Himanshu G Ladani

Abstract

Background: The incidence of proximal femoral fractures are markedly increasing because of increasing life expectancy and motor vehicle accidents. Subtrochanteric fractures of femur pose a great problem because of diversity of fracture patterns and difficulty in attaining anatomical reduction and also it is high stress region, having less vascularity. Intramedullary fixation devices like PFN is technically demanding and many times it needs open reduction of fractures. Favourable mechanics is attained by flexible intramedullary nailing like Ender’s nailing. Materials and Methods: This is a comparative study of 40 cases of subtrochanteric fractures of femur, out of which 20 treated with Ender’s nailing and other 20 treated with PFN. All were closed fractures. Age was ranging from 20 to 70 years. In our study patients distribution according to Frank- Seinsheimer classification was as follows… Type I – Nil, II A – 1 pt., II B – 6 pts., II C – 1 pt., III A – 11 pts., III B – 6 pts., IV – 7 pts., V – 8 pts. In PFN open reduction was done in 5 pts., while in Ender’s nailing all pts. were managed by close reduction. Results: Average union time was 18 weeks in PFN, while 15 weeks in Ender’s nailing. Reoperation due to implant breakage and/or Z-effect was required in two cases in PFN. Shortening upto 1 cm. seen in 2 pts. in PFN, while in Ender’s nailing upto 1 cm. in 6 pts. and from 1 to 2 cm in 2 pts. Conclusion: In obese pts. Ender’s nailing is easy, while PFN is more technically demanding. Union is earlier in Ender’s nailing v/s PFN. PFN is more stable implant. Excellent or good results are seen in 15 out of 20 pts. in PFN, while 18 out of 20 pts. in Ender’s nailing.   Keywords: Ender’s nailing, PFN, Subtrochanteric, Femur.

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Abstract

Background: Fractures of distal tibial metaphysis present a management challenge because of their inherent instability, scarcity of soft tissue, subcutaneous nature and poor vascularity of bone. MIPO techniques are advantageous because of limited soft tissue strapping, maintenance of the osteogenic fracture haematoma without interrupting vascular supply to the individual fracture fragments. Materials and Methods: This is a study of 20 patients of closed extra articular distal tibial fractures treated with anatomical LCP applied on antero-medial surface of lower end tibia with MIPO technique. Age was ranging from 20 to 60 yrs. 14 male and 6 female patients were there. 7 patients were having fibula fracture at same level of tibia fracture, they were fixed with DCP/ 1/3 tubular plate before fixing tibia. Results: AO/OTA type 43 A1 fractures were there in 15 patients. 4 pts. were having 43 A2 and one pt. was having 43 A3 type fracture. Average operation time was 80 mins. Average union time was 18.5 weeks. One pt. was having delayed union, one having superficial skin infection, one having 6* varus angulation and one having malleolar skin irritation. No pts. required second surgery of bone grafting. No implant failure. Conclusion: MIPO with LCP is a reliable and effective method of treatment for the distal tibial extra-articular fractures, preserving most of the osseous vascularity and fracture haematoma and thus providing a more biological repair. Using indirect reduction technique and small incision is technically demanding. Keywords: Anatomical LCP, Distal tibial fractures, MIPO.

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