Journal of Orthopedic Education

  Ankle fractures are the commonest type of injuries seen in emergency department. The purpose of treatment is to obtain an anatomical reduction and painless ankle after treatment. The aim of this study is to assess functional outcome after surgical treatment of malleolar fractures. Materials and method: This is a prospective study of thirty four patients conducted at tertiary care hospital from Jan 2014 to Dec 2017. Surgical management of malleolar fracture with various methods to restores the articular congruity of joint. Baird and Jackson’s ankle scoring method was used during follow-up. Results: In our study, fourteen cases (41.18%) were in 31-40 years the age group. 24 patients were males (70.59%). 15 (44.12%) cases had supination-external rotation injury. 20 (58.82%) patients had bimalleolar fracture. Medial malleolar fractures were fixed with malleolar screw in 22 cases (73.33 %). Lateral malleolar fractures were fixed with plate in 15 cases (57.69%). Excellent results were found in 16 cases (47.06%). 

Keywords: Functional Outcome; Malleolar Fractures; Ankle.

  Introduction: About 70% of clavicle fractures are in middle third shaft. Traditionally these fractures are treated non-operatively. By closed method it is practically impossible to maintain anatomical reduction and hence certain amount of deformity and disability is expected in adults. We studied functional outcome of displaced middle third clavicle fracture. Methodology: Patients with displaced middle third clavicle fracture were included in study (Robinson’s classificationtype 2B). All patients underwent open reduction and fixation with plate and screws. Patients evaluated for Radiological union and functional outcome (Constant and Murley score). Results: 30 patients included in study (23 male and 7 female). In 26 patients fracture was united by three weeks. Four patients had delayed union. 23 patients (76.7%) had excellent functional outcome. 

Conclusion: Operative fixation of a displaced and comminuted fracture of the clavicle results in excellent functional outcome and a lower rate of malunion and nonunion with decreased immobilization time.

Keywords: Clavicle; Fracture; Plate Fixation; Non Union

  Introduction: Fractures of the clavicle constitute 2.6% of all fractures, account for 44% of the injuries around the shoulder girdle, approximately 70-80% of which occur in the middle third. Even when significantly displaced traditionally these fractures are treated without surgery. Conservative treatments either by sling/figure of 8 bandage/clavicular brace is favored by patients, but the results are much inferior to what reported previously. Present study conducted to operate fresh fracture with displacement >2cm, non-union by ORIF with locking plate with or without bone grafting. Objective is relief from pain, restoration of activities as far as possible & better cosmetic appearance. Material & methods: 28 cases of clavicle in healthy active individuals between 16-65 yrs. of age operated between Dec. 2012 to September 2016 in Hi-Tech Medical College, Rourkela, Odisha. Fracture classified by Allman in to three groups as middle 1/3rd, distal 1/3rd, medial 1/3rd. Indications for surgery either opens, vascular injuries, initial displacement >2cm, nonunion, cosmetically conscious patients. Results: 15 cases of fresh, 6 cases of symptomatic delayed union and 7 cases of nonunion operated with precontoured plate with or without bone grafting. The average hospital stay was 3-7 days. The average time of fracture union was 10 weeks (8-12 weeks). Patients were followed weekly up to 4 weeks and then after 2 and 6 months. The functional outcome according to Constant and Murley score is excellent in 17 patients (60.7%), good in 10 patients (35.7%) and satisfactory in 01 case (3.6%). There was no major complication, 1 patient had superficial infection, deep infection in 1 case, nonunion in 1 case and plate breakage in 1 patient. Results were compared with cases treated conservatively. 

Conclusion: In present era of competition, cosmesis and advancement with least morbidity & excellent results is required. ORIF in selected cases is a very good option in comparison to accept morbidity, cosmetic disfigurement and below average functional results. 

Keywords: Osteosynthesis; Symptomatic; Non-Union; Fracture; Clavicle. 

  Background: Supracondylar and Intercondylar in fractures of distal humerus are one of the common and complex fractures encountered in trauma care with a challenging management in terms of surgical approach as well as attainment of acceptable congruity of joint for proper elbow joint function. The aim of the study was to access the outcome of bicolumnar supracondylar and intercondylar fractures of distal humerus managed by orthogonal plating. Materials and method: This study was carried out under the Department of Orthopaedics, S.R.G. Hospital and Jhalawar Medical College, Jhalawar (Rajasthan). The study comprised of 15 patients 11 males and 4 females (fracture type, c1 - 9 cases, c2 - 4 cases, c3 - 2 cases) of supra and intercondylar fracture of distal humerus treated by orthogonal plating of both medial and lateral column of supracondylar humerus with olecranon osteotomy. all cases intra operative range of the motion was 100%, with appreciable stable fixation. Results: Results were analysed by mayo elbow performance index (MPEI) and Out of 15 patients 9 had excellent outcome, 5 patients had good outcome, 1 case fair results were obtained due to poor bone stock and compliance.

Conclusion: The posterior trans-olecranon approach gives excellent exposure of the distal articular surface of the humerus. Use of bicolumnar orthogonal plating is found to be successful method in obtaining the desired results if performed with expertise.

Keywords: Supra Condylar Intercondylar; Trans Olecranon; Bicolumnar; Orthogonal Plating