51 male and 49 female. Average age of 48.0 (25.3–63.8IQR) 45 Simple, 46 comminuted and 9 pathological fractures. 70 were isolated and 10 were part of multiple trauma fractures. 91 closed and 9 open fractures. 52 fractures due to simple falls, 30 road traffic accident,9 pathological fracture,8 work related and 1 unknow cause. Out of 100 nails, 90 were statically locked while 9 were locked proximally and 1 was locked only distally. The outcomes were assessed clinically, radiologically and using the Disability of Arm Shoulder and Hand (DASH) function scoring system. Statistically Cronbach’s alphas were calculated for the three scales of the DASH instrument. These scales were the function/symptom scale consisting of 30 items, sports/music module containing 4 items, and work module comprising 4 items. Medians (interquartile ranges) and ranges are presented for numerical variables. Mann-Whitney U tests (two-tailed) and Univariate and multivariate regression analysis were used.
The DASH function scale scores was categorised into good 71 patients 85.5% (Score 0-<
25), Medium 4 patients 4.8% (Score 25-<
40) and Poor 8 patients 9.6% (Score 40+). Univariate and multivariate regression analysis showed, Increasing age (adjusted OR=0.96,95%CI 0.93–0.99,P<
0.01) and communited compared to simple fractures (adjusted OR=0.12,95%CI 0.03–0.45,P<
0.01) were associated with reduced likelihood of attaining full range of motion. Male patients (unadjusted OR=2.37,95%CI 0.90–6.25,P=0.08) and patients involved in RTA compared to falls (unadjusted OR=4.5,95%CI 0.96–21.07,P=0.06) were associated with higher likelihood of attaining full range of motion. 85 % had no complication, while 15 % had complications. One nerve palsy and one case of infection. Seven patients required nail removal and 3 required removal of proximal locking screw.
Patients were matched for age, gender, pathology, weight, implant type, pre operative haemoglobin and senior operator in all three groups. We assessed intra-operative and total blood loss, transfusions requirements, postoperative wound complication, regaining of the range of motion, incidence of systemic effects of tourniquet and duration of hospital stay. We also looked at the effects of NSAIDS on blood loss and compared the validity of various factors reported in the literature to be predictive of future transfusion after the surgery. Statistical analysis used were, student’s t-test, univariate and multivariate analysis and regression statistical analysis.
Treatment of scaphoid fractures continues to be a difficult problem for both acute unstable fractures and non-unions. In our study, the results of a consecutive series of symptomatic non-unions of scaphoid fractures treated with Herbert screw and bone graft during period between July 1996 and June 2000 are studied. Out of a total of 66 patients (one bilateral), 61 (91.04%) cases who had symptomatic non-unions (type D) were treated with Herbert screw plus iliac crest bone graft while 6 (8.95%) cases were treated for acute unstable fractures (type B) with Herbert screw only (these are excluded from the study). All fractures were classified according to Herbert classification. Russe approach was used in 50 patients while dorsal approach was used in 11 cases with proximal pole fracture non-union. The time interval between injury and surgery was 12.2 months (range 2–72 months). Patients were followed up for radiological evidence of union and clinically for range of movement of wrist, grip strength and outcome score. The site of fracture, type, screw placement, the time interval between the original injury and non-union surgery, and age of the patient, were investigated to assess whether they influenced outcome.