Results of treatment of distal extra: articular femur fractures with locking plates using minimally invasive approach--experience with 25 consecutive geriatric patients.

PURPOSE: Fractures involving the femur in older adults are reasonably common. The aim of this study was to evaluate the results of MIPO technique using locking plates in geriatric patients for distal extra-articular femur fractures. METHODS: About 25 consecutive patients with distal extra-articular femur fractures aged 60 years and above were treated using locking plates and minimally invasive technique. Patients were studied prospectively over a period of 3 years. Parameters studied included patient demographics, fracture type, time taken for the surgery, time to union and any complications. RESULTS: Mean age of patients was 66.5 years. Nineteen (76%) patients were females. Most of fractures in our study were type 33A2 fractures (64%). Average time to full weight bearing was 14.32 weeks, and fractures united at an average of 16.88 weeks. There were two (8%) patients with superficial infection, two (8%) with implant tenderness. One (4%) patient developed knee stiffness. Five (20%) patients had extension lag of average 5°. One (4%) patient sustained a peri-implant fracture at 2 months. None of the patients developed non-union or delayed union. According to criteria laid by Schatzker's and Lambert, excellent results were achieved in 22 (88%) patients. CONCLUSIONS: Outcome of minimally invasive fixation of distal extra-articular femur fractures with locking plates in patients of age 60 years and above seems to be good with high union rate despite high prevalence of osteoporosis and comminution.

Injuries from leopard attacks in Kashmir.

Increased incidence of wild-animal attacks has made these a serious threat to public health in Kashmir. To establish patterns of injury and management, 35 case histories were reviewed. After resuscitation, of paramount importance were vigorous irrigation, removal of all foreign material, administration of antibiotics, and prophylaxis against rabies and tetanus as indicated. A multidisciplinary approach and aggressive management are necessary to prevent death and provide acceptable cosmetic and functional results.

Comparison of Injury Pattern in Victims of Bear (Ursus thibetanus) and Leopard (Panthera pardus) Attacks. A Study from a Tertiary Care Center in Kashmir.

INTRODUCTION: Patients injured in bear and leopard attacks present with different patterns of injuries and have different mortality rates. A common protocol may not be suitable for the management of injuries inflicted by these two large wild animals. MATERIALS AND METHODS: A retrospective study was conducted by the Department of Orthopedics, Government Medical College Srinagar (India) to compare the injury patterns among victims of bear and leopard attacks. RESULTS: One hundred and fifty-five cases with 120 (77.4%) bear and 35 (22.5%) leopard attacks were recorded over a period of 43 months. Eighty-six males and 34 females including two children were injured in bear attacks. Eleven males and 24 females including 13 children were attacked by leopards. The leopard attacks were usually fatal (48.5%), whereas the bear attacks were mostly nonfatal in nature (1.6%). The patients had a combination of injuries affecting multiple parts of the body. Injuries of the cervical spine, cervical cord, major vessels of neck, pharynx and eye were striking observations in leopard attacks. Fractures of the upper limb, facial and skull bones were common in the victims of bear attacks. The survivors were treated as per advanced life trauma support, with an average follow-up of 24.5 months (5-42 months). CONCLUSION: Wild animals usually attack in remote areas, where composite trauma centers do not exist, and the urgent referrals of these patients will have a significant impact on the final outcome. The management of these patients requires a team approach involving all of the subspecialties of traumatology.

Delayed fixation of displaced femoral neck fractures in younger adults.

We report the results of 52 patients aged 20-55 years with displaced femoral neck fractures, in whom delayed closed reduction and internal fixation was performed. Seven patients developed avascular necrosis (AVN) and non-union was seen in five patients. Whereas most patients with non-union were subjected to repeat procedures, none of the patients with AVN required surgery. The follow-up averaged 40 months (range 22-64 months). Three patients were lost to follow-up. Functional outcome was defined by Judet's system. Good to excellent functional outcome was achieved in 45 cases. The study demonstrated that delayed closed reduction and internal fixation of displaced fractures in young adults which, we believe, is the prevalent form of treatment of these injuries in the developing world results in high rate of fracture union and good functional outcome. The rate of AVN, however, may be a concern if the patients are followed for a longer period.

Acute invaginating docking for infected non-unions of the humerus.

PURPOSE: To assess the efficacy of acute invaginating docking for infected non-unions of the humerus. METHODS: Eight men and 3 women aged 17 to 59 years with infected non-unions of the humerus underwent acute invaginating docking with shortening and Ilizarov fixation. RESULTS: The mean shortening was 2.9 cm owing to additional debridement. The mean time to external fixator removal was 14.9 (range, 8-28) weeks. The final bone result was excellent in 1, good in 8, and fair in 2. The functional result was excellent in 7 and good in 4. CONCLUSION: This modality enables simultaneous treatment of infected non-unions, axial alignment, vascularity, stability, and function.