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

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.

Epidemiology Of Proximal And Diaphyseal Humeral Fractures In Children: An Observational Study From The Swedish Fracture Register

Background: Most fractures in children are fractures of the upper extremity. Proximal and diaphyseal humeral fractures account for a minority of these fractures. To our knowledge, few previous reports address these fractures. This study aimed to describe the epidemiology and current treatment of proximal and diaphyseal humeral fractures by using the Swedish Fracture Register (SFR). Methods: In this nationwide observational study from the SFR we analysed data on patient characteristics, injury mechanism, fracture classification and treatment. We included patients aged <16 years at time of injury with proximal or diaphyseal humeral fracture registered in 2015-2019.Results: 1996 (1696 proximal and 300 diaphyseal) fractures were registered. Proximal fractures were more frequent in girls whereas diaphyseal fractures were more frequent in boys. The median age at fracture was 10 years in both fracture types but patient’s age was more widespread in diaphyseal fracture (IQR 5-13 compared to IQR 7-12 in proximal). In both sexes, the most registered injury mechanism was fall. Horse-riding was a common mechanism of injury in girls, whereas ice-skating and skiing were common mechanisms in boys. The majority of fractures were treated non-surgically (92% of proximal and 80% of diaphyseal fractures). The treatment method was not associated with the patient’s sex. Surgery was more often performed in adolescents. The most common surgical methods were K-wire and cerclage fixation in proximal fracture and intramedullary nailing in diaphyseal fracture.Conclusion: Following falls, we found sex-specific sport activities to cause most proximal and diaphyseal paediatric fractures. Further studies on prophylactic efforts in these activities are needed to investigate whether these fractures are preventable. The majority of the fractures were treated non-surgically, although surgical treatment increased with increasing age in both sexes.

Outcome of Intramedullary Interlocking Nailing in the Management of Gustillo-I Diaphyseal Fracture of Tibia

Objective: To evaluate the outcome of intramedullary interlocking nailing in the management of Gustillo-I diaphyseal fracture of tibia. Study Design: This is an observational study. Setting: Study carried out at Orthopaedic Surgery department, Liaquat University of Medical and Health Sciences Jamshoro, form March 2018 to February 2021. Materials & Methods: 72 consecutive patients of Gustillo Type-I diaphyseal fracture of tibia. All patients age between 18-60 years with traumatic fracture like Gustillo Type-I diaphyseal fracture of tibia were included in this study. Patients reported chest, abdominal and head trauma with neurovascular deficit were excluded. Patients were prepared for surgery after relevant investigation and radiographs. Results: Out of 72 patients included in this study 11.11% were female (N=8) and 88.88% male (N=64); with mean age was 38.26±8.20 years (Range 18 to 60 years). Road traffic accident was common cause of tibia fracture (Gustillo Type-I). Postoperative mean union time of tibial fractures were 9.9±3. 2 week.Postoperatively started partial weight bearing associated with help of two axillary crutches. The patients walking with partial weight bearing allowed at 4.1±1.12 weeks. While patients walking with full weight bearing allowed at 10.8±2.4 weeks. Postoperatively 11(15.27%) patients were complaining of pain. Wound infection observed in 7(9.72%) cases. Clinically excellent results were found in 24(33.33%) patients, while good results remained in 30(41.66%) patients and fairs in 18(25%) patients. Conclusion: We conclude that interlocking intra-medullary nailing may be considered as a suitable option for treatment of Gustilo-I diaphyseal fracture of tibia.

Controversial technologies in intramedullary osteosynthesis of rats femur fractures

The aim: to conduct a comparative study of osteoreparative regeneration, namely in the periosteal and intermediate areas of the cortex, during intramedullary osteosynthesis of the femur of rats with and without reaming of the bone marrow canal. Materials and methods. The work is based on the results of an experimental study conducted on 56 white mature laboratory rats, which simulated diaphyseal fracture of the femur and performed stable nail osteosynthesis with reaming of the bone marrow canal in the first series and without reaming in the second series of the experiment. Histological examination of the specimens was performed on the 7th, 14th, 28th and 90th day after surgery. Results. The procedure of reaming the bone marrow canal reduces the potential reparative capacity of bone tissue in the endosteal area and leads to “distorted” activation of the process of the cortex restructuring. There is a significant activation of osteoclastic resorption. Conclusions. Bone fusion is more active with the use of intramedullary fixator without reaming of the bone marrow canal, because its reaming reduces the manifestations of reparative potentials in the endosteal region and leads to excessive activation of the resorptive process of restructuring the cortex of both endosteal and central part

A PROSPECTIVE STUDY : CLINICAL OUTCOME OF TIBIA DIAPHYSEAL FRACTURE IN PEDIATRIC AGE GROUP MANAGED WITH TITANIUM ELASTIC NAILING SYSTEM

Introduction : 1 Pediatric tibial fractures are the third most common pediatric long bone fracture after the femur and forearm . They representing 2 15% of all pediatric fractures . The most common location of tibia fractures is in the distal third of the tibia (50-70%) followed by middle and then proximal (less common) thirds. This study was performed to nd out clinical outcome of tibia diaphyseal fracture in paediatric age group managed with titanium elastic nailing system. Material And Methods : This hospital based prospective, randomized, single centre study was conducted in the Department of Orthopaedics, JLN Medical College & Hospitals, Ajmer during the December 2018 to December 2020. These cases including close, open grade 1 and 2 paediatric tibia diaphyseal fractures and fractures with inability to achieve close reduction. Results & Observations : In our study, 32 patients of paediatric age group with tibia diaphyseal fractures were managed with TENS. According to FLYNN'S criteria the nal outcome was excellent in 84.35% (27 out of 32), satisfactory or good in 12.5 % (4 out of 32) cases and poor outcome was reported in 1 case (3.15%) only. Conclusion : TENS which is safe and effective method to maintain the reduction of displaced tibial fractures including length and rotation. It is simple, rapid and safe procedure with advantages of early union, early mobilization and early return to function with minimum complications. Elastic medullary nailing advantages make it a valuable choice to consider in managing children shaft tibial fractures.

Simulating Metaphyseal Fracture Healing in the Distal Radius

Simulating diaphyseal fracture healing via numerical models has been investigated for a long time. It is apparent from in vivo studies that metaphyseal fracture healing should follow similar biomechanical rules although the speed and healing pattern might differ. To investigate this hypothesis, a pre-existing, well-established diaphyseal fracture healing model was extended to study metaphyseal bone healing. Clinical data of distal radius fractures were compared to corresponding geometrically patient-specific fracture healing simulations. The numerical model, was able to predict a realistic fracture healing process in a wide variety of radius geometries. Endochondral and mainly intramembranous ossification was predicted in the fractured area without callus formation. The model, therefore, appears appropriate to study metaphyseal bone healing under differing mechanical conditions and metaphyseal fractures in different bones and fracture types. Nevertheless, the outlined model was conducted in a simplified rotational symmetric case. Further studies may extend the model to a three-dimensional representation to investigate complex fracture shapes. This will help to optimize clinical treatments of radial fractures, medical implant design and foster biomechanical research in metaphyseal fracture healing.