Union in Fracture Tibia Managed with Closed Intramedullary Interlocking Nail, Our Hospital Results

Introduction: The purpose of this research was to present our hospital results in union of fracture Tibia managed with close intramedullary interlocking nail. Methods: This research was carried out at Liaquat University of Medical and Health Science Jamshoro Pakistan from June 2020 to June 2021. A total of 250 patients with a closed tibial shaft fracture were recruited from the emergency room and outpatient clinics for this study. Our study's clinical outcomes were categorized as union, nonunion, delayed union, or malunion based on the criteria. All of the patients were given anesthesia, either general or spinal. All of the patients were tracked for a period of nine months. Results: In 90–150 days, about 88 percent (220/250) of patients had union, with a mean of 110.68. Union occurred in 11.2 percent (28/250) of patients in 95–109 days, with a mean of 103.38. There were 7.2 percent (18/250) delayed unions and 4.8 percent (12/250) non unions treated with dynamization and bone transplant. The outcomes were outstanding in 88 percent (220/250) of the patients and good in 7.2 percent (18/250). Our patients all had full range of motion in their knees and ankles at the time of their examination. Conclusion: We found that this approach is beneficial due to early mobilization (early weightbearing), reduced complexity, good outcomes, and low cost.

REHABILITATION OF PATIENT WITH TIBIA-FIBULA FRACTURE

An orthopedic surgeon may find compound fractures of tibia-fibula challenging to treat. The degree of joint motion and the adequacy of reduction are the two factors that determine whether or not these fractures can be treated successfully. In many patients, open surgical treatment of comminuted tibial pilon fractures is associated with significant complications. Indirect reduction and stabilization of fractures using a circular external fixator can be a useful way of achieving adequate joint restoration, and it uses closed reduction principles to realign disturbed bones and joint structures. In this report, we describe about the effects of early rehabilitation compound grade IIIB fracture tibia, fibula of right side. The patient co-operation and motivation to return to daily functional activities also prove to very crucial for the rehabilitation process. The defect in bone is usually a result of high velocity trauma or a sudden impact. In present case open reduction and external fixation for distal one-third of tibia and fibula on right side was carried out followed by the rehabilitation protocol. Outcome measure used to check for the pain was NPRS. The patient morale and goal-oriented rehabilitation protocol progressed him to return to his functional activities.

Management of Orthopaedic Injuries following 2015 Gorkha Earthquake: Our Experience in Public Health Concern Trust Nepal

Background: On April 25 2015, a magnitude of 7.8 earthquake struck in central Nepal, causing a huge physical and social disturbances. Physical impacts comprised casualties with deaths and injuries and damage to infrastructure, cultural heritage and natural environment while social impacts are demographic, psychological and economic consequences. We report our experience in treating victims who were brought at our centre via different means.Objectives: to provide an overview the caseload and provide analysis of earthquake victims for improving the future strategies in similar scenarios.Methods: A retrospective study of the clinical characteristics and patterns of hospitalised patient after the 2015 earthquake was conducted. Demographic evaluation, surgical procedures and morbidities were reviewed. The patients were followed up for an average of 24 months, detail records were kept on their recovery and function.Results: A total of 85 patients were treated with subsequent follow-up. The proportion of males admitted was similar to that of females (49.4% and 50.5% respectively). The highest number of admitted age group ranges (17- 45) was about 37.64%. Most injured site was lower limbs (68.23%) where fracture tibia and fibula had the highest incidence (56.89%). Out of all, 14.11% of cases were open fractures. Trauma severity was assessed with injury severity score and most of them categorized as mild one (95.29%). The most common procedure performed was closed reduction and pinning (n=28), followed by open reduction and fixation (n=24). Overall, mortality rate was 2.35% (2 of 85). Total 25 implants were removed within three years of period and 28.6% of patients were not returned to date.Conclusions: The injury epidemiology reported in this study showed quite congruence with most other earthquake related studies. Analysis profiles of injuries and clinical features of earthquake victims will definitely impact rescue efforts and treatment of fracture injuries in possible future natural calamities.

Functional Cast Bracing in Selected Cases of Tibial Shaft Fracture in the Population of Odisha - A Prospective Study

BACKGROUND Tibial shaft fracture is one of the commonest fractures encountered in orthopaedic clinics today. With recent trend being surgical management, it has increased the economic burden in developing countries like India. Thus, interest in functional cast bracing can manage many of the fractures safely with less cost and shorter hospital stay with equally good results. METHODS This prospective study included 30 patients with closed tibial shaft fracture with minimal displacements who were treated with 3 weeks of initial long leg cast followed by functional cast bracing as described by Sarmiento in 1967 with a below knee patellar tendon bearing (PTB) cast with encouraged progressive weight bearing for 6 to 9 weeks. Our goal was to achieve shortening of < 10 mm, angulations of less than 5 degrees in any plane with full range of motion at knee as per Sarmiento. RESULTS Union was seen in 25 (83 %) cases. Angulations of < 5 degrees was noted in any plane in 79 % cases. Varus and apex posterior angulations were the most common deformity. Shortening 10 mm was noted in 72 % cases with almost complete ROM of knee joint in all patients. Non-union was noticed in 2 (7 %) cases. CONCLUSIONS Functional cast bracing can still be an ideal method of management for many of the tibial shaft fractures and with better understanding of the technique and proper application, it can safely be used on other long bones as well. KEYWORDS Closed Fracture Tibia, Functional Cast Brace

RESULT OF MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS (MIPO) WITH USE OF LOCKING PLATE IN FRACTURE TIBIA DISTAL END

Background: The fractures of distal tibia including tibial pilon pose a great challenge to the surgeon due to subcutaneous location, scarcity of blood supply and paucity of soft tissue coverage. Minimal invasive plating osteosynthesis (MIPO) has evolved as a newer concept to treat distal tibial fractures with minimal articular comminution and minimal soft tissue damage. Aim of the present study was to evaluate the results of MIPO technique with use of a locking plate in fracture tibia distal end. Method: During the study period of two years, total 45 cases of closed distal tibial fractures (Diaphyseal and metaphyseal region) were operated by MIPO technique with a distal tibial anatomical locking plate (3.5 and 4.5 mm). They were followed up at regular intervals and results were evaluated. Results: The age of the patients ranged from 20-60 years with the majority (19; 42.22%) of them being in the age of 40-50 years. The most common mode of injury was road traffic accident (33; 73.33%). In all patients MIPO was performed, in none of them, fracture site was opened. Mobilization of adjacent joints was carried out mostly from second to fourth postoperative day. Most of the fractures united between 10-12 weeks (26; 57.77%). On analyzing the results of MIPO, excellent results were seen in 66.66% cases and 33.34% had satisfactory results. Conclusion: Hereby we concluded that though various modalities of treatment of fractures of the distal tibia are present MIPO seem to be better technique if done under skillful guidance as done in this study.

Stress Fracture Tibia among Military Recruits Management by Patellar Tendon Bearing Cast

Introduction: Lower limb overuse injuries are common features of military training. Female recruits have significantly higher incidence of fracture than male recruits. In addition to the cost and time of rehabilitation, injury leads to disillusionment among recruits. Conventionally stress fracture tibia is treated with long leg posterior cast for 6-8 weeks but little is known about the length of time required for rehabilitation and to return to pre-injury level. Objectives: To see the outcome of management of stress fracture tibia among military recruits treated with Patellar Tendon Bearing (PTB) cast for 8 weeks and to find out the rehabilitation time to return to pre-injury level. Materials and Methods: This prospective study was conducted in Combined Military Hospital, Bogura, Bangladesh, from January 2015 to December 2016. Out of 2600 recruits 74 (male 60 females 14) were diagnosed as case of stress fracture tibia during the period. They were treated by PTB cast for 08 weeks and their treatment and rehabilitation to pre-injury level (follow-up) were recorded prospectively. Results: Total 85 patients were clinically suspected to have stress fracture tibia, out of them 74(87.06%) patients were finally diagnosed as case of stress fracture. Of these 74 patients 44(59.46%) were diagnosed by initial x-ray and 30(40.54%) were diagnosed by MRI scan. Prevalence of stress fracture in male was 2.45% and in female recruits 9.33%, overall prevalence was 2.85%.About 56(75.67%) patients developed stress fracture in 0-8 weeks of training, mean rehabilitation time to return to pre-injury level was 15.51 weeks, there was no recurrence of stress fracture and all the patients completed 12 months training, none of them was relegated or withdrawn from training on medical ground. Conclusion:Patellar tendon bearing cast is an effective, technically simple method for treating stress fracture of tibia in military recruits with excellent outcome. This method not only treats the fracture but also prevents depressive disorders. JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 196-199

Comparative Study between Nancy Nail and Conservative Treatment in Diaphyseal Fracture Tibia in Children

Background nonphyseal fractures of the tibia and fibula are among the most common injuries involving the lower extremities in children and adolescents; represent approximately 15% of all pediatric fractures. They occur more frequently in boys than girls. Aim of the Work assessing of efficacy and safety of treatment of diaphyseal fracture tibia in children by nancy nail versus conservative treatment. Patients and Methods this review was done using standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. Results ESIN is an ideal device for treating pediatric tibial fractures allowing mobilization and maintenance of alignment until bridging callus forms. The device would exploit the rapid healing and ability to remodel without risking the physis or blood supply to the tibia. Conclusion the present study supports the treatment of tibial shaft fractures in children aged 8-13 years with ESIN, as it hastens fracture union, and allows earlier, weight bearing, rehabilitation and return to normal activity.