Femoral neck system versus inverted cannulated cancellous screw for the treatment of femoral neck fractures in adults: a preliminary comparative study

Background The femoral neck system (FNS) may be a valid alternative for treating femoral neck fractures, but few studies have compared the outcomes between FNS and cannulated cancellous screws. This study aimed to compare the clinical efficacy and complications of FNS with those of inverted cannulated cancellous screws (ICCS) for the treatment of femoral neck fractures in adults. Methods This retrospective study evaluated patients with femoral neck fractures who underwent FNS or ICCS internal fixation between June 2019 and January 2020. The operative time, intraoperative blood loss, number of fluoroscopies, length of surgical incision, length of hospital stay, time to fracture healing, and other indicators were compared between the two groups. The incidence of complications such as nonunion, avascular necrosis of the femoral head, loosening of the internal fixation, and shortening of the femoral neck during follow-up was also assessed in both groups. Results Among the 92 patients included, 47 and 45 patients were categorized into the FNS and ICCS groups, respectively. Follow-up ranged from 14 to 24 months. There were no significant between-group differences in sex, age, side of the injured limb, and type of fracture and in operative time, intraoperative blood loss, incision length, and length of hospital stay (all P > 0.05). The incidence of complications such as fracture nonunion, avascular necrosis of the femoral head, and screw loosening was also comparable between the two groups. However, the number of fluoroscopies was significantly lower in the FNS group than in the ICCS group (P < 0.05). The fracture healing time was also significantly lower in the FNS group than in the ICCS group (P < 0.05). Furthermore, the femoral neck shortening and Harris hip score at the last follow-up were significantly better in the FNS group than in the ICCS group (P < 0.05). Conclusions FNS for femoral neck fractures improves hip functional recovery and reduces the femoral neck shortening rate and fluoroscopy exposure postoperatively. Thus, FNS can be an alternative to ICCS for the treatment of femoral neck fractures.

A Comparative Study of Functional Outcome of Olecranon Fractures Managed with Tension band Wiring Using K Wires with Tension Band Wiring Using Cancellous Screws Fixation

Introduction: Olecranon fracture are some of the common injuries seen in emergency with commonest mode of trauma being fall on outstretched hand and road traffic accident. Methods: This prospective comparative study was carried out from May 2020 to May 2021 within a study period of 1 year in Datta Meghe Medical College. 20 patients of olecranon fractures were enrolled randomly. Results: According to the Mayo classification, the majority of the cases in our study were type II A fractures. The Mayo elbow performance score. In the K wire category, 5 patients (50%) had excellent results, 3 patients (30%) had decent results, and 2 patients (20%) had fair results. In both categories, there were no negative repercussions. In the cancellous screw category, excellent results were found in 8 patients (80%), nice in 1 patient (10%), and fair in 1 patient (10%). Conclusions: From this study, we came to the conclusion that for displaced olecranon fractures as per Mayo’s II A classification fixed by using cancellous screw with tension band wiring gives better clinical outcome When compared to tension band wiring, K-wire fixation keeps costs down, time, and the chance of implant removal complications.

Result of Ankle Fracture Fixation, Our Hospital Experience

Aims and Objectives: The goal of this study was to see the outcome of open reduction and internal fixation for ankle fractures. Methods: A prospective analysis of 40 ankle fractures of adult patients handled surgically using diverse approaches in the period from January 2019 to January 2020 at the Orthopedic department of SMBBIT, Dow University of Medical and Health Sciences. Karachi Pakistan. The ankle grading system developed by Baird and Jackson was used to assess the functional result. Results: We achieved 87.5 percent outstanding to good outcomes, 6.3 percent fair outcomes, and 6.2 percent bad outcomes in our study. The findings were comparable to those of other researchers around the world. Interpretation and Conclusion: In 87.5 percent of patients, the operational results were satisfactory, with good to outstanding functional outcomes. With stable fracture fixation, excellent outcomes are attained. Cancellous screws are better for internal fixation of the medial malleolus, while Malleolar screws are superior for that task. For ankle fractures treated surgically, patients may expect to have satisfactory function thereafter.

Screws vs. Solid Wires - The Better Method for Transverse Patellar Fracture Fixation - A Prospective Randomised Study

BACKGROUND Patella is a sesamoid bone that plays an important role in the extensor apparatus of the knee joint. Fractures of the patella constitute about 1 % of all fractures. Definitive treatment of the patellar fractures depends on the type of fracture, displacement, joint congruity, and intactness of the extensor apparatus. There is significant controversy about the surgical options for displaced patellar fractures. Although conventionally tension band wiring using K-wires (TBW-K wire) is a common procedure, tension band wiring using cancellous screws (TBW-CCS) is gaining popularity. A study was undertaken to compare outcomes between the two procedures (TBW-CCS & TBW-K wire). METHODS A prospective randomised study was planned. Inclusion & exclusion criteria were laid down. Institutional ethical committee clearance was obtained. 68 consenting patients with transverse patellar fractures underwent surgery (TBW-CCS or TBWK wire) after randomisation. Demographic, clinical, and radiological assessment was done. Bostman score was used as an outcome measure. Statistical analysis was done. RESULTS 85.5 % of cancellous screw group patients had excellent outcome scores as against 41.2 % in the K wire group. The difference was statistically significant. 5.8 % of patients in the cancellous group complained of implant prominence as against 17.6 % in the K wire group which was statistically significant as well. Patients in TBW-CCS had a statistically significant difference in Bostman scores at 6 weeks, 3 months, and 6 months. CONCLUSIONS Tension band wiring with cannulated cancellous screws is a safe and reliable technique in the management of transverse patellar fractures with fewer chances of implant failure and soft tissue irritation. Based on our study, tension band wiring with cannulated cancellous screws is a better method to treat transverse fractures of the patella when compared to the modified tension band wiring technique using K-wire. KEYWORDS Patella, Transverse Fracture, Tension Band Wiring, Cancellous Screws

Outcome of neglected talus neck fracture and it’s management: A Case Report

Introduction: Talus fracture is an uncommon fracture that can be encountered on day- to- day basis. However, it is the 2nd most common tarsal bone to get fractured after calcaneum and accounts for approximately 1% of all fractures around foot and ankle. The anastomotic ring around the talar neck is highly likely to get damaged at the time of the fracture, which, in turn, hampers the blood supply to the body of talus. As a result, the bone healing is delayed and the integrity of the healed fracture is poor which leads to poor functional outcome. Almost 39% cases are missed during the initial evaluation, and talus fracture accounts for almost 50% of all the missed injuries (6–8). A high level of clinical suspicion is required to avoid missing such injuries. Case Report: A 26-year-old male presented to the outpatient department with chief complaint of pain over the left foot while walking for past 6 months. There was a history of significant trauma to the foot 6 months back (fall from 12 feet) for which he sought medical advice and was managed with analgesics and rest for a couple of weeks. He presented to us 6 months later with chronic, dull aching, and continuous pain which aggravates while walking and standing. The diagnosis of the non-union fracture neck of talus was made after radiology and was managed by open reduction and internal fixation with cannulated cancellous screws along with contralateral iliac crest cancellous bone grafting. Conclusion: Delay in diagnosing such injuries accelerates the vascular compromise, delays timely intervention, and ultimately leads to increased morbidity. Keywords: Talar neck fracture, non-union talus fracture, delayed union talus.

MANAGEMENT OF A CASE OF ISOLATED MEDIAL CONDYLE FEMUR FRACTURE IN A 65 YEARS OLD MALE WITH EXCELLENT FUNCTIONAL OUTCOME : CASE REPORT

Isolated medial condyle femur fracture without fracture of the lateral condyle is relatively rare entity. Unlike lateral femoral condyle, there is no anatomically contoured plate available for the medial condyle xation. A 65 years old male presented to us with isolated medial condyle femur fracture. ORIF was done with cannulated cancellous screws and reconstruction plate. Post-operative early range of motion was started and the patient had full range of motion at the nal one-year follow-up.

Cannulated cancellous screws versus dynamic hip screw in femoral neck fractures: a comparison in productive age group at tertiary care hospital of North India

<p class="abstract"><strong>Background:</strong> Since intracapsular fracture neck femur was recognized by Ambrose Pare almost 4 centuries back, the management of intracapsular neck femur fracture has undergone many changes. The multitude of various implants designed and techniques available for its treatment themselves indicate the inadequacy of the various methods of treatment. Objective was to compare cannulated cancellous screws (CCS) versus dynamic hip screw (DHS) in femoral neck fractures in productive age group.</p><p class="abstract"><strong>Methods:</strong> This observational study with both prospective and retrospective data analysis of patients operated by different surgeons in same hospital setup has been conducted from March, 2018 to February, 2020 at the department of Orthopedics, Government Medical College (GMC), Jammu. 105 cases satisfying the inclusion criteria admitted in GMC Jammu were included clinically and radiologically. Total number of patients included in the study was 97 patients as 8 patients were lost to follow-up. Functional outcome was evaluated by using Harris hip scoring.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study 8 CCS cases were lost to follow up. Total 97 of cases were followed up till one year both radiologically and clinically after a given time intervals and final assessment done on the basis of Harris hip score. Among 97 cases 71 were males most of them in age group of 41-45 years and 26 were females with 46-50 years age group predominance. 47.42% fractures were classified as type III in garden’s staging. </p><p class="abstract"><strong>Conclusions:</strong> DHS is a better implant than CCS in hands of doctors who lack of expertise and precision i.e. required for CCS in fracture neck femur in young adult patients.</p>