No abstract

Background: Surgical reduction and internal fixation are the mainstays for the treatment of the Monteggia fracture-dislocation in adult and there are various surgical modalities for internal fixation. Various types of implants used in fixation of Monteggia fracture dislocation in adult and the outcome also differ. Small DCP is one of the important implants. The fracture of the proximal third of the ulna with dislocation of the head of the radius was commonly known as Monteggia fracture dislocation. Objective: To assess the radiological and functional outcome of internal fixation of monteggia fracture dislocation by (DCP) in adult patients. Methods: This prospective observational study had been conducted in Monno Medical College and Hospital, Manikganj, to evaluate the results of open reduction and internal fixation of the ulna with small DCP and anatomical reduction of radial head in early cases of Monteggia fracture dislocation in adult from January 2022 to December 2022. Total 40 patients with radiologically proven closed Monteggia fracture-dislocation that were enrolled in this study by purposive sampling method. Radiological and functional outcome were assessed and followed up for 24 weeks. Results: Results were evaluated by Quick DASH score, VAS scale, ROM of flexion-extension and supination-pronation. Final functional outcome was done with Anderson criteria. Results: Total 40 patients were included. Among 15 (37.5%) patients were from 20-29 years age group, 8 (20.0%) were from 30-39 years age group, 11 (27.5%) were from 40-49 years age group and 6 (15.0%) were from 50-55 years age group. The mean age of the patients was 35.96±11.48 years where minimum age was 20 years and maximum age was 55 years. 32 (80.0%) patients were male and 8 (20.0%) patients were female. Out of the 40 patients, 35 (87.5%) presented with Bado type I fracture and 5 (12.5%) presented with Bado type II fracture. The mean time interval between injury and surgery was 10.13±3.86 days. Post-operative complications (tourniquet palsy and wound infection) developed in 5 (12.5%) patients. According to Anderson criteria nine (22.5%) patients had excellent, 25 (62.5%) patients had good, 3 (7.5%) had fair and 7 (7.5%) patients had poor outcome. Final outcome was satisfactory (excellent and good) in 35 (87.5%) patients and unsatisfactory (fair and poor) in 5 (12.5%) patients. Patients who had Bado type II fracture had less satisfactory outcome (p=0.004). Again, patients who had more time interval between injury and surgery also had less satisfactory outcome (p=0.012). Conclusion: Monteggia fractures are uncommon injuries. The commonest type of monteggia fracture dislocation in adults according to Bado’s classification is type-1. Operative treatment of Monteggia fracture-dislocation by the selected implant, leads to excellent to good radiological and functional result with uncomplicated recovery in majority of the cases.

Background: Fracture of the ankle is the most common fracture involving joints. Being a weight-bearing joint maximum thrust passes through it. It is a complex weight-bearing joint and is subjected to many different types of injury. Successful treatment will allow early mobilization to avoid complications. AOFAS Ankle Hind foot score is the most commonly used tool to measure this outcome. Objective: To assess prediction of functional outcome of surgical treatment in Danis-Weber type-C closed ankle fracture using AOFAS Ankle Hind Foot Score. Methods: A prospective observational study was carried out in Monno Medical College and Hospital, Manikganj, from June 2022 to December 2022. A total of 32 patients with Danis-Weber type-C ankle fracture were taken in this study. All the patients were initially managed by analgesic and short leg posterior slab. After admission, all were treated by ORIF with small DCP for fractured fibula and ORIF by two 4mm cannulated cancellous screws for fractured medial malleolus. Operations were done within 4 days to 14 days. The average follow up was 24 weeks. The outcome was assessed by the AOFAS score. Results: The mean age was 34.68+10.79 years with a male predominance, 23 (71%). Most of the patients, 14 (44%), were service holder. Right-sided injury, 20 (63%), were more than left. The main cause of injury was RTA, 22 (69 %), and the commonest mechanism of injury was pronation external rotation, 37 (84%). Syndesmotic injury was present in 28 (88%) cases. The mean duration of hospital stay was 14+2.68 days. Superficial infection was in 2 (6%) patients. The mean AOFAS pain score at 12th and 24th weeks follow up were 29.21+6.18 and 34.3+45.64, which was significant (p-.0005). The mean duration of radiological healing was 13.34+1.56 weeks. The mean dorsiflexion and plantar flexion at 12th weeks follow up was respectively 8.81±1.59 and 43.18+4.70; and 24th weeks follow up was respectively 10.87±1.43 and 51.25+1.11, which was significant .......