Abstract

Purpose: To eliminate iatrogenic Ulnar Nerve injury.

Methods: We prospectively reviewed 25 consecutive paediatric gartland’s type 3 supracondylar fractures with a minimum follow-up of 1 yr operated by our novel technique. Good reduction was achieved with closed reduction in 20 and 5 cases warranted an open reduction. Our technique involved passage of two percutaneous 1.6 mm smooth K-wires supero-medially from lateral condyle across the fracture site to obtain a purchase in upper medial cortex of proximal fragment. A third K-wire was passed percutaneously from lateral supracondylar pillar proximal to the fracture site in infero-medial direction to gain purchase in distal fragment’s subchondral bone of medial condyle thus creating a cross construct. Care was taken not to breach the subchondral bone so as to avoid ulnar nerve injury. All patients were operated in supine position under general anaesthesia and lateral collateral approach was used with same K-wire construct in cases that needed open reduction. Stability was checked post-operatively by rotation under real time imaging. The mean age of patients was 6.8 yrs. The mean time from sustaining the fracture to operative pinning was 24 hrs. An above elbow immobilisation backslab was applied for 3 weeks. The K-wires were removed at 3 and 4 weeks in cases that had closed and open reduction respectively and active assisted movements were initiated. All patients were followed up at 1/52, 3/52, 6/52, 3/12, 6/12 and 1 year post-operatively.

Results: Flynn’s criterion was used for post-op functional evaluation. 20 cases had excellent and 5 had good outcome at end of 1 year. There was no case of nerve palsy (superficial radian or ulnar N), pin-tract infection, loss of reduction or late cubitus varus/valgus or hyper-extension deformities.

Conclusion: Our innovative technique is an excellent alternative option without compromising on fracture stability in the treatment of these fractures.

Purpose: There is no data concerning morphological dimensions of distal femur(DF), proximal tibia(PT) and thickness of patella(TP) in Indian population and our objective was to analyse the anthropometric data in Indian knees and to correlate them with existing knee arthroplasty systems.

Methods: MRI scans of 25 patients(15M;10F) who underwent bilateral knee scans for ligamental injuries were collected. Patients with arthritis, bone loss, varus/ valgus deformity of > 150 and those with immature skeleton were excluded. The mean age was 32 years (range 18–53y). Three surgeons independently measured medio-lateral(ML), antero-posterior(AP) lengths & aspect ratio(AR) of DF, PT and TP on three occasions one week apart to account for intra & inter-observer variability. The resultant data of 50 knees was analysed using SPSS v16.0 and compared with five different knee arthroplasty systems (PFC sigma/NexGen/Scorpio/IB-II/ Gender specific knee).

Results: The mean ML & AP for proximal tibia was 73.3±5.3 & 47.8±4.3 mm. The mean ML & AP (lateral condyle) for distal femur was 74.3±5.9 & 65.4±5.0 mm. The mean unresected thickness of patella was 24.7 & 21.8 mm in males & females respectively. The ML & AP showed a statistically significant positive correlation with person’s height (ML®=0.55;AP®=0.50 & p=0.01). A decrease in AR for increasing AP dimension was noted for both distal femur and proximal tibia (Tibia®=0.153;p=0.29 & Femur:®=−0.91;p=0.001).

Discussion: None of the prosthesis designs mimicked this decrease in AR and NexGen infact showed increase in AR.

Only Gender specific knee closely mimicked normal variation in AR and is available only for females (in India). Most of the available TKR prosthesis designs differ from true knee morphometry of Indian population. These data provides the basis for designing optimal prosthesis for people of Indian/Asian origin in UK/overseas.