The Functional outcome of distal end femur fractures treated by minimally invasive plate osteo-synthesis using locking compression plate: a prospective study in 50 adults

Jati S
Bansal H
Bohra T
Kumar M
junior resident

Background: Distal femoral locking compression plate can be done via minimal invasive methods, overcoming the drawbacks of excessive stripping as caused by open methods. Fixed locking construct of the plate also provides stable fixation needed for early mobilization in fractures of distal femur. Hence, we evaluated the results of distal femoral locking compression plate done via minimally invasive technique in fractures of distal end femur.

Material and methods: 50 cases of fracture distal end femur were treated by internal fixation with distal femoral locking compression plate via minimal invasive techniques and were evaluated radiologically for union and functionally, using NEER’S Score.

Results: 50 distal end femoral fractures (29 males and 21 females) with mean age of 51 years (range 20 to 83 years) were included in study. Mean duration for surgery was 67 minutes (range 60 to 89 minutes), mean blood loss was 119 ml (range 100 to 140 ml) and mean union time was 14.3 weeks (range 11 to 20 weeks). 38 (76 %) patients had excellent results and 8 (16%) had satisfactory results as per NEER’s scoring system with mean NEER’s score of 90.133 (range 74 to 96). Complications seen were knee stiffness as seen in 4 (8%) cases, 4(8%) had superficial infection, 1 (2%) had implant failure, 2 (4%) had malalignment and 1(2%) had nonunion.

Conclusion: Pre-contoured distal femoral locking compression plate by virtue of its features, to provide stable fixation and done via minimal invasive technique, provides excellent function, high rate of bone union and fewer complications, even in severely comminuted fractures and osteoporotic bones of distal end femur.


Shubham Jain
3rd year Resident, M.S Orthopaedics
Saket Jati
Professor and Unit head at SAIMS medical college, Indore
Himanshu Bansal

Introduction: Osteoarthritis is a chronic, non-inflammatory, degenerative condition of synovial joint associated with pain, deformity, disability in movement, and reduction in the quality of life. This Study is aimed to assess the utilization and efficacy of Platelet- rich plasma (PRP) in the management of osteoarthritis knee.

Material and methods: This present, prospective, observational study was conducted on patients with symptomatic osteoarthritis knee. The Patients were chosen from OPD with the help of knee radiograph according to Kellgren and Lawrence classification of osteoarthritis knee. They underwent infiltration of 5ml of platelet rich plasma into the knee joint and were evaluated post procedure using WOMAC score for 6 month.

Result: The mean age in our study group was 52.02 ± 6.18 (S.D.) years There were 32 (64.0%) patients were in the K-L Grade III group and 18 (36%) patients were in the K-L Grade II group. For K-L grade II, the mean womac score at pretreatment was 57.11 ± 6.36and at 6 months it was 22.11 ± 2.99. (p=0.001).

For K-L grade III, the mean score at pretreatment was 59.21+_5.63 which decreased to 32.12+_2.66 at 6 months follow up.


Conclusion: Use of single PRP injection in the treatment of osteoarthritis knee has an advantage of high safety. In our study, PRP injection was found to be more effective in patients with early stages of osteoarthritis i.e. K-L grade II. The clinical utility of PRP injection in subjective pain relief after 1 month of injection was proved which increased later upon 6 months.


Dr.Saket Jati
[Professor , Department of Orthopaedics, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India]
Junior Resident [ Department of Orthopaedics, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India]
Dr. Morin Joy Daya
Junior Resident [Department of Orthopaedics, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India]
Dr. Himanshu Bansal

 Tibial plateau fractures are common intra-articular fractures, representing 1.2% of all fractures. These fractures are common in two age groups: as higher-energy fractures in younger patients and lower-energy fractures in elderly patientsModern locking plate systems, provides increased angular stability, has low implant profile, improved design matching the peri-articular bone surface, as well as is compatible with the minimal invasive techniques. We performed this study to evaluate the functional outcome of tibial plateau fractures using locking compression plate using minimally invasive technique.

A comparative analysis to determine the functional outcome of standard long incision total knee replacement when compared to minimally invasive total knee replacement surgery.

Kedar Parelkar
DR.D.Y.Patil hospital and medical college
DR.D.Y.Patil hospital and medical college



Minimally invasive surgery has gained popularity over the past several years .Early results have shown no clear advantage of shorter incision over longer incision in the functional outcome and early recovery in total knee replacement surgeries.


The study is to analyze the functional outcome of standard long incision total knee replacement when compared to short incision total knee replacement surgery.


All cases operated for total knee replacement with both minimally invasive and conventional TKR were studied .This group included 20 patients operated by short incision total knee replacement (minimally invasive surgery) compared to 20 patients operated by long incision total knee replacement (standard technique )


Patients in the group operated with conventional total knee surgery showed a better functional outcome due to reduced operative time, reduced tissue trauma due to retractors and precise implant placement due to a good visualization of the surgical field .It was also noted that in a traditional total knee replacement surgery there is a shorter learning curve ,easier availability of implants and instrument sets.


After analysis, we would like to suggest in our limited 40 patient study group traditional total knee replacement surgery provided a better functional outcome as compared to a minimally invasive total knee replacement surgery.


KEYWORDS: - Traditional total knee replacement, minimally invasive total knee replacement, standard approach in total knee replacement.


Patel Evaluate the Management of Sub-trochanteric Femur Fractures with Long Proximal Femoral Nail

divyanshu Patel divya

Introduction: Sub-trochanteric fractures of the femur remains one of the most challenging fractures faced by orthopaedic surgeons. This study was done to analyse the management and complications of sub- trochanteric fractures using long proximal femoral nail (PFN).

Materials and Methods:This was a Prospective study from September 2018 to March 2020. Three years of retrospective study from January 2015 to September 2018 of 32 patients with sub-trochanteric fractures of femur who were treated with long PFN at a tertiary care center.The fractures were classified according to Seinsheimer classification. All patients were assessed functionally by Harris Hip Score.

Results: Average of union was 14 weeks. As per Harris Hip score, excellent results were noted in 21.8% cases, good in 53.12 % cases and fair in 21.87 % cases.

Conclusion:It is concluded from our study that proximal femoral nailing is a suitable implant for Subtrochanteric Femoral Fractures and its use in unstable intertrochantricfractures is very encouraging

Evaluation of percutaneous fixation of intra articular fractures of calcaneum using Essex Lopresti maneuover

Kothari Nilesh

Background: Calcaneal fractures are the most common fracture of the tarsal bones and represent 1%-2% of all fractures. Intra-articular fractures account for 75% of fractures of the calcaneus. Anatomic restoration of the three dimensional anatomy of the calceneum, along with articular congruity is the goal of management of calcaneal fractures
Materials and Methods 23 patients with 30 tongue-type fractures of calcaneum were operated by Essex-Lopresti’s method of Percutaneous pin fixation and closed reduction. Follow-ups were taken at 2, 6, 12,and 24 weeks. Functional and radiological outcomes were assessed.
Results: Mean Bohler angle correction achieved was 16.27 degrees which resulted in good to excellent MFS scores indicating good functional outcomes. The outcome was excellent in 20%, Good in 66.7%, Fair in 13.3% and Poor in none as per MFS score.
Conclusion:The morphology of the calcaneum improved and was properly maintained in terms of Bohler’s angle. Final functional outcome correlated well with the post operative Bohler angle achieved and thus can be used as a prognostic indicator.
Keywords:Bohler’s Angle, Maryland Foot Score, Percutaneous Fixation

Congenital Pseudoarthrosis of Tibia Treated with 4 in 1 Osteosynthesis

Dr. Mitul Jain
Myh hospital Indore

Congenital pseudiarthrosis of tibia (CPT) is a rare pediatric disorder characterised by presence of fibrous hamartomatous tissue in periosteum. The low osteogenicity and high osteoclasticity of hamartomas results in very little to no remodeling potential of the bone. Children with this condition, at birth present with anterolateral bowing of tibia that progress to pseudoarthrosis often within first 5 years of life. Here we present a similar case of a 5 year old child that presented to us with a visible deformity of distal leg that was diagnosed as CPT. The child first underwent hamartoma excision with bone transport using ilizarov external fixator and intramedullary nailing but patient did not show any signs of healing. Child was finally reoperated with 4 in 1 osteosynthesis technique along with bone grafting.