Comparison of Fixation Techniques in Young Patients with Fracture Neck of Femur: Multiple Hip Screws with Fibular Graft or Multiple Hip Screws Alone.

Background: Fracture neck of femur occurs infrequently in young patients compared to geriatric age groups. The occurrence in the younger age group is associated with high-energy trauma and more complications. The study was conducted to compare the results of two fixation techniques in management of fracture neck of femur in young age group patients. Methods: A total of 60 patients included in this prospective randomized trial were divided into two groups. Group I includes patients managed by multiple hip screws with fibular graft and group II includes patients managed by multiple hip screws alone. Assessment of fixation was done on basis of Harris Hip score at 6 week and 3 monthly intervals. Results: According to Garden's classification, a total of 40 (66.67%) cases were of type III, out of which 24 patients were in group I and 16 were in group II. The rest 20 (33.33%) patients were of type IV with 6 cases ingroup I and 14 cases in group II. In our study, functional outcome was calculated according to Harris hip score. In Group I we got 21 patients (70%) with excellent result, 7 patients (23.33%) with good result and 2 patients were failure cases. In Group II 17 patients (56.67%) got excellent outcome, 9 patients (30%) good outcome and 4 were failure cases.Conclusion: The study showed that there was no significant difference in any of the procedures and either of the technique could be employed depending on user experience and skills.

Leeds procedure--a treatment modality for scoliosis.

The present study comprises of forty patients of scoliosis in growing age group (10-25 years) with Cobbs angles ranging from 52"-98". They were treated with Leeds procedure which is by anterior loosening followed by Posterior Harrington fixation + Luque derotation + Fusion and Costoplasty. Majority of the curves were thoracic (60%), and right sided (72%). Average correction of the deformity after surgery was 45%. Satisfaction level of patients and parents was good in 60% of the cases. The modality of treatment was decided on the basis of personality of each case, its demand and requirement, time of presentation and the potential for increasing severity. Anterior spinal surgery for scoliosis is an effective procedure in hands of experienced surgeons and it reduces stiffness of the curve, shorten the anterior column, decreases thoracic lordosis which leads to some improvement of pulmonary function. But there is greater risk of damage to vital structures with higher risks of cardiorespiratory failure. The potential risks have to be balanced with the expected rewards. The optimum method of correction has to be decided by careful preoperative evaluation. Combined procedure of anterior and posterior surgery causes lesser decrease in pulmonary functions than costoplasty alone, and achieving better cosmetic correction. This study reaffirms the role of anterior spinal surgery in India as the patients due to lower levels of health awareness present late and with severe deformities.

Cubitus varus--correction by distraction osteogenesis.

Cubitus varus deformity in thirty children was corrected by gradual medial opening wedge osteotomy. The osteotomy was stabilized and distracted by simple external fixator-cum-distractor. The patients of both sexes and age from 6 to 14 years, had varus deformity from 17 degrees to 43 degrees. We achieved good to excellent results in 28 cases as regards to correction of deformity and range of motion at elbow joint. None of the cases had neurological deficit or permanent stiffness. One case had fair result due to under-correction and another case had a poor result as osteotomy united before correction. The main complication faced was superficial pin-site infection particularly in summer season and a in fatty children but was managed by good pinsite dressing and care. The technique has been found to be quite effective, technically simple, cosmetically acceptable and with little, if any, lazy S deformity.

Functional restoration by excision arthroplasty in temporomandibular joint ankylosis--a report of 35 cases.

OBJECTIVE: To evaluate the long term functional results of excision arthroplasty in treatment of temporomandibular joint (TMJ) ankylosis. MATERIAL AND METHODS: This retrospective study includes 35 patients of TMJ ankylosis who were treated by excision arthroplasty and followed for a maximum period of eight years after surgery. Past trauma was documented as a major etiological factor in 63% cases. Fibrous ankylosis & unilateral involvement was found to be more common. Peroperatively a gap of 1 1/2 to 2 cm was created. The results were assessed according to a criteria based on inter-incial month opening, deviation of jaw and complications. They were satisfactory in 29 cases and there were 3 recurrences. CONCLUSION: Childhood trauma is a major cause of TMJ ankylosis in India. Long term results of excision arthroplasty are satisfactory & comparable to other surgical modalities that are in vogue, provided the patients are operated when young, the ankylosis is in early stage, gap created is adequate and post operative exercise regimen is followed diligently.

Role of percutaneous bone marrow grafting in delayed unions, non-unions and poor regenerates.

The present study comprises of 72 patients of post traumatic delayed unions, established non-unions, poor regenerate in segmental bone transportation and limb lengthening procedure treated by percutaneous injections of autogenous bone marrow at the site of failed healing. The average follow up was 4 years. Bone union was achieved in 68 patients. Overall, 72.2% of the patients had an excellent result, 11.1% a good result, 11.1% a fair result and 5.5% a poor result or failure. These results with only 4 failures (5.5%) are encouraging and suggest that percutaneous autogenous bone marrow grafting is a simple, safe and useful technique in the treatment of delayed unions and non-unions. We believe that this technique of percutaneous autogenous bone marrow grafting can be a procedure of choice in those patients where Phemister or Forbes methods of bone grafting alone is required, especially in limbs with scarred and poor soft tissue coverage. This procedure can also be useful in iatrogenic delayed or non-unions which is the commonest cause of non-union in present era of enthusiastic fracture fixation.

Isolated traumatic rupture of the adductor longus muscle.

A rare case of traumatic rupture of Adductor longus muscle in a young Kabaddi player is presented. Excision of ruptured muscle mass was done. Maximum follow-up at eighteen months showed no disability.

Treatment of intractable spasticity in spinal cord injured patients.

Spasticity and flexor spasms can be most incapacitating in SCI victims. Muscle relaxants, physiotherapy and elimination of triggering factors must be tried before opting for peripheral surgery or alcohol block. The choice of alcohol block or peripheral surgery depends in whether damage to the spinal cord is complete or incomplete. Results of both the procedures are satisfactory in rightly chosen patients. Alcohol block is a simple, safe and effective method of treating spasticity in the patients of complete paraplegia. The effect is immediate and almost permanent. However, alcohol block is contra-indicated in the patients of incomplete paraplegia where peripheral surgery is a better choice.

Myositis ossificans in tetanus. A rare complication.

Myositis ossificans developing as a complication of tetanus is very rare. There are only nine cases reported so far. We report here a case of a young female who developed myositis ossificans in both the elbow joints as a complication of severe tetanus.