Bilateral Floating Knee Injuries in an Infant: A Case Report and Literature Review

Background: Floating knee injury is defined as ipsilateral fractures of the femur and tibia. It was mostly seen among young men and is generally caused by high-velocity trauma such as motor vehicle accidents and falling from height. Although isolated fractures of the femur or tibia are relatively common in children, floating knee injuries are rare in adolescents and even less frequent in younger children. Case Report: In this study, we reported a case of bilateral floating knee injuries of a 10-month old girl infant. Radiographic examinations revealed diaphyseal fracture of the left femur and proximal metaphyseal fracture of tibia compatible with floating knee injury type B according to the classification proposed by Letts et al. To the best of our knowledge, there was not any previous report of bilateral infantile floating knee injury in the literature. Conclusion: Pediatric floating knee injuries are relatively uncommon and extremely rare among infants. The preferred method of treatment is a surgical fixation for all fractures of all ages.

A STUDY TO DETERMINE THE FUNCTIONAL OUTCOME IN THE MANAGEMENT OF STABLE PER TROCHANTERIC HIP FRACTURES WITH DYNAMIC HIP SCREW.

BACKGROUND: The use of a dynamic hip screw (DHS) for stable as well as unstable intertrochanteric hip fracture xation has been successfully applied in fracture healing for more than 25years. DHS xation on unstable trochanteric fractures still has a more failure rate compared to stable fractures, mostly due to osteoporosis in patients. Thus, this study is aimed to investigate the biomechanical property of the DHS system to provide the stable xation in intertrochanteric A1 and A2 fractures1. MATERIAL AND METHODS: This is a retrospective study of 54 patients with trochanteric fractures of the femur that were treated with DHS (Dynamic hip screw) during the period of two years from April 2019 to March 2021 in a tertiary care hospital. All surgeries were performed under spinal and epidural anaesthesia. Surgery done was an internal xation with DHS plate. Results: Among 54 cases, 55.5% were A1, and 44.4% were A2 pertrochanter fractures. The clinical and functional outcomes of the procedure were excellent in 25 patients (46.29%), good in 19 patients (35.18%), fair in 8 patients (14.81%), and 2 (3.7%) of the patients had poor results. CONCLUSIONS: Intertrochanteric fractures are essentially fractures of the elderly, which demand prompt treatment and early ambulation. The dynamic hip screw is the operative treatment of choice for stable trochanteric fractures

RETROGRADE INTRAMEDULLARY INTERLOCKING NAILING: A PROSPECTIVE STUDY IN SUPRACONDYLAR FRACTURE OF FEMUR

Introduction: In addition, a retrograde intramedullary supracondylar nail has got distinct advantages of preservation of fracture hematoma, decreased blood loss, minimal soft tissue dissection, less operative time, and reduced rate of infection. The purpose of this study is to evaluate the results of supracondylar and intercondylar fracture of the femur, treated by close or open reduction and internal xation using a retrograde intramedullary supracondylar nail. Methods: A total number of 32 patients were enrolled in this study who presented with supracondylar femur fracture and had undergone a closed reduction and internal xation by Retrograde Femoral nail. Neer's and Sander's evaluation scoring system was used for evaluation. Results: Neer's rating was used to assess the result, according to which there were good to excellent results in 74.20% of cases. Conclusion: Supracondylar femur nail is an optimum tool for many supracondylar fractures of the femur, but it needs attention to technique to prevent the difculty

Zimmer Natural Nail and ELOS nails in pertrochanteric fractures

Background Pertrochanteric fractures of the femur in the elderly are very common. As the average age of the population increases, the incidence of such fractures also raises, resulting in high healthcare costs. The type of surgical devices employed for their surgical management influences these costs. Methods A comparative clinical study was conducted on patients operated by one single surgeon between December 2018 and November 2020 in a high-volume regional referral centre. All patients who received a Zimmer Natural Nail (ZNN) or ELOS devices were included. Results In 119 (66.48%) of the 179 fractures, a ZNN nail was used. Post-operatively, the TAD (tip-to-apex distance) was measured at an average value of 17.05 (4.42–41.85) mm and the CalTAD (calcar-referenced TAD) at an average of 20.76 (10.82–43.63) mm. The mean hospitalization time was 10.19 (4–22) days. In the other 60 trochanteric fractures, an ELOS nail was used. Post-operative imaging indicated a TAD of 19.65 (5.08–31.4) mm and a CalTAD of 22.86 mm (12.66–33.77). The average time of the operation was 45.82 (20–110) min. The average period of hospitalization was 10.45 (5–24) days. Conclusion Both devices give similar results in terms of short-term post-operative outcome and hospitalization. The price difference between the devices does not translate in different short-term results on the operated patients.

Atypical fractures secondary to bisphosphonate therapy: A case series and pictorial review

Osteoporosis is a ubiquitous and chronic process that affects an increasing number of people each year. Various forms of treatment are currently used including bisphosphonates which have been linked to atypical fractures of the femur. We present a case series of eight osteoporosis patients who developed atypical femoral fractures, while on bisphosphonate therapy. This pictorial review aims to increase awareness of bisphosphonate-related atypical fractures, discuss the current literature recommendations, and provide clear learning points from each case-based discussion.