Comparative Study between the Precontoured Anatomical Locking Plate and Clavicle Brace for Displaced Mid-Shaft Clavicle Fractures.

BACKGROUND: Most of the midshaft clavicle fractures heal conservatively without further complications with union rate of 94 to 99.7%. Several recent studies recommend surgery for displaced midshaft fracture, to reduce risk of non-union malunion and clavicle shortening. So there is still dilemma for the optimal treatment for displaced midshaft clavicle fracture. METHODS: This was the prospective comparative study performed in Civil Service Hospital, Nepal. Patients were divided into the two groups each containing 40 patients and were treated with figure of eight brace for group 1while group 2 patients were treated surgically. RESULTS: Mean time to unite the fracture was 11.87±1.78 versus 11.55±1.46 weeks (P value 0.37). There were 14 (35%) cases of malunion more than 10 degree in group 1 and 1 (2.5%) malunion in group 2 (P value 0.001). Twenty nine (72.5%) patients in group 1 and 35 (87.5%) in group 2 were fully satisfied one year after treatment Constant and Murley score in group 1 were 75.22±2.85, 90.87±3.39 and 96.30±1.80 at the time of fracture union, six month and one year after surgery while that score in group 2 were 81.67±2.86, 93.87±2.17, 98.20±1.20 respectively ( P value <0.001). CONCLUSIONS: There is higher incidence of nonunion, symptomatic malunion and inferior perception of satisfaction in conservatively treated patients. Functional outcomes are comparable one year after surgery, however it is significantly better in operative group before that.

Bilateral Simultaneous Total Knee Arthroplasty in Elderly Patients with Severe Osteoarthritis of Knee Joint in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Total knee arthroplasty is one of the most successful orthopedic surgeries performed in recent decades. However, there are controversies regarding the simultaneous or staged bilateral total knee arthroplasty. The aim of this study is to find the prevalence of bilateral total knee arthroplasty in elderly patients among severe osteoarthritis of knee joints in a tertiary care hospital. METHODS: This is a descriptive cross-sectional study conducted from hospital records of 2015 to 2019 in elderly patients with severe osteoarthritis in a Tertiary Care Hospital. Ethical clearance (20/2020) was taken from Institutional Review Board. Convenience sampling was used and statistical analyses were performed using the Statistical Package for the Social Sciences software (version 16.0). Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 1200 patients with severe osteoarthritis, the prevalence of bilateral total knee arthroplasty was found to be 80 (6.67%) (95% Confidence Interval = 6.60-6.74). The mean Knee Society Score was 36±3.70 preoperatively. There were 21 (26.2%) patients having hypertension, 17 (21.2%) diabetes mellitus, 14 (17.5%) chronic obstructive pulmonary disease and 7 (8.7%) coronary artery disease. CONCLUSIONS: Bilateral simultaneous total knee arthroplasty was required in less patients with severe osteoarthritis of knee joints. Bilateral simultaneous total knee arthroplasty is safe, convenient, effective with early functional recovery, higher patient satisfaction and cost effective with acceptable cardiac, pulmonary and neurological complications in properly selected patients.

Multiply Broken Metallic Hardware Removal for United Patella Fracture Applied Twenty Years Before: A Case Report.

Breakage of tension band wires, used to treat the patella fracture, is not uncommon several years after the fracture fixation. Broken wires may migrate to surrounding neurovascular structures, other vital organs like heart and may cause potentially fatal complications. Once the wires have been broken, it is very difficult to remove the broken pieces of metal wires. We report a 50 years old male patient with broken tension band wires at multiple sites for patella fracture. The broken wires were removed 20 years after the initial surgery without any undue complications, however patient sustained significant soft tissue damage to remove all the pieces of broken wires that would otherwise have been removed without any undue complications immediately after fracture union.