Osteosynthesis of Common Acetabular Fractures Operated on Through a Single Posterior (Kocher-Langenbeck) Approach with or without Trochanteric Flip Osteotomy. A Case Series

Background. The Kocher-Langenbeck approach is recommended in the majority of common posterior acetabular injuries. Trochanteric osteotomy can be used to extend the exposure of the Kocher-Langenbeck approach superiorly and anteriorly. We evaluated the functional outcome of common acetabular fractures operated on through the Kocher-Langenbeck approach with or without trochanteric flip osteotomy. Material and methods. This prospective study enrolled 42 patients with posterior wall, posterior column, transverse, posterior wall with posterior column, transverse with posterior wall and both column acetabular fractures. The Kocher-Langenbeck approach was used in 35 patients and trochanteric flip osteotomy was done in 7 patients. The radiological outcome was evaluated by Matta’s criteria and the functional outcome was evaluated using modified Merle d'Aubigné and Postel criteria. Results. D’Aubigne Postel scores at the final follow-up were excellent in 12 patients, good in 18, fair in 8 and poor in 4. Thirty-seven patients had congruent reduction (anatomical in 29, imperfect in 8) and 5 patients had non-congruent reduction on radiographs as per Matta’s criteria. Radiographic congruity (88.09%, 37 out of 42 cases) correlated fairly well with the functional outcome (excellent or good functional outcome in 71.4%, 30 out of 42 cases). The complications included traumatic nerve palsy (3 cases), iatrogenic nerve palsy (2 cases), deep venous thrombosis (2 cases), wound infection (3 cases), non-congruent reduction (5 cases), 8 cases of osteoarthritis of hip, 2 cases of avascular necrosis of femoral head and 3 cases of heterotrophic ossification. Conclusions. 1. Surgical treatment of common acetabular fractures with major posterior involvement can be attempted via a single posterior approach (Kocher-Langen­beck with or without trochanteric flip osteo­tomy) and leads to good-to-excellent results in a majority of the cases. 2. It is superior to conservative management, which has been found to be accompanied by a much higher rate of complications. 3. A thorough study of the pre-opera­tive radiographs, Judet’s views and 3D-reconstructed CT images helps in classifying the fracture and thereby assigning or not assigning it for the posterior approach.

A STUDY OF DISLOCATION AFTER PRIMARY TOTAL HIP REPLACEMENT BY POSTERIOR APPROACH

Dislocation after primary Total Hip Arthroplasty is devastating complication which may lead to neurovascular damage if not treated urgently. Posterior approach to hip is most commonly used worldwide. It said to have increased chances of dislocation postoperatively as compared to other approaches according to literature but still a debatable topic of discussion. In our study , we retrospectively studied 189 patients operated for primary THA in tertiary care centre fullling inclusion criteria. These patients were operated by same surgeon with posterior approach and uncemented implant with 28mm femoral head .Demographic data of patients and incidence of dislocation studied. Our observations and results found out that male patients are more common and are of young age group who undergone THA. Most common indication for surgery was Avascular necrosis of femoral head. Out of 189 , only 3 patients had episode of dislocation. With our study , we conclude that posterior approach to hip is safe if done by experienced surgeon with ideal implant positioning ,meticulous soft tissue repair & proper patient counseling for post-op rehabilitation

STUDY OF STAGING OF MAGNETIC RESONANCE IMAGING IN AVASCULAR NECROSIS OF FEMORAL HEAD

Avascular Necrosis refers to the bone death in epiphyseal or subarticular location secondary to interruption of blood supply. MRI has become the most sensitive, specic and widely used diagnostic imaging modality for evaluation of AVN of femoral head. The aim was to study the stages of presentation of Avascular Necrosis of femoral head on Magnetic Resonance Imaging in tertiary care centre .It is a Hospital record based descriptive study carried out at the Department of Radio-diagnosis, those patients which showed signs for avascular necrosis of femoral head over a period of three years were included in the study. Staging of Avascular Necrosis of femoral head was done as per Ficat and Arlet classication and distribution was done on the basis of Age, Gender and Laterality. Out of 129 patients with suspected AVN, 68 patients showed features of AVN of femoral head on MRI .It was found that males were commonly affected with mean age group between 31-40 years. Most of the patients had bilateral involvement. It was found that most of the patients presented during stage III of the disease. It was also observed that Coronal sequence of T1w image was useful in diagnosing most cases of AVN and hence can be used as a rapid protocol in diagnosing AVN.

AYURVEDIC INSIGHTS OF AVASCULAR NECROSIS OF FEMORAL HEAD

Avascular necrosis of the femur head (AVNFH) is a debilitating disease caused due to the use of alcohol, steroids, following trauma or unclear (idiopathic) etiology, affecting mostly the middle aged population. Clinically AVNFH is associated with impaired blood supply to the femoral head resulting in bone necrosis and collapse.In Ayurveda, there is no direct reference of disease resembling to Avascular necrosis of femoral head, hence it can be understand on the basis of Vikaraprakriti of disease caused by vitiation of Dosa, Adhisthana (abodesite) and Hetu (causes of vitiation of Dosa). In the present study an effort has been made to understand AVN on the ground of Ayurveda.

ROLE OF DASHMOOLADI MAJJA SNEHA (THERAPEUTIC ENEMA) IN AVASCULAR NECROSIS: A CASE STUDY

Introduction:Avascular necrosis is also known as aseptic, osteonecrosis and ischaemic necrosis of bone. There are a multitude of risk factors but over 80% of cases are attributed to glucocorticoid treatment or alcohol excess. Avascular Necrosis of femoral head is the most common type of necrosis, because the artery supplying to neck of femur is very narrow which easily gets injured. In modern medicine there is no specic treatment rather than surgery. In Ayurveda avascular necrosis can be correlated with Asthimajjagatvata. Aim: To assess the efcacy of Dashmooladi Majja Sneha in the management of avascular necrosis. The objective of the treatment includes the preservation of structure and function of hip joint with symptomatic relief. Materials & Methods:The present case study is upon a 32 year old, diagnosed case of avascular necrosis of femoral head with complaints of pain in bilateral sacroiliac joint since one and half years which was associated with difculty in doing normal daily activities such as walking, sitting, squatting along with change in the gait, at the Panchakarma OPD of Govt. Ayurvedic hospital Bhopal. The patient of idiopathic AVN of femoral head was treated with Dashmooladi Majja Sneha, Brihatvata Chintamani Rasa, Amritaristha, Panchtikta Ghrita Guggulu and Shastik Shali Pind Swedan have done as per the classical method for 30 days. Assessment was done after treatment and follow up after 15 days for 2months. Observations: The Ayurvedic therapies and oral medicines yielded complete symptomatic relief from pain, general debility and improvement in the gait. Conclusion: On the basis of the results obtained it can be concluded that Dashmooladi Majja Sneha, Shastik Shali Pind Swedan and some oral medicines can be used as an effective treatment in the management of Avascular Necrosis.