A Novel Case of Neglected Monteggia Fracture Dislocation

Background: The Monteggia fracture-dislocation is a rare condition among children, and its treatment is still controversial. The treatment can become quite complicated when the diagnosis is delayed. There is a broad range of surgical treatments with various complications like subluxations, degenerative changes, and radial head deformity. The present case was reported as a novel surgical treatment choice for neglected Monteggia fracture-dislocation. Case Report: A 16 year-old boy presented with left elbow severe range of motion (ROM) limitation and pain who was diagnosed with neglected Monteggia fracture-dislocation. The patient went through open reduction beside internal fixation of the ulnar shaft via Limited Contact Dynamic Compression Plate (LC-DCP) and radio-capitellar joint reduction and provisional fixation by a pin. The patient recovered after three months with a significant increase in elbow ROM without any complications. Conclusion: This method could be an appropriate treatment of choice for neglected Monteggia fractures which indeed had excellent outcomes without complication.

Distal 3rd Diaphysial Fracture of Humerus Fixed with Dynamic Compression Plate Using Posterior Approach- The Assessment of the Outcome

Objectives: The effectiveness of open reduction and Dynamic Compression Plate (DCP) fixation with or without autogenous bone grafting using the posterior midline approach in the treatment of distal third diaphyseal humeral fractures was assessed. Methods: For humeral nonunion, comminuted fractures, or early failure of conservative therapies, 33 patients (24 men, 9 women; mean age 37 years; range 20 to 60 years) were operated on. The study was carried out at Dhaka Medical College Hospital (DMCH), Dhaka from July 2005 to December 2006. Results: After an average of 17 weeks, all of the patients had union (range 14 to 26 weeks).There was no deep infection, nonunion, malunion, implant failure, or nerve injury in any of the patients. In two cases, transient radial nerve palsy occurred. Minor infections were seen in four of the individuals. All of the patients were pain-free after surgery.The functional outcome was outstanding in all instances and good in 16 patients, yielding 87 % satisfying results. Functional outcomes increased considerably postoperatively compared to preoperatively (p<0.001). In 20 individuals, the range of motion of the shoulders was great. The range of motion at the elbow was considerable in 21 patients and moderate in seven others. More than three-quarters of the patients (75.8%) experienced no problems. Four patients (12.1%) were infected, and two patients (6.1%) developed iatrogenic radial nerve palsy as a result of the surgery. One patient (3%) had a loose screw, while another (3%) needed blood transfusions owing to extensive bleeding at the donor graft site. Conclusion: In distal third humeral fractures, open reduction and posterior DCP fixing, with or without autogenous bone grafting, is a safe and effective treatment option, especially when there is no infection or bony or neurovascular damage. Very few study conducted on distal 3rd diaphysial fracture of humerus fixed with DCP using posterior approach, therefore this study conducted to know the assessment of the outcome.

Functional Outcome of Shaft of Humerus Fractures Managed Surgically by Dynamic Compression Plating Technique

The study analyzed 20 cases of fracture shaft of hummers treated with Dynamic Compression Plate. There was a male preponderance in our study 17 (85%). Almost Also 13% of patients treated by functional bracing end up with cosmetically unacceptable angulation of>15%, whereas all operative procedures achieve good alignment of the fractured bone was observed. The rate of union in Plate osteosynthesis is 93% and the time of union is 16 - 20 weeks, and more than 90% united in 18 weeks and 7% went for non union.

“Comparing Locking Compression Plate with Limited Contact Dynamic Compression Plate for the Treatment of Adult Diaphyseal both Bone Forearm Fractures”

Introduction: The human forearm serves an important role in upper extremity function, facilitating placement of the hand in space, thus helping to provide the upper extremity with its unique mobility Fractures involving the bones of forearm present unique problem not encountered with fractures of other long bones. Objective: To evaluate and compare the outcomes of locking compression plate (LCP) with limited contact dynamic compression plate (LC-DCP) for the treatment of adult diaphyseal both bone forearm fractures. Material and Methods: This study conducted in the Department of orthopedics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2018 to December 2020 included 20 patients with 40 fractures in each group. Patients were selected randomly to receive either LCP (20 patients, 40 fractures) or LC-DCP (20 patients, 40 fractures). Operative time, callus formation, functional outcome and complications were recorded. Results: Mean operative time did not differ significantly in the LCP and LC-DCP group (71.25 and 75.70 minutes respectively) .There was some difference in callus formation and mean time to bone union between the two groups which was significant. However, overall functional outcome did not differ significantly between both the groups. One case had delayed union in the (LC-DCP) group while one patient in each group developed superficial infection. Conclusion: In this prospective study comparing LCP with LC-DCP, the outcomes were equal in terms of final functional outcomes and mean operating time but LCP showed slight advantage in terms of callus formation and mean time to bone union.

“Comparing Locking Compression Plate with Limited Contact Dynamic Compression Plate For the Treatment of Adult Diaphyseal Both Bone Forearm Fractures”

Introduction: The human forearm serves an important role in upper extremity function, facilitating placement of the hand in space, thus helping to provide the upper extremity with its unique mobility Fractures involving the bones of forearm present unique problem not encountered with fractures of other long bones. Objective: To evaluate and compare the outcomes of locking compression plate (LCP) with limited contact dynamic compression plate (LC-DCP) for the treatment of adult diaphyseal both bone forearm fractures. Material and Methods: This study conducted in the Department of orthopedics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2018 to December 2020 included 20 patients with 40 fractures in each group. Patients were selected randomly to receive either LCP (20 patients, 40 fractures) or LC-DCP (20 patients, 40 fractures). Operative time, callus formation, functional outcome and complications were recorded. Results: Mean operative time did not differ significantly in the LCP and LC-DCP group (71.25 and 75.70 minutes respectively) .There was some difference in callus formation and mean time to bone union between the two groups which was significant. However, overall functional outcome did not differ significantly between both the groups. One case had delayed union in the (LC-DCP) group while one patient in each group developed superficial infection. Conclusion: In this prospective study comparing LCP with LC-DCP, the outcomes were equal in terms of final functional outcomes and mean operating time but LCP showed slight advantage in terms of callus formation and mean time to bone union.

Surgical Sponge Retained in Femoral Canal for 22 Years: A Case Report

Background: Retained surgical items (RSIs) are not very common in the orthopedic surgery. Here, we are reporting a case of a sponge pad left in the femoral canal for 22 years. We could not find any other reported case of retained surgical sponge in the femoral canal and that is what makes this case report unique. Case Report: The patient was a 42 year-old man who underwent surgery for the fixation of a fractured femur 22 years ago. On August 2020, this patient was seen complaining about pain at the surgical site. The assessments revealed a sponge pad retained in the femoral canal, which was removed by surgery. The union of fractured bone did not take place in the first surgery, so after 6 months a second surgery was performed and the dynamic compression plate (DCP) placed was successfully replaced with an intramedullary nail. Conclusion: The surgeon could not detect the pad 22 years ago and the patient had no significant symptom all this time. The most important take-away lesson of this paper is that retention of surgical pads could also occur with correct gauze counting, so detection and prevention protocols for RSIs must be taken seriously.

Diaphyseal Humeral Fractures Treated by Bracing versus Dynamic Compression Plate

Objective: To compare the results of humerus shaft fractures treated by functional bracing and dynamic compression plate. Study Design: Cross sectional comparative study. Place and Duration of Study: Department of Orthopaedic Surgery & Traumatology, Liaquat University Hospital Hyderabad/Jamshoro from 1st June 2015 to 31st May 2016. Methodology: Eighty cases selected from accident emergency department and outpatient departments. Cases were divided in two groups; group A (dynamic compression plate) and group B (functional bracing). Patients of either gender with age range 18-50 years with an isolated closed fracture of the humeral shaft, of duration within 2 weeks and who were willing to participate in the study were included in the study while open fractures, bilateral injuries, poly-trauma, pathological fracture, smoker, alcoholic, immune compromised, and history of poor compliance, psychiatric disease were excluded. Results: In conservative group, 32 (80%) were males and 8 (20%) females while in dynamic compression plate group, 30 (75 %) were males and 10 (25%) females with mean age was 35.75±9.083 year. There were 46 (57.5%) patients who sustained fractures following road traffic accidents 16 (20%) cases had fall from height and 18 (22.5 %) cases had after assault. Fracture location was middle third in most of cases in both groups. Mean time for union was 15.45±2.864 and 14.325±3.033 weeks and mean time of follow-up was 48.35±6.436 & 42.52±9.33 weeks in dynamic compression plate and functional bracing groups respectively Conclusion: Plating of humeral shaft fracture was found to be satisfactory method of treatment with high fracture union rates, better functional outcome [DASH Score] and low complication rate as compared to functional bracing group. Keywords: Humeus shaft, Fracture, Dynamic compression plate, DASH score, Conservative, Functional bracing

Successful utilization of triphasic silica containing ceramic coated hydroxyapatite (HASi) for the treatment of comminuted tibial fracture in a goat: a case report

A one year old female Sirohi crossbred goat was presented with a history of non weight bearing lameness on right hind limb. Radiography revealed comminuted fracture of tibial mid diaphysis. The comminuted fracture fragments and bone devoid of any soft tissue were surgically removed and the resultant segmental defect was reinstated with triphasic silica containing ceramic coated hydroxyapatite (HASi) after stabilising the fracture fragments with 2.7mm dynamic compression plate and screws. The animal recovered with normal limb ambulation after the eighth post-operative week.

Gambaran Luaran Fungsional Tatalaksana Pasien Neglected Fraktur Sub-trokanter Menggunakan Reversed Distal Femur Limited Contact Dynamic Compression Plate di Rumah Sakit Bhayangkara Manado

Subtrochanter fracture is still a health problem due to the difficulty of treatment and the high incidence of non-union and malunion after treatment. Limited Contact-Dynamic Compression Plate (LC-DCP), an implant designed to be used in distal femur fractures, is reported as an alternative for the treatment of subtrochanter fractures. This study was aimed to obtain the functional outcome of neglected subtrochanter fractures using reversed distal femur LC-DCP at Bhayangkara Hospital Manado. This was a retrospectoive study using the medical record and by-phone evaluation of patients with neglected subtrochanter that were managed with the reversed distal femur LC-DCP in 2018-2019 at Bhayangkara Hospital, Manado. Patients were evaluated with the Harris Hip Score (HHS). The results showed that there were 6 patients who met the inclusion criteria and could be contacted by phone. The HHS results showed 6 patients of poor category (mean score of 25.6) at 3 months after surgery; 3 patients of poor category and 3 patients of fair category (mean score of 66.4) at 6 months after surgery; and 4 patients of good category and 2 patients of excellent category (mean score of 89.9) at 12 months after surgery. In conclusion, the functional outcomes of the patients were poor category at 3 months after surgery, poor to fair at 6 months after surgery, and good to excellent at 12 months after surgery.Keywords: functional outcome, neglected subtrochanter fracture, reversed distal femur limited contact – dynamic compression plate, Harris hip score Abstrak: Fraktur subtrokanter masih merupakan masalah kesehatan karena sulitnya penanganan dan tingginya angka kejadian non-union dan malunion setelah penanganan. Limited contact-dynamic compression plate (LC-DCP) yaitu implan yang dirancang untuk fraktur femur bagian distal dilaporkan dapat dijadikan alternatif untuk penanganan fraktur subtrokanter. Penelitian ini bertujuan untuk memperoleh gambaran luaran fungsional tatalaksana pasien neglected fraktur subtrokanter menggunakan reversed distal femur LC-DCP di RS Bhayangkara Manado. Jenis penelitian ialah retrospektif menggunakan data rekam medis dan evaluasi melalui telepon pada pasien dengan neglected fraktur subtrokanter yang ditatalaksana menggunakan reversed distal femur LC-DCP pada tahun 2018-2019 di RS Bhayangkara Manado. Pasien dievaluasi dengan Harris Hip Score (HHS). Hasil penelitian mendapatkan 6 pasien yang memenuhi kriteria inklusi. Hasil evaluasi HHS mendapatkan 6 pasien kategori poor (rerata skor 25,6) saat 3 bulan pasca operasi; 3 pasien kategori poor dan 3 pasien fair (rerata skor 66,4) saat 6 bulan pasca operasi dengan; dan 4 pasien kategori good dan 2 pasien dengan kategori excellent (rerata skor 89,9) saat 12 bulan pasca operasi. Simpulan penelitian ini ialah luaran fungsional pasien-pasien tersebut ialah HHS poor pada 3 bulan pasca operasi; HHS poor-fair 6 bulan pasca operasi; dan HHS good-excellent pada 12 bulan pasca operasi. Kata kunci: luaran fungsional, neglected fraktur subtrokanter, reversed distal femur limited contact – dynamic compression plate, Harris hip score