BIPUL BORTHAKUR

Background- Clavicle fractures were traditionally treated nonoperatively, but due to higher rates of delayed union, non-union, symptomatic, malunion cosmetic deformity and other complications there is an increasing trend for operative management. The aim of the study was to evaluate the clinical outcome of displaced midclavicular fractures (DMCFs) in adults treated with 1/3rd tubular plate Materials and methods Prospective study was conducted between 2012 and 2016 in which 32 patients (23 males and 9 females) with mean age of 34.56 years with DMCFs underwent surgical fixation with 1/3rd tubular plate. Evaluation done by constant-murley shoulder outcome and dash scores at 6, 12 weeks, 3, 6, and 12 months to determine outcomes. Results All the patients achieved clinical and radiological union at 9.66±1.75weeks. The final Constant and DASH scores were 91.09±4.18 and 6.09±1.17 There were no major complications, only minor complications of superficial infection (n=2, 6.25%) , deep infection (n=1, 3.13 %) ,hypertrophied scarring without pain(n=2, 6.2 % ), limited shoulder motion(n=2, 6.25%), screw loosening causing neither pain nor functional disablility(n=1, 3.13% ), breakage of plate (n=1, 3.13%) Conclusion Clavicle fractures are usually treated conservatively but there are specific indications for which operative treatment is needed. In this study 1/3rd tubular plates were used as it can be contoured to the shape of the clavicle and fixation of DMCFs with 1/3rd tubular plate provides good functional outcome, high union rate, return to work, and results with minimal complications.

Introduction- Sub axial cervical spine accounts for about 65% of all cervical spine injuries. Adequate treatment can only be embarked upon after complete understanding of spinal biomechanics and the ability to determine the injury to various anatomical components of the spinal column. The current study discusses the treatment strategies and assesses the outcome of treatment in such injuries. Material & Methods- 36 patients (22 males, 14 females; age range: 18-60 years) with unstable cervical spine injuries (C4 to C7) with neurological deficit graded according to ASIA impairment scale were treated at Assam Medical College & Hospital between June 2010 to September 2014. Patients with bilateral facet dislocation were treated with either posterior or anterior approach after failed preoperative traction. Unilateral facet dislocation was treated with lateral mass fixation or anterior plating. Patients with compressive flexion injury were treated with corpectomy, bone grafting/ cage and anterior plating. Vertical compression fractures were treated with corpectomy, bone grafting and anterior plating. Results & Discussion- The fusion time were 4 to 6 months and there was no residual instability of spine or loosening of the internal fixation at 12 months. Conclusion- Operative treatment of sub axial cervical spine injury decreases the complications related to prolonged immobilization and improves neurological outcomes. Both posterior and anterior surgical approaches are viable alternatives for treating these injuries with different indications and risk profiles. Identifying and understanding the injury, proper selection and planning of cases, preoperative optimisation and thorough knowledge of anatomy is essential to obtain benefits of operative treatment.