OBJECTIVE:The purpose of this study is to evaluate the usefulness of external fixation of intertrochanteric fractures in high risk geriatric patients. DESIGN: Prospective clinical study. SETTINGS: Level-1 trauma Centre. PATIENTS: Fifty high risk geriatric patients with intertrochanteric fractures. INTERVENTION: Close reduction and external fixation using AO external fixator. OUTCOME MEASURED: fracture union, time to union, pin tract infection rate, shortening, varus collapse and range of motion at knee. RESULTS: Fifty patients with average age of 68.5 years all high anaesthetic/surgical risk were managed by closed reduction and external fixation. Forty were operated under regional and ten under local anaesthesia. Eight patients died before fracture union and four were lost in follow up after removal of fixator. Remaining thirty eight were in regular follow up for at least six months. Pin tract inflammation was the most common complication while shortening and varus collapse occurred in ten cases. CONCLUSION: external fixation of intertrochanteric fractures is useful in high risk geriatric patients. KEYWORDS: intertrochanteric fractures, external fixation. INTRODUCTION:Hip fractures are a leading cause of death and disability among the elderly. 1 These fractures include femoral neck and intertrochanteric fractures. Intertrochanteric fractures generally occur as a result of low energy trauma in advanced age, whereas they are caused by high energy trauma in young age. 2 The incidence of intertrochanteric fractures is increasing day by day as is the life expectancy. Life time risk in industrialized countries of intertrochanteric fractures is 6% for men and 18% for women. 3 Thus we have old patients, many of them with co morbidities, having intertrochanteric fractures. Treatment goals in this population include early rehabilitation, restoration of the anatomic alignment of the proximal part of the femur and maintenance of the fracture reduction. 4 Various treatment methods used for intertrochanteric fractures include operative and nonoperative. 5 Historically, non-operative management took one of the two different protocols. In first approach, directed at early mobilization within the limits of the patient discomfort, the patient is allowed out of bed and in chair within a few days of injury. Ambulation was delayed, but the early bed to chair mobilization helped prevent many complications of prolonged recumbence. This approach did not attempt to treat the fracture specifically and accepted the deformity that invariably ensues. The second approach, in contrast, attempted to establish and maintain a reasonable reduction via skeletal traction (Hamilton Russel traction) until fracture union occurred. This technique was prolonged with difficulty in maintaining the reduction; further all the complications of prolonged recumbence like pressure sores, urinary tract infection, deep vein thrombosis, pulmonary embolism, chest infection are there. Operative methods include open reduction and internal fixation by sli...

Background. Joshi’s External Stabilization System (JESS) is an external fixator based methodology to correct different deformities of club foot using differential distraction. Material and methods. 31 difficult clubfeet feet in 24 patients who were neglected, neurogenic or relapsed were treated using JESS between July 2013 to June 2015 with an average follow-up of 4. 2 years. There were 16 males and 8 females in an age group of 2–10 years. 30 feet belonged to the severe and most severe group as per the Dimeglio Scoring System. All patients achieved correction of all components of the clubfoot. Results. However, one patient required tibialis anterior transfer for dynamic forefoot adduction at the end of treatment. The mean total duration in JESS fixation was 69.5 days/foot (range 44-123 days) and the mean time to achieve correction within JESS averaged 52 days. The deformities improved from a mean Dimeglio score of 14.06 to 2.93. The objective radiological assessment of the deformities revealed improvements in the talocalcaneal angle on AP view from 16.39° to 34.52° and on lateral view from 15.97° to 33.03°. The Talo-1st metatarsal angle (AP view) improved from 35.29° to 7°. Complications included 11 cases of superficial pin tract infection, two instances of pin loosening and a case of pin cut out. There were three cases of 1st metatarsophalangeal dislocation that were managed by reversing the process of distraction. Conclusion. JESS is an effective method for managing difficult clubfeet.

Background:The bone and joint infections in the pediatric population account for one of the major causes of childhood morbidity and when complicated with sepsis, the results can be devastating. Hence the timely diagnosis and appropriate treatment are cardinal to minimize complications and improve outcomes. This study aims to evaluate the prevalence of septic arthritis and osteomyelitis in children with sepsis, the organisms implicated, and their antibiotic sensitivities. Patients and Methods: During one year period 21 patients with bone and joint infection complicated with sepsis, severe sepsis, and septic shock were included in our study. Demographical details were collected from these patients with clinical features suggestive of septic arthritis and acute osteomyelitis, after proper clinical examination and appropriate investigations. Results: Twenty-one patients with bone and joint infections complicated with sepsis, severe sepsis, and septic shock were included of which 13 patients were males and 8 were females. The median age at presentation was 6.7 years. The median interval between symptom onset and hospital admission was 8 days. Septic arthritis was seen in 14 patients, and osteomyelitis was seen in 7patients. Multiple sites were involved in 2 patients. The most common joint was the knee (28.5%) followed by the hip (19%), and the most common bone involved was the femur (23.8%) followed by the tibia (9.5%).C-reactive protein (CRP) was raised among all patients with a median of 96 mg/L (range 48-170mg/L].14 [66.6%] cases were culture positive and Staphylococcus aureus (MRSA) was detected either in their blood or aspirate in 12 [85.6%] of such patients. Conclusion: Acute osteomyelitis and septic arthritis are relatively common serious bacterial infections that can progress to disseminated sepsis and septic shock. A multidisciplinary approach including the consideration of combined medical and surgical management should be considered in these patients.

Background. Joshi’s External Stabilization System (JESS) is an external fixator based methodology to correct different deformities of club foot using differential distraction. Material and methods. 31 difficult clubfeet feet in 24 patients who were neglected, neurogenic or relapsed were treated using JESS between July 2013 to June 2015 with an average follow-up of 4. 2 years. There were 16 males and 8 females in an age group of 2–10 years. 30 feet belonged to the severe and most severe group as per the Dimeglio Scoring System. All patients achieved correction of all components of the clubfoot. Results. However, one patient required tibialis anterior transfer for dynamic forefoot adduction at the end of treatment. The mean total duration in JESS fixation was 69.5 days/foot (range 44-123 days) and the mean time to achieve correction within JESS averaged 52 days. The deformities improved from a mean Dimeglio score of 14.06 to 2.93. The objective radiological assessment of the deformities revealed improvements in the talocalcaneal angle on AP view from 16.39° to 34.52° and on lateral view from 15.97° to 33.03°. The Talo-1st metatarsal angle (AP view) improved from 35.29° to 7°. Complications included 11 cases of superficial pin tract infection, two instances of pin loosening and a case of pin cut out. There were three cases of 1st metatarsophalangeal dislocation that were managed by reversing the process of distraction. Conclusion. JESS is an effective method for managing difficult clubfeet.