No abstract

Introduction:The absolute majority of the trochanteric and subtrochanteric hip fracture patients are fragile patients with a tendency to fall and an increased risk of major morbidity and mortality. It is important to provide adequate management to these patients and the treatment of choice is normally surgical with internal fixation. The surgical options for these fractures commonly include plating with sliding hip screw or intramedullary nailing, with nailing today being the predominant procedure in many parts of the world. The rationale of operative treatment of subtrochanteric fracture should be to obtain adequate reduction, achieve stability and to provide adequate fracture fixation. The final aim of treatment remains early union in anatomical position with early, active, pain free mobilization and the patient returning to his routine activities at the earliest. During the last century several implants have been tried to treat these fractures surgically. The very fact that several implants have been tried proves that no one implant is found suitable in all cases. Extramedullary implants like Dynamic Hip Screw and Dynamic Condylar Screw were used to fix the fracture. Dynamic Hip Screw often fails to prevent lateral drift of the proximal fragment which leads to implant failure. Dynamic Condylar screw provides better stability because of the fixation of proximal fragment with an additional screw in the calcar region, it also facilitates vertical load transmission.The dynamic condylar screw (an extra medullary implant) which exerts vertical forces on weight bearing is a better option as it provides strong fixation in the cancellous bone of the neck and head with considerable rotational stability. Material and Methods: We evaluated the functional outcome of subtrochanteric fractures treated with Dynamic Condylar Screw in 12 patients from October 2015 to September 2017 at Kamineni Institute of Medical Sciences in a prospective study. Results: Mean age of the patients in the was 58.9 years. Mode of injury -75% (9) patients sustained injury due to road traffic accidents and 25% (3) patients sustained injury due to fall.66.67% (8) patients were males and 33.33% (4) patients were females. There was almost an equal distribution in regards to side of injury. Average radiological union duration was 17 weeks. Duration of follow up was 6months.8.33% (1) patient had superficial infection.8.33% (1) patient had lag screw cut through for which secondary procedure was done. Modified Harries Hip score at the end of the follow up was 58.34% (7) patients with excellent score, 33.33% (4) patients with good score and 8.33% (1) patient had poor score. Conclusion: Subtrochanteric fractures of the Femur pose a challenge to the surgeon in the view of its peculiarities of anatomy, biomechanical forces acting across the fracture site and technical difficulties of reduction and application of a suitable implant. Many implants both Intramedullary and Extramedullary have been tried by various surgeons in different time periods with varying re...

Introduction: The success of a TKR depends on various factors which include appropriate choice of implant and meticulous surgical technique. A simple soft-tissue tension in the anterior knee after TKA can cause knee pain and loss of ROM. Surgical technique significantly influences joint function recovery after TKA. Research mainly focuses on flexion and extension gap balance, rotational alignment and medial and lateral collateral ligament balance. The traditional knee wound closure in extension may lead to soft-tissue misalignment, resulting in higher soft-tissue tension of the anterior knee in flexion. This condition may lead to anterior knee pain and may limit postoperative ROM recovery. Material and Methods: This study is a prospective randomised study of 6 months duration done in Sunshine Hospital, Secunderabad, Telangana A total of 66 patients from June 2016 to November 2016 were enrolled in this study. The patients were randomized according to the type of wound closure: Extension group for full extension and Flexion group for 90° flexion. In the flexion group, the knee will be kept in high flexion for 1 to 2 min after wound closure. Age, gender, body mass index, ROM, visual analogue scale (VAS) pain score of anterior knee and Knee Society Score (KSS, American Society of Knee Surgery) were not significantly different between the two groups. Thus, extension group and flexion group were comparable. Results: In post op evaluation VAS for anterior knee at 6 th wk follow up was found to be statistically significant (p-0.004) in favour of flexion group but at 3 month follow up the difference was not found to be statistically significant (p-0.010).In post op ROM evaluation between two groups showed higher ROM at 6 th wk and 3 rd month which was statistically significant with p-0.001 and 0.001 respectively. Knee society score was found to be statistically significant only at 3 rd month follow up between the groups, with better score in flexion group. Conclusion:The knee position during wound closure after TKA is not only critical but also very important for postoperative knee function recovery. Wound closure in flexion can effectively decrease anterior knee pain after TKA and promote the early recovery of ROM. This difference is more pronounced in patients with BMI >30.Furher study has to be done for 6 th month and 1 yr follow up evaluation to see whether these differences will persist.