No abstract

Total dislocation of the talus has been reported as 0.06% of all dislocations and 2% of all talar fractures. It usually occurs from considerable violence. Total dislocation of the talus is frequently an open injury, or the skin may be tented over the dislocated talus leading to skin slough. Closed total dislocation of talus with posterior process injury is rare. The functional prognosis is poor due to osteonecrosis of the talus which develops in the majority of cases. Review of literature reported successful closed reduction in cases of closed pan-talar dislocation under anesthesia. However, there were few cases where there was difficulty in closed reduction. Operative technique has also been described in different reports of similar cases. Case report We present a case of pan-talar dislocation of the left talus in a 25-year-old road accident victim, with posterior talar process fracture. Reduction of dislocation was attempted in emergency department by external manipulation. Reduction process failed, and hence planned for reduction under anesthesia. It required a open reduction after a unsuccessful closed reduction attempt. The talus after reduction was found to be unstable hence, stabilized with trans-calcaneotalar Steinmann pin. At 1-year follow-up, the right ankle was pain free and stable. Motion was satisfactory. The talus after a follow-up of 1 year did not show any signs of subluxation or avascular necrosis. Conclusion The main obstacle to closed reduction appeared to be talus had button holed through dorsal fascia. The talus after reduction was found to be unstable hence stabilized with trans-calcaneotalar Steinmann pin. The management of the associated fracture will depend on many factors, particularly displacement of the fracture fragments. How to cite this article Kumar MP, Gopinath KM, Kumar BNR, Balaji GAG. Closed Pan-talar Dislocation with Posterior Talar Process Fracture. J Med Sci 2015;1(2):32-35.

Objective: To assess the use of anteromedial plating in the shaft of humerus fractures concerning the union of fracture and to assess the frequency of complications associated with this approach. Study Design: Cross Sectional study. Setting: United Medical and Dental College, Shaheed Muhatarma Benazir Bhutto Medical College Lyari and Khairpur Medical College. Period: 15 January 2016 to 15 January 2019. Material & Methods: All the patients aged 18 years or over presenting with the shaft of humerus fracture were included in the study. The anterolateral approach was used to expose the fracture, and the plate was applied on the anteromedial surface of the humerus. Rodriguez Merchan criteria assessed the functional outcome. All the data was recorded on designated Performa and entered and analyzed by SPSS version 20. Results: Two hundred twenty-five patients of both sexes were included in the study. The mean age of the patients in the study was 38.06 ± 11.51. The mean union time of fracture in our study was 11.76 ± 2.72 weeks.  Functional outcome was assessed using Rodriguez Merchan criteria excellent functional outcome was achieved in 165(73.3%) of the cases and good functional outcome in 58 (25.8%) of cases. A fair outcome was achieved in 2 (0.9%) cases. Conclusion: Anteromedial plating is the viable option for treating shaft of humerus fractures as it is associated with a high union rate and low or no complications.

Objectives: To determine functional outcome of Subtrochanteric femur fractures fixed with dynamic condylar screw. Study Design: Single group quasi experimental study. Setting: Orthopedic Surgery, creek general hospital, united medical and dental college and KVSS SITE hospital Karachi. Period: 15th February 2015 to 30th November 2016. Material & Methods: All the patients with Type 32A (A1, A2 and A3) subtrochanteric fractures of femur presenting within two weeks of injury were included in the study. Functional outcome was assessed by modified Schatzker and Lambert Criteria. Results: 79 patients with closed subtrochanteric fractures were included in study. The mean age of the patients was 41.2±12.98 years, mean duration of fracture was 4.58±1.25 days. Male to female ratio was 2.04 to 1, 42(53.16%) were injured in road traffic accident and 37(46.84%) were due to fall, right side were effected in 40.51% cases and left side effected in 59.49% cases. Acceptable functional outcome achieved in 82.28% (65/79) of cases. Conclusion: We conclude that open reduction and internal fixation are the best procedure to treat difficult fractures like subtrochanteric fractures and to avoid complications like implant failure, nonunion, and mal-union. In our study we attained satisfactory results by the use of dynamic condylar screw in patients with subtrochanteric fracture of femur.