Johnsen Villumsen (branchden9)

Depressed articular fractures of tibial plateau are treated by elevation of the fracture fragments to maintain the articular congruity and filling the void with any bone substitutes, followed by screw or plate fixation. This elevation of the fragments to maintain articular congruity poses a surgical challenge even in experienced hands. Many techniques have been described for the same, as the use of the metallic-bone-tamps, elevators and more recently inflatable-balloon-tamps. But due to the lesser cross-section area, these often led to comminution of the fragile articular bone fragments. The inflatable-balloon-tamp caused extrusion of contrast-dye or unintentional posterior-wall displacement. We treated a series of 25 patients with tibial plateau depressed fractures by a novel technique using posterior-vertebral-body-wall-impactor. This helped in a uniform dissipation of force over a large cross-sectional area under the fracture fragment, leading to minimal comminution of the depressed fragment, maintaining the articular congruency. Rest of the fixation was done in the standard manner. There were no intra-operative or post-operative complications. All patients had good knee function according to Rasmussen Knee Function Grading System and achieved radiological union of fracture at follow-up (with a range of 12-18 months). Selleckchem RepSox Hence, this technique may be a safer and effective alternative for the elevation of depressed articular fractures of tibia.Trochanteric lateral wall fracture (LWF) indicates instability and is found to be an important predictor of reoperations following trochanteric fracture fixation. A single unified technique for lateral wall reconstruction may not adequately stabilize all the fracture patterns. We have presented morphology specific lateral wall reconstruction techniques using cerclage wire around proximal femoral nails. Various LWF patterns have been simplified into three types. Type-specific lateral wall reconstruction techniques using cerclage wire were adopted in 49 consecutive unstable trochanteric fractures presented to our institute between 2016 and 2018. We analyzed the fracture pattern, fixation method used, union time, and complications. The functional outcome was analyzed using the Harris hip score (HSS). The mean follow-up period was 13 months (range 10-36 months). The mean age of the population was 66 years (range 36-91 years). There were 15 patients with type 1 LWF pattern, 26 patients with type 2, and 8 were of type 3 pattern. The mean operating time was 66 min. The mean union time was 14 weeks (10-24 weeks). HSS was excellent in 9 patients, good in 33 patients, fair in 4 patients, and poor in 5 patients. Complications include one patient with avascular necrosis (AVN) of the femoral head, varus collapse with non-union in one patient, screws back out in one patient, superficial infection in 4 patients, and distal screw breakage in one patient. Type 2 is the most common LWF type in our study. In unstable trochanteric fractures, morphology specific lateral wall reconstruction using cerclage wire loops around the proximal femoral nail is a simple technique with promising results with minimal complications. The transosseous suture fixation is a recognised surgical technique for inferior pole patella fractures. However, post-operative range of motion (ROM) is typically restricted to reduce complications of fracture displacement. We present a novel modified surgical technique using a supplemental Ethibond figure-of-eight stitch to reinforce the transosseous suture repair and studied its outcomes. We performed a retrospective study looking at outcomes of patients with displaced inferior pole patella fractures who underwent modified suture fixation from 2010 to 2018. In the modified suture fixation technique, after the standard transosseous repair was performed, the remnant Ethibond suture was placed in a figure-of-eight tension band fashion anteriorly across th