Prospective Study of functional outcome analysis of mini external fixator in short long bones

Karthi Cumaran, S A (2016) Prospective Study of functional outcome analysis of mini external fixator in short long bones. Masters thesis, Tirunelveli Medical College, Tirunelveli.


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AIM OF THE STUDY : To evaluate the functional outcome of mini external fixator in short long bones of hand and foot. MATERIALS AND METHODS : This is a prospective study of 120 patients carried out in the Department of Orthopaedics ,Tirunelveli Medical College Hospital,Tirunelveli from August 2013 to August 2015 .The study includes both closed and open metacarpal and phalangeal fractures of hand,both closed and open metatarsal and phalangeal fractures of foot.The study excludes fractures with associated vascular injury. Closed fractures of hand are evaluated with radiographs and either open or closed reduction with external fixation done under fluoroscopic guidance.Mean operative time is 25 minutes. Finger mobilization and wrist mobilization exercises started from day 1.Patients are followed up at weekly interval for 8 weeks. External fixator are removed at an average period of 23 days .Functional outcome in hand fractures is analysed using DUNCAN score at the end of 6 weeks.Functional outcome in fractures of foot are analysed using Foot Ankle Disability Index(FADI) at 8 weeks. OBSERVATION OF THE STUDY : In our study hand fractures constitutes 76.6%,fractures of foot constitutes 23.3%.Among hand fractures ,closed fractures constitutes 58.7% and compound fractures constitutes 41.3%. Among the closed fractures of hand,metacarpal fractures of hand constitutes 51.9%,phalangeal fractures constitutes 40.7%,both are involved in 7.4%.Among the compound fractures of hand,metacarpal fractures includes 31.6%,phalangeal fractures includes 47.4%,both are involved in 21%. Among fractures of foot,closed fractures constitutes 57.1%,open fractures constitutes 42.9%.Among the closed fractures of foot, metatarsal fractures constitutes 50%,phalangeal fractures includes 37.5%,both are involved in 12.5%.Among the compound fractures of foot, metatarsal fractures constitutes 16.7%,phalangeal fractures includes 33.3%,both are involved in 50%. Complications landed in our study are pin site loosening, infection ,skin complications,deformity and tendon impingement RESULTS: Functional outcome among fractures of hand are analysed using DUNCAN ‘S score at 6 weeks. Results are excellent in 57.5% ,good in 25%,fair in 12.5%,poor in 5% among fractures involving metacarpals.Excellent in 52.5%,good in 30%,fair in 10%,poor in 7.5%among fractures involving phalanges.Excellent in 33.3%,good in 25%,fair in 25%,poor in 16.6% among fractures involving both metacarpals and phalanges. Functional outcome among fractures of foot are analysed using FADI score. Results obtained are excellent to good in majority of patients. DISCUSSION : Most of the fractures of miniature bones are treated conservatively. Open reduction and internal fixation is performed for unstable fractures for absolute stability,thereby promoting early union and movement of joints. But open reduction and internal fixation cannot be achieved in all cases due to nature of injury. Also open reduction and internal fixation requires additional soft tissue stripping which sometimes hinders union or leads to adhesion preventing active movement of digits. In our study, mini external fixator is applied to all types of fractures ,both closed and compound fractures of hand and foot except those associated with vascular injury .External fixator avoids additional injury to the soft tissue. It also promotes wound healing in case of compound fractures.Operative technique is simple with the use of image intensifier. The results obtained in our study is better than the study conducted in 33 patients that includes 29 phalangeal and seven metacarpal fractures J Bone Joint Surg [Br] 1998;80-B:227-30. Received 7 July 1997; Accepted after revision 10 November 1997, where the study group is small.Excellent to good results are obtained in 82.5% of patients with metacarpal and phalangeal fractures which is far better than 69% and 71.4% with phalangeal and metacarpal fractures respectively,obtained in the above mentioned study. In our study involving 28 patients involving fractures of metatarsals and phalanges of foot, functional outcome is analysed using FADI (Foot Ankle Disability Index). Closed and compound fractures are almost equal in frequency. Distribution of fractures in foot cannot be determined with this small patient group.FADI is questionnaire measuring patient’s functional ability after intervention. Results are excellent to good in majority of patients treated with external fixator especially compound fractures. CONCLUSION: Mini External fixator is one of the ideal treatment modality in the management of fractures of short long bones especially in open fractures ,communited fractures,intraarticular fractures, fractures with bone loss. Mini external fixator helps in preservation of movements and gives best functional results by providing stable fixation .Simple surgical technique will minimize complications and an aggressive rehabilitation regime will ensure the best possible result. In general ,mini external fixator is a alternative treatment for management of fractures of miniature long bones especially in certain situations with best functional outcome.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Metacarpals, phalanges ; Metatarsals ; Mini external fixator ; DUNCAN,S score ; FADI score.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 18 Sep 2017 03:20
Last Modified: 21 Sep 2017 01:43

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