Long Term Results of PHILOS Plating and Percutaneous K-Wire Fixation in Proximal Humerus Fractures in The Elderly.

ABSTRACT: This is a report of a study on the long term results of PHILOS plating and percutaneous K-wire fixation in a prospective series of proximal humerus fractures in elderly patients. We reviewed a total of 60 patients with proximal humerus fractures in 30 patients (Group 1), who were treated by open reduction and internal fixation with Proximal Humeral Internal Locking System (PHILOS) plate and 30 patients (Group 2) who were treated with percutaneous K-wire fixation. Functional outcome was assessed using Visual Analogue Scale(VAS) and Constant-Murley Score. Mean Constant-Murley score was 84.6 points (range: 61- 100) in Group 1 and - 76.4 points(range:56-100) in Group 2 at final follow up. Values varied depending upon the fracture type with worst in 4-part fractures. Mean VAS Score was 2.6(range:0-10) in Group 1 and 3.8(range:0-10) in Group 2. We obtained satisfactory results in both the groups, with each procedure having its advantages and shortcomings. We found that PHILOS plate fixation provided stable fixation with minimal implant problems and enabled early range-ofmotion exercises to achieve acceptable functional results. Fixation with percutaneous K-wires presented an efficient treatment option with the advantages of minimal invasiveness and soft tissue dissection. KEY WORDS: Proximal humerus fractures, PHILOS plate and K-wires.

Fracture union in closed interlocking nail in femoral fracture.

INTRODUCTION: Fractures shaft femur is a major cause of morbidity and mortality in patients with lower extremity injuries. The objective of this study was to find out the outcome of Interlocking nail in fracture femur. METHODS: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2008. Seventy eight patients were recruited from Emergency and out patient department having closed fracture of femoral shaft. All patients were operated under general or spinal anesthesia. All patients were followed for nine months. RESULTS: Out of seventy eight patients, sixty nine patients underwent union in 90 to 150 days with a mean of 110.68 days. Touch down weight bearing was started on 2nd post-operative day. Complications found in four patients who had non-union, and five patients had delayed union which was treated with dynamization and bone graft. The results were excellent in 88.46% and good in 6.41% patients. CONCLUSIONS: We concluded that this technique is advantageous because of early mobilization (early weight bearing), less complication with good results and is economical.

STABILIZATION OF THORACOLUMBAR SPINAL INJURIES.

Spinal Cord injury cases are being managed in Base Hospital Delhi Cantt since Oct. 97. 27 cases of thoracolumbar injuries were admitted in this hospital during the period Oct 97 to Aug 99. 20 patients underwent surgical treatment (9 thoracic and 11 lumbar) and 7 were treated conservatively. All these operations were done within 3 weeks following trauma, and methylprednisolone therapy was instituted in those who reached the hospital early. Contraindications to surgery included stable fracture, bed sores, any focus of sepsis and generalized bone disorders. Transpedicular fixation with Dyna-lok system was done in 10 cases, universal spinal system was applied in 6 cases and Harrington instrumentation was carried out in 4 cases. Decompression laminectomy was done in all cases. Patients with incomplete cord injury showed neurological improvement and early rehabilitation was possible after surgery.