Introduction: The proximal femoral nail (PFN) and dynamic hip screw with trochanteric support plate are two implants used in the management of pertrochanteric hip fracture. In this study, we try to find out if one implant is better than the other. Materials and Methods: A total of 40 patients were included with 20 each in both the groups between August 2016 and February 2018 in this prospective observational study. All patients were recorded and analyzed for the length of incision (LoI), period of hospitalization (PoH), blood loss, time of union (ToU), duration of surgery (DoS), Parker and Palmer mobility score (PPMS), and Harris hip score (HHS). Results: PFN was found to have a statistical advantage over TFN in terms of LoI (6.4 vs. 14.7 cm.), DoS (70.65 vs. 105.25 min), blood loss (97.25 vs. 294.0 ml), ToU (14.9 vs. 17 days), and PoH (18.1 vs. 21.6 days). While PPMS (7.05 vs. 6.5) was comparable in both groups, HHS (90.25 vs. 81.6) was better in the PFN group. Conclusions: PFN was found to be a better minimally invasive implant for pertrochanteric fractures when closed reduction is possible in terms of LoI, PoH, ToU, DoS, blood loss, and HHS but not for PPMS.
Introduction: Compound tibial shaft fractures are conventionally managed by debridement and primary stabilization by external fixators, followed by definitive fixation after the wound healing; however, many problems such as infection, difficult soft tissue reconstruction, and psychosocial effects encountered. Hence, a technique of antibiotic-impregnated cement-coated intramedullary nailing has been advocated. Aims: The aim of the study is to compare functional and biological outcomes of antibiotic-impregnated cement-coated nail with external fixators. Settings and Design: This was a prospective interventional study. Subjects and Methods: A total of 20 patients with Compound Grade 3A and 3B (Gustilo and Anderson) tibial shaft fractures who met the inclusion and exclusion criteria from January 2020 to June 2021 were selected. Group 1 was operated with antibiotic-impregnated cement-coated nails. Group 2 was operated with external fixators. Clinical and laboratory parameters were used to evaluate infection control. Final follow-up was taken at 6 weeks. Results: The infection rate after nailing was 10% in Group 1 (1/10) and 50% in Group 2 (5/10). Intraoperative time taken for soft tissue reconstruction procedures after primary fixation such as flap cover and skin grafting was comparatively less in Group 1 (mean time – 32 min ± 6.23) compared to Group 2 (51 min ± 5.83). Duration between primary and definite fixation was comparably less in Group 1 (mean duration 5.7 weeks ± 0.45) compared to Group 2 (6.3 weeks ± 1.004). Conclusions: Primary antibiotic-impregnated cement-coated nail is better than external fixator in terms of infection control and providing stability in compound fractures of shaft of tibia.
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