TO EVALUATE THE FUNCTIONAL OUTCOME OF LOCKING COMPRESSION PLATE FOR FRACTURES AROUND KNEE JOINT(DISTAL 1/3RD FEMUR OR PROXIMAL 1/3RD TIBIA)

Background: To evaluate the functional outcome of locking compression plate for fractures around knee joint (Distal 1/3rd femur or proximal 1/3rd tibia) Methods: This prospective functional out-come study has been conducted on This prospective study has been conducted on 50 patients with Distal 1/3rd femur and 50 patients with proximal 1/3rd tibia Results: According to Modified Mehrotra’s Criteria, the excellent (44.00%) and fair (42.00%) and (14.00%) had poor result Conclusion: Locking compression plate is the optimal tool for many supracondylar fractures of femur and proximal tibia fractures. It provides rigid fixation, where a widening canal, thin cortices and frequently poor bone stock make fixation difficult. Keywords: Femur, Tibia, Locking plate, MIPO, Outcome.

Result of Ring Fixator in High-energy Schatzker Type VI Fractures of Proximal Tibia

Background: Significant articular depression, separation of both condyles, diaphyseal comminution and dissociation, and loss of soft-tissue envelope integrity are all associated with high-energy proximal tibia fractures (Schatzker VI). Over the past 50 years, there has been a lot of research on plating problems in these complicated fractures. For the care of these complex injuries, Ilizarov devised a new method (ring fixator). Aim of the Study: To examine the outcomes of patients who received a ring fixator for the treatment of high-energy proximal tibia fractures (Schatzker VI). Materials and Methods: Fourteen patients (mean age 36) were treated with the Ilizarov fixator and transfixion wires for high-energy fractures of the proximal tibia (Schatzker VI). Nine of the patients had open fractures, and five of them had significant soft tissue damage. They were all tracked for an average of 19.4 months. The result was analyzed using the criteria set by Honkonen & Jarvinen (1992). Results: Thirteen fractures healed in an average of 14.6 weeks, with one taking six months. Twelve patients recovered complete extension, while eight others regained more than 110 degrees of flexion. All of the patients knees were stable, except one who had a minor varus deformity. Nine patients walked normally, while four had a little limp. Except for one, all of the knees exhibited an articular step-off of less than 4 mm and normal axial alignment. Six knees were found to be outstanding, five to be decent, and three to be fair. There were no instances of postoperative skin infection or septic arthritis, however, three patients did have a pin tract infection that was effectively managed. Conclusion: The technique is suitable for the treatment of complex proximal tibia fractures when there is substantial comminution at the fracture site as well as soft tissue damage (Schatzker VI).

Clinical and Radiological Outcome of Complex Proximal Tibia Fractures Managed with Hybrid/Ilizarov Fixator with or without Minimal Internal Fixation

Background. Complex high grade proximal tibia fractures with associated extensive soft tissue injury pose a management challenge. The timing of surgery and fracture fixation options depend upon the extent of soft tissue damage. Post-operative complications such as wound breakdown, infection and infected non-union are common in such cases managed early with open reduction and internal fixation. Such fractures can be treated with primary closed reduction and Ilizarov/hybrid fixator application. Materials and methods. It is a retrospective cross sectional study conducted at two tertiary care multispecialty hospitals to report the mid-term clinical and radiological outcomes of complex high grade proximal tibia fractures. These injuries were managed by closed reduction and external fixation with/without minimal internal fixation as a definitive procedure and outcome measures were checked with serial radiographs and functional scores at a regular interval of follow up. 17 patients with Schatzker’s type 5 or 6 proximal tibia fractures with soft tissue compromise were operated on at two tertiary care referral centres from 2017 to 2019. These cases were operated on by two experienced trauma surgeons. Periodic follow-up was done and radiological and functional progression noted from case records. Results. Average time to union was noted to be 12.59 weeks and mean time of fixator removal was 21.4 weeks. At the end of 1 year of follow-up, average range of motion was 121.76 degrees, average WOMAC score was 74.81(63-82) and KOOS score was 78.24(63-85). Conclusions. 1. Hybrid/Ilizarov fixator method is a safe way of fixing high energy proximal tibia fractures. It is associated with a good functional outcome, less soft tissue complications and allows early weight bearing. 2. We recommend this method of treatment for complex high grade proximal tibia fractures.

Outcome after polyaxial locking plate osteosynthesis in proximal tibia fractures: a prospective clinical trial

Background The aim of this study was to evaluate the clinical and/or radiologic outcome using different polyaxial locking plates for the treatment of proximal tibia fractures, the Non-Contact-Briding plate (NCB-PT®) by Zimmer or the Variable Angle Locking Compression Plate (VA-LCP®) by Synthes. Methods This study enrolled 28 patients with proximal tibia fractures (AO/ OTA 41 B-C) and indication for locking plate osteosynthesis. All patients were treated with a polyaxial locking plate system. Depending on the fracture morphology, patients were either treated with a NCB-PT® or VA-LCP®. The implant was chosen according to the surgeon’s experience and preference, in case of a higher degree of comminution the tendency was observed to use the NCB-PT® plate. After a time interval of 12 months postoperative we conducted clinical (e.g.exempli gratia range of motion, the Rasmussen score) and radiological (e.g. primary/secondary loss of reduction) follow-ups. Results Patients provided with the NCB-PT® (9 patients) showed longer operation time, use of longer implants, longer interval from injury to surgery and lower clinical scores after the 12 months follow-up compared with the VA-LCP® group (19 patients). Interestingly, the results showed no significant differences regarding the clinical and radiologic outcome. Conclusions The small number of patients as well as the heterogeneity of fractures constitute a limitation of this study. Nevertheless, the differentiated use of implants is associated with comparable clinical and radiological outcomes. This trial emphasizes the need for further prospective randomised trials with higher patient numbers. Trial registration Retrospectively registered 21.12.2020. Registration number NCT04680247.

Evaluation of the functional outcome of locking compression plate for fractures around knee joint distal 1/3rd femur or proximal 1/3rd tibia

<p><strong>Background:</strong> The aim of the study was to evaluate the functional outcome of locking compression plate for fractures around knee joint (Distal 1/3^rd femur or proximal 1/3^rd tibia).</p><p><strong>Methods:</strong> This multicentric prospective functional out-come study has been conducted in the department of orthopedics, Barmer medical college and hospital, Barmer, Rajasthan and department of orthopedics, Pacific institute of medical sciences, Udaipur, Rajasthan. A total of 90 patients were studied, out of which 60 patients were with fracture distal femur and 30 patients were with proximal tibia fractures. At the end of study, 20 patients were lost to the follow-up (16 patients were with distal femur fracture and 04 patients were with proximal tibia fracture).</p><p><strong>Results:</strong> According to modified Mehrotra’s criteria for distal femur fracture excellent (43.18%) and fair (43.18%) and (13.64%) had poor result. All followed-up patients of proximal tibia fracture managed with MIPO technique had excellent (11.11%), good (66.67%) and fair (22.22%) functional outcome and no failure. While 17.65% followed patients of proximal tibia fracture who were managed with ORIF technique had failure.</p><p><strong>Conclusions:</strong> Locking compression plate is the optimal tool for many supracondylar fractures of femur and proximal tibia fractures. It provides rigid fixation, where a widening canal, thin cortices and frequently poor bone stock make fixation difficult.</p>

DEFINING “IMPENDING” COMPARTMENT SYNDROME AND DEVELOPING INDIAN DISTRICT HOSPITAL PROTOCOL FOR HIGH ENERGY PROXIMAL TIBIA FRACTURES.

Background and objectives: High energy proximal tibia fractures (OTA 41/Schatzker 4/5/6) are common in motorbike accidents even in semi urban and sub-urban areas. Recommended management involves two stages with conventional Mantra of 'Span-Scan-Plan'. First stage involves temporary knee spanning external xator to prevent or manage impending compartment syndrome. This is followed by CTScan. The second stage is the denitive internal xation. These recommendations are not universally followed due to certain infrastructural and acceptability constraints inuencing decision making. Summary: The study is designed as prospective observational study. It is conducted in a District Hospital setup. An effort to dene and recognise “Impending Compartment Syndrome” is made by developing a clinical criteria based evaluation score. This score was used to monitor fracture related soft tissue changes over the initial period until denitive xation. All patients underwent temporary stabilisation by different methods. These different temporary xation methods were compared amongst each other to nd out their efcacy. Patient was assessed to the end point of where soft tissues settled down for denitive xation. Surgical site infection and knee function was assessed to nd out whether the type of temporary xation had any subsequent on soft tissue and knee joint. The results were statistically analysed to nd out clinical signicance.

Outcome of Biological Plating of Extra-articular Proximal Tibia Fractures

Introduction: The most prominent transformation in the treatment of fractures has been modified from intensive open reduction and internal fixation with absolute stability to the biological fixation with relative stability and secondary healing with callus formation, with priority on preservation of the vascularity of bone and soft tissue to improve fracture healing. Aim: To evaluate the outcome of biological fixation of extra-articular proximal tibia fractures in adults using the locking compression plate. Materials and Methods: The present prospective longitudinal study was conducted at Government Medical College and Hospital, Nagpur, which included 30 patients who had extra- articular proximal tibia fractures belonging to AO type 41A2 and 41A3 treated by proximal tibia lateral locking plate 4.5/5.0 mm. The patients were followed-up at two weeks, six weeks, three months, six months and one year. The fracture union, coronal, sagittal alignment was assessed radiologically at the end of follow-up. Functionally the outcome was evaluated using lower extremity functional score. Descriptive statistics were used for statistical analysis. Results: Biological plating with locking compression plate has shown promising results both in terms of function and radiology. There was non-significant difference in lower extremity functional score between patients with malunion and normal alignment. Mean union time was 19.93 weeks with a standard deviation of 2.21 weeks. There was non-significant difference between the range of motion and fracture type (p-value 0.38) as well as that between Lower Extremity Functional Score (LEFS) and fracture type (p-value 0.0501). On functional evaluation of patients treated with biological plating, there was statistical significance in Knee Range of Motion (ROM) for the patients between malunion and normal alignment (p value 0.01). Conclusion: The biological fixation using minimally invasive techniques is an effective method of stabilisation for extra-articular proximal tibia fracture, yielding good mechanical alignment and protecting soft tissues and blood supply, leading to higher union rates with good functional outcome.