Sheshagiri

Abstract

Introduction: The treatment of complex proximal tibial fractures with ilizarov external fixators is slowly gaining more popularity and acceptability in traumatology, complex tibial plateau fractures pose a significant risk of soft tissue problems, edema and compartment syndrome, its management throws a great challenge. These fractures were treated with ilizarov external fixators. Materials and Methods: The prospective study was conducted in JSS Medical College and Hospital over a period of April 2016 to September 2017. A total of 30 patients who were treated with ilizarov ring external fixator for schatzkers type V and VI tibial plateau fractures were included in the study, each patients were randomly assigned to be treated with two methods, the Russian technique and the Rancho hybrid fixation technique, these patients were followed up and their data with regard to fracture union time and pin tract infections were collected in a Microsoft excel and the results were scrutinised. Results: There was a predominantly male population and the road traffic accidents was the most common followed by self-fall, The mean union time was 18.27+_1.79 weeks in the Russian technique and 23.47+_2.72 weeks in the rancho hybrid system the union time was assessed using the RUST criteria and The Rancho technique pin tract infection rate was 20% and it was 26.67% in the Russian technique, the incidence of pin tract infection was even though a little higher in the Russian technique the difference was not statistically significant (OR1.45(0.26-8.1)p0.5) the pin track infection was graded using the checkers and buns. Conclusion: the ilizarov Russian technique fares over the rancho hybrid fixation technique in achieving union earlier by enhancing the micromotion at the fracture site being a less rigid construct. Keywords: Ilizarov fixator, Russian technique, Rancho technique, Schatzkers type V and VI fractures, Union time, Pin tract infections.

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Abstract

The approach of surgical management of distal intraarticular radial fractures is gaining popularity in the current scenario, and there is no concluding evidence as to which method of surgery fares better than the other, this article attempts to compare the radiological and functional outcome of trinary surgical treatment (percutaneous pinning, ligamentotaxis and plate and screw fixation) for distal end radius intraarticular fractures. Materials and Methods: It was a prospective study involving 90 patients who presented with distal end intra-articular radius fractures, each of these patients were randomly assigned to be treated by ligamentotaxis and plate and screw fixation, percutaneous pinning, (n = 30) each who were operated between January 2016 to May 2017 and their data with respect to functional and radiological outcome were collected over one year. Results: In this research paper out of the 90 patients, the excellent scores were in 13 patients accounting 14.4%, good scores 47.8% in 43 patients and fair and the poor scores 25.6% and 12.2% functionally were seen in 23 and 11 patients respectively, The Cramer s V value was not found significant, the values noted are 0.84. A significant association between groups and Volar tilt, Radial angle and Radial shortening. Cramer’s V was found to be significant (P- value 0.0001) radiologically. The outcome with respect to radiology and the function was measured using werley and gartland scoring and the lidstorm scoring system. Conclusion: In this study the open reduction and internal fixation with plate and screws gave a restored radiological outcome compared to the ligamentotaxis and percutaneous pinning group but the functional outcome remained the same in all the three treatment groups. Keywords: Distal radius Intra articular fractures, Volar locking plate, Percutaneous Kirshner wire fixation, Ligamentotaxis.

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