Vishal M Mehta

Abstract

Background: The follow-up observational study between TENS and PLATE group in Displaced Midshaft Clavicular fracture conducted in the Department of Orthopaedics, Sir Takhtsinhji Hospital, Bhavnagar, after getting permission from ethical committee. Materials and Methods: All patient coming to Sir Takhtsinhji General Hospital, Bhavnagar with midshaft clavicular fracture and who admitted for surgery and met the criteria was included in this study. Patients with fractures older than 4 weeks or with pathological fractures or those having associated head injury or having bilateral fracture was excluded from the study. After explaining the purpose of the study, a written informed consent was taken from all the participants before data collection. The data were recorded in a predesigned and pretested proforma. Data was collected from past records, and in subsequent 6 weeks, 3 and 6 months postoperative follow up. Result: At the end of the study, we had 15 patients in the Plate group and 15 in the TEN group for comparison. In the Plate group, we had 08 male and 07 female patients, whereas there were 09 male and 06 female patients in the TEN group. The Duration of Surgery was 71.346.67 in the Plate group and 485.60 in the TEN group. The use of minimally invasive antegrade TEN for fixation of displaced midshaft clavicle fractures is recommended The functional outcome at 3 months was good in 14 cases (46.66%), adequate in 16 patients (53.34%). Out of all the good outcomes, 9 cases (60%) were from TEN group while 5 patients (33.3%) from plate group. Conclusion: All patients were evaluated at 6 weeks, 3 and 6 months with follow up radiologically by xrays. In our study Road Traffic Accident was the most common cause for clavicle fractures. Fall on out stretched hand was the commonest mechanism of injury. We studied the fracture pattern (intra operatve finding) based on mode of injury and mechanism of injury. From this AO 2B2 (comminuted mid shaft fracture) is associated with high velocity injury and direct impact on the shoulder. Keywords: RTEN, Plating and MSCF.

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Abstract

Introduction: The role of the posterior cruciate ligament (PCL) in total knee arthroplasty (TKA) has been widely discussed in the orthopaedic literature. Theoretical and functional arguments and survivorship have all been used to support both its retention and its substitution. Moreover, with the advent of robotics and ever evoluting kinematic surgical procedures, the results for the cruciate-retaining arthroplasties are found to be more variable than for the cruciate substituting arthroplasties. The present study is sought to investigate if there was a difference in the clinical outcome as measured by the commonly-used scoring systems which includes (International Knee Society Score, Western Ontario McMasters Osteoarthritis (WOMAC) index and the SF- 36 health survey along with the radiological scores and outcomes of the two procedures in TKA. Methodology and Results: We performed a prospective, randomized trial of 30 patients to compare the functional outcomes of a posterior-cruciate-ligament-retaining and posterior- cruciate-ligament substituting total knee arthroplasty. Statistical analysis was performed using the Student’s t-test and ANOVA test for multiple trials. At follow-up at 3 months, no statistically significant differences were found in the clinical outcome measurements for either design. The results of theWOMAC 35 score which were subdivided into pain, stiffness and function showed high scores for cruciate substituting groups for pain as compared to the cruciate retaining groups whereas, other parameters were same in both the groups. For other systems including SF-36 and knee society score the results did not seem to vary to a great extent statistically. Conclusion: To conclude the present study found almost similar results for Cruciate ligament retaining and substituting procedures in long term follow up at 3 months, with slightly better outcomes for Cruciate ligament retaining groups at the earliest phases pre operatively and post operatively. Keywords: PCL, Total knee arthroplasty, WOMAC system, SF36 system, Knee society score, Posterior cruciate retention surgery, Posterior cruciate ligament substitution

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