A Single Surgeon’s Experience of Infection Rates in K-Wires in Hand Surgery: Buried vs. Exposed.

There is anecdotal evidence suggesting buried K-wires are superior to unburied or exposed K-wires due to lower pin track infection rates, although the evidence remains unclear. We present a closed loop audit looking at a single surgeon’s experience of 111 consecutive cases requiring K-wires in hand surgery. Our pin track infection rates differed between a series of 3 consecutive cohorts. Pin track infection rates were 2% in an initial cohort of buried K-wires, 14.3% in a second cohort of exposed K-wires and 0% in a third cohort when practice was changed back to burying the K-wires. Our experience demonstrates there was a measurable difference in post-procedure infection rates between burying and exposing K-wire ends.

Humeral lengthening by Ilizarov technique in patients with post septic shortening

Purpose: Humeral lengthening in patients with post septic shortening is a challenging procedure for Orthopaedic surgeon. The aim of this study was to evaluate the efficacy and safety of humeral lengthening using Ilizarov fixator. We reviewed the literature on humeral lengthening using different fixators with regard to indications, operative technique, results and complications. We also retrospectively reviewed 12 patients treated with humeral lengthening using Ilizarov external fixation. The etiology was epiphyseal injury (7 cases), infection (5 cases). The average age at surgery was 14,5 years (range 12,5-23,5) with post septic humeral shortening. The patients were assessed clinically and radio-graphically. Follow up ranged from 1-10-years.The magnitude of lengthening achieved ranged from 5-15cm with an average of 7, 5cm. Functionally all the patients returned to their preoperative jobs and daily activities including sports. Complications included pin track infection in 8 patients, radial nerve palsy which recovered completely in one patient. Conclusion; Humeral lengthening is a valid method that improves the outcome following arm shortening and deformity correction including angulation and rotation. Extensive lengthening up to 100% of the original length could be achieved without increasing the risk of complications.

Bifocal osteosynthesis to treat radial shortening deformity with dislocation of the inferior radioulnar joint

Background Several methods have been reported to correct deformity and shortening of the distal radius. However, the results are not entirely satisfactory. The results of bifocal osteosynthesis were retrospectively analyzed in this study. Methods Eight patients treated with bifocal osteosynthesis were evaluated retrospectively. Pre-operative and post-operative clinical and radiographic examinations were performed. Subjective symptoms and objective joint function were assessed. Radiographic data of the extent of radial lengthening and distal radial articular angle were collected. Results The mean follow-up period was 46 months (37–68 months). Satisfactory wrist appearance and radial lengthening was achieved in all patients. All patients were satisfied with the wrist appearance and willing to undergo the same treatment again. The range of motion (ROM) of the forearm and wrist was significantly improved. Pin-track infections occurred in two patients, for which they received wound care and oral antibiotics. Complications such as fixation device failure, tendon rupture, fracture of regenerated bone or nerve impairment did not occur. The duration of lengthening depended on the shortening of the radius. Delayed union in the docking site was observed in two patients and union was achieved after bone grafting. Conclusions Bifocal osteosynthesis using the Ilizarov method provides a useful method for correction of radial shortening deformity with dislocation of the inferior radioulnar joint. Despite the fact that we did not validate pre-and post-operation functional outcome scores, all patients were satisfied with the wrist appearance and function.

PENGARUH SUHU QUENCH DAN TEMPER PADA PROSES PENGERASAN PERMUKAAN BAJA AISI 1045

Perlakuan panas (heat treatment) didefinisikan sebagai kombinasi operasi pemanasan dan pendinginan yang terkontrol dalam keadaan padat untuk mendapatkan sifat- sifat tertentu pada baja. Salah satu metode perlakuan panas yaitu proses quenching dan tempering dengan mesin pemanas induksi. Penelitian kali ini bertujuan untuk mengetahui kekerasan, struktur mikro dari pin track link bulldozer dan untuk mengetahui pengaruh temperatur tempering pasca quenching dengan media air pada baja AISI 1045 terhadap struktur mikro dan kekerasan menggunakan mesin pemanas induksi dengan variasi temperatur quenching dan tempering. Hasil pengujian kekerasan spesimen pin track link bulldozer dari tepi ke tengah spesimen mengalami penurunan. Nilai rerata pada tepi spesimen jarak 1 mm adalah 50,5 HRC, pada jarak 14 mm dari tepi spesimen memiliki nilai kekerasan 28 HRC, struktur mikro memperlihatkan martensit pada tepi ferrite dan pearlite pada tengah spesimen. Sedangkan pada baja AISI 1045 kekerasan maksimum setelah mengalami proses quenching adalah 61,5 HRC dan setelah proses tempering mengalami penurunan yaitu sebesar 49 HRC, struktur mikro memperlihatkan martensit ditepi spesimen uji dan ferrite-pearlite pada tengah spesimen uji.Kata kunci: perlakuan panas, pemanas induksi, uji kekerasan, struktur mikro

TIBIAL PLATEAU FRACTURES

Background: Tibial fractures is most common type of long bone fractures. Highspeed lifestyles with vehicles motorcycles as well as growing waves of violence, contributingincrease occurrence of tibial fractures. Tibial plateau fractures continues to be a challenge fororthopedic surgeon. Treatment of these fractures have been plagued by complications. Recentimprovements in the techniques and development of hybrid external fixator have revolutionizedthe treatment of such fractures. Objective: To evaluate the clinical outcomes of hybrid externalfixator in high energy Schatzkar V and VI tibial plateau fractures. Study Design: Descriptive,Case series. Period: 27 June 2013 to 26 June 2016. Setting: Nishtar Hospital, Multan. Materialand methods: A total of 125 patients with open and close tibial plateau fractures, 20 to 50 yearsof age of both genders were included in the study. Patients having history of pervious surgeryor intervention tibial plateau fractures, and h/o malignancy were excluded. All the patients wereoperated by a consultant orthopedic surgeon. Outcome was assessed at 16 weeks by serialradiological x-ray by formation of callus and noting any grade of pin track infection. Results; Ourstudy comprised of 125 patients having Schatzker V and Schatzker VI tibial plateau fractureswho met our inclusion criteria. Mean age of 38.925 ± 7.09 years. Majority of the patients 47(37.60%) were between 41 to 50 years of age. Mean duration since injury in our study was 13.18± 4.79 hours. Out of 125 patients, 102 (81.60%) were males and 23(18.40%) were females withmale to female ratio of 1.2:5.4. Fifty three (42.4%) patients presented with Schatzker V and 72(57.6%) had Schatzker VI type of tibial plateau fractures. In our study, non-union was seen in10cases (8.0%) and pin track infection was noted to be present in 19 (15.20%) patients. So, theacceptable outcome (achievement of union without non-union or pin track infection during 16weeks) was seen in 96(76.8%) patients. Conclusion: This study concluded that there is highrate of acceptable outcome (achievement of union without any non-union or pin track infectionduring 16 weeks) after hybrid external fixator of the open and closed fractures of tibial plateauamong the patients having schatzker-V and VI.

The Role of Taylor Spatial Frame in the Treatment of Blount Disease

Background: Alteration of the posteromedial part of the proximal tibia is the main characteristic of Blount’s disease and if left untreated, leg alignment and normal development of the lower limbs may be compromised. Aim: To report treatment outcomes in children with Blount’s disease using the Taylor Spatial Frame (TSF). Materials and methods: From January 2007 to December 2014, 16 young children (24 tibia) with a mean age of 7.5 years (range of 3-14 yrs) and severe Blount’s disease were treated using TSF. Preoperative long standing radiographs were performed and anatomic medial proximal tibial angle (MPTA), diaphyseal-metaphyseal tibial angle (Drennan), femoro-tibial angle and leg length discrepancy (LLD) were measured. Results: Post-operative improvement of all measurements was observed. MPTA increased from a mean of 71.8° (58° - 79°) to 92.5° (90° - 95°), the Drennan decreased from 16.6° (14° - 18°) to 3.6° (0° - 6°), the F-T angle changed from 15.4° (10° - 25°) of varus to 5.9° (2° - 10°) of valgus and the LLD decreased from 208 mm (150-320) to 69 mm (0- +120). Mean follow-up was 45.6 months. According to Paley’s criteria pin track infection was present in 6 tibiae, while in 5 patients software changes were necessary. Recurrence was observed in 3 patients (triplets). Complete restoration of the mechanical axis was obtained at the end of the treatment. Conclusions: In the last decades, different surgical treatments have been proposed for Blount’s disease (tension band plate, staples, osteotomies using external or internal fixation). External fixation using the TSF allows gradual safe correction of multiplanar deformities and is a well-tolerated technique by patients with Blount’s disease.

PERBEDAAN PANJANG TUNGKAI (LEG LENGTH DISCREPANCY) DALAM ORTHOPAEDI

Masalah leg length discrepancy dalam orthopaedi bukan hanya permasalahan kosmetik, tetapi juga permasalahan fungsional. Ada empat jenis terapi yang memungkinkan untuk menyeimbangkan panjang tungkai : (1) sepatu tambahan atau konversi dengan prostetik (2) epiphysiodesis pada sisi tungkai yang panjang (3) pemendekan pada sisi tungkai yang panjang (4) pemanjangan pada sisi tungkai yang pendek. Kombinasi antara pemanjangan pada ipsilateral dan epiphysiodesis pada kontralateral dapat digunakan pada ketidaksamaan yang bermakna untuk mengurangi jumlah pemanjangan yang dibutuhkan. (Champbell,2007) Semua tipe alat dan teknik pemanjangan tungkai memiliki komplikasi. (1) Pin Track Infection (2) berhubungan dengan otot, terjadi Flexion contracture (3) Subluksasi/ dislokasi sendi (4) infeksi, pseudoarthrosis, plate patah dan malunion. (Stanitski ,1999) Keywords : Leg length discrepancy, terapi, komplikasi.