Anish Vernekar

Abstract

Subtalar joint dislocations are very uncommon and occur following high energy injury, usually following motor vehicular accidents. They account for around 1-2% of dislocations. We present to you, a few cases of subtalar joint dislocation managed initially by closed reduction, followed by open reduction under anesthesia, with excellent functional outcome. Close to fifty percent of patients suffering from complicated injury, are frequently at risk of developing complications. Avascular necrosis of the talus is the most common complication, following dislocation. Other long-term sequelae include osteochondral fracture and subtalar joint instability. This study is presented because of its rarity in clinical practice.   Keywords: Dislocation, Subtalar joint, Reduction.

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Abstract

Background: Open/Compound fractures of tibia are the most common type of fracture to occur following road traffic accidents; however, sports injury, fall from height can also frequently produce these fractures. Open fractures of tibia (Type 3B) are quite challenging to treat, with respect to associated soft tissue injury and the decision for type of implant to be used by an orthopaedic surgeon. The decision making is based on the wound condition, the amount of muscle and soft tissue damage, type of fractures, and availability of equipments. This study was undertaken to evaluate the most optimal method for the management of compound fractures of tibia vis a vis comparing reamed tibia interlocking nail and external fixator in the management of type 3b compound fractures of tibia. Controversy exists over whether the use of external fixation or tibial intramedullary nailing is optimal for the treatment of open tibial fractures. The aim of this study was to compare clinical outcomes in terms of postoperative infection, malunion, delayed union, nonunion and hardware failure between these two treatment methods. Materials and Methods: The study was undertaken in the Department of Orthopedics, Goa Medical College. The study involved both male and female patients with open fractures of tibia, (Gustillo and Anderson, Type 3B). This was a prospective study conducted from month of September 2017 onwards. Hundred patients who had compound fracture of tibia (Type 3B) were evaluated. The patients were followed-up for duration of 6 to 10 months (Average 8 months). Detailed analysis of function of the patient was done on the basis of following criteria by Johner and Wruh. Conclusion: The study conducted on 100 patients, who suffered from compound fracture tibia (Type 3b), it was reported that patients who were operated with reamed tibia interlocking nail had better outcome and decreased morbidity, as compared to patients treated with external fixator.   Keywords: Tibia, Type 3b, Intramedullary nailing, External fixator.

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