Brijbhushan S. Mahajan ¹, Vishal Patil ¹, Yogesh Rathod ¹, Ameya Kulkarni ¹, Nimesh Nebhani ¹, Bhalchandra Prabhakar Bhalerao ¹

Affiliations
1 Department of Orthopaedics, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik – 422003, Maharashtra, IN

Abstract

Background: One of the most common injuries encountered in orthopedic practice are Distal Radius fractures. This comprises of 8%−15% of all fractures in adults¹. The reason for comminuted DER fractures is high-energy trauma in young and low-energytrauma in elderly. They present as shear and impacted fractures involving the articular surface of the distal radius with displacement of the fragments^2-7. External fixation for distal radius fracture relies on the principle of Ligamentotaxisin which, a distraction force applied to the carpus aligns the fragments by means of intact ligaments. The length and alignment of fracture fragment is guided by pull and counter pull which are otherwise difficult to control⁸. Objective: To study functional outcome of distal end radius fracture treated by ligamentotaxis with evaluation of functional results according to Disabilities of the Arm, Shoulder and Hand (DASH) score system. Material and Methods: We included 30 patients (Male 24 and Female 6) treated for distal end radius fracture during a period from 2015 to 2017. Patients were evaluated clinically by subjective assessment using DASH Scoring system. Result: After functional evaluation of patients according to the scheduled follow up with mean DASH Score of 76.08 at 1st month, 62.92 at 3rd month and 42.60 at 6th month, and was found to be Highly Significant (p<0.001) among all the compared groups. Conclusion: We concluded that external fixation and ligamentotaxis applied to complex distal radius fractures, when added with augmented K-wire fixation can provide direct augmentation of fracture stability and a good wrist function.

Keywords

Disabilities of the Arm, Shoulder and Hand (DASH) Score, Ligamentotaxis, Radius Fracture.

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Sandeep Pangavane ¹, Nikhil Challawar ², Ameya Kulkarni ³, Nimesh Nebhani ³, Nitish Agrawal ³, Bhalchandra Bhalerao ³

Affiliations
1 Professor and HOD, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik − 422003, Maharashtra, IN
2 Assistant Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik − 422003, Maharashtra, IN
3 Post-Graduate Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik − 422003, Maharashtra, IN

Abstract

Introduction: Intertrochanteric fractures are one of the most common fractures in elderly population and have a huge impact on the health care system of the society. Objectives: The objective of our study was to compare functional outcome and complication rates of bipolar hemiarthroplasty to dynamic hip screw which is a established procedure for unstable intertrochanteric fracture femur. Materials and Methods: The present study included 50 patients over the age of 55 years, 25 undergoing bipolar hemiarthroplasty and 25 undergoing dynamic hip screw for unstable intertrochanteric fracture femur and their functional outcomes were compared with Harris hip score. Results: We found that the average Harris hip score was better for the bipolar hemiarthroplasty group than for the dynamic hip screw group at 6 months. Conclusion: Bipolar hemiarthroplasty is an effective alternative to dynamic hip screw for unstable intertrochanteric fractures in elderly patients as it has a good function outcome and lower complication rate. A larger randomized control trial has to be conducted to arrive at a conclusion.

Keywords

Dynamic Hip Screw, Primary Bipolar Hemiarthroplasty, Unstable Inter-trochanteric Fractures.

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Nitin Wagh ¹, Brijbhushan Mahajan ², Bhalchandra Prabhakar Bhalerao ³, Nitish Agrawal ³, Nimesh Nebhani ³, Yogesh Rathod ³

Affiliations
1 Associate Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Nashik – 422003, Maharashtra, IN
2 Assistant Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Nashik – 422003, Maharashtra, IN
3 Former PG Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Nashik – 422003, Maharashtra, IN

Abstract

Background: Most commonly reconstructed ligament of knee is Anterior Cruciate Ligament that aims to halt or minimise the number of instability episodes 1. Testing with biomechanical parameters has shown that there is correlation between graft cross-sectional area and maximum load to failure 2. This study attempts to analyse the functional outcome of ACL reconstruction with 5 strands of hamstring autograft. Aims and Objectives: This study is based on hypothesis that larger graft will be stronger, stiffer providing better functional outcome. Materials & Methods: 35 Patients having ACL injury were treated at a tertiary care hospital; using a 5-strand hamstring graft, fixed with suspensory fixation at femoral side and aperture fixation at the tibial side. Cases were diagnosed with ACL on clinical examination & MRI. Tegner-lyshom score and International Knee Documentation Committee - Orthopaedic Scores (IKDC) is used post-operatively to grade the functional outcome of an ACL reconstruction. Results: Male predominance was observed in study subjects than female with left side slightly more commonly involved than right. Laterality didn’t influenced outcome. Graft diameter observed is 9mm in 68.6%, 8 mm and 10 mm was observed in 11.4% and 20% respectively. Lysholm score at baseline was 41.63 which increased progressively to 93.45 at the end of 9 months. The IKDC score at baseline was 32.5 which increased progressively to 83.45 at the end of 12 months. Superficial infections was seen in 8.6% while complaint of knee pain was given by 2.9% cases. Lachman test was positive in 2 (5.7%) cases. Conclusion: Five-strand graft offers very high strength and more length than the 4ST. It is useful in patients with ligamentous laxity, small tendons, or other stability risk factors.

Keywords

ACL, Autograft, Graft Diameter, 5 Strand

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Mukesh Agarwal ¹, Sandeep Pangavane ², Nimesh Nebhani ³, Ameya Kulkarni ³, Nitish Agarwal ³, Yogesh Rathod ³

Affiliations
1 Associate Professor, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN
2 Professor and Head, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN
3 Former PG Resident, Department of Orthopedics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, IN

Abstract

Background: Primary lumbar vertebral instability or “spondylolisthesis” is perhaps one of the commonest radiological sign associated with lumbo-sacral pain after the third decade of life. Aims and Objectives: To find out the functional outcome in terms of clinical improvement in cases of single level lumbar spondylolisthesis by bone grafting and interbody cage fusion and pedicle screw fixation after decompression of neural elements. Materials and Methods: All the patients were evaluated by anteroposterior and lateral radiographs of the lumbosacral spine centered at the appropriate level. In all cases flexion and extension views were taken to assess the instability. More than 4 to 5 mm of sagittal translation and 10 degrees of rotation were considered as instability. All cases were evaluated further by MRI to evaluate facet joint pathology, sacralization/lumbarisation and to find the associated disc changes and the nerve root involvement. All patients were treated by decompression and interbody fusion with cage and bone graft by either Transforaminal or Posterior approach and instrumentation done with pedicle screws. Post operatively all patients were assessed for the functional outcome using the Oswestry Disability Index at 1 month, 3 month and 6 months Results: There is statistically significant difference in ODI Scores (Oswestry Disability Index) post operatively at 1 month, 3 month and 6 months. Conclusion: In agreement with good results, found in our study, we strongly believe that this technique of fusion and instrumentation is very useful in management of lumbar spondylolisthesis. However, this study should further be extended to a wider sample of patients with a longer follow-up.

Keywords

Back Pain, Interbody Cage fusion, ODI Score, Spondylolisthesis

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