Premjit Sujir

Clinical and radiological outcome of percutaneous plating in extra-articular proximal tibia fractures: a prospective study.

BACKGROUND Despite various techniques of fixation, proximal tibia fractures are associated with poor outcome and increased rates of complications. Minimal access and rigid fixation are the keys for optimal outcome in such fractures. Therefore, this study was designed to look for the clinical and radiological outcomes of percutaneous locked plating (PLP) in extra-articular proximal tibia fracture. METHODS Between April 2008 and September 2010, 47 consecutive patients with 49 proximal third extra-articular tibial fractures (29 closed and 20 open injuries) underwent PLP. The patients were followed up at 6 weeks, 3 months, 6 months and 1 year. The union rate and complications of this fixation were evaluated. The clinico-radiological outcomes were assessed at 1 year of surgery. RESULTS Four patients had infection in the postoperative period which needed repeated debridement, gentamycin bead application and prolonged antibiotic therapy. Three of these infective cases ended up with nonunion and needed cancellous bone grafting. All the remaining fractures united. The average time for union was 20 weeks in closed and type I open fracture and 25 weeks in type II and III fractures. No neurovascular injury, hardware failure or loss of fixation was documented till the last follow-up. The mean range of knee joint movement was 119°. The average lower extremity functional score (LEFS) was 59 (74%). There were 10 cases of malunion (20.14%), with six varus/valgus and five procurvatum/recurvatum (one having both sagittal and coronal malunion) angulations. There were no statistical differences between patients with malunion and normal alignment with regard to knee range of motion and LEFS. CONCLUSION Minimally invasive osteosynthesis using PLP in extra-articular proximal tibia fractures showed a promising result with minimal complications.

Ulnar buttress arthroplasty after enbloc resection of a giant cell tumor of the distal ulna

Enbloc resection with or without ulnar stump stabilization is the recommended treatment for giant cell tumors (GCT) of the distal ulna. A few sporadic reports are available where authors have described various procedures to prevent ulnar stump instability and ulnar translation of carpal bones. We report a GCT of the distal ulna in a 43-year-old male which was resected enbloc. The distal radioulnar joint was reconstructed by fixing an iliac crest graft to the distal end of the radius (ulnar buttress arthroplasty) and the ulnar stump was stabilized with extensor carpi ulnaris tenodesis. After a followup at three years, there was no evidence of tumor recurrence or graft resorption; the patient had a normal range of movement of the wrist joint and the functional outcome was excellent as per the score of Ferracini et al.

Bilateral stress fractures of femoral neck in non-athletes: a report of four cases

&NA; Femoral neck stress fractures (FNSFs) are rare, constituting only 5% of all stress fractures in young adults. These fractures are usually seen in athletes, military recruits and patients with underlying metabolic diseases. The treatment of FNSFs is still controversial because of the inherent complications associated with the treatment procedure. We came across 4 cases of bilateral FNSFs in non‐athletic individuals who were manual labourers without underlying bony disorders. Two patients with FNSFs and coxa vara deformity on both sides were managed by subtrochanteric valgus osteotomy and dynamic hip screw fixation. One of the remaining two patients was treated by cannulated cancellous screw fixation on one side and subtrochanteric valgus osteotomy on the other side. The fourth patient received subtrochanteric valgus osteotomy on one side and bipolar hemiarthroplasty on the other side after failed cannulated screw fixation. All the fractures healed without any complications. No evidence of avascular necrosis or arthritis was noted in our series. Subtrochanteric valgus osteotomy restores normal neck‐shaft angle in patients suffering from FNSFs combined with coxa vara deformity. Moreover, it helps to bring the forces acting around the hip to normal biomechanical levels, leading to fracture union and better results. Replacement arthroplasty is recommended to patients who fail to achieve bony union after fixation.

Correlation between the forearm plus little finger length and the femoral length.

Purpose. To assess the correlation between the forearm plus little finger length and the femoral length in 100 volunteers. Methods. The forearm plus little finger length and the ipsilateral femoral length of 68 male and 32 female volunteers aged 19 to 55 (mean, 35.8) years were measured using a measuring tape. The forearm plus litter finger length was measured from the tip of the olecranon to the tip of the little finger, whereas the femoral length was measured from the tip of the greater trochanter to the level of proximal pole of the patella over the outer aspect of thigh. Two observers made the measurements on 2 separate occasions. Intra- and inter-observer variations were calculated. A value of ≥0.75 indicated excellent agreement. Results. The mean forearm plus little finger length and femoral length were 39.87 (SD, 2.73) and 39.85 (SD, 2.44) cm, respectively. The mean difference between these 2 measurements was 0.028 (95% CI, −0.109 to 0.165) cm. The correlation between these 2 measurements was 0.861 (p<0.001). Patient age, sex, and body mass index did not affect this correlation. The intra- and inter-observer reliability was excellent. Conclusion. The forearm plus little finger length correlated with the femoral length. This method is simple, radiation-free, and can be applied in day-today practice.