RESUMEN
BACKGROUND: Intertrochanteric (IT) fracture is one of the most common fractures seen in an orthopaedic practice. Proximal femoral nailing (PFN) is a common modality of fixing IT femur fracture. We retrospectively studied whether a PFN with two proximal lag screws can be done without distal interlocking screws in the 31-A1 and 31-A2 fracture patterns according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) guidelines for IT femur fractures. AIM: To compare the outcomes of IT fractures (AO/OTA 31-A1 and 31-A2) treated by PFN with and without distal interlocking screws. METHODS: We carried out a retrospective study of 140 patients in a tertiary care centre who had AO/OTA type 31-A1 and 31-A2 IT fractures. We divided the patients into two groups, in which one of the groups received distal interlocking screws (group 1) and the other group did not (group 2). The subjects were followed up for a mean period of 14 mo and assessed for radiological union time, fracture site collapse, mechanical stability of implant, and complications associated with the PFN with distal interlocking and without distal interlocking. Then, the results were compared. RESULTS: PFN without distal interlocking screws has several advantages and gives better results over PFN with distal interlocking screws in the AO/OTA 31-A2 fracture pattern. However, similar results were observed in both groups with the fracture pattern AO/OTA 31-A1. In patients with fracture pattern AO/OTA 31-A2 treated by PFN without distal interlocking screws, there were minimal proximal lock-related complications and no risk of distal interlock-related complications. The operative time, IITV radiation time and time to radiological union were reduced. These patients also had better rotational alignment of the proximal femur, and the anatomy of the proximal femur was well maintained. It was also noted that in the cases where distal interlocking was performed, there was a gradual decrease in neck shaft angle, which led to varus collapse and failure of bone-implant construct in 21.40%. CONCLUSION: In fracture pattern AO/OTA 31-A2, PFN without distal interlocking had better results and less complications than PFN with distal interlocking.
RESUMEN
BACKGROUND: Floating knee is a condition resulting from high energy trauma usually associated with minor to life threatening injuries making it challanging to treat There are no studies available in literature describing cross leg sitting and squatting after surgical management of floating knee. This study analyzes prognostic factors, plan of management, functional outcomes (special attention to squatting and cross legged sitting), complications. MATERIALS AND METHODS: 52 patients with floating knee injuries treated over a period of 3 years were included in this study. The study followed an algorithmic approach for the management. Femur fractures were fixed before fixing the tibia according to fracture type that was classified by Fraser classification after the stabilization of patient. The mean followup duration was 21 ± 6 months. The outcome was assessed using Karlstrom criteria after bony union. RESULTS: The study consists of majority (46) of male. Thirty three patients had some types of significantly associated injury. The mean postoperative range of motion of the knee was observed to be 97° ± 27°. Twenty one patients showed excellent results, whereas 17, 8, and 6 patients had good, fair, and poor results, respectively, as per Karlstrom criteria. Knee pain, stiffness, infection, nerve palsy, delayed union, and nonunion were some of the complications observed. Cross legged sitting was possible in 40 patients and squatting in 31. CONCLUSION: The prognosis of floating knee injury is dependent on factors such as type of fracture, soft tissue condition, and management. Excellent outcomes following these injuries can be achieved with individualized plan of management by multidisciplinary team.
RESUMEN
ABSTRACT: The aim of the study was to evaluate results of closed intramedullary nailing using Talwarkar square nails in adult forearm fractures. We prospectively evaluated 34 patients with both bone forearm fractures. The average time to union was 12.8 (SD +3.2) weeks with cast support for a mean of 8.2 weeks. Union was achieved in 31 out of 34 patients. Using the Grace and Eversmann rating system, 17 patients were excellent, 10 were good, and 4 had an acceptable result. Three patients had non-unions, 2 for the radius and one for the ulna. There were two cases of superficial infection, one subject had olecranon bursitis, and one case of radio-ulnar synostosis. Complication rates associated with the use of square nails were lower compared to plate osteosynthesis and locked intramedullary nails. To control rotation postoperatively, there is a need for application of an above-elbow cast after nailing. KEY WORDS: Adult radius-ulna fractures, square nail, closed intramedullary nailing, radius-ulna nailing.
