BACKGROUND: The present study aimed to compare outcome of primary and secondary Illizarov's fi xator application as a treatment method for type III open tibial fractures in terms of nonunion and wound infection.ME...BACKGROUND: The present study aimed to compare outcome of primary and secondary Illizarov's fi xator application as a treatment method for type III open tibial fractures in terms of nonunion and wound infection.METHODS: This prospective study was done in a tertiary care center. Forty-eight type III tibial fractures were treated with Illizarov's apparatus between 2008 and 2011. The patients were divided into two groups depending on the treatment protocol, timing of wound closure and Illizarov's application, primary(n=28) and secondary(n=20).RESULTS: In the primary group, healing was achieved in all 28 patients. The median time to recovery was 24 weeks, and the median number of operations was 3. There were 6 patients with a bone defect. In the secondary group, complete recovery was achieved in 18 out of 20 patients. The median time to recovery was 30 weeks, and the median number of operations 5. There were 9 patients with a bone defect. The median time to recovery and the number of operations were signifi cantly smaller in patients undergoing primary operation. Union was 100% in the primary group and more than 95% in the secondary group. Chronic osteomyelitis persisted in one patient and below amputation was done in one patient in the secondary group.CONCLUSION: Primary wound closure and Illizarov's fixation required a smaller number of operations and shorter time to recovery than secondary wound closure and Illizarov's fi xation, mostly due to a signifi cantly less number of patients with a bone defect in the primary group.展开更多
Purpose:Hip fractures in elderly have a high mortality.However,there is limited literature on the excess mortality seen in hip fractures compared to the normal population.The purpose of this study was to compare the m...Purpose:Hip fractures in elderly have a high mortality.However,there is limited literature on the excess mortality seen in hip fractures compared to the normal population.The purpose of this study was to compare the mortality of hip fractures with that of age and gender matched Indian population.Methods:There are 283 patients with hip fractures aged above 50 years admitted at single centre prospectively enrolled in this study.Patients were followed up for 1 year and the follow-up record was available for 279 patients.Mortality was assessed during the follow-up from chart review and/or by telephonic interview.One-year mortality of Indian population was obtained from public databases.Standardized mortality ratio(SMR)(observed mortality divided by expected mortality)was calculated.Kaplan-Meir analysis was used.Results:The overall 1-year mortality was 19.0%(53/279).Mortality increased with age(p<0.001)and the highest mortality was seen in those above 80 years(aged 50-59 years:5.0%,aged 60-69 years:19.7%,aged 70-79 years:15.8%,and aged over 80 years:33.3%).Expected mortality of Indian population of similar age and gender profile was 3.7%,giving a SMR of 5.5.SMR for different age quintiles were:3.9(aged 50-59 years),6.6(aged 60-69 years),2.2(aged 70-79 years);and 2.0(aged over 80 years).SMR in males and females were 5.7 and 5.3,respectively.Conclusions:Indian patients sustaining hip fractures were about 5 times more likely to die than the general population.Although mortality rates increased with age,the highest excess mortality was seen in relatively younger patients.Hip fracture mortality was even higher than that of myocardial infarction,breast cancer,and cervical cancer.展开更多
Intracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fra...Intracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fracture table is a prerequisite to facilitate fracture manipulation, traction, reduction and fluoroscopy assessment. However, positioning the limbs of bilateral above-knee amputees for internal fixation of related proximal femoral fractures is a difficult task, which requires customized inventory for effective limb positioning and fracture manipulation. This study reported a rare case following a crush injury of bilateral lower limb in a road traffic accident, and described some technical tips of acute femoral neck fractures in bilateral above-knee amputation. The patient was managed with immediate guillotine amputation and later secondary wound closure followed by internal fixation of the right-sided femoral neck fracture with multiple cancellous cannulated screws.展开更多
Bipolar clavicular dislocation is rare,and therefore its management is contentious.With an increase of patient’s physical demand and a near-normal shoulder function,there has been a shift in the paradigm of its manag...Bipolar clavicular dislocation is rare,and therefore its management is contentious.With an increase of patient’s physical demand and a near-normal shoulder function,there has been a shift in the paradigm of its management from a conservative one to a stabilized one of anatomical open reduction.Proposed methods of fixation have also evolved with the advent of more biological fixation devices,which elude implant or fixation related complications.This case report highlights the salient features of this rare case and details the management options along with the benefits of biological anatomical repair and reconstruction.展开更多
Background:Regional anaesthesia has been proposed to reduce intraoperative blood loss,duration of hospital stay and in-hospital complications with improved postoperative pain control.General anaesthesia is advantageou...Background:Regional anaesthesia has been proposed to reduce intraoperative blood loss,duration of hospital stay and in-hospital complications with improved postoperative pain control.General anaesthesia is advantageous for prolonged surgeries.We hypothesized that combined regional and general anaesthesia would offer advantages of both in pelvi-acetabular fracture surgeries.Methods:We identified 71 patients who underwent open reduction and internal fixation of pelvi-acetabular fractures from May 2012 to 2013 in our trauma centre.We excluded patients with incomplete records(n=4)and other injuries operated along(n=8).Hence,59 patients were divided into three groups:G group(general anaesthesia),R group(regional anaesthesia)and GR group(combined regional and general anaesthesia).Main outcome measurements studied were intraoperative blood loss,duration of hospital stay,duration of surgery and intraoperative and postoperative complications.Results:No differences were obtained in between the groups in terms of age,gender,Injury Severity Score,number of comorbidities,or duration from injury to surgery.No significant differences were found between the three groups for intraoperative blood loss,days of hospital stay and duration of surgery.Intraoperative and postoperative complications were also comparable between the groups(p>0.05).Conclusions:There is no specific significant advantage of the technique of anaesthesia on the observed perioperative complications in pelvi-acetabular fracture surgeries.展开更多
文摘BACKGROUND: The present study aimed to compare outcome of primary and secondary Illizarov's fi xator application as a treatment method for type III open tibial fractures in terms of nonunion and wound infection.METHODS: This prospective study was done in a tertiary care center. Forty-eight type III tibial fractures were treated with Illizarov's apparatus between 2008 and 2011. The patients were divided into two groups depending on the treatment protocol, timing of wound closure and Illizarov's application, primary(n=28) and secondary(n=20).RESULTS: In the primary group, healing was achieved in all 28 patients. The median time to recovery was 24 weeks, and the median number of operations was 3. There were 6 patients with a bone defect. In the secondary group, complete recovery was achieved in 18 out of 20 patients. The median time to recovery was 30 weeks, and the median number of operations 5. There were 9 patients with a bone defect. The median time to recovery and the number of operations were signifi cantly smaller in patients undergoing primary operation. Union was 100% in the primary group and more than 95% in the secondary group. Chronic osteomyelitis persisted in one patient and below amputation was done in one patient in the secondary group.CONCLUSION: Primary wound closure and Illizarov's fixation required a smaller number of operations and shorter time to recovery than secondary wound closure and Illizarov's fi xation, mostly due to a signifi cantly less number of patients with a bone defect in the primary group.
文摘Purpose:Hip fractures in elderly have a high mortality.However,there is limited literature on the excess mortality seen in hip fractures compared to the normal population.The purpose of this study was to compare the mortality of hip fractures with that of age and gender matched Indian population.Methods:There are 283 patients with hip fractures aged above 50 years admitted at single centre prospectively enrolled in this study.Patients were followed up for 1 year and the follow-up record was available for 279 patients.Mortality was assessed during the follow-up from chart review and/or by telephonic interview.One-year mortality of Indian population was obtained from public databases.Standardized mortality ratio(SMR)(observed mortality divided by expected mortality)was calculated.Kaplan-Meir analysis was used.Results:The overall 1-year mortality was 19.0%(53/279).Mortality increased with age(p<0.001)and the highest mortality was seen in those above 80 years(aged 50-59 years:5.0%,aged 60-69 years:19.7%,aged 70-79 years:15.8%,and aged over 80 years:33.3%).Expected mortality of Indian population of similar age and gender profile was 3.7%,giving a SMR of 5.5.SMR for different age quintiles were:3.9(aged 50-59 years),6.6(aged 60-69 years),2.2(aged 70-79 years);and 2.0(aged over 80 years).SMR in males and females were 5.7 and 5.3,respectively.Conclusions:Indian patients sustaining hip fractures were about 5 times more likely to die than the general population.Although mortality rates increased with age,the highest excess mortality was seen in relatively younger patients.Hip fracture mortality was even higher than that of myocardial infarction,breast cancer,and cervical cancer.
文摘Intracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fracture table is a prerequisite to facilitate fracture manipulation, traction, reduction and fluoroscopy assessment. However, positioning the limbs of bilateral above-knee amputees for internal fixation of related proximal femoral fractures is a difficult task, which requires customized inventory for effective limb positioning and fracture manipulation. This study reported a rare case following a crush injury of bilateral lower limb in a road traffic accident, and described some technical tips of acute femoral neck fractures in bilateral above-knee amputation. The patient was managed with immediate guillotine amputation and later secondary wound closure followed by internal fixation of the right-sided femoral neck fracture with multiple cancellous cannulated screws.
文摘Bipolar clavicular dislocation is rare,and therefore its management is contentious.With an increase of patient’s physical demand and a near-normal shoulder function,there has been a shift in the paradigm of its management from a conservative one to a stabilized one of anatomical open reduction.Proposed methods of fixation have also evolved with the advent of more biological fixation devices,which elude implant or fixation related complications.This case report highlights the salient features of this rare case and details the management options along with the benefits of biological anatomical repair and reconstruction.
文摘Background:Regional anaesthesia has been proposed to reduce intraoperative blood loss,duration of hospital stay and in-hospital complications with improved postoperative pain control.General anaesthesia is advantageous for prolonged surgeries.We hypothesized that combined regional and general anaesthesia would offer advantages of both in pelvi-acetabular fracture surgeries.Methods:We identified 71 patients who underwent open reduction and internal fixation of pelvi-acetabular fractures from May 2012 to 2013 in our trauma centre.We excluded patients with incomplete records(n=4)and other injuries operated along(n=8).Hence,59 patients were divided into three groups:G group(general anaesthesia),R group(regional anaesthesia)and GR group(combined regional and general anaesthesia).Main outcome measurements studied were intraoperative blood loss,duration of hospital stay,duration of surgery and intraoperative and postoperative complications.Results:No differences were obtained in between the groups in terms of age,gender,Injury Severity Score,number of comorbidities,or duration from injury to surgery.No significant differences were found between the three groups for intraoperative blood loss,days of hospital stay and duration of surgery.Intraoperative and postoperative complications were also comparable between the groups(p>0.05).Conclusions:There is no specific significant advantage of the technique of anaesthesia on the observed perioperative complications in pelvi-acetabular fracture surgeries.
