A COMPARATIVE STUDY OF PLATE OSTEOSYNTHESIS VERSUS LOCKED INTRAMEDULLARY NAILING IN DIAPHYSEAL HUMERUS FRACTURE IN ADULTS

2021 ◽  
pp. 64-66
Author(s):  
Ravindra Prasad ◽  
L B Manjhi
Keyword(s):  
Functional Outcome ◽  
Intramedullary Nailing ◽  
Plate Osteosynthesis ◽  
Randomized Study ◽  
Humerus Fracture ◽  
Treatment Modalities ◽  
Diaphyseal Fracture ◽  
Early Return ◽  
Increased Risk ◽  
Radiological Union

Introduction: Nonoperative treatment of fracture of humeral diaphysis generally has provided acceptable results. However, to achieve faster union and early return to preinjury state along with preserving functionality and motion of adjacent joints, operative management is preferable. Various choices of internal xation for managing these fractures exist. However, the preferred method of internal xation for these fractures remains debatable. to compare the clinical, radiological, functional outcome Aim: of plate Osteosynthesis versus intramedullary nailing in management of diaphyseal humerus fracture in adults. a prospective, randomized study Method: including 49 patients with diaphyseal fracture of humerus randomized into two groups in which one group (n=29) was treated with internal xation with plate Osteosynthesis while the other group (n=20) was treated with antegrade intramedullary nailing. Parameters examined included shoulder and elbow range of motion and evidence of clinical and radiological union along with presence of any complication. Mean a Result: ge of the patients in the Plating group was 44.3 years while in the Nailing group, it was 42.9 years. Mean time to radiological union in the plating was 17.6 weeks compared to 15.7 weeks in the nailing group. Non union was seen in 6.8% of patients with plating as compared to 10% in patients treated with nail. Mean ASES score for plating group was 81.6 while for the nailing group it was 76.3. Conclusion: For diaphyseal fracture of humerus in adults, both the treatment modalities i.e. antegrade intramedullary nailing and internal xation with plating are almost similar with regard to functional outcome and union rate. Antegrade Intramedullary nailing has better rate of union but is associated with signicantly increased risk of shoulder complications which may adversely affect outcome. Plating isour treatment modality of choice for managing these fractures in view of minimal complications with optimal outcome.

scholarly journals Fixation of proximal humerus fracture in adult by locking plate: Clinical study

2020 ◽  
Vol 6 (5) ◽  
pp. 325-332
Author(s):  
Dr. Vivek Amritbhai Patel ◽  
◽  
Dr. Vishal A. Pushkarna ◽  
Dr. Dhruvin J. Patel ◽  
◽  
...  
Keyword(s):  
Functional Outcome ◽  
Proximal Humerus Fracture ◽  
Locking Plate ◽  
Proximal Humerus ◽  
Plate Fixation ◽  
Humeral Fracture ◽  
Humerus Fracture ◽  
Functional Evaluation ◽  
Locking Plates ◽  
Radiological Union

p>Aim: The present study aimed to examine the functional outcome of the locking plate in theproximal humerus fracture treatment. Material and Methods: The study consists of 20 patientsdiagnosed with NEER’s 2 – part, 3- part, and 4 – part proximal humerus fracture. All the includedpatients were treated with internal locking plates. Based on the functional evaluation by Constant-Murley shoulder score and the assessment of radiological union foundation. Results: Excellentresults were obtained in 45% of the patients, a good result was seen in 25%, 20% of the patientshad fair results and the poor result was seen in 10% of the patients. The mean Constant-Murleyshoulder score that was obtained in the present study was 75.04. Conclusion: It’s concluded thatthere is a satisfactory functional outcome with the fixation of the proximal humerus fracture withlocking plates. While using the plate fixation for fracture the plate position is of the utmostimportance. Due to angular stability, the locking plates are the advantageous implants in case ofproximal humeral fracture.

scholarly journals Functional outcome evaluation of distal humerus fracture fixation

2020 ◽  
Vol 6 (3) ◽  
pp. 467
Author(s):  
Boddu Sunil ◽  
Sandeep Krishna Avulapati ◽  
Suraj Kumar Choudhary ◽  
Susmitha Koneru
Keyword(s):  
Functional Outcome ◽  
Locking Plate ◽  
Distal Humerus ◽  
Outcome Evaluation ◽  
Humerus Fracture ◽  
Treatment Modalities ◽  
Research Centre ◽  
Distal Humerus Fracture ◽  
Humerus Fractures ◽  
Distal Humerus Fractures

<p class="abstract"><strong>Background:</strong> Distal humerus fracture are complex, difficult to reduce and fix, cumbersome post-operative mobilization, and yet functional outcome is doubtful. Though various treatment modalities available for past many decades ranging from conservative management, K wire fixation to plate and screws, but still treatment remains difficult. The objective of the study was to assess functional outcome of operative fixation of distal humerus with locking plate and screws.</p><p class="abstract"><strong>Methods:</strong> Prospective study was done in during November 2015 to June 2016 in Vydehi Institute of Medical Sciences and Research Centre, Bengaluru. Patients with distal humerus fractures who were admitted into hospital for operative treatment after fulfilling inclusion and exclusion criteria were included into study. They were followed up to 6 months post-operatively. Functional outcome evaluation was done with Mayo’s elbow performance score.<strong></strong></p><p class="abstract"><strong>Results:</strong> 30 patients were included into study with full data. We had excellent, good, fair and poor outcome in 17, 8, 3, 2 patients respectively. Except for infection in one, elbow stiffness in two and non-union in two patients, we had no other complications.</p><p class="abstract"><strong>Conclusions:</strong> Management of distal humerus fractures with preoperative evaluation, pre-operative planning, use of locking plate and screws, early mobilization can result in good functional outcome.</p>

scholarly journals Evaluation of Results of Closed Reamed Nailing for Diaphyseal Fracture of the Tibia-Experience of 35 cases

2019 ◽  
Vol 32 (1) ◽  
pp. 9-16
Author(s):  
Md Habibul Hasan ◽  
Mohd Alamgir Hossain ◽  
Md Enamul Haque ◽  
Md Ahsanuzaman ◽  
Elora Parveen ◽  
...  
Keyword(s):  
Open Fracture ◽  
Full Range ◽  
Shaft Fracture ◽  
Treatment Modalities ◽  
Soft Tissue Coverage ◽  
Tibial Shaft Fracture ◽  
Diaphyseal Fracture ◽  
Primary Surgery ◽  
Early Return ◽  
Image Intensification

Introduction: Tibia is a subcutaneous bone and is more prone to trauma. Different treatment modalities exist for fracture shaft of the tibia. Intramedullary nailing in the treatment of fractures of the long bones was technically developed and popularized by Küntscher in the 1940’s. Treatment of tibial fracture in adult is a challenge to orthopedic surgeons due to poor soft tissue coverage and blood supply. Materials and methods: This study was prospective and interventional. This study was carried out in the private hospitals in Rajshahi over a period of 3 years. Total 35 patients with tibial shaft fracture were studied. Inclusion criteria were displaced closed diaphyseal fracture shaft of the Tibia, open fracture with Gustillo 1, 2 and 3A attended within 24 hours. Exclusion criteria were patient’s age below 16 years, grossly lacerated fracture, undisplaced fracture, patient unwilling to operate. Thirty three cases were operated within one week only two cases operated at 2 months due to angulations following conservative treatment. Open fracture was fixed within 24-48 hours. Broad spectrum antibiotic injectable Moxifloxacin was used in most of the cases for 2 doses then oral, Injectable Meropenem was used for the open fracture. Those patients suffering from G-3A fracture wound were covered by Hemisoleal flap Two weeks after primary surgery and were uneventful. In most of the cases image intensification was not used only three cases needed image intensification in case the fractures in lower ¼ th of the shaft to see the end of the Nail. Results: Two patients developed postoperative superficial wound infection which was recovered by regular dressing. Only one patient needed post-operative cast support because the fracture was comminuted. All patients started Knee bending from first post-operative day. Full range of knee movement was found in all patients. All fracture united properly within 12 weeks to 22 weeks with mean of 17 weeks. No cases of implant failure detected during the study period. Conclusion: The results of the current study reveal that the reamed interlocking nail in treatment of tibial diaphyseal fracture is safe, easy, successful and preferable method may be recommended as a stable fixation with early return to daily activities. TAJ 2019; 32(1): 9-16

scholarly journals Intramedullary nailing versus plating in shaft humerus fractures: a prospective randomized study

2017 ◽  
Vol 3 (3) ◽  
pp. 578
Author(s):  
Nachiket Kailash Pansey ◽  
Gaurav Mahesh Sharma ◽  
Lokesh Gudda Naik ◽  
Krishna Sudhakar Badgire ◽  
Faisal Qureshi ◽  
...  
Keyword(s):  
Intramedullary Nailing ◽  
Road Traffic ◽  
Plate Osteosynthesis ◽  
Dynamic Compression ◽  
Fracture Pattern ◽  
Common Mechanism ◽  
Diaphyseal Fracture ◽  
Non Union ◽  
The Mean ◽  
Fracture Humerus

<p>Introduction- The two most commonly used modalities of internal fixation in fracture shaft of humerus are Plate osteosynthesis and Intramedullary nailing. The present study aims to analyze and compare both the techniques in terms of functional and radiological outcome. Material and Methods- 43 patients with diaphyseal fracture humerus were treated with Intramedullary nailing and plating between March 2015 and March 2016. The inclusion criteria were patients with closed diaphyseal fracture humerus. Compound fractures, pathological fractures, Non-union, mal-union fractures were excluded from the study. Results- 22 (51.2%) cases were operated using the antegrade nailing technique whereas dynamic compression plating was done in 21 (48.8%) cases. The mean age was 42±4.2 years. Road traffic accident was the most common mechanism of injury with 29 (67.5%) cases. 12-A2 type of fracture pattern were most common involving 23 (53.5%) cases. The mean surgical time was 68 mins in cases where nailing was done and 115 mins in cases with plating (P&lt;0.001). Radiological union was seen at 13±4.8 weeks and 15±3.9 weeks in the nailing and plating group respectively. There were 2 (9.09%) cases in the nailing group and 1 (4.7%) case in the plating group which had delayed union. 3 (13.6%) cases in the nailing group had post-operative shoulder stiffness. The mean ASES score at the end of one year was 31.3 in nailing and</p><p class="abstract"><strong>Background:</strong> <span lang="EN-IN">The two most commonly used modalities of internal fixation in fracture shaft of humerus are plate osteosynthesis and intramedullary nailing. The present study aims to analyze and compare both the techniques in terms of functional and radiological outcome.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">43 patients with diaphyseal fracture humerus were treated with Intramedullary nailing and plating between March 2015 and March 2016. The inclusion criteria were patients with closed diaphyseal fracture humerus. Compound fractures, pathological fractures, non-union, mal-union fractures were excluded from the study</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">22 (51.2%) cases were operated using the antegrade nailing technique whereas dynamic compression plating was done in 21 (48.8%) cases. The mean age was 42±4.2 years. Road traffic accident was the most common mechanism of injury with 29 (67.5%) cases. 12 A2 type of fracture pattern were most common involving 23 (53.5%) cases. The mean surgical time was 68 minutes in cases where nailing was done and 115 minutes in cases with plating (P &lt;0.001). Radiological union was seen at 13±4.8 weeks and 15±3.9 weeks in the nailing and plating group respectively. There were 2 (9.09%) cases in the nailing group and 1 (4.7%) case in the plating group which had delayed union. 3 (13.6%) cases in the nailing group had post-operative shoulder stiffness. The mean ASES score at the end of one year was 31.3 in nailing and 29.6 in plating group (P =0.327). There were 37 (86.5%) cases with excellent to good results. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Nailing and plating have equal functional outcomes in cases with shaft humerus fracture.</span></p><p>29.6 in plating group (P=0.327). There were 37 (86.5%) cases with excellent to good results. Conclusion- Nailing and plating have equal functional outcomes in cases with shaft humerus fracture.</p>

scholarly journals Current Trends and Characteristics of Hepatocellular Carcinoma in Patients with Autoimmune Liver Diseases

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1023
Author(s):  
Eirini I. Rigopoulou ◽  
George N. Dalekos
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Liver Diseases ◽  
Treatment Modalities ◽  
Primary Biliary Cholangitis ◽  
Autoimmune Liver Diseases ◽  
Increased Risk ◽  
Liver Cancers ◽  
Medium Risk ◽  
Causes Of Mortality

Hepatocellular carcinoma (HCC), the commonest among liver cancers, is one of the leading causes of mortality among malignancies worldwide. Several reports demonstrate autoimmune liver diseases (AILDs), including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) to confer increased risk of hepatobiliary malignancies, albeit at lower frequencies compared to other liver diseases. Several parameters have been recognized as risk factors for HCC development in AIH and PBC, including demographics such as older age and male sex, clinical features, the most decisive being cirrhosis and other co-existing factors, such as alcohol consumption. Moreover, biochemical activity and treatment response have been increasingly recognized as prognostic factors for HCC development in AIH and PBC. As available treatment modalities are effective only when HCC diagnosis is established early, surveillance has been proven essential for HCC prognosis. Considering that the risk for HCC is not uniform between and within disease groups, refinement of screening strategies according to prevailing demographic, clinical, and molecular risk factors is mandated in AILDs patients, as personalized HCC risk prediction will offer significant advantage in patients at high and/or medium risk. Furthermore, future investigations should draw attention to whether modification of immunosuppression could benefit AIH patients after HCC diagnosis.

Abstract 3438: Intracranial Arterial Occlusion and Extent of Hypoattenuation on CT Angiography Source Images may Modify the Benefit of Thrombolysis

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Imanuel Dzialowski ◽  
Volker Puetz ◽  
Jasmin Renger ◽  
Andrei Khomenko ◽  
Ulf Bodechtel ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Ct Angiography ◽  
Time Window ◽  
Brain Infarction ◽  
Randomized Study ◽  
Arterial Occlusion ◽  
Extended Time ◽  
Anterior Circulation ◽  
Nihss Score ◽  
Mca Occlusion

Background: CT angiography source images (CTASI) improve diagnostic accuracy for ischemic brain infarction compared to non-contrast CT (NCCT). We studied whether CTASI alone or combined with the CTA occlusion status may improve patient selection for thrombolysis in an extended time window. Methods: We prospectively observed patients presenting with anterior circulation ischemic stroke within 12 hours from symptom onset and an NIHSS score ≥ 3. All patients underwent cranial NCCT and CTA. Patients were treated with intravenous and/or intra-arterial thrombolysis at the discretion of the treating stroke neurologist and neuroloradiologist. We determined intracranial occlusion status and applied the Alberta Stroke Program Early CT Score (ASPECTS) to CTASI. Primary clinical outcome measure was independent outcome at 3 months, defined as mRS scores 0-2. We calculated unadjusted risk ratios to assess the effect of thrombolysis on functional outcome in patients with: 1) minor ischemic changes on CTASI (CTASI-ASPECTS >5) and 2) patients with minor ischemic changes on CTASI and middle cerebral artery (MCA) occlusion. Results: We enrolled 102 patients with a mean age of 71 +/- 12 years, median onset-to-CTA time of 112,5 (range 37-898) min, a median NIHSS score of 9.5 (3-39), and a median CTASI-ASPECTS of 8. Sixty-two patients (61%) received any thrombolysis (56 IV, 5 IV/IA, 1 IA). MCA occlusion was present in 57 patients (56%), 80/101 (80%) assessable patients had a CTASI-ASPECTS >5 and 37/101 (37%) patients had a CTASI-ASPECTS >5 in the presence of a MCA occlusion. At 3 months, 52 (51%) patients had an independent functional outcome. When patients with CTA-SI ASPECTS > 5 received thrombolysis, 30/46 (65%) achieved an independent functional outcome, whereas 20/35 (57%) without thrombolysis were functionally independent (RR 1.1, CI 95 0.8-1.6). In patients with CTASI-ASPECTS > 5 and additional MCA-occlusion, 13/24 (54%) with thrombolysis and 3/13 (23%) without thrombolysis achieved an independent functional outcome (RR 2.3, CI 95 0.8-6.8). Conclusion: In our non-randomized study, the extent of CTASI hypoattenuation alone did not identify patients benefiting from thrombolysis. In the presence of an MCA-occlusion, however, CTASI might identify patients with benefit from thrombolysis in an extended time window.

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