RESUMEN
Most patients of symptomatic osteo-arthrosis of knee are associated with varus malalignment that is causative or contributory to painful arthrosis. It is rational to correct the malalignment to transfer the functional load to the unaffected or less affected compartment of the knee to relieve symptoms. We report the outcome of a simple technique of high tibial osteotomy in the medial compartment osteo-arthrosis of the knee. Between 2007 and 2012 we performed closing wedge osteotomy in 44 knees in 42 patients. Of the 10 patients who had bilateral symptomatic disease, 2 opted for high tibial osteotomy of their second knee 1-3 years after the first operation. Pre-operative grading of osteoarthrosis and postoperative function was assessed using Japanese Orthopaedic Association (JOA) rating scale. At a minimum follow-up of 6 months (range 0.6-5 years) 6-10 degrees of valgus correction at the site of osteotomy was maintained. The visual analogue scale (VAS) score improved from mean of 5.77 to 1.5. Approximately 19 satisfied with this operation. The JOA score mean 55 (range 45-61) improved to 86.18 (range 82 to 89). The activity of daily living (ADL) like rising from chair, going upstair and downstair, improved in all patients. Walking distance improved in all patients. No patient was lost any pre-operative knee function. Closing wedge high tibial osteotomy performed by our technique can be undertaken in any set-up with moderate facilities. Operation related complications are minimal and avoidable. Closed wedge osteotomy is least likely to interfere with replacement surgery if it becomes necessary.
Asunto(s)
Osteoartritis de la Rodilla/cirugía , Osteotomía/métodos , Tibia/cirugía , Actividades Cotidianas , Femenino , Estudios de Seguimiento , Humanos , Masculino , Escala Visual AnalógicaRESUMEN
The clavicle fractures managed non-operatively have shown a high prevalence of symptomatic malunion and non-union. We sought to compare patient-oriented outcome and complication rates following non-operative treatment and those after operative treatment of clavicular fractures. In a prospective randomised study, 30 patients with 30 clavicle fractures were randomised by systemic allocation to either operative treatment or non-operative treatment. Fifteen patients were in each group. Outcome analysis included standard clinical follow-up and the disability of the arm, shoulder and hand (DASH) score, and plain radiographs. The mean follow-up of both groups were 12.56 months. DASH scores were significantly improved in the operative fixation group at all time-points. The mean time to radiographic union was 27.46 weeks in the non-operative group compared with 15.73 weeks in the operative group (p = 0.000). There were no non-unions in both groups. Symptomatic malunion developed in seven patients (46.66%) in the non-operative group and in none in the operative group. The complications in the operative group were hardware-irritation (one case) and incisional numbness (one case). At final follow-up, the patients in the operative group were more satisfied with the appearance of the shoulder (p = 0.039) and with the shoulder in general than were those in the non-operative group. There were no differences between the two groups with respect to patient age, sex, side of injury or associated injuries. Operative fixation of AO type B2 clavicular fracture results in improved functional outcome and early union compared with non-operative treatment at one year of follow-up. This study supports primary operative fixation of completely displaced mid shaft clavicular fractures in active adult patients.
Asunto(s)
Clavícula/lesiones , Clavícula/cirugía , Fracturas Óseas/terapia , Tirantes , Evaluación de la Discapacidad , Fijación de Fractura , Curación de Fractura , Fracturas Mal Unidas/etiología , Humanos , Satisfacción del Paciente , Estudios ProspectivosRESUMEN
The present study was being undertaken in retrospective and prospective basis to investigate the ultimate outcome of the procedure in type IIIA and type IIIB injuries. We have used simple AO type of external fixator and applied uniplanar double tube frame and unilateral biplanar frame. Frames were selected randomly; unilateral uniplanar frame in some patients having type IIIA wound and in some patients having type IIIB wound. Similarly, unilateral biplanar frames were used in some patients with observations have shown that these external fixators are simple, easy to apply, cost-effective and yield acceptably good results. Thus, the 'external fixator' application for the management of open fractures of tibia may give good results even to the poor patients and may be suitable for underdeveloped and developing countries. A study was undertaken by the committee on fracture and traumatic surgery of the American Academy of Orthopedic Surgeons to evaluate the efficacy and practicability of this method of treatment. The study was carried out in the department of orthopaedics, RG Kar Medical College & Hospital, Kolkata in retrospective and prospective basis since June, 2005. Forty-seven patients were selected from the outpatients department and emergency department having open fracture of shaft of the tibia with or without fracture of the fibula and were treated in the orthopaedic indoor department. The patients were followed up for 6 months to 2 years. Out of 47 cases, 2 patients could not be communicated for follow-up. Normal union could be seen in 25 patients followed by delayed union (n = 11) and malunion (n = 11). Joint shiffness was seen in 16 patients.