An outcome analysis of bicolumnar fixation in distal humerus fractures in adults

Dinesh, C (2013) An outcome analysis of bicolumnar fixation in distal humerus fractures in adults. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: The shoulder (gleno-humeral) joint is the one joint with maximum mobility and thus resulting in increased chances of instability which commonly occur in the young individuals . The incidence of recurrent glenohumeral instability is 16 per 100 000 per year 3 with a majority of them are of anterior type. In recurrent anterior glenohumeral instability, there is no role for conservative management as there is no spontaneous recovery 10, unless some surgical intervention is carried out to stop the recurrence cycle to bring out cure for the patient and reduce the apprehension of dislocation so that the patient is free from restricting himself from his routine daily activities. AIM: The aim of the study is to analyse the functional outcome of patients treated with modified Bristow’s repair in recurrent anterior shoulder dislocation in Institute of Orthopaedics and Traumatology, Government General Hospital Chennai from May 2010 to September 2012. MATERIALS AND METHODS: The study was approved by the Ethical Committee of the Hospital, and informed consent was obtained from the patients. Total number of 30 cases who got admitted in between March 2010 to October 2012 in Rajiv Gandhi govt. general hospital Chennai, were taken for the study. All the cases were operated and followed with ROWE scoring. All the patients had a positive apprehension test and experienced at least two episodes of dislocation. Data collected from the patients: 1. Mechanism of injury, 2. Age at the time of first episode of traumatic dislocation, 3. Number of recurrences, 4. Dominant extremity. Inclusion criteria: 1. Large or engaging Hill-Sach’s lesion, 2. Glenoid bone loss > 25%, 3. Bony bankart’s lesion, 4. Shoulder instability severity index > 3, 5. Other failed procedures. Exclusion criteria: 1. Less than 3 anterior dislocation, 2. Multidirectional / Posterior instability, 3. Bilateral dislocation, 4. Patients with voluntary dislocation, 5. Atheletes involved in throwing sports. RESULTS: In the series, twelve cases (40%) were in between the age group of 16-25 yrs, ten cases (33%) were in 26-35 yrs, eight cases (27%) were in 36-45 yrs Recurrence rate was inversely proportional to the age of the patient at the time of initial dislocation and the severity of the injury. Most of the patients in the study presented with episodes of recurrent dislocations within two years of initial dislocation as evidenced by the following table and most of the primary instabilities occurred before the age of 25 years. 15 patients (50%) were affected before the age of 25 years. CONCLUSION: The aim of the study is to prevent the recurrence in patients with recurrent shoulder dislocation treated with modified Bristow’s repair. Shoulder dislocation is commoner in young active males, involved in sports related activities. Proper selection of the patients for our procedure with proper history, physical examination, radiographs, computed tomograms and MRI is mandatory. Good results were obtained when the transferred coracoid after osteotomising it from its base along with the conjoined tendon, heals onto the anteroinferior glenoid. Intaroperatively, utmost care should be taken in not fracturing the coracoids process, as it may significantly affects the outcome.

Item Type: Thesis (Masters)
Uncontrolled Keywords: outcome analysis ; bicolumnar fixation ; distal humerus fractures ; adults.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 14 Sep 2017 03:37
Last Modified: 14 Sep 2017 03:37

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