No abstract

Background. Anterior bridge plating with minimally invasive technique in humeral shaft fractures is reported as an acceptable, less traumatic and reproducible procedure by several authors. We have evaluated the clini­cal, radiological, and functional outcome of such fractures in eleven patients, all of which were managed with dynamic compression plates over an average follow-up period of 22 months. Material and methods. Forty patients with humerus shaft fractures managed by anterior bridge plating using the MIPO technique between 2014 and 2016 were included in this series. All cases were treated with closed reduction and 10-12 hole 4.5mm dynamic compression plate fixation over anterolateral aspect in bridging mode using the MIPO technique. The UCLA shoulder and Mayo elbow performance scores were used for assessing shoulder and elbow function. Results. Of the forty patients followed up for a minimum of 18 months in the study, 26 were males and 14 were females. The mean age was 34.3 years (range 20 to 53 years). 24 out of the forty patients (60%) had the dominant side fractured. The mean surgical time was 72.5 minutes (range: 45–100 minutes) and mean radiation exposure was 160 seconds (range: 100–220 seconds). The mean radiological fracture union time was 13 weeks (range: 8–18 weeks). Shoulder function based on the UCLA score was excellent to good in 33 cases (82.5%), fair in 6 cases (15%) and one patient (2.5%) developed infection for which the plate was removed prematurely at the 4th month and the wound was meticulously debrided and then managed conservatively. Road traffic accident (RTA) was the most common mode of injury, found in 27 cases; 12 patients sustained blunt trauma due to a fall; one patient sustained an injury following a direct blow by stick. Conclusions. 1. The mini-incision anterior bridge technique for humeral shaft fractures gives good functional results and should be considered an effective, cosmetically advanced surgical option in the treatment of humeral shaft fractures. 2. The mini-incision anterior bridge technique is a safe and less method for simple types of humeral shaft fractures when the surgeon is experienced in the technique.

1. Although conventional short segment posterior fixation (SSPF) has become an increasingly popular method of treatment of thoracolumbar burst fractures, providing the advantage of incorporating fewer motion segments in the fixation, a review of literature demonstrated that SSPF led to 9-55% incidence of implant failure and long term loss of kyphosis correction. 2. Short segment posterior fixation with pedicle fixation at the level of the fractured vertebra (short same-segment fixation) provides more biomechanical stability than traditional SSPF.

Introduction: Tibial fractures are the most common long bone fracture. The standard of care for the treatment of diaphyseal tibial fractures is an intramedullary nail (IMN). Implant removal is one of the most common procedures in bone and joint surgery, and criteria for implant removal are typically left to the treating surgeon. We conducted a prospective study to investigate effects of intramedullary nail removal after tibial fracture union. Methods: Sixty patients at our hospital were enrolled in a prospective study and divided into moderate/severe knee pain (visual analog scale (VAS) -4) and mild/no knee pain (VAS < 4) groups after interlocking intramedullary nailing. Variables studied included the distance from the tip of the nail to the tibial plateau and the front of the tibia on a normalized lateral X-ray, the VAS score of knee and ankle pain, the range of motion of the knee and ankle, and Johner-Wruhs criteria before, 6 weeks after operation, and at the last follow-up. Results: Fifty-seven patients were followed for a mean of 8.4 (2-17) months. In patients with moderate or severe knee pain intramedullary nail removal led to significant pain reductions (p < 0.05). A significantly shorter distance from the tip of the nail to the tibial plateau (<10 mm) and the anterior border of tibia (<6 mm) was found in the 24 patients with moderate or severe knee pain. Conclusion: For patients complaining knee pain after interlocking intramedullary nailing of tibial fractures, especially with a short distance from the tip of the nail tail to the tibial plateau(<10 mm) and the anterior border of the tibia (<6 mm) removal of the intramedullary nails relieved the pain significantly.

Diabetic foot ulcers are main cause of hospitalization in diabetic patients. Patients with diabetes mellitus are at higher risk of lower extremity complications than their non diabetic counterparts. Every year approximately 5%of diabetic patients develop a foot ulcer. Approximately15% of all diabetics develop foot problems during course of their illness (1-2). Diabetic foot ulcers carry a significant risk of amputation. Therefore diabetic foot disease has major medical, economic and social consequences. This was a prospective observational study conducted Tertiary Care Teaching Hospital of North India and included 100 patients with diabetic foot ulcer presenting over a period of one year. The aim of this study was to evaluate and manage different lesions of diabetic foot according to Wagner classification. A treatment oriented assessment of diabetic foot ulcers based on a cross-examination of the medical, foot, and wound history, risk factors, a systemized and detailed physical examination and the results of complementary diagnostic procedures were recorded. Diabetic foot disease presented more among male in older age group and was more common in patients with uncontrolled diabetes, with longer duration of disease, with more than one co morbid condition. 38 patients (38%) had insulin dependent diabetics; and 87 (87%) of them were on irregular treatment. Other 58 patients (58%) had non-insulin dependent diabetes; out of which 19 (70.0%) were on irregular. Treatment. Remaining 4 patients(4%) were not getting any treatment for their disease The commonest disease was Grade 4 that comprised of 34 patients, followed by Grade 2 in 22 patients, followed by Grade 3 in 16 patients. These patients were managed according to Wagner classification as shown above. Conservative management with good diabetic control, antibiotic cover and foot care was carried out in 25 patients. Surgical intervention was carried out in rest of 75 patients. . The commonest procedure was incision & drainage of foot abscess and debridement, that was performed in 40(40 %) of patients; while 35 (35.0%) patients needed some form of amputation . Multiple amputations were performed in 2 (2%) patients.This study confirmed that diabetic foot ulcers is quite prevalent among diabetic population and thus, a multidisciplinary approach approach prioritizing invasive infection drainage, necrosis debridement, and the prompt start of empirical antibiotic therapy, followed by complete, appropriate