OBJECTIVE: We hypothesized that the exact time of fixation of paediatric proximal femur fractures will have an effect on the ultimate clinical and radiological outcome. This article aimed to compare the clinical-radiological outcomes in paediatric proximal femur fractures having early and delayed presentation. METHODOLOGY: A prospective cohort study was conducted from January 2019 to November 2022 in patients of age of 5 to 16 years presented with proximal femur fracture and divided into two groups: group A: early presentation, presented <48hours of injury; group B: delayed presentation, presented >48hours of injury. Patients underwent internal fixation treatment modality and followed up to assess clinical outcomes and radiological outcomes, and final outcome was assessed as per Ratliff's criteria. RESULTS: In the study of 44 patients, 72.72% were male, and 27.27% were female, with male-to-female ratio to be 2.6:1. The commonest mode of injury was fall from height accounting for 52.27% followed by road traffic accidents (RTA) in 38.63%. The most common fracture type observed was Delbet type II, which was observed in 43.18%. There was significant shorter duration of surgery in group A (p-value=0.013), VAS score (p=0.045), and limb length discrepancy (p=0.022). Also, there was a statistical difference in AVN (p-value=0.0295) and growth disturbance (p-value=0.0394) between two groups. Also, there was statistically significant difference between Ratliff's criteria two groups (p-value=0.030). CONCLUSION: Early presentation has shorter duration of surgery, less VAS score at final follow-up, and less limb length discrepancy, less development of complications like avascular necrosis of the femoral head, and growth disturbance. LEVEL OF EVIDENCE: III.
Fracture Fixation, Internal , Humans , Child , Male , Female , Prospective Studies , Adolescent , Child, Preschool , Fracture Fixation, Internal/methods , Time-to-Treatment , Treatment Outcome , Time Factors , Femoral Fractures/surgery , Femoral Fractures/diagnostic imaging , Proximal Femoral Fractures
Background: Aneurysmal bone cysts are common osteolytic tumours that have ability to expand and produce pathological fractures. Recurrence is a major issue in such tumours posing a treatment dilemma to clinicians. Injection polidocanol has shown promising results, but the number of injections still remains a topic of debate. Methodology: A prospective interventional study done on 13 patients of biopsy-proven aneurysmal bone cysts. Patient related outcome measures(PROM's) seen using VAS score, SF-12 score and ROM of the involved extremity. Radiologically volume of tumour and cortico-medullary ratio were calculated. All patients received single dose of injection polidocanol and were followed up to 6 months. Results: The mean age of patients was 9.5 years, with slight female predominance. Most cases had Campana grade 1. Mean VAS score improved from 9/10 to 1/10, ROM of the proximal and distal joints of the involved bone improved from 60 % (± 20 %) to 100 %. Mean SF12 score increased from 41 (±7): 47 (±3) to 54 (±2): 58 (±2) at the end of 6 months(p < 0.05).Mean volume of the lesion decreased from 6.30 cc (± 1.30) to 2.86 cc (±1.34) (p < 0.0005) with a reduction of MCR from 4.8 (±0.6) to 3.6 (±0.5) on a similar time span (p < 0.0005) at end of 6 months. 2 patients showed recurrence with none of the patients showing any complication. Conclusion: Single dose of Injection Polidocanol for Aneurysmal Bone Cysts is a unique study, not described in literature before. The smaller lesion in initial staging can be treated effectively with single dose of polidocanol reducing morbidity and treatment cost to the patient. It is as good as giving multiple doses of Polidocanol as per as functionality of the limb is concerned.Also, we propose a new parameter "Medullary-cortical ratio", which is an effective way to assess the improvement and resolution of ABC after administration of Polidocanol.
Purpose: Tibial torsion is important to be factored in during calculations of angular deformities of the lower extremity. Three methods are commonly used, thigh foot angle, measurement of transmalleolar axis with proximal tibia or knee as a reference, and Computerized tomography. The purpose of the current study was to find out the effectiveness of clinical methods and compare CT based method for tibial torsion. Methods: A total of 68 limbs (34 subjects) were included. Tibial torsion was measured using thigh foot angle, transmalleolar axis in relation to knee forward position (Knee ankle axis) and CT based evaluation using Jend method. Results: Pearson correlation coefficient showed strong correlation between CT values and thigh foot angle (r = 0.848) as well as between CT values and Knee ankle axis (r = 0.889). Scatter plots also showed a linear distribution. Conclusion: Both thigh foot angle and Knee ankle axis provide reliable alternative to ionizing CT in measuring tibial torsion.
