Radiation-free Insertion of Interlocked Intramedullary Tibial Nail in Closed Extra-articular Displaced Tibial Shaft Fractures in an Emergency Setup

Background. Interlocking nailing is considered a gold standard surgical treatment of mid-shaft closed diaphyseal tibial fractures. With increasing exposure of orthopaedic surgeons to radiation, we propose a solution to this health hazard through a study wherein we perform the surgery without any radiation or C-arm exposure. Material and methods. This prospective study was done at GMC Jammu from January 2017 to February 2020 and included 218 patients, with 18 patients having bilateral tibia fractures in the age group 15 to 58 years (mean of 37.6 years), including 63.7% males (n=139) and 36.3% females (n=79). The 236 extra-articular closed tibial mid-diaphyseal fractures were operated on and intramedullary tibial nailing was performed without a single C-arm exposure. Postoperative x-rays were done and reduction assessed by standard acceptable criteria. Results. Among 236 cases in which nailing was done, 227 (96%) patients were successfully distally locked, including 128 (56.3%) locked through the jig and 99 (43.6%) by “hit and trial method.” All cases met acceptability criteria set for management of tibia by nailing. Conclusions. 1.This study strengthens the proof that closed extra-articular diaphyseal fractures of the tibia can be managed by nailing without using the C-arm with excellent results. 2.The C-arm is always available for cases where distal locking could not be achieved. 3. The technique has a great role in centres with limited facilities of intra-operative radiography in emergency operation theatres.

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Functional outcome of diaphyseal fractures of forearm in adolescents treated with TENS

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20190642 ◽

2019 ◽

Vol 5 (3) ◽

pp. 69

Author(s):

Divyanshu Goyal ◽

S. L. Sharma ◽

Laxmikant Meena ◽

Ravindra Lamoria ◽

Mahesh Bansal

Keyword(s):

Range Of Motion ◽

Functional Outcome ◽

Case Series ◽

Age Group ◽

Forearm Fractures ◽

Retrospective Case ◽

Superficial Infection ◽

Fractures In Children ◽

Case Series Study ◽

Diaphyseal Fractures

Background: A retrospective case series study was done on forearm diaphyseal fracture in adolescents treated with TENS (titanium elastic nailing system). Purpose of the study was analysis of functional outcome of TENS in forearm diaphyseal fractures in children between 12-18 year age group.Methods: We retrospectively evaluated 30 patients operated by same senior surgeon during the period from March 2014 to February 2015 with closed diaphyseal forearm fractures in age group 12–18 years treated with TENS in whom closed reduction could not be achieved. Nail diameter taken as 33-40% of narrowest diameter of diaphysys were introduced proximally in ulna and distally in radius under image intensifier in closed manner. Postoperatively, patients encouraged for active shoulder, elbow and finger movements and suture removal done after 2 weeks. Patients were followed up for minimum period of one year. Results: In terms of union and range of motion using Anderson et al criteria 24 patients had excellent results, 4 patients had satisfactory results and one patient had poor result having non-union of ulna. Two patients had superficial infection at the nail entry site which eventually resolved. One patient lost for follow up.Conclusions: We conclude that TENS in both bone forearm fractures in adolescent age group in terms of union and range of motion is a minimally invasive and effective method of fixation.

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Functional outcome of minimally invasive plate osteosynthesis with the use of locking plate in fracture distal end of tibia

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20204591 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1239

Author(s):

Prashant Kamble ◽

Nandan Marathe ◽

Sudhir Sharan ◽

Ayush Sharma ◽

Ashwin Sathe ◽

...

Keyword(s):

Minimally Invasive ◽

Open Reduction ◽

Plate Osteosynthesis ◽

Distal Tibia ◽

Minimally Invasive Plate Osteosynthesis ◽

Locking Plates ◽

X Rays ◽

Functional Scores ◽

Tibia Fractures ◽

Distal Tibia Fractures

Background : Distal tibia fractures or pilon fractures are usually the result of combined compressive and shearing forces, which may lead to instability of the metaphysis. Poor vascularity, lack of muscle cover and frequent intra-articular extension often make these fractures very challenging to manage. There are plenty of options available to treat a distal tibia fracture which includes intramedullary nailing, external fixation, open reduction and internal fixation and minimally invasive plate osteosynthesis (MIPO). The aim of this study was to evaluate the results of MIPO with respect to the healing of fracture site, the incidences of complications and to conclude whether MIPO circumvents the problems of formal open reduction and fixation with other implants.Methods: A series of forty patients with fracture of the distal tibia on preoperative X-rays were treated with minimally invasive plate osteosynthesis using pre-contoured locking plates from June 2014 to October 2018 and followed up at regular intervals with X-rays and monitoring for complications.Result: The functional scores were evaluated using Teeny and Wiss clinical rating system for ankle joints. Thirty-two patients had an ‘Excellent’ or ‘Good’ outcome. One patient was diagnosed with a soft tissue complication and delayed union and 3 patients were diagnosed with malunion without significant functional disability at follow up. Conclusion: Minimally invasive plate osteosynthesis with pre-contoured locking plates is associated with high union rate and good functional outcomes. It is an effective treatment modality for distal tibia fractures.

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Elastic Stable Intramedullary Nailing for Treatment of Pediatric Tibial Fractures

Journal of Lumbini Medical College ◽

10.22502/jlmc.v4i1.82 ◽

2016 ◽

Vol 4 (1) ◽

pp. 11

Author(s):

Sandeep Gurung ◽

Dipendra KC ◽

Roshni Khatri

Keyword(s):

Intramedullary Nailing ◽

Demographic Data ◽

Elastic Stable Intramedullary Nailing ◽

Tibial Shaft ◽

Elastic Stable Intramedullary Nail ◽

Shaft Fractures ◽

Tibia Fractures ◽

One Year ◽

Skeletally Immature Patient ◽

Tibial Shaft Fractures

Introduction: Tibia fractures in the skeletally immature patient can usually be treated with above knee cast or patellar tendon bearing cast. The purpose of our study was to evaluate epidemiology and outcome of Elastic stable intramedullary nailing fixation of pediatric tibial shaft fractures treated at our institution. Methods: Over a period of one year, fifty pediatric patients of tibial shaft fractures, with average age of 9.68 yr (SD=2.37), were treated with elastic stable intramedullary nail. Demographic data, union and complication rate were evaluated. Results: There were 36 closed and 14 open fractures. The average time to union was 11.6 weeks (SD=2.65) for close and 14.3 weeks (SD=2.62) for open fracture. There were no instances of growth arrest, remanipulations, or refracture. Conclusion: We conclude that flexible intramedullary fixation is an easy and effective method of management of both open and closed unstable fractures of the tibia in children.

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Radiographic Diagnosis of Sinusitis

PEDIATRICS ◽

10.1542/peds.52.6.889b ◽

1973 ◽

Vol 52 (6) ◽

pp. 889-890

Author(s):

Robert S. Thompson

Keyword(s):

Infants And Children ◽

X Rays ◽

Age Group ◽

Normal Children ◽

Sinus Disease ◽

Radiographic Diagnosis ◽

Radiographic Changes ◽

In Infants And Children

The article by Kogutt and Swischuk(Pediatrics, 52:121, 1973), purporting to show the utility of sinus x-rays in the diagnosis of sinusitis in infants and children does no such thing. Rather, I believe it demonstrates that uncontrolled trials often give misleading results. This conclusion is demonstrated by perusal of the work of Maresh and Washburn1 who did serial sinus films on 100 normal children from birth to adolescence. These authors showed that radiographic changes often considered to be diagnostic of sinus disease are found in nearly 60% of normal children in the birth to 1-year age group, 33% of those aged 5 to 6 years, and 14% of those 11 to 12 years old.

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A Practical Method for Obtaining True Lateral Elbow X-rays in a Paediatric Age Group: Lateral Elbow X-ray in the Standing Salute Position

Indian Journal of Orthopaedics ◽

10.1007/s43465-020-00238-9 ◽

2020 ◽

Author(s):

Mehmet Burtaç Eren ◽

Murat Aşçı ◽

Erkal Bilgiç ◽

Taner Güneş ◽

Orhan Balta ◽

...

Keyword(s):

Practical Method ◽

X Rays ◽

Age Group ◽

X Ray ◽

Lateral Elbow ◽

Paediatric Age

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Intramedullary Tibial Nail Fixation of Simple Intraarticular Distal Tibia Fractures

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000000697 ◽

2016 ◽

Vol 30 ◽

pp. S12-S16 ◽

Cited By ~ 5

Author(s):

John A. Scolaro ◽

Francis H. Broghammer ◽

Derek J. Donegan

Keyword(s):

Distal Tibia ◽

Tibial Nail ◽

Tibia Fractures ◽

Distal Tibia Fractures

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A clinical profile of leprosy patients in a tertiary hospital, Karnataka: a retrospective study

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20193239 ◽

2019 ◽

Vol 5 (3) ◽

pp. 615

Author(s):

Vinay K. Nirvanappa ◽

Soumya G. Hegde

Keyword(s):

Retrospective Study ◽

Major Part ◽

Health Hazard ◽

Public Health Problem ◽

Mycobacterial Infection ◽

Tertiary Hospital ◽

Lepromatous Leprosy ◽

Age Group ◽

Major Health ◽

Leprosy Patients

Background: Leprosy is a chronic mycobacterial infection and is still a major health hazard in India.Methods: This was a retrospective study over 12 years of all cases diagnosed clinically as leprosy in a tertiary hospital at Hassan district, Karnataka. Confirmation of diagnosis was based on slit skin smear and biopsy was done in doubtful cases.Results: Out of 214 patients, 152 were males and 62 were females. The prevalence was maximum in the age group 21-30 years. Borderline group formed the major part of the spectrum, consisting of 154 (71.96%) patients. Maximum patients 97 (45.3%) were of borderline tuberculoid (BT) leprosy, followed by 59 (27.57%) cases of borderline lepromatous leprosy (BL). 25 (11.68%) cases had tuberculoid leprosy (TT) and 20 (9.34%)cases were of lepromatous leprosy among which 3 were diagnosed as histoid leprosy. 6 patients had pure neuritic leprosy and 4 patients were in relapse.Conclusions: Even though leprosy is eliminated, it continues to be a public health problem in our country. Stricter surveillance for early diagnosis and treatment is needed to eradicate leprosy from India.

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A study of minimally invasive percutaneous plate osteosynthesis for tibial plateau fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175656 ◽

2017 ◽

Vol 4 (1) ◽

pp. 92

Author(s):

Ujwal S. Ramteke ◽

Vidyadhar Telang ◽

Nadir Shah ◽

Ayush Singh ◽

Hitesh Mangukiya ◽

...

Keyword(s):

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Weight Bearing ◽

Full Range ◽

Tibial Plateau Fractures ◽

Type I ◽

X Rays ◽

Age Group ◽

Schatzker Type ◽

Plateau Fracture

Background: Fractures of proximal tibia involve a major weight-bearing joint and are serious injuries, which, if not treated well, result in functional impairment. To preserve normal knee function one must strive to maintain joint congruity, preserve the normal mechanical axis, ensure joint stability and restore a full range of motion. This is a formidable task to accomplish, especially in the face of associated medical conditions of the patients.Methods: In our study, 30 cases were selected. Selection of cases were done on the basis of X-rays. Schatzker type I, II, III, IV, V & VI included in study. Criteria for acceptable reduction 1) <5 mm of articular step; 2) <5 mm of articular depression. Each case is referred to one set of tibial plateau fracture, showing distribution of tibia plateau fractures that we treated with MIPPO. Clinical follow-up examination was performed at 4, 6, 10, 12 weeks and 3, 6 months. Clinico-radiological assessment was done at 3 month and grading was done. Patients were evaluated according to grading minimum 3 months after injury.Results: Our study of 30 tibial plateau fractures confirms that the MIPPO technique is an excellent treatment modality in case of tibial plateau fractures. We observed these fractures mainly in age group of 30-40 years, which were involved in road traffic accident. Tibial plateau fractures seen in elder age group were mainly due to abnormal loading patterns on the leg. We have found oblique views very much informative especially for posterolateral or posteromedial displacement, articular depression which helps to plan the position and direction of screws to be used for fixation. Conclusions: In view of the excellent results obtained with this technique, we advocate MIPPO over conventional open reduction and internal fixation technique for tibial plateau fracture fixation.

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A study of clinical evaluation and management of inguinoscrotal swelling in paediatric age group

International Surgery Journal ◽

10.18203/2349-2902.isj20181976 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2097

Author(s):

Himadra Koranga ◽

R. Chandrasekaran

Keyword(s):

Undescended Testis ◽

Surgical Repair ◽

Emergency Operation ◽

Age Group ◽

Infancy And Childhood ◽

Operative Complications ◽

Paediatric Age ◽

Hernia Inguinal ◽

Scrotal Swelling ◽

Post Operative Complications

Background: Inguino-scrotal swellings are one of the commonest problems in infancy and childhood throughout the world. They represent the conditions most frequently requiring surgical repair in the paediatric age group. In many of these cases, clinical examination may sufﬁce to obtain a deﬁnite diagnosis, but when the diagnosis is inconclusive, ultrasonography can play an important role. Post-operative complications are usually rare following elective operation whereas minor complications do occur after emergency operation. In this study we evaluated various presentations of inguino-scrotal swellings, their management and complications in paediatric age group.Methods: This is a hospital based prospective study, to have an overview of a spectrum of the paediatric cases admitted in the department of surgery with inguino-scrotal swelling that includes 40 patients with age below 13 years, irrespective of sex. Data regarding clinical features, birth history, immunization, family history various blood and radiological investigations was noted. Incidences of associated anomalies, complications and any form of treatment given to the patient were recorded and findings were analysed.Results: Out of 40 cases, all were males with maximum number of cases between the age group of 3-4 years.24 cases were right sided, 12 left sided and 4 bilateral. Hydrocele was associated with 10 of the cases, undescended testis with 2 cases and 1 had encysted hydrocele of the cord. There were no complicated cases like incarceration, obstruction or strangulation. Post-operative complications were noted in 4 cases, out of which 2 were wound haematoma and one case each of wound infection and stitch granuloma.Conclusions: Childhood inguinal hernias are more common on right side due to delay in descent of right testis and males are more commonly affected. Congenital hydrocele may involutes spontaneously, so we should observed at least upto 1 year of age before considering repair but not in the case of congenital inguinal hernia. Inguinal herniotomy in children is a safe and effective operation.

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Hydatid disease in children: a single centre study with analysis of treatment protocol

International Surgery Journal ◽

10.18203/2349-2902.isj20202601 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2141

Author(s):

Atul Mishra ◽

Kalpesh Patel

Keyword(s):

Hydatid Cyst ◽

Hydatid Disease ◽

Low Socioeconomic Status ◽

Health Hazard ◽

Treatment Protocol ◽

Complete Recovery ◽

Age Group ◽

Diagnostic Modality ◽

Pediatric Age Group ◽

The World

Background: Hydatid disease or hydatidosis is a zoonosis which is still an important health hazard in the world. This disease is a parasitic infestation which is endemic in many sheep and cattle raising areas of the world including India. The aim of this study was to evaluate the clinical features, diagnosis, and treatment of hydatid cyst in pediatric population.Methods: This prospective study evaluated 32 pediatric patients with hydatid cyst who were treated at Geetanjali Hospital, Udaipur from 2016-2018. Medical records of these patients were studied and analyzed.Results: 32 cases were in the age group of 7 to 14 years and were from rural background/ farming community and of low socioeconomic status. Male children, lungs were predominantly involved. Cattle rearing were common to the households of all patients. Ultrasonography and computed tomography scan were done in all patients and was the main diagnostic modality. All cases were managed surgically along with albendazole therapy and had complete recovery with no recurrence till date in any of our patients.Conclusions: Hydatid disease is not rare in the pediatric age group. The liver and lung are commonly involved, but it may also present as primary disease in unusual sites like the spleen and brain. Careful surgery to avoid spillage with full course of drug therapy with albendazole can ensure permanent cure. A 28 day post-operative course was sufficient in majority of the cases. The disease can be prevented by proper community based measures like availability of clean water, sanitation and drug prophylaxis.

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