Modification of ordinary jig (angle guide) used for DCS fixation so as to make it more suitable for biological DCS. We have modified the jig used for ordinary DCS fixation so as to make it more suitable for biological DCS. In ordinary DCS jig, the hole for guide wire lies towards one end and the handle is attached at the other end. We have removed the handle and attached it adjacent to hole for guide pin so that the other end is free and can be slided in submuscular plane without actually exposing the whole length of femur. Subsequently, we beveled the free end and removed the sharp points and this helps in making sub muscular plane easily and with minimum soft tissue trauma. The modified jig was applied in a patient with fracture subtrochanteric femur in submuscular plane through 2 cm long incision and its position confirmed by c-arm. Position was found to be similar to that observed with ordinary DCS jig. The idea of making this presentation is that we can modify classical instrumentation used for internal fixation to make them suitable for biological fixation. This is a small innovation in that direction.
Anatomically contoured periarticular plates for treatment of proximal tibia fractures is fast becoming the standard for care. The aim of our study was to assess the accuracy of the anatomic contour of proximal lateral tibial plates of AO Stryker and Zimmer in Indian patients. We assessed the accuracy of the anatomic contour of proximal lateral tibial plates of AO Stryker and Zimmer in 50 Indian dry tibiae. All the plates were placed on the 50 tibia by two independent surgeons according to what they felt was the best fit. The tibiae and the plate fits were mapped, quantified, and analysed using digital image capturing and adobe photoshop software. By corresponding the clinical appearance of good fit with our digital findings, we created numerical criteria for plate fit in three planes: coronal (volume of free space between the plate and bone), sagittal (alignment with the tibial plateau and shaft), and axial (match in curvature between the proximal horizontal part of the plate and the tibial plateau). An anatomic fit should mirror the shape of the tibia in all three planes and only ten plates of different companies qualified this Recognising and understanding the substantial variations in fit that exist between anatomically contoured plates, it might be worthwhile developing proximal tibia plates specific for the Indian population or validating this study by having a larger multicentric study group. This paper would suggest caution when these plates are used as a tool for indirect reduction of the fractures.
Displaced intra-capsular fractures of femoral neck are treated by osteosynthesis in young adults. Using a standard protocol, we have compared the results of internal fixation after closed (CRIF) and open reduction (ORIF) in these patients. We have also studied the risk factors that influence non-union and avascular necrosis (AVN). Patients in the age group of 15–50 years, who were scheduled for internal fixation within 1 week of injury, were randomized into two groups, one for closed reduction and the other for open reduction. The two groups were compared for factors such as age, gender, time of surgery and posterior comminution as well as union and complications. Using univariate and multivariate methods the factors influencing non-union and AVN were analyzed. The average duration of surgery in patients undergoing CRIF was less than half of that in the ORIF group. The rates of union (p=0.93) and avascular necrosis at 2 years (p=0.85) were comparable. Rates of complications like deep vein thrombosis and infection were also found to be comparable. Guide wire breakage was found in 2 patients undergoing CRIF. Posterior comminution, poor reduction and improper screw placement were the major factors influencing non-union. An accurate reduction in both the planes and placement of screws parallel or slightly divergent to each other had a positive influence on union. An overall AVN rate of 16.3% (15/92) was encountered and it was not influenced by any of the factors. A delay of more than 48 hrs in surgery did not influence the rates of union or AVN.
Twenty-six patients with femoral neck fractures were treated by open reduction, cancellous screw fixation and free fibular grafting. The patients were between 14 and 50 years of age. There were 16 old and 10 fresh fractures. Four patients had radiological signs of avascular necrosis before the treatment was instituted. Bony union was achieved in all patients except one, where the failure occurred because of a technical error. The patients were followed up for at least two years. No new case of avascular necrosis was detected after treatment, and there was clinical and radiological improvement in all four patients with pre-operative avascular necrosis.
