Analysis of radiological and functional outcome of comminuted long bone fractures managed by Biological Plate Osteosynthesis

Srivatsa, B S (2011) Analysis of radiological and functional outcome of comminuted long bone fractures managed by Biological Plate Osteosynthesis. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Modern way of living has lead to increased incidence of high velocity accidents. This has resulted in an increasing number of comminuted long bone fractures. These high velocity injuries tend to affect the young and working population and hence associated with increased morbidity and loss of function. Management of these fractures has always been a challenge. The goal of treatment in such situations is not only to heal the fracture, but also to aid the patient to return to pre-injury status as early as possible. Traditionally the fractures were treated by rigid internal fixation after anatomical reduction. However this was associated with increased soft tissue stripping and hence more instances of non unions, delayed unions and other complications like infections – as the swiss surgeon Fehr has said “in no area of surgery so many mistakes have been made as in operative fracture fixation”. AIM: To analyze prospectively the radiological and functional outcome of comminuted fractures of long bones managed by biological plate osteosynthesis in our institute from July 2008 to August 2010. MATERIALS AND METHODS: Patients who sustained comminuted fractures of long bones were treated by the method of Biological plate Osteosynthesis during the period of July 2008 to August 2010 at Institute of Orthopaedics and Traumatology, Madras Medical College and Government General Hospital, Chennai. A total of 32 cases were treated, out of which 2 cases lost to follow up and one died because of an unrelated cause and were excluded from the study. 29 cases were followed up over a mean period of 20 months ( range – 16-24 months). The patients were either directly admitted in our hospital or were referred from a primary centre after hemodynamic stabilization. Out of the 28 cases, 11 presented to us within 6 hours of injury, 6 cases from 6–12 hours following injury and 7 cases from 12–24 hours, and remaining 5 cases presented after 24 hours. The patients were received in our trauma ward, and after hemodynamic stabilization, x-rays of the injured part were taken and the fracture pattern were analysed. CT – scan were done in cases with intra-articular extensions. They were classified according to the AO classification of fractures as it is easily recordable and reproducible. It accurately describes the extensiveness of the fracture. Fractures were immobilized by splinting or by pin traction as per the convenience. Age of the patients averaged 25 years (range 14 to 58 years). 2 were aged between 10-20 years, 8 of them between 20-30 years, 13 were between 30-40 years and 5 were aged between 40-50 years and 1 with age above 50 years. RESULTS: The mean Neer – Grantham – Shelton score was 83 (range – 45 to 95). The clinical outcome was graded as excellent in 12 cases (41.37%), good in 11 (37.9%) cases, fair in 4 (13.7%) cases and failure in 2 (0.068%) cases. The clinical score of the patients is depicted in graph 5. CONCLUSION: Indirect reduction and minimally invasive percutaneous fixation appear to be very effective and have a proven value in the management of various spectrum of comminuted diaphyseal — metaphyseal fractures.• Its greatest value appears to be in treating peri-articular metaphyseal and metaphyseo-diaphyseal comminuted fractures.• It reduces the duration of surgery, intraoperative blood loss and hence post operative morbidity, which allows early rehabilitation and early return of function.• It is also associated with less incidence of infections, non unions and implant failures and other complications.• Accurate restoration of Limb length, rotation and alignment is possible.• However the technique appears to be technically challenging. Hence early surgery, careful planning, intra-operative fluoroscopic monitoring and accurate contouring of the plate are essential.• In case of intra-articular fractures, accurate alignment of the articular surface is imperative for good clinical outcome.• The condition of the soft tissues and co-morbid conditions deserves to be respected.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Analysis ; radiological and functional outcome ; comminuted long bone fractures ; Biological Plate Osteosynthesis.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 14 Sep 2017 03:21
Last Modified: 14 Sep 2017 03:21

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