COMPARISON OF EFFECTS OF DIFFERENT NAIL TIP POSITIONS ON ANTERIOR KNEE PAIN AFTER INTRAMEDULLARY INTERLOCKING NAILING FOR TIBIAL SHAFT FRACTURES

Objective: To determine the frequency of anterior knee pain after intramedullary interlocking nailing in tibial shaft fractures and to compare the intensity of anterior knee pain between positive and negative anterior cortex nail groups.Study Design: Quasi-experimental study. Place and Duration of Study: Department of Orthopaedic Surgery, Combined Military Hospital Rawalpindi, from Oct 2018 to Apr 2019. Methodology: 100 cases of tibial shaft fracture were divided into two groups according to anterior cortex nail distance. Patients 18-40 years of age of both genders, closed fractures, Gustilo Andersen I open tibial diaphyseal fractures and nail tip more than 5mm from tibial tuberosity were included. Patients with osteoarthritis, pathological fractures, renal disease, open fracture GA-II & GA-III and knee instability were excluded from the study. Both groups with positive and negative anterior cortex nail distance were compared for pain using the chi-square test. Results: Frequency of anterior knee pain after intramedullary interlocking nailing in tibial shaft fractures was found in 24% of patients. 8 (16%) out of 50 patients in the group with nail tip deep to anterior cortex had anterior knee pain while 16 (32%) out of 50 patients in the group with nail tip protruding from anterior cortex suffered anterior knee pain (p-value = 0.061). Conclusion: Intramedullary interlocking nailing in tibial shaft fractures with nail tip deep to anterior cortex showed less pain as compared to nail tip protruding from anterior cortex although it was not statistically significant.

A STUDY ON FRACTURE OF FEMUR SHAFT TREATMENT WITH INTRAMEDULLARY INTERLOCKING NAILING

Background: Rigid interlocking nailing for femoral shaft fracture is ideal for use in adolescents in terms of stability of the fracture and convenience for the patient. Closed reduction and intramedullary interlocking nailing is the surgical treatment of choice for the closed shaft fractures of femur. Present study conducted to study the principles of intramedullary interlocking nailing and to assess the outcome of the patient. Methods: The present study comprises of 30 cases of fracture shaft of the femur in adults about >20 years old. All the fractures, which were included in the study were traumatic in origin, most of them are due to road traffic accidents. Results: The delayed union rate in our series was 6.67%. There were no non-unions. Conclusions: It is concluded that closed intramedullary interlocking nailing method given good result in treatment of shaft fractures of femur. Keywords: Intramedullary nailing, Femur, Diaphysis fractures, Interlocking

Comparitive Study of Reamed vs Unreamed Interlocking Intra Medullary Nailing for Fracture Shaft of Tibia

Tibia is the commonest bone to sustain open injury because of subcutaneous position. Treatment of open fractures requires simultaneous management of both skeletal and soft tissue injury. Intramedullary nailing with reaming is generally considered to be contraindicated for open fractures tibia, because it damages the endosteal blood supply which will lead to non-union, deep infection. However, recent studies with or without reaming in open fracture tibia shows no influence in healing of fracture. Purpose: To compare the clinical and radiological results of intramedullary interlocking nailing of open fractures of the tibial shaft after reaming versus unreamed medullary canal. The aim and objective is a comparative study on the technique, outcome and time taken for clinical and radiological union in either of the reamed or unreamed interlocking nailing in tibial shaft fractures. The operative technique, advantages and disadvantages, follow up, time taken for bony and radiological union and complications if any and overall functional outcome will be evaluated in patients. The follow up of patients will be done in the immediate post operative period and subsequently at periodic intervals both clinically and radiologically and the result so obtained will be compared.

Lassa fever presenting as a cause of post-operative pyrexia following open femoral interlocking nailing

We report a case where Lassa fever was diagnosed in the search for post-operative pyrexia. Protective measures may have prevented any transmission to the attending medical staff.

A prospective comparative study of functional outcome in patients treated with interlocking nailing and dynamic compression plating for fracture shaft of humerus in adults

<p><strong>Background: </strong>Aim of the study was to compare the functional outcome in patients with fracture shaft of the humerus treated with dynamic compression plating (DCP) and those treated with intramedullary interlocking nailing.</p><p><strong>Methods: </strong>Of 44 patients with humeral shaft fracture were included in this study and were divided in the following two groups of 22 patients: Group A: Patients treated with DCP by triceps splitting approach and group B: Patients treated with standard intramedullary interlocking nailing. All patients were followed up at 6 weeks, 3 months and 6 months post operatively. Functional outcome was assessed using Rodriguez-Merchan criteria on follow up at 6 months post op.</p><p><strong>Results: </strong>The mean age of patients in group A was 39.05±13.13 years and group B was 38.73±12.95 years. According to Rodriguez-Merchan criteria, 8 (36.4%) and 12 (54.6%) patients in group A had excellent and good functional outcome respectively and 4 (18.2%) and 10 (45.4%) patients in group B had excellent and good functional outcome respectively.</p><p><strong>Conclusions: </strong>DCP offers better functional outcome than interlocking nailing.</p>