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Transarticular screw fixation for atlantoaxial instability (MODIFIED Magerl's technique)
j o u r n a l o f c l i n i c a l o r t h o p a e d i c s a n d t r a u m a 6 ( 2 0 1 5 ) 7 1 e7 3
period was 20 months. One patient was excluded from the study due to drop out from follow up. Results: Most of the patients of the study group were young (2030yrs old) males. 12 cases were of Tibia, 6 of Femur and 1 of Humerus. In majority of patients the cause of Bone Gap was bone loss in Compound Fractures resulting from Road Traffic Accident. Treatment with C.H.A. Blocks along with autogenous bone grafting showed Excellent results in 8 cases, Good results in 6 cases, Fair in 4, and Poor in 1 case. The use of C.H.A. did not cause any foreign body reaction and there was satisfactory healing in all Gap Non-Union Cases. The average rate of union was approx. 22 weeks. The common complication that was seen was increased drain collection in early post-operative period. Significant limb length discrepancy was not seen in any case. Conclusion: C.H.A. blocks along with autogenous bone grafting has an excellent role in filling bone gaps and hence treating GapNon Unions. The use of LCP prevents shortening, deformity and joint stiffness by allowing early mobilization.
AT8. Flexor tendon repair rehabilitation protocols: A randomized prospective trial of Kleinert protocol compared with Duran protocol S.P. Ahluwalia1, S. Pandey2, R. Sarad3, R.S. Boparai2 1 Maulana Azad Medical College, New Delhi, India; 2Government Medical College, Amritsar, India; 3SGRDIMSR, Amritsar, India Background: Human hand is a highly adaptable organ of prehension, sensation, expression and communication. The whole new concept of tendon healing has undergone a revolutionary change but still the perfect suture and ideal mobilization technique eludes this generation of hand surgeons. This study was undertaken to determine which flexor tendon rehabilitation protocol provides the best outcome after surgical repair Methods: 30 patients of either sex with a flexor tendon injury were operated by modified Kessler repair technique using Nonabsorbable monofilament (Prolene) sutures and were randomized to the following protocols: passive flexion and active extension protocols (Kleinert type protocols) and controlled passive motion protocols (Duran type protocols). The functional outcome after tendon repair were assessed by calculating total active range of motion (TAM) as suggested by American Society for the Surgery of Hand (ASSH). Results: The Kleinert protocols exhibited the highest proportion of digits with excellent or good results assessed by total active range of motion (TAM) as suggested by American Society for the Surgery of Hand (ASSH).The mean rate of rupture was lowest in the Duran
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protocols and highest in the Kleinert protocols. No statistically significant differences were found. Conclusion: Surgical repair of flexor tendon requires an exact knowledge of anatomy, careful adherence to some basic surgical principles, sound clinical judgment, strict atraumatic surgical technique and a well planned post operative programme. Both Kleinert and Duran protocols result in low rates of tendon rupture and acceptable range of motion following flexor tendon repair.
AT9. Transarticular screw fixation for atlantoaxial instability (MODIFIED Magerl's technique) J. Singh, R. Bahadur, S.S. Dhatt PGIMER, Chandigarh, India Background: Symptomatic Atlanto-Axial instability needs stabilization. Among various techniques for Atlanto-Axial fixation, Magerl's technique remains gold standard. Traditionally, it comprises of Trans-Articular Screws and Posterior Wiring. The aim of study is to evaluate clinical and radiological outcomes in subjects with Atlanto-Axial Instability, operated using Trans-Articular Screws and iliac crest bone graft, without Sub-Laminar wiring (Modified Magerl's Technique). Materials and methods: We retrospectively evaluated 38 subjects with Atlanto-Axial instability, operated with modified technique. Pain, fusion rates, neurological status and radiographic outcomes were followed up. Final outcome was graded both subjectively and objectively. Results: Instability in 34 subjects was secondary to trauma, 3 due to rheumatoid arthritis and 1 tuberculosis. Neurological deficit was present in 17 subjects. Most common presenting symptom was neck pain in 35 of 38 subjects. Postoperatively, residual neck pain was present in 8 subjects. Neurological deficit persisted in only 7 subjects. Vertebral artery injury was seen in 3 subjects. None had any neurological deficit or vertebral insufficiency. 3 cases had nonunion. At follow up, subjectively, 24 subjects had good result, 6 fair and 8 bad result. On objective grading, 24 had good result, 11 fair and 3 bad result. Mean follow up was 41 months. Conclusions: Trans-Articular screw fixation is an excellent technique for Atlanto-Axial complex fusion. It provides highest fusion rates, and is important in subjects at risk for nonunion. Omitting posterior wiring used with bone graft in traditional Magerl's technique achieves equally good fusion rates and is an important modification, avoiding complications of Sub-Laminar wire passage.
period was 20 months. One patient was excluded from the study due to drop out from follow up. Results: Most of the patients of the study group were young (2030yrs old) males. 12 cases were of Tibia, 6 of Femur and 1 of Humerus. In majority of patients the cause of Bone Gap was bone loss in Compound Fractures resulting from Road Traffic Accident. Treatment with C.H.A. Blocks along with autogenous bone grafting showed Excellent results in 8 cases, Good results in 6 cases, Fair in 4, and Poor in 1 case. The use of C.H.A. did not cause any foreign body reaction and there was satisfactory healing in all Gap Non-Union Cases. The average rate of union was approx. 22 weeks. The common complication that was seen was increased drain collection in early post-operative period. Significant limb length discrepancy was not seen in any case. Conclusion: C.H.A. blocks along with autogenous bone grafting has an excellent role in filling bone gaps and hence treating GapNon Unions. The use of LCP prevents shortening, deformity and joint stiffness by allowing early mobilization.
AT8. Flexor tendon repair rehabilitation protocols: A randomized prospective trial of Kleinert protocol compared with Duran protocol S.P. Ahluwalia1, S. Pandey2, R. Sarad3, R.S. Boparai2 1 Maulana Azad Medical College, New Delhi, India; 2Government Medical College, Amritsar, India; 3SGRDIMSR, Amritsar, India Background: Human hand is a highly adaptable organ of prehension, sensation, expression and communication. The whole new concept of tendon healing has undergone a revolutionary change but still the perfect suture and ideal mobilization technique eludes this generation of hand surgeons. This study was undertaken to determine which flexor tendon rehabilitation protocol provides the best outcome after surgical repair Methods: 30 patients of either sex with a flexor tendon injury were operated by modified Kessler repair technique using Nonabsorbable monofilament (Prolene) sutures and were randomized to the following protocols: passive flexion and active extension protocols (Kleinert type protocols) and controlled passive motion protocols (Duran type protocols). The functional outcome after tendon repair were assessed by calculating total active range of motion (TAM) as suggested by American Society for the Surgery of Hand (ASSH). Results: The Kleinert protocols exhibited the highest proportion of digits with excellent or good results assessed by total active range of motion (TAM) as suggested by American Society for the Surgery of Hand (ASSH).The mean rate of rupture was lowest in the Duran
73
protocols and highest in the Kleinert protocols. No statistically significant differences were found. Conclusion: Surgical repair of flexor tendon requires an exact knowledge of anatomy, careful adherence to some basic surgical principles, sound clinical judgment, strict atraumatic surgical technique and a well planned post operative programme. Both Kleinert and Duran protocols result in low rates of tendon rupture and acceptable range of motion following flexor tendon repair.
AT9. Transarticular screw fixation for atlantoaxial instability (MODIFIED Magerl's technique) J. Singh, R. Bahadur, S.S. Dhatt PGIMER, Chandigarh, India Background: Symptomatic Atlanto-Axial instability needs stabilization. Among various techniques for Atlanto-Axial fixation, Magerl's technique remains gold standard. Traditionally, it comprises of Trans-Articular Screws and Posterior Wiring. The aim of study is to evaluate clinical and radiological outcomes in subjects with Atlanto-Axial Instability, operated using Trans-Articular Screws and iliac crest bone graft, without Sub-Laminar wiring (Modified Magerl's Technique). Materials and methods: We retrospectively evaluated 38 subjects with Atlanto-Axial instability, operated with modified technique. Pain, fusion rates, neurological status and radiographic outcomes were followed up. Final outcome was graded both subjectively and objectively. Results: Instability in 34 subjects was secondary to trauma, 3 due to rheumatoid arthritis and 1 tuberculosis. Neurological deficit was present in 17 subjects. Most common presenting symptom was neck pain in 35 of 38 subjects. Postoperatively, residual neck pain was present in 8 subjects. Neurological deficit persisted in only 7 subjects. Vertebral artery injury was seen in 3 subjects. None had any neurological deficit or vertebral insufficiency. 3 cases had nonunion. At follow up, subjectively, 24 subjects had good result, 6 fair and 8 bad result. On objective grading, 24 had good result, 11 fair and 3 bad result. Mean follow up was 41 months. Conclusions: Trans-Articular screw fixation is an excellent technique for Atlanto-Axial complex fusion. It provides highest fusion rates, and is important in subjects at risk for nonunion. Omitting posterior wiring used with bone graft in traditional Magerl's technique achieves equally good fusion rates and is an important modification, avoiding complications of Sub-Laminar wire passage.