Journal of Orthopedic Education

Fragility fractures are lesions due to mechanical stress or trivial trauma which are not ordinarily resulting in fracture. The incidence of osteoporosis increasing day by day and now it is the most common metabolic disorder. Overt or subclinical thyroid dysfunction, renal dysfunction, post-menopausal women, ovarian failure, pregnancy, diabetes, hypertension and heart disease may increase the risk of fragility fractures. Thyroid hormone replacement stimulates calcium absorption and bone maturation, but recovery may be incomplete dependent on the duration and severity of hypothyroidism before treatment. Recent studies have demonstrated that the prevalence of fracture is high even in early stages of chronic kidney disease, including in those with age-associated renal impairment and leads to renal osteodystrophy which subsequently leads to osteoporosis. It’s a case of 36yrs old young pregnant women carrying twin babies of 35weeks 6days primigravida who underwent In Vitro Fertilization due to premature ovarian insufficiency had a history of trivial trauma due to pre-eclampsia induced seizure and sustained right proximal humerus and left acetabulum fracture with ongoing treatment for hypothyroidism and renal osteodystrophy.

Keywords: Fragility; Fractures; Osteodystrophy; Hypothyroidism.

Backgroung: Intercondylar fractures of distal humerus are uncommon injuries and present the most difficult challenge among fractures of lower end of humerus.Distal humerus fractures with intraarticular extension are complex injuries that require meticulous approach for fixation. The principle involves anatomical reduction and absolute fixation with perfect stabilization of extraosseous implants. The functional outcome has been greatly influenced by the early graduated rehabilitative exercise. Aim and Objectives: The Aim of the present study is to evaluate the Functional Outcome of Surgical Management of Intercondylar Fractures of distal humerus in Adults by Open Reduction and Internal Fixation using pre-contoured locking compression plates through trans-olecranon approach. Materials and Methods: Prospective study includes 20 Adult patients with intercondylar fracture of distal humerus admitted to Chigateri General Hospital and Bapuji Hospital attached to J.J.M Medical College, Davangere between the periods September 2016 to September 2018 satisfying inclusion criteria. Results: In this study of 20 cases, there were 10 males and 10 females with average of 50.8 years. 12 cases were due to RTA and 8 due to direct fall. There was a predominance of left side (13). Out of 20 Cases, 3 (15%) were of B1 type, 1 (5%) were of type B2, 6 (30%) were of CI, 5 (25%) of C2 and 5 (25%0 were of type of C3. Excellent results in 12 (60%), good in 4 (20%), fair in 3 (15%).and poor results in 1 (5%) case, according to MEPS. Conclusion: Anatomically pre-shaped distal humerus locking plate system is useful in providing stable fixation for complex distal articular fracture and facilitating early postoperative rehabilitation. Clinical and radiological results show good healing rate with good range of motion. Keywords: Intercondylar; Pre-contoured LCP; Trans-olecranon; Distalhumerus.

Introduction: Fractures of the humeral shaft are common, accounting for approximately 3% of all orthopaedic injuries. With improved and newer implants design and surgical techniques, surgical management of humeral shaft fractures has increasingly become accepted. The purpose of this study is to compare the functional and clinical outcomes of conventional open reduction and internal fixation (ORIF) by posterior plating with minimally invasive plate osteosynthesis (MIPO) done by anterior approach in patients with fractures in humeral shaft. Patients and Methods: In the current prospective-retrospective study, 30 patients with humeral shaft fractures were treated using ORIF (15 patients) or MIPO (15 patients) in our institute & followed up for 12 months. Comparison made between surgical duration, mean blood loss, time of union and complications in these two groups. Also, Mayo Elbow performance indexes (MEPI) and simple shoulder test (SST) questionnaire were used to compare the functional outcomes between the two groups. Results: In our study, for MIPO group, the mean blood loss was 118.67 ± 34.98 ml, while in the ORIF group it was 357.33 ± 51.61 ml. For MIPO group, the mean duration of surgery was 79.33 ± 10.15 min, while in the ORIF group it was 111.00 ± 13.91 min. The mean union time in MIPO was 12.73 ± 1.75 weeks, while in ORIF group it was 15.87 ± 1.88 weeks. The difference was found to be statistically significant (p<0.05), showing a higher mean duration of surgery in the ORIF with posterior plating group. The mean Mayo Elbow Performance Index at the end of 12 month follow up for the MIPO group was 94.67 ± 7.19, while in the ORIF group was 92.33 ± 6.51. The difference was found to be statistically not significant (p>0.05). The mean points for the SST (max 12) for MIPO group and ORIF group were 11.73 ± 0.46 and 11.73 ± 0.59. Conclusions: The MIPO technique provides early union time, to some extent fewer complication rate than open plating and similar functional and clinical outcomes, the authors recommend to use the MIPO technique in treating the humeral shaft fracture.

Keywords: Humeral Shaft; Minimally Invasive Surgical Procedures; Internal Fracture Fixation