Shashikant B Ganjale

Background: Intertrochanteric fractures can be fixed with various implants with surface implants or intramedullary implants. A study was done on Fixation of trochanteric fractures with Hip Fixation Nail/Intra Medullary Hip Screw an innovative cephalomedullary nail designed by author to determine its efficacy, union operative use and functional outcome. Materials and Methods: Trochanteric fractures of hip were classified upon number of parts, stable and unstable fractures in initial 43 cases. All Intertrochanteric fractures stable as well as unstable were fixed and stabilized by Dr Shashikant B Ganjale’s innovative Nail Hip Fixation nail (HFN) / Intra medullary hip screw Nail (IMHSN). 5 cases were fixed with Trochanteric Buttress Plate alongwith Hip fixation nail for lateral wall comminution. Results: The results were Excellent in 31 cases, Good in 5 cases, and fair in 2 cases as seen in our study according to Kyles criteria. Five cases did not follow up. Conclusion: Author’s (Dr Shashikant B Ganjale) innovative Nail Hip Fixation nail /Intra medullary Hip Screw Nail (IMHSN) is a very simple minimally invasive, cephalomedullary single screw fixation nail suitable for fixing all stable and unstable trochanteric fractures, especially in young as well as elderly osteoporotic patients with minimal instrumentation and excellent functional outcome.   Keywords: Trochanteric fractures, Hip Fixation Nail (HFN, Intra Medullary Hip Screw (IMHSN).

Wound infection is commonest problem encountered in orthopaedic practice may be due to compound wounds or infection of surgical wound in post operative period. The wound infection is ubiquitous in hospital environment and is a real challenge to treat. The most common pathogen is Pseudomonas aeruginosa involving skin and subcutaneous tissue. Though Staphylococcus Aereus Staph epidermidis are also secondary microorganisms found. Many wound care methods and local disinfectants solutions antibiotics are been used in practice for wound care and its early healing. Inspite of availability of all antimicrobial agents, it is difficult to treat wound infection. In our present study an attempt was made to assess the results of local use of Vinegar (acetic acid) in treating infected wounds, which is economical and easily available for infected wound care. Materials and Methods: A prospective study was done in orthopaedic infected wounds which were not responding to traditional wound care. The infected wounds included in our study were compound fracture wounds and infected surgical wounds. The infected wounds were dressed up with local soaked gauge piece in acetic acid or local infiltration at wound edges with proper debridement. Results: Culture sensitivity of discharge from wounds revealed pseudomonas aeruginosa and were resistant to almost all available antibiotics used in our Government hospital. These wounds responded dramatically with use of acetic acid locally. Their hospital stay was reduced. Conclusion: Infected wound care with local acetic acid is effective in treating compound wounds and surgical wound infections. Keywords: Infected wound, Vinegar (Acetic Acid).

Background: The conventional methods like conservative treatments are well accepted for managing shaft fractures of humerus. But this needs continuous frequent vigilance on the clinical and radiological follow up to see any displacements and may need to change the line of treatment requiring surgical intervention. Closed Interlocking nailing of humerus mid shaft is routinely done as frequently as open plating because of its encouraging results. Fractures of distal one third humerus shafts are challenging for nailing especially if there is comminution and segmental fracture with short distal segment. Distal humerus fractures can be stabilised with intramedullary interlocking nails, provided adequate length is available in distal segment. The aim of this study is to explain difficulties faced in closed interlocking nailing of distal one third and below distal one third humerus shaft and solutions to overcome them and remove the hesitancy of performing nailing without any complications in such circumstances in a closed technique with minimal surgical trauma. Materials and Methods: A prospective study of 27 patients with fracture of Humerus shaft at and below one third level fractures was done. They were treated by closed interlocking nailing in period of five years from 2014 -2019. These patients were followed up till fracture union & evaluated further postoperatively for finding its benefits over open plating. Results: In our study, the age varied from 25 to 68 years. The mean age of patients was 45 years. 18 were males (65%) and 9 were females (35%). The results were based on type of fracture and healing period, infection, stiffness of elbow, restriction of movements. The results were encouragingly excellent in clinical radiological and functional outcome. Conclusions: From our present study we conclude that closed nailing of distal humerus fracture is a reliable minimal invasive alternative procedures than extensive open reduction and plating. It is especially beneficial in conditions like osteoporosis, segmental fractures humerus. Keywords: Distal one third humerus shaft fractures, Antegrade interlocking nailing.

Introduction: Metacarpal fractures are one of the most common orthopedic injuries seen in orthopaedic practice. The aim was to study the technique and functional outcome of metacarpal shaft fracture treated with percutaneous flowering (Bouquet Technique/Foucher’s technique) intramedullary fixation of precontoured K wires. Materials and Methods: A nonrandomized, uncontrolled prospective study was performed on 38 patients with 47 metacarpal fractures. They were treated by percutaneous enders type flowering technique (Bouquet) with intramedullary precontoured thin K wires. All patient were screened using inclusion and exclusion criteria and followed up prospectively and assessed the Hand radiologically, clinical and functional outcome, Total active movement, Grip strength, VAS score. Results: Male patients had a significantly higher frequency (68.1%) in comparison to female patients (31.9%) Most common ray affected was 4th and 5th ray followed by 2nd ray and then third ray. 38.3% of fractures were oblique type and 53.2% fractures were transverse, spiral and comminuted being 8.5%. Shaft of metacarpal fracture was maximum affected (74.5%) followed by base (14.9%) and neck (10.6%). 50% patients underwent implant removal in a period of 6 weeks. Conclusion: This method is simple, needs minimal instruments like plier, T handle, k wire cutter bender and is cost effective, and well tolerated and with added advantage of early bone healing with good functional outcome. Being percutaneous technique there is no operative incision scar or need of anaesthesia required for removal of k wires after the treatment period. Keywords: Bouquet technique of Precontoured, Intramedullary K wire flowering fixation, Metacarpal fracture.

Introduction: Most of the hip fractures are managed in supine position on a fracture table with foot attached to foot plates and biplanar fluoroscopy supervision under c-arm. But this procedure has its own difficulties in managing especially comminuted subtrochanteric fractures, where in different fragments and segments are being pulled by strong muscles around hip, and getting good reduction and alignment is difficult due to displaced bony fragments being held in traction on fracture table and cannot be manipulated easily. This leads to prolonged operative time, opening of fracture site, increased bleeding, increased chances of infection and over all increased anaesthesia time adding up to risk factors. The purpose of this study was to report how these difficulties can be overcome by operating on a simple radioluscent top operating table in lateral position without a fracture table. Materials and Methods: 74 cases of subtrochanteric fractures with or without comminution were operated in lateral position on simple ordinary radioluscent top table with lesser attachments and adjustments to operating table during the study duration were included in the study. We used long Proximal Femur Nail (PFN) (length more than 25cms 34, 36, 38, 40cms long) to fix these fractures. Results: In the present study, age group of patients was 25yrs to 74yrs. Male patients (83.7%) were more than female patients (16.3%) An average of less than 150 ml in closed surgery. The average operative time for all cases was 80 minutes. Union time varied from 16 weeks in simple fractures to 26 weeks in comminuted fractures. Clinical function of hip and knee was excellent with full range of movements. Conclusions: Reduction and fixation of proximal femoral fractures in the lateral position with fluoroscopy or portable radiography in the anteroposterior view for small set ups and rural hospitals that lack a fracture table or advanced fluoroscopic devices may be executable and probably safe. Keywords: Long PFN, Subtrochanteric fracture, Lateral position, Ordinary operating table.

Introduction: Due to modern lifestyle changes, the incidence of distal femur fractures has risen and more so in association with shaft fractures of femur because of fast world and high velocity trauma occurring in road traffic accidents. Dilemma arises when we face distal third shaft and associated supracondylar or inter-condylar fracture of femur. The aim of this study is to remove the hesitancy of performing retrograde nailing by long IMSC nail without any complications. Materials and Methods: A prospective study of 150 patients with fracture of femur shaft and supracondylar fractures was done. They were treated by using this technique, from January 2003-2017. These patients were followed up till fracture union & evaluated further postoperatively for finding its benefits. Results: In our study, the mean age of patients was 35 years. 65.3% were males and 34.7%% were females. The mode of injury in case of majority of the patients had RTA (road traffic accident) 93 patients (62%). In the present, surgical and technical related complications were encountered in 10 patients (6.7%). Our patients had a mean value of 80 points according to Neer score. Conclusions: We conclude that retrograde long IMSC nail is reliable as an alternative for conventional procedures like ante-grade nailing and plate fixation in femoral fracture shaft and supracondylar region. It is especially beneficial in conditions like osteoporosis, pregnancy & previous implant or prosthesis on ipsi-lateral side and ankylosed hip. Retrograde nailing can be done on simple radio-luscent top operating tables which are commonly available everywhere. Keywords: Femur shaft fractures, Supracondylar femur fractures, Retrograde long IMSC nailing, Fracture union.