group, consisted of 30 individuals of either sex in age group of 45-65 years. The control group consisted of 30 asymptomatic age matched individuals. MRI scans were performed on 1.5 Tesla scanner. Dimensions of lumbar canal at all the levels (L1-L5) of lumbar vertebra of 60 patients were measured. Results: In our study, in symptomatic group, narrowest mid-sagittal diameter antero-posterior (mean 10.61) was at L5-S1 level. The interligamentous diameter (ILD) showed no significant difference between the two groups. Lateral recess depths showed a significant difference between the two groups at all levels except L1 on right side and L1 and L2 on left side. Critical canal dimension was found to be 11.13 mm. Conclusion: MRI can effectively evaluate the lumbar canal stenosis. The critical canal dimensions at which symptoms of stenosis appear were 11.13.
  11,558 712 -
A new technique for surgical management of old unreduced elbow dislocations: Results and analysis
Parag Garg, Soumya Paik, Sisir Sahoo, Vimal Raj, Aniruddha Pispati, Subhashish Mitra
July-December 2014, 2(2):45-51
DOI:10.4103/2319-2585.145599  
Background: Open reduction of neglected dislocations of elbow often leads to less than optimal results. Extensive release during reduction and early mobilization may lead to instability. Post-surgical immobilization to recover the stability leads to loss of range of motion. Arafiles described a technique of creating a cruciate ligament like structure to provide stability while early mobilization is advocated. We have modified this technique in several aspects. We report a retrospective analysis of 26 such cases where we evaluated and compared the standard immobilization technique of K-wires with this new modified technique. Materials and Methods: Twenty-six consecutive cases of dislocated elbow with duration ranging from 4 to 56 months were included in this study. We performed standard open reduction and fixation with K-wire followed by immobilization for 3 weeks for the first 12 cases. In the next 14 cases after standard release and reduction we provided extra stability by adding a cruciate ligament like structure both on the medial and lateral side using autologous semitendinosus graft. Post-operative mobilization was advised the very next day. We evaluated the results of this technique and compared it with the previous one using MEPI scores, complication rate and radiological evaluation.Results: The average follow-up duration for the 26 patients is 4.5 years (2−7 years). All patients achieved full functional ROM in both planes. The mean increase in the MEPI score was significantly more for group II (53.5) than group I (36.6). Movement, activities and stability was better for this group II. Complication rates for both were similar.Conclusion: Providing stability at the time of operation with a mediolateral cruciate ligament provides the option of immediate mobilization post-operatively in open reduction of neglected dislocations of elbow. Thus, this technique provides excellent results disregarding the duration of dislocation with minimal morbidity for the patient.
  7,834 793 -
Manipulation under anesthesia for stiffness after total knee replacement: A systematic review
Shishir Nawghare, Stuart Brooks
January-June 2013, 1(1):7-13
DOI:10.4103/2319-2585.117381  
Introduction: Stiffness following total knee replacement (TKR) is a debilitating complication. Manipulation under anesthesia (MUA), arthroscopy, and open arthrolysis are used to treat the stiffness. Objectives: The aim of the review was to answer the following questions. What is the gain in range of motion (ROM) after MUA for stiffness following TKR? Is the gain in ROM after MUA for stiffness following TKR retained at the last follow-up? What is the gender distribution amongst the patients presenting for MUA following TKR? What is the mean age of the patients presenting for MUA following TKR? What is the influence of timing of MUA following TKR on the ROM? The review was aimed towards establishing the current available evidence regarding MUA for stiffness. Materials and Methods: A systematic review of the current available literature was performed and the relevant studies were critically appraised. Results: Nine studies were identified to be relevant to the review (1-Level 2; 2-Level 3; 6-Level 4). It was found that there was a gain in the ROM after MUA and it was retained at the final follow-up. The patients presenting for MUA were younger and were predominantly females. Early MUA was found to be more effective, although late MUA was also beneficial. Conclusions: With limited and low quality of evidence, it is not possible to draw any conclusions.
  7,647 389 1
REVIEW ARTICLE
Congenital clubfoot
Sanjay Meena, Pankaj Sharma, Shreesh Kumar Gangary, Lalit Kumar Lohia
July-December 2014, 2(2):34-39
DOI:10.4103/2319-2585.145593  
Clubfoot is the most common congenital deformity of lower limbs. Its etiology remains an enigma. The aim of the treatment is to obtain a plantigrate, painless and functional foot. Conservative treatment with Ponseti method of clubfoot is well-accepted and has been reported to result in good correction ranging from as low as 50% to as high as 90%. Surgical treatment is indicated only after failure of conservative methods, with limited release also known as " a la carte"release. This review looks at etiology, clinical assessment, scoring and provides an overview of operative and non-operative treatment options.
  5,649 1,574 -
CASE REPORTS
Complete avulsion of the adductor longus in a semi-professional football player: Rapid return to play with nonoperative treatment
Vince W Lands, Daniel M Avery, Steven T Puccio
January-June 2016, 4(1):45-48
DOI:10.4103/2319-2585.180693  
The adductor longus has become recognized as one of the more commonly injured muscles in the medial compartment. Acute complete rupture injuries occurring at the proximal aspect of the muscle are less common. Limited data exist regarding management of the injuries in athletes required for return to play and functioning. The current data favors operative management; however, nonoperative treatment may be a viable option. Nonoperative management of avulsion injuries of the proximal adductor longus tendon may prove equal results to surgical repair in return to play and functioning. A semi-professional football player sustained a left groin injury while participating in the play. Due to continued pain, swelling, and suspicion of injury, a magnetic resonance imaging was performed diagnosing a complete tear of proximal adductor longus tendon. Physical examination, strength, and range of motion were recorded until the patient was able to function normally without strength deficit, the range of motion loss, and the return of speed. The player was treated nonoperatively and was eventually allowed to return to play. The time of return to play was 6 weeks. Strength deficit was not appreciated or loss of motion and player was able to return to baseline function. Nonoperative management of complete avulsion injuries of the proximal adductor longus tendon result in faster return to play than operative management even if significant retraction is present.
  5,847 429 -
EDITORIAL
Recent advances in shoulder surgery
Vishal Sahni, Ashish Narang
July-December 2014, 2(2):29-33
DOI:10.4103/2319-2585.145588  
  2,909 2,532 -
REVIEW ARTICLE
Apophyses and physeal equivalents in the pediatric pelvis
Vineet Tyagi, Sarah Milla
January-June 2015, 3(1):4-7
DOI:10.4103/2319-2585.155908  
Injuries to pediatric athletes are becoming increasingly common as children compete in more physically demanding sports. These athletic injuries may be acute or as the result of chronic overuse. Acute trauma may lead to damage to tendons, ligaments, and muscles, as well as their bony attachment sites. Infections such as osteomyelitis must also be considered in the differential of pediatric patients presenting with hip or groin pain. This review will discuss the normal muscular attachments to hip physes and physeal equivalents, as well as common injuries and their management. These findings are important to help with the diagnosis and treatment of pediatric patients who present with hip pain.
  4,972 432 -
ORIGINAL ARTICLES
Correlation of clinical, MRI and arthroscopic findings in diagnosing meniscus and ligament injuries at knee joint: A prospective study
Kamini Gupta, Munish Guleria, Parambir Sandhu, Ritu Galhotra
January-June 2013, 1(1):2-6
DOI:10.4103/2319-2585.117379  
Objective: The purpose of this study was to correlate clinical, MRI, and arthroscopic findings in diagnosing ligament and meniscus tears in knee joint injuries. Materials and Methods: Our study included 20 patients in the age range of 11-60 years who were referred to radiology department for MRI of knee joint following injury to the knee. Prior to MRI, a detailed history, clinical, and local examination was done in all the subjects. MRI was carried out on 1.5 Tesla MR Machine and the standard protocol consisted of fat-suppressed PD (TE 45, TR 2800) in axial, sagittal, and coronal planes, T2W (TE 80, TR 4000) in sagittal plane and T1W (TE 11, TR 495) in sagittal plane. All the patients underwent arthroscopy by an orthopedic surgeon. Results: MR had 100% sensitivity and NPV of diagnosing ACL tears in this study. Clinical examination had sensitivity of 88% and NPV 75% in diagnosing ACL injuries. There was high NPV of MR examination (96%) in diagnosing meniscus tear while the PPV of MR examination was low (71%). These values were low in case of clinical examination. Conclusions: MRI is a useful non-invasive modality having high diagnostic accuracy, sensitivity, and negative predictive value making it a very reliable screening test for diagnosing internal derangements.
  4,306 564 1
Evaluation of percutaneous pinning in unstable proximal humeral fractures: A novel technique
Nishikant Kumar, Sumit Anand, Rishi Raj, Anil Mehtani
July-December 2013, 1(2):33-36
DOI:10.4103/2319-2585.125042  
Management of unstable proximal humeral fractures has remained controversial since ages. Open reduction and internal fixation have resulted in devastating complications like stiffness of shoulder joint, avascular necrosis, infection, etc., We are presenting a novel method of percutaneous pinning of unstable proximal humeral fractures. All cases (32) were done closely without soft tissue stripping. All cases were followed-up for a period of 3 years; and results were assessed according to 100 point constant score. A total of 75% cases showed excellent to good results. To minimize the complications like pin site infection, loosening, neurovascular damage we used fixed pin site insertion technique, and threaded pins in osteoporotic patients. So percutaneous pinning is a safe and novel method of management of unstable proximal humeral fractures if certain principles are borne in mind before using it.
  3,734 508 -
LETTER TO EDITOR
High signal intervertebral disc in T1-weighted magnetic resonance imaging
Amit Agrawal, Kishor V Hegde, Umamaheswara V Reddy, Satish S Kumar, Malleswara G Rao
July-December 2015, 3(2):79-80
DOI:10.4103/2319-2585.158519  
  3,962 274 -
EDITORIAL
Effects of platelet-rich plasma in supraspinatus tendinopathy
Pradeep K Singh, Narendra Kumar Saxena, Sohael Khan
July-December 2015, 3(2):53-54
DOI:10.4103/2319-2585.167981  
  1,338 2,887 -
CASE REPORTS
Simultaneous bilateral isolated greater trochanter fracture
Maruti Kambali, Venugopal Narayanappa, Arun Hedduru Shantappa, Naryan Sreenivas Gudi, Siddhartha Saive, Priyamargavi Hanumantharayappa Kambali, Mohammad Imran
July-December 2013, 1(2):47-50
DOI:10.4103/2319-2585.125048  
A 48-year-old woman sustained simultaneous isolated bilateral greater trochanteric fracture, following a road traffic accident. The patient presented to us 1 month after the injury. She presented with complaints of pain in the left hip and inability to walk. Roentgenograms revealed displaced comminuted bilateral greater trochanter fractures. The fracture of the left greater trochanter was reduced and fixed internally using the tension band wiring technique. The greater trochanter fracture on the right side was asymptomatic and was managed conservatively. The patient regained full range of motion and use of her hips after a postoperative follow-up of 6 months. Isolated fractures of the greater trochanter are unusual injuries. Because of their relative rarity and the unsettled controversy regarding their etiology and pathogenesis, several methods of treatment have been advocated. Furthermore, the reports of this particular type of injury are not plentiful and the average textbook coverage afforded to this entity is limited. In our study we discuss the mechanism of injury and the various treatment options available.
  3,505 237 -
Chloroma (Granulocytic sarcoma): An unusual cause of shoulder pain in chronic myeloid leukemia; a diagnostic dilemma
Sachin Upadhyay, Shyam Ji Rawat, Gourav Gupta, Upasna Saxena
January-June 2014, 2(1):20-23
DOI:10.4103/2319-2585.134206  
At one point or another in their lives, most people will experience some degree of shoulder pain. It may be secondary to a variety of underlying pathology. We report a case of shoulder pain caused by a granulocytic sarcoma (chloroma) in chronic myeloid leukemia (CML) patient misdiagnosed initially as synovitis. Although granulocytic sarcoma has many classic musculoskeletal manifestations, to our knowledge, a case of CML concurrent with chloroma of the shoulder joint has not been reported in the literature. We must not forget that the shoulder pain arising from granulocytic sarcoma may be the initial presenting feature of underlying hematological malignancy such as CML.
  3,298 210 3
LETTER TO EDITOR
Pitfalls in the radiographic diagnosis of the transverse processes fracture of the lumbar vertebrae
Kishor V Hegde, Reddy V Umamaheswara, Amit Agrawal
July-December 2014, 2(2):63-64
DOI:10.4103/2319-2585.145607  
  3,232 196 -
ORIGINAL ARTICLES
Surgical management of congenital idiopathic clubfoot by twin incisions
HS Varma, Alok C Agrawal, Pradeep K Singh
January-June 2013, 1(1):18-21
DOI:10.4103/2319-2585.117383  
Background: Idiopathic clubfoot surgery is known for a number of complications, that is, skin slough and wound dehiscence medially, infection and limitation of full correction at the time of surgery which leads to excessive scar hypertrophy, recurrence of deformity, and a poor functional outcome. Many procedures done in the past have reported complications ranging from 3 to 30%. We are doing surgical correction of congenital idiopathic clubfoot by two incisions avoiding dissection of the medial skin to overcome these problems and are reporting our results. Materials and Methods: We used two incisions (a medial and a posterior incision) in cases with moderate to severe congenital idiopathic clubfoot. These were those cases who did not want to continue with Ponseti's technique so as to avoid repeated follow-ups. Assessment of results was done by comparing preoperative and postoperative Pirani scores. Results: Our results were excellent in 7.9% (6 feet), good in 72.3% (55 feet), and fair in 15.8% (12 feet) cases. All of our cases had primary wound healing and no delayed scar related complication. Conclusions: Two incisions avoid stress on the medial skin. They permit release of all contracted structures posteromedially. We are describing this technique for its simplicity.
  3,013 337 -
CASE REPORTS
Intraosseous ganglion of the talus with extension in the subtalar joint
Pulak Sharma, Ashish Gohiya, Siddharth Jain, Sanjiv Gaur
January-June 2014, 2(1):14-16
DOI:10.4103/2319-2585.134204  
Intraosseous ganglion is a benign bony cyst that mainly involves the epiphysis and metaphysis of long bones. Intraosseous ganglions are rare in talus, and in all the cases reported in literature, the patients had symptoms pertaining to the ankle joint. No case has been reported where the lesion in the talus has caused symptoms specific to the subtalar joint. A 20-year-old female presented to our hospital with pain in the right foot from last 6 months. Ankle joint movements were within normal limits, but the subtalar movement were significantly reduced. Plain radiographs of the foot and ankle were normal. Computed tomography (CT) scan of the foot and ankle showed a cystic lesion (0.5 × 0.5 cm) involving the base of the talar body which communicated with the subtalar joint. The patient was treated by curettage of the lesion through a curvilinear incision over the medial aspect of the subtalar joint. The clinical results after 3 months were excellent. The patient returned to her regular and light recreational activities with full, painless range of motion. There was no recurrence of symptoms at 6 months. Intraosseous ganglion is of talus is a rare entity. Symptomatic patient should be treated surgically.
  3,071 237 -
EDITORIAL
Platelet-rich plasma therapy in orthopedic clinical practice: "Again I ask the gentleman…"
Vijay D Shetty
July-December 2016, 4(2):53-53
DOI:10.4103/2319-2585.193751  
  745 2,281 -
GUEST EDITORIAL
Scope and future of minimal invasive spine surgery
Yue Wai Mun
July-December 2013, 1(2):24-24
DOI:10.4103/2319-2585.125034  
  943 2,044 -
CASE REPORTS
Spontaneously disappearing large herniated lumbar disc fragment
Umamaheswara V. Reddy, Amit Agrawal, Kishor V. Hegde, P. Suneetha, Malleswara G. Rao
January-June 2014, 2(1):26-28
DOI:10.4103/2319-2585.134208  
There are reports of spontaneous regression of large extruded disc; however, the exact underlying mechanism and management of such cases remains controversial. We report a 40-year-old female who opted for conservative management for a large extruded lumbar disc. Follow-up magnetic resonance imaging (MRI) showed complete disappearance of the disc fragment; however, there were degenerative changes in the upper and lower adjacent margins of the vertebral body. Spine surgeons should be aware of spontaneous regression of the disc phenomenon as a patient with a large extruded disc who opted for the conservative management initially can have persistence pain, but there may not be an underlying protruded disc.
  2,749 231 -
ORIGINAL ARTICLES
Is intraarticular administration of tranexamic acid better than its intravenous administration in reducing blood loss after total knee arthroplasty?
Ameet Pispati, Parag Garg, Nikhil Patil, Abhijeet Savedekar, Nitin Jaiswal, Animesh Kumar
July-December 2013, 1(2):28-32
DOI:10.4103/2319-2585.125039  
Context: It has been well-established now that intravenous (IV) tranexamic acid (TXA) is a potent agent to control postoperative blood loss following total knee arthroplasty (TKA). Recently, intraarticular administration of this agent has also shown good efficacy for the same. Aims: Comparison of postoperative blood loss between IV and topical administration of TXA in TKAs. Materials and Design: Eighty-six TKAs on knees were included in this study. Randomization was done so that 40 TKA received 1 g of IV TXA, while 46 had intraarticular administration of 1 g TXA. Subjets and Methods: We compared the postoperative blood loss by calculating the difference in pre- and postop hemoglobin and need for blood transfusion. Functional assessment was done on basis of Western Ontario McMaster Osteo-Arthritis Index (WOMAC) scores and complications like postoperative infection, oozing from the wound site and thromboembolic manifestations. Results: Blood loss was significantly less in the intraarticular administration group as compared to the IV injection group. Total blood loss, blood transfusion group, and drain output was also less but the difference was not significant. The functional assessment (WOMAC) scores were equivocal and so were the complications including thromboembolic manifestations (two cases each of deep vein thrombosis (DVT) and no cases of pulmonary embolism (PE)). Conclusion: Intraarticular administration of TXA to prevent postoperative blood loss in TKA is a safe and effective alternative/adjunct to its IV administration.
  2,585 386 3
CASE REPORTS
A unusual presentation of syringomyelia as neuropathic arthropathy of elbow joint and review of literature
Samir Dwidmuthe, Gajanan Pisulkar, Narendra Saxena, Karan Mane
July-December 2013, 1(2):40-43
DOI:10.4103/2319-2585.125045  
Neuropathic arthropathy (NA) is one of the less understood and challenging condition to treat in clinical practice. Jean Martin Charcot described neuropathic joint in 1868. He has shown occurrence of NA in cases of syringomyelia and tabes dorsalis. Since then NA has been described in various other conditions. Knee and ankle joints are most commonly affected. Occurrence of neuropathic joint in upper extremity is very rare. Elbow is less commonly affected joint. We describe two cases of NA of elbow joint with unusual presentation. One patient presented with 3 month history of elbow injury with gross destruction of elbow joint. Another patient presented with acute swelling of elbow joint mimicking septic arthritis with ulnar nerve involvement. We reviewed literature to discuss etiopathogenesis, clinical presentation, and treatment available for NA of elbow joint.
  2,599 187 -
ORIGINAL ARTICLES
Delayed presentation of fracture of lateral condyle of humerus in pediatric age group treated by ORIF and ulnar peg grafting: A case series
Nishikant Kumar, Anil Mehtani, Chandrashekhar Yadav, Rishi Raj, Sanjay Meena, Nilesh Barwar
January-June 2015, 3(1):12-16
DOI:10.4103/2319-2585.155911  
Background: Fractures of lateral condyle of humerus in pediatric age group, the most common being distal humerus epiphyseal injury, are commonly associated with delayed presentation to terminal health care providers. Reasons accounted might be at every level, right from the patient to the physician. In the backdrop of existing disputed treatment strategy operative v/s non-operative treatment of fractures having more than 3-week duration of injury, same were treated by open reduction and k wire fixation using ulnar peg graft. Final functional result was evaluated with longest follow up of over 1 year. Materials and Methods: Twenty children having fracture of lateral condyle of humerus with duration of trauma more than 3 week were included in the prospective study. Age ranged from 5 years to 15 years. Average age was 8 years. Among the 20 patients, 8 were male and 12 were female. Average time of presentation was after 5 weeks of injury. Seven patients had milch type 1 injury and 13 patients had milch type II injury. All patients were treated by open reduction and internal fixation using k wires and ulnar peg graft. The follow-up period was over 1 year. Result: Results were evaluated using radiograph, and functional results were evaluated using the Liverpool elbow scoring system. In the present series, all fractures united with 92% excellent, 5% good, and 3% poor results. Poor results were associated with greater displacement of fracture, prior repeated attempts of close reduction, and history of massage. Conclusion: Being an epiphyseal injury and a common occurrence, fracture of lateral condyle of humerus in pediatric age group are commonly maltreated, with error contributed right from parents to even physician. Common reasons of delayed presentation are ignorance on parents' side, malpractice by some bone-setters, poorly done radiograph, inaccurate radiographic interpretation by the physician, and poor selection of treatment methods.
  2,402 332 -
Role of bipolar hemiarthroplasty and total hip arthroplasty in unstable intertrochanteric fracture femur
Chandra Prakash Pal, KS Dinkar, Vivek Mittal, Amrit Goyal, Mreetaunjay Singh, Asif Hussain
July-December 2016, 4(2):69-74
DOI:10.4103/2319-2585.193844  
Introduction: Intertrochanteric femur fracture incidence has increased due to increased life expectancy and osteoporosis. Management of these fractures in elderly is challenging due to difficult anatomical reduction, poor bone quality and osteoporosis. Internal fixation in these cases usually involves prolonged bed rest to prevent implant failure which leads higher complication such as deep vein thrombosis, pneumonia pulmonary embolism, bed sores, increased morbidity. Materials and Methods: We have done a prospective study in 18 cases of unstable intertrochanteric fracture where 12 (not associated hip arthritis) patients are operated by bipolar hemiarthroplasty and 6 (associated hip arthritis) patients operated by total hip arthroplasty (THA). Results: Patients were followed for an average of 12 months duration (9-15 months). Patients treated by bipolar hemiarthroplasty group (Group 1) have an average surgery duration of 95 min and blood loss of 315 ml. While patients treated with THA (Group 2) has average surgery duration of 152 min, blood loss of 565 ml. About 91% of 1 st group and 100% of 2 nd group has an excellent to fair outcome. Conclusion: Bipolar hemiarthroplasty for unstable intertrochanteric fracture femur without hip arthritis, and THA for intertrochanteric fracture with hip arthritis in elderly patient results in early ambulation and good functional outcome. However, as our study group is small, so further large randomized trail required before reaching conclusion.
  2,320 391 1
Volar plating in distal end radius fractures and its clinical and radiological outcome as compared to other methods of treatment
Sohael M Khan, Narendra K Saxena, Shraddha K Singhania, Mahendra Gudhe, Sunil Nikose, Mridul Arora, Pradeep K Singh
January-June 2016, 4(1):40-44
DOI:10.4103/2319-2585.180692  
Background: Fracture of the distal end radius constitutes one of the most common skeletal injuries treated by the orthopedic surgeon. Wide arrays of techniques have been described including closed reduction, percutaneous fixation and open methods of reduction, and stabilization. Displaced extra- or intra-articular distal radius fractures require accurate reduction to allow a good outcome. We assessed the outcome of volar plate osteosynthesis and compared its outcome with other methods of treatment to confirm satisfactory reduction and functional outcomes. Materials and Methods: Prospective study conducted in our medical institution between 2012 and 2013. Inclusion criteria included skeletally mature patients who presented to casualty with fractures of the distal radius. Closed reduction cast application/K-wire fixation/open reduction and internal fixation with a volar plate was done under general anesthesia in 60 patients (20 cases each). During the follow-up, radiological and functional parameters were assessed and Gartland and Werley scoring was done. Results: Patients with volar plate fixation had a better outcome than the K-wire fixation and cast application. Radiological parameters were well-maintained, and functional parameters showed a significant improvement during the follow-up period. The complication rate was less and insignificant. 
Conclusion: Primary volar plate fixation of unstable distal radius fracture provides a stable construct that helps in early mobilization, thereby better functional outcomes and minimizes chances of delayed/malunion and, thereby is an upcoming method of choice for fracture distal end of radius. The present study comprised of 60 patients of distal radius fractures in 20 patients treated by plating, 20 by cast application and 20 by K-wire application. The minimum follow-up was 8 weeks, and the maximum was 36 weeks. This study was undertaken to assess the functional outcome of operative management of distal radial fractures and the following conclusions were drawn - male patients predominated female patients (36 males to 24 females) and average age of patients is 46.01 years. Left sided fractures were more common (61.6%). Road traffic accident was the commonest cause of the trauma (73.3%). AO 23 A-2 was the most common type of fracture, accounting for (26.6%) with Associated injuries seen in 4 patients (6.6%). Functional outcome as per Gartland and Werley was 3.75 for plating, 8.6 for cast application, and 7.55 for K-wire fixation. About 90% excellent to good results were observed in plating group as compared to 55% in cast and 65% in K-wire fixation in demerit score. Complication such as irregular articular surface, wrist pain, finger stiffness, K-wire loosening was observed. Thus, based on this study, we conclude that volar plating has relatively better outcome for distal end fractures of radius particularly volar Barton fractures, with minimum chance of loosening of implant even in highly comminuted cases and cases having osteoporosis.
  2,233 354 -
Anatomical reconstruction of unstable trochanteric fractures through posterior approach
Partha Saha, Saankritya Ayan, Utpal Bandyopadhyay, Anindya Sundar Mukhopadhyay, Gautam Bhattyacharyya, Kiran Kumar Mukhopadhyay
July-December 2015, 3(2):55-58
DOI:10.4103/2319-2585.158516  
Objective Unstable intertrochanteric fractures continue to be a challenge for orthopedic surgeons due to the functional limitations it results in the postoperative period. Anatomical reconstruction of the posteromedial fragment becomes difficult through conventional lateral approach, leading to excessive fracture collapse and limping. Materials and Methods: prospective, nonrandomized study was done with 40 patients. They were operated in prone position through posterior approach. Cancellous screws or SS-wires were used to fix the greater or lesser trochanteric fragments and dynamic hip screw (DHS) or dynamic condylar screw (DCS) for the main two fragments. Bone grafts were used to pack cavities at the posterior trochanteric regions. Results: Fracture healing occurred earlier compared to conventional lateral approach without excessive fracture collapse in majority of cases (average time to achieve union was 13.8 weeks; range: 10–18 weeks). Good functional recovery was noted with 75% 'Good' or 'Excellent' Harris Hip Scores at 24 weeks. Conclusion: Anatomical reconstruction of unstable trochanteric fractures becomes easier through posterior approach with earlier and better functional recovery.
  1,715 747 1
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