A Comparative Study to Determine the Outcome of Supracondylar Fracture of Humerus in Children Treated with Percutaneous Cross Pinning Versus Two Lateral Pinning

Objective: Analysis and assessment of anatomical refurbishment with the use of percutaneous cross pinning versus two lateral pinning and to determine the functional consequences of these procedures, to evaluate the hurdles faced in these treatment methodologies, and the comparison between the patient acceptances in both methods. Methods: This research was a comparative cross-sectional analysis which was conducted at Orthopedics department of Ayub Teaching Hospital Abbottabad for duration of six months i.e from March 2021 to August 2021. The sample size for the research was 50 patients who were admitted both at the (outpatient department) OPD and in the emergency ward. All the patients were clinically examined carefully and thoroughly, and all of their details were recorded. Base line investigations and X-rays were performed of every patient. Results: Percutaneous cross pinning or two lateral pinning methods were used to treat 50 patients suffering from supra-condylar fracture of humerus. Two groups were formed, each had 25 patients. Group A consisted of patients were treated from PCP, while group B patients were treated from TLP. Among the patients of Group, A, 20(80%) were male, 5(20%) were female, with a female: male ratio of 1:5, while in group B patients, 22(88%) were male, 3(8%) were female, with a female: male ratio of 1:8. The average age of both the groups was 7.30+3.30 years. The most prominent reason of fracture in the designed study was fall during playing (54%), 24% patients reported falling from bicycle, while only 22% patients had fallen from trees, the height of which was around 5-7 feet. Postero-medial displacement was observed in 66% patients, while Postero-lateral displacement was observed in 34% patients. Among the list of complications, in TLP, 8% patients suffered from superficial pin tract infection, 12% patients suffered from non-union, and 4% patients had K-wire migration and 4% had Cubitus varus. On the other hand, in PCP group patients, one patient developed superficial pin tract infection, 8% patients had nonunion, and 4% patients had K-wire migration. When the results were analyzed using the Flynn criteria, they were excellent (48% group A patients versus 36% patients of group B), 32% patients in group A had good results and 28% in group B, 20% patients of group B versus 12% patients of group A were regarded as fair, and 8% patients of group A versus 16% patients of group B were considered as poor. The patients who carried angle loss were 12% of group A versus 24% of group B, and who complained about loss of motion were 15% patients of group A versus 25% patients of group B were classified according to Flynn criteria Conclusion: Percutaneous cross pinning is concluded as the better, and more predictable treatment method in terms of management, as compared to two lateral pinning method to treat the Supra-condylar fractures. Key Words: Percutaneous cross pinning, two lateral pinning, supra-condylar fracture, humerus

Risk factors of pin tract infection during bone transport using unilateral external fixator in the treatment of bone defects

Background The bone transport using the unilateral external fixator, one of the Ilizarov techniques, is widely practiced in lower limb reconstructive surgery. Pin tract infection (PTI), one of most common complication, has become the important postoperative problems which plague clinicians gradually. Methods A group of 130 patients who received bone transport surgery for tibia or femur defects using the unilateral external fixation (Orthofix limb reconstruction system, Verona, Italy) and met the inclusion criteria were selected for the study from 2015 to 2019. Regular pin tract care was performed twice a day, and the conditions of the pin tract were evaluated by the same observer using clinical appearance criteria. The Saw’s classification of PTI was used to assess the condition around screws. After the data were significant by the T-test or Pearson’s Chi-square test analyzed, odds ratios were calculated using logistic regression tests to describe factors associated with the diagnosis of PTI. Results Ninety-one males and thirty-nine females with a mean age of 43 years (range 28–58 years) were included in this cohort. 7816 observations were documented from 12 to 36 months, and 58 cases (44.6%) of PTI (thirty-nine cases in grade 1, 17 cases in grade 2, and 2 cases in grade 3). The top five risk factors were agricultural work (OR 1.86, CI 0.94–2.39), non-urban living (OR 1.75, CI 1.24–3.26), male (OR 1.71, CI 1.02–2.31), smoking (OR 1.53, CI 0.76–1.89), and diabetes (OR 1.26, CI 1.12–2.64). No long-term sequelae were observed at the latest clinical visit. Conclusion Occupation, gender, living environment (non-urban), smoking, and diabetes were the top five significant risk factors for PTI in the period of bone transport using unilateral external fixation. Awareness of predictable risk factors of PTI is beneficial to avoid or early detect the severe complications which can affect the effectiveness.

A PROSPECTIVE STUDY OF A MODIFIED PIN-IN-PLASTER METHOD FOR THE TREATMENT OF FRACTURES OF THE DISTAL RADIUS

Introduction:- The motive of this study is to introduce a modied technique of 'pin in plaster.' that is a favourable treatment option for unstable fractures of the distal radius. This study was shown to narrated a modied technique using 'pin in plaster' that is a favorable treatment option for unstable fractures of the distal radius. A fracture of the distal radius is one of the most customary types of fracture, in the pediatric population fracture was 24% and up to 20% in the elderly, male-to-female ratio of one to four in older age groups. Methods:- 54 patients with fractures of the distal radius were followed for one year postoperatively. Patients were debarred if they had type B fractures according to AO classication, multiple injuries, or pathological fractures and were treated more than seven days after injury. Radiographic parameters, tilt and height including radial inclination, were measured pre-and postoperatively. Results:- The radial height was 10.2 mm at the sixth month postoperatively, and the average radial tilt was 10.6° of volar. Three patients of pin tract infection were recorded. There were no cases of pin loosening. Total 73 patients underwent surgery, and three cases of radial nerve irritation were recorded at the time of cast removal. All radial nerve palsies resolved at the six-month follow-up. Conclusion:- Our modied technique is successfully restoring anatomic congruity and maintaining the reduction in fractures of the distal radius.

External fixation versus elastic stable intramedullary nailing in the treatment of open tibial shaft fractures in children

Introduction External fixator (EF) is a popular choice for open tibial fractures, but pin tract infection (PTI) and refracture are common complications. Elastic stable intramedullary nail (ESIN) has been reported in the treatment for open tibial fractures. This study aims to compare the clinical outcomes of EF vs. ESIN in the treatment for open tibial shaft fracture in children retrospectively. Methods Patients aged 5–11 years with Gustilo-Anderson II and IIIA tibial shaft fracture treated at our institute from January 2008 to January 2018 were reviewed retrospectively and categorized into EF and ESIN groups. Patients with pathological fracture, neuromuscular disorder, metabolic disease, previous tibial fracture or instrumentation, and polytrauma were excluded. Patients with follow-up < 24 months or incomplete medical records were also excluded. Results In all, 55 patients (33 males, 22 females) were included in the EF group, whereas 37 patients (21 males, 16 females) were included in the ESIN group. There was no statistically significant difference between the two groups concerning sex, age, body weight, duration from injury to surgery, Gustilo-Anderson (GA) classification, and concomitant injuries. There was no case of nonunion and malunion in either group. The angulation at the latest follow-up was higher in the EF group than the ESIN group (P < 0.01). The radiological union was faster in the ESIN group (7.0 ± 0.9 weeks) than those in the EF group (9.0 ± 2.2 weeks) (P < 0.01). Limb length discrepancy (LLD) was more in the EF group (12.1 ± 4.4, mm) than in the ESIN group (7.3 ± 4.3, mm) (P < 0.01). Conclusion ESIN is a viable option in selected patients of GA grade II and IIIA open tibial fractures with comparable clinical outcomes as external fixator. Pin tract infection is the most troublesome complication in the EF group while implant prominence is a nuisance in the ESIN group.

Complications Associated with Bifocal Bone Transport Using Unilateral External Rail Fixator in the Reconstruction of Femur Defects Caused by Infection: Outcome Analysis of 76 Patients

Background: The purpose of this study is to evaluate the outcomes of single-level bone transport in the treatment of femoral bone defects after radical debridement, which were caused by infections.Methods: Clinical and radiographic data of patients with infected femoral nonunion treated with a unilateral external fixator (Orthofix limb reconstruction system, LRS) at our hospital from 2010 to 2019 were analyzed retrospectively. The Association for the Study and Application of the Method of Ilizarov (ASAMI) standard was applied to assess the bone and functional outcomes and postoperative complications evaluated by Paley classification. Results: Seventy-six cases of infected femoral bone defects (31 proximal, 19 intermediate, and 26 distal) were managed by single-level bone transport using a unilateral external fixator with a mean follow-up time of 30.8 (23 to 41) months. There were 58 men (76.3%) and 18 women (23.6%), with a mean age of 38.8 years (range, 23 – 60 years). The bone union was achieved in 76 cases with a mean time of 6.9 months (range, 5-8 months). Complications included 29 cases (38.1%) of pin tract infection, 7 cases (9.2%) of muscle contractures, 3 cases (7.9%) of joint stiffness, 13 cases (17.1%) of axial deviation, 2 cases (2.6%) of delayed union, one case (1.3%) of nonunion, and none (0%) of transport gap re-fracture. One patient (1.3%) was scheduled for knee arthroplasty when bone transport treatment ended.Conclusions: Bone transport in the reconstruction of femoral bone defects using unilateral external rail fixator had a satisfactory rate of bone healing and limb function recovery. Complications of distal femoral bone transport were more severe than other sites, but the complication rate was the least of the three. Complications of the proximal were comparable to the intermediate, and soft-tissue-related complications were more likely to occur in the intermediate transport.

Study to Determine the Efficacy of Illizarov Fixator for the Treatment of Complex Tibial Plateau Fractures

Aim: To evaluate the results of illizarov external fixation using ligamentotaxis technique in high-energy plateau fractures of the tibia. Methodology: The external fixation of illizarov external fixation using ligamentotaxis was performed in 32 patients aged 18-50 years due to high-energy plateau fractures of the tibia. 18 on the right knee and 14 on the left knee. 28had closed wound and four had open wound fractures. According to the classification of Schatzker’s; classification was carried out for fractures. After two years (range 12 to 24 months) of follow-up, each affected knee was assessed using the Knee Society Score (KSS). Results: There were 24Schatzker type VI and eight type V fractures of the tibia. Complications included deep infection in two cases, one patient had pin tract infection, deep vein thrombosis in two patients and one had fusional defect. The knee motionmean range was 120 degrees of flexion and six degrees of deficiency in extension. According to the KSS criteria, the outcomes were excellent in 22 patients (68.75%), 4 patients (12.5%)have good results, moderate in 5 patients (15.65%) and weak in 1 patient (3.12%). Conclusion: Ilizarov External fixation gives good anatomicalreduction of joint surface, earlypainfreewt bear, stable fixation and maintain soft tissue envelope without major complications.

Bone transport over the nail vs Ilizarov method in the treatment of posttraumatic defects of the femur and tibia

Relevance. From the point of view of using the advantages of both external fixation and internal osteosynthesis, the method “Bone transport over the nail” (BTON) deserves attention.Intention: To compare the effectiveness of the BTON and Ilizarov method in the treatment of patients with post-traumatic defects of the long bones of the lower extremities.Methodology. We analyzed 24 BTON cases and 47 cases of defects replacement via the Ilizarov method. The analysis included patients with segmental defects of the tibia, femur and knee joint bone defects complicated by chronic osteomyelitis.Results and Discussion. The external fixation period in BTON group was 3 times less than in the comparison group, as was the external fixation index. In case of monolocal defect replacement, the external fixation period and external fixation index in the BTON group was 4 times less than in the Ilizarov defect replacement group. With bifocal replacement of the defect, the external fixation period was 2.5 times less, and the external fixation index was 2 times less. BTON interventions were associated with complications in 31 cases (129.2 %) vs 82 cases for the Ilizarov method (174.5 %). The most pronounced decrease (3 times) was noted for cases of transosseous elements inflammation.Conclusion. The “Bone transport over the nail” technique reduces the external fixation period by an average of 3 times. This facilitates management of the outpatient phase and reduces the number of complications, especially the pin-tract infection. Cable technique combined with an orthopedic hexapod allows bifocal replacement of extended defects of the distal femur and knee joint applying the apparatus only to the lower leg. Risks of jamming the transported bone fragments by the intramedullary nail are thus excluded. To avoid breaking the traction cable, only designated devices should be used.

EVALUATION OF RESULTS OF GRADUAL DISTRACTION TECHNIQUE FOR CORRECTION AND FUNCTIONAL RECOVERY OF NEGLECTED CTEV

INTRODUCTION: Congenital talipes equinovarus (CTEV) or clubfoot is commonest congenital foot deformity. The incidence of Congenital Idiopathic Clubfoot ranges from 0.36/1000 to 6.8/1000 in some populations and about 1.2/1000 births among Caucasians including Indians, with a 1 much higher occurrence in the affected families . More common in male (2:1). Bilateral cases account for about 50%. In unilateral cases right side affected more. The term talipes is derived from talus (ankle bone) and pes (foot). AIMS & OBJECTIVES:To assess the efcacy of gradual differential distraction with JESS as a method of treatment in neglected CTEV. Evaluation of functional recovery of neglected CTEVusing this technique. To assess the morbidity & complication of the technique. MATERIALS AND METHODS: Study area: - The study was institution based, conducted at the Orthopaedics department of I.P.G.M.E.R.& S.S.K.M. Hospital, Kolkata, a tertiary care centre catering to people of West Bengal and adjacent states of Eastern India Study population: Patients attending Orthopedics' O.P.D. of IPGMER & SSKM Hospital. Study period: From May 2016 to Oct 2017 (18 months duration) Sample size: 20 patients (24 feet) Sample design: Patient selection: RESULTS AND ANALYSIS: 2(8.3%) patients exion deformity of toes. 1(4.2%) Persitant cavus, 1(4.2%) had liniar skin necrosis, 1(4.2%) patients had pressure sore, 1(4.2%) had oedema of feet, 1(4.2%) persistent all deformity, 2(8.3%) patients had persistan tequinus, 5(20.8%) patients had persistant heel varus, 2(8.3%) patients had forfoot adduction, 3(12.5%) patients had pin tract infection and 11(45.8%) had no complication. 4(16.7%) patients had excellent functional outcome, 8(33.3%) patients had good functional outcome, 8(33.3%) patients had moderate functional outcome and 4(16.7%) patients had poor functional outcome. CONCLUSION: In our study 12(82.3%) feet had excellent to moderate result, only 4(16.7%) had poor result with limited complication. Few patients left with one or more persistent deformity but the nal outcome was functionally satisfactory. JESS is an excellent technique in the management of neglected cases of CTEV especially when it is done at an early age. Differential distraction by JESS xator for the correction of neglected idiopathic CTEV is an effective and patient-friendly method of management. Therefore the differential distraction with JESS can be considered as a treatment modality for the neglected CTEV.

The Role of Chlorhexidine in the Prevention of Pin Tract Infection as Compared to Povidone-Iodine in Patients Managed by Ilizarov Circular Fixator

Objective: To compare the efficacy of Chlorhexidine in the prevention of pin tract infection as compared to Povidone-iodine antiseptic. Study Design: Prospective, single blinded randomized trial. Study Setting and Duration: Liaquat University of Health Science (LUMHS), Jamshoro between July 2018 to November 2020. Methodology: All patients who underwent Ilizarov external fixation as per indications were eligible for the study. Individuals with a previous history of osteomyelitis were excluded from the study. Pin sites were cleansed with normal saline using clean applicators. In the group chlorhexidine, the antiseptic was applied on the pin skin interphases (1% chlorhexidine). Similarly, 10% povidone iodine was applied to patients in group C. The control group was cleansed with normal saline. Pin sites were either dressed daily or weekly. The primary outcome was the rate of pin site infection days. Results: Chlorhexidine group had significantly lesser pin-site infections as compared to the povidone-iodine group with a frequency of 13 (39.39%) and 19 (63.33%), p=0.04, respectively. The mean pin tract infection rate days ± SD were significantly lower in the chlorhexidine group as compared to the povidone-iodine group (1.35 ± 2.26 vs 3.54 ± 4.30, p=0.041). Similarly, the mean duration to onset of pin site infection was also significantly higher in the chlorhexidine group compared to povidone-iodine and control groups. Conclusion: Patients who used Chlorhexidine as the cleansing agent had significantly fewer pin-site infections as compared to the povidone-iodine group. Keywords: Chlorhexidine, Ilizarov fixator, fracture, Povidone-iodine