PURPOSE: Tibial plateau fracture (TPF) is a devastating injury as it shatters lower articular surface of the largest joint. Apart from bony injury, TPF can lead to great soft tissue envelope compromise which affects the treatment plan and outcome. In the present study, clinical results were assessed in cases of high energy TPFs treated in staged manner. METHODS: Twenty-three (20 males and 3 females) patients of high energy communited TPFs (Schatzker type V and VI) were consecutively treated. All the patient had compromise of overlying skin conditions. They were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were healed. Schatzker type I, II, III and IV were excluded from the study. Primary survey was done and patient who had head injury, chest and abdominal injury, pelvic injury and contralateral limb injury and open fractures were excluded from the study. The patients were also evaluated in terms of wound complications, axial and rotary alignment of limb, fixation failure, articular congruity and range of motion of the knees and post injury employment. Statistical analysis was done using SPSS software. RESULTS: Maximum follow-up period was 13 months. All the fractures were united at final follow-up. Clinical evaluation was done with the Tegner Lysholm knee scoring scale. Excellent results were found in 78% cases and good and fair results in 22% cases. There was significant correlation between range of motion and the Tegner Lysholm knee score (p < 0.001, Pearson correlation coefficient = 0.741). The correlation between the score and the radiographical union duration was significant (p = 0.006, Pearson correlation coefficient = -0.554). CONCLUSION A staged treatment plan allows healing of soft tissue envelope, with avoidance of dreadful complications such as compartment syndrome and chronic infection. In addition, a staged treatment strategy does not hamper the fracture reduction, bony union and the functional results.
Adult ; Compartment Syndromes ; prevention & control ; Connective Tissue ; physiopathology ; Female ; Fracture Fixation, Internal ; methods ; Fracture Healing ; Fractures, Comminuted ; physiopathology ; surgery ; Humans ; Knee ; physiopathology ; Male ; Middle Aged ; Range of Motion, Articular ; Tibial Fractures ; physiopathology ; surgery ; Treatment Outcome

OBJECTIVEDynamic hip screw (DHS) is recommended for the fixation of stable intertrochanteric fractures. Its postoperative cut-out rate ranges from 1% to 6%. In osteoporotic bone, normal screws in DHS blade provide less anchorage compared to locking screws. This study aims to compare DHS with locking side plate and conventional side plate.

METHODSFifty consecutive patients with intertrochanteric fractures were randomly allocated for fixation with a standard DHS (group A) and locking DHS (Combi plate, group B). We compared the clinical and radiological outcomes for the conventional DHS and locking DHS in intertrochanteric fractures. Functional outcome was evaluated using the Parker mobility score.

RESULTSCoxa valga was found more frequently in group A than in group B (12% vs. 0%, P=0.42). Coxa vara showed the same trend (12% vs. 8%, P=0.81). Rate of restoration of postoperative neck-shaft angle within 20° of sound side was higher in group B (8% cases) than in group A (4% cases, P=0.98). The rate of anteversion angle restoration within 10° of sound side was also higher in group B (100% vs. 88%, P=0.85). The average lag screw slippage in group A and group B was 3.2 mm and 4.2 mm, the average fracture union duration was 17.1 weeks and 16.4 weeks, and the mean Parker score was 5.6 and 5.8 respectively. Screw cut-out was seen in one patient in group A. No cut-out was seen in any of the patient in group B. No patient developed deep infection, avascular necrosis, deep vein thrombosis or any other significant complications.

CONCLUSIONThe present study demonstrated that treating intertrochanteric fracture with a locking DHS allows sound bone healing and is not associated with any major complications. Although this report is promising, it should be interpreted with caution because only a prospective study with a large sample size would allow definitive conclusion.

Bone Plates ; Bone Screws ; Female ; Fracture Fixation, Internal ; instrumentation ; Fracture Healing ; Hip Fractures ; surgery ; Humans ; Male ; Middle Aged ; Prospective Studies

Breakage of K-wires and stainless steel wires which are used for fracture fixation is not uncommon, but migration is rare. We report a case of migration of broken K-wire used for patella tension band wiring to the popliteal fossa. The broken hardware was removed surgically. We would like to suggest that K-wire and wire fixation used for treatment of patellar fractures can migrate into the posterior compartment of the knee and cause clinical symptoms. Close clinical and radiological follow-up after internal fixation to identify the presence of hardware breakage or movement and removal of wires once fracture has united can avert such complications.
Adult ; Bone Wires ; Equipment Failure ; Foreign-Body Migration ; etiology ; Fracture Fixation, Internal ; instrumentation ; methods ; Fractures, Bone ; diagnostic imaging ; surgery ; Humans ; Male ; Patella ; diagnostic imaging ; injuries ; Radiography ; Time Factors