As the life expectancy has increased in recent years, the incidence of proximal femoral fractures is on rise. Common techniques for fixation of these fractures are sliding hip screw and plate or intramedullary nailing. Intramedullary nailing has advantage of short incision, less operative time, rapid rehabilitation & thus decreased medical complications. PFNA-II is newer intramedullary implant developed to obtain better fixation strength in osteoporotic bones. Prospective observational study was conducted on 49 patients. All fractures were classified by AO/OTA classification system. Patients were followed up at 4, 8, 12 and 16-weeks. Functional outcomes were assessed according to pain assessment by numeric rating scale, Parker Palmer mobility score, Harris hip score. Fracture union and mechanical failure were assessed radiologically. Mean age of the entire group was 71.84years. Male to female sex ratio was 0.81:1.00. 32.7% had A1 type, 61.2% had A2 type and 6.1% had A3 type fracture. Mean OT time was 49.29mins and mean blood loss was 117.14ml. Mean pain score at 16-weeks was significantly lower compared to that at 4, 8 and 12-weeks post-op follow-up. Distribution of mean Palmer Parker mobility score and Harris hip score at 16-weeks post-op follow-up was significantly higher compared to that at 4, 8 and 12-weeks post-op follow-up. 38.8% had excellent, 40.8% had good, 12.2% had fair and 8.2% had poor functional outcome. Helical blade back out, cut-out and medial migration was seen in one patient each. 95.9% cases had maintenance of reduction and fracture union. Mean time for fracture union was 14.26 weeks. Use of the PFNA-II to treat intertrochanteric fractures has the following advantages: quick procedure with small incision, less operative time, minimal blood loss, few complications, early weight bearing, less union time, good clinical efficacy and very few cases of complications. Good functional outcomes can be achieved, when the radiological parameters are restored. We conclude that PFNA-II is an effective treatment modality for intertrochanteric fractures, with excellent functional outcome and regaining back the pre-fall ambulatory status with minimal mechanical complications.
Clavicle fracture is a common traumatic injury around shoulder girdle due to their subcutaneous position. It is caused by either low-energy or high-energy impact. Fractures of the clavicle have been traditionally treated non-operatively. Although many methods of closed reduction have been described, it is recognized that reduction is practically impossible to maintain and a certain amount of deformity and disability is expected in adults. 30 patients with mid-shaft clavicle fracture were systematically randomized (alternate patient) into either operative treatment with plate fixation or non-operative treatment with clavicle brace and sling. All fractures were classified using Robinson's classification for clavicle fractures and only Type 2A2 and 2B1 were considered for the study. Patients were followed up at 3wks, 6wks, 3rd month & 6th month. Functional outcomes were assessed according to the Constant and Murley Scoring and radiologically. Maximum number (90%) of patients had Robinson's Type 2B1 fracture. The mean duration of hospital stay for patients in Group A(operative) and Group B(non operative) was 3.67 ± 0.90 days and 1.73 ± 0.46 days respectively. In Group A, the mean duration of trauma to surgery was 3.13 ± 2.64 days. While the mean operative time was 104.87 ± 13.52 minutes. The duration of union was significantly lesser in Group A as compared to Group B according to Chi-Square test (p<0.05) The mean duration for time till Return to Functional ROM in Group B was 8.73 ± 4.33 weeks. There was no significant difference between the groups as per Chi-Square test (p>0.05). Primary open reduction and internal fixation with pre-contoured clavicle plate for displaced, middle third clavicle fractures provide a more rigid fixation and allows early mobilization whereas conservative treatment require longer periods of immobilization till fracture union. Functional outcomes are better with surgical management of middle third clavicle fractures with pre-contoured locking compression plate. The successful use of locking compression plate for middle third fractures of clavicle requires careful assessment of fracture pattern, patient selection, meticulous operative technique, appropriate choice of fixation, judicious internal fixation, careful post-operative monitoring and aggressive early institution rehabilitation. So, there is need to individualize the treatment as per the need and functional demand of the patient to give the optimum outcome.
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