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Chinese Journal of Traumatology 2011年第3期14卷 188-192页

作者： Sameer Aggerwal nitesh gahlot Uttam C. Saini Kamal Bail Department of Orthopaedics Post Graduate Institute of Medical Education & Research Chandigarh 160012 India

Breakage of locking bolts is an important cause of interlocking nail failure in femoral fractures. It usually occurs in the form of single breakage in one of the distal bolts of the nail or nail breakage around the distal locking hole. Here we report an unusual ease ofintramedullary femoral nail failure with segmental breakage of both the distal locking bolts. Such a scenario usually complicates further management. We successfully managed this casewith exchange nailing without bone grafting. Here we briefly reviewed the literature regarding such an unusual presentation and discussed in detail the possible etiology of such a presentation and the management options when facing such a complex situation.

关键词： Femoral fractures Bone screws Fracture ftxation, intramedullary Fracture healing

Cephalomedullary fixation for femoral neck/intertrochanteric and ipsilateral shaft fractures： surgical tips and pitfalls

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Chinese Journal of Traumatology 2013年第1期16卷 40-45页

作者： Kamal Bali nitesh gahlot Sameer Aggarwal Vijay Goni Department of Orthopaedic Surgery Post GraduateInstitute of Medical Education and Research ChandigarhIndia Department of Orthopaedics University of CalgaryAlberta Canada

Objective： Surgical management options for femoral shaft fracture and ipsilateral proximal fe- mur fracture vary from single-implant to double-implant fixation. Cephalomedullary fixation in such fractures has rela- tive advantages over other techniques especially because of less soft tissue dissection and immediate postoperative weight beating with accelerated rehabilitation. However, the surgery is technically demanding and there is a paucity of literature describing the surgical techniques for this fixation. The aim of the study was to describe the surgical technique of cephalomedullary fixation for femoral shaft fracture and ipsilateral proximal femur fracture. Methods： Sixteen cases （10 males and 6 females with a mean age of 41.8 years） of ipsilateral proximal femur and shaft fractures were treated by single-stage cephalomedullary fixation at tertiary level trauma center in northern India. The fractures were classified according to AO classification. An intraoperative record of duration of surgery as well as technical challenges unique to each fracture pattern was kept for all the patients. Results： The most common proximal femoral pattern was AO B2.1 observed in 9 of our patients. The AO B2.3 fractures were seen in 4 patients while the AO A1.2 fractures in 3 patients. Four of the AO B2.1 and 2 of the AO B2.3 frac- tures required open reduction with Watson-Jones approach. The mean operative time was around 78 minutes, which tended to decrease as the surgical experience increased. There was only one case of malreduction, which required revision surgery. Conclusion： Combination of ipsilateral femoral shaft fracture and neck/intertrochanteric fracture is a difficult frac- ture pattern for trauma surgeons. Cephalomedullary nail is an excellent implant for such fractures but it requires careful insertion to avoid complications. Surgery is technically demanding with a definite learning curve. Nevertheless, a majority of these fractures can be surgically managed by

关键词： Femoral fractures Fracture fixation, internal Nails

Does a staged treatment of high energy tibial plateau fractures affect functional results and bony union?A case series

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Chinese Journal of Traumatology 2020年第4期23卷 238-242页

作者： Nilesh Barwar Abhay Elhence Sumit Banerjee nitesh gahlot Department of Trauma&Emergency Orthopedics All India Institute of Medical SciencesJodhpur 342005India Department of Orthopedics All India Institute of Medical SciencesJodhpur 342005India

Purpose:Tibial plateau fracture(TPF)is a devastating injury as it shatters lower articular surface of the largest *** from bony injury,TPF can lead to great soft tissue envelope compromise which affects the treatment plan and *** the present study,clinical results were assessed in cases of high energy TPFs treated in staged ***:Twenty-three(20 males and 3 females)patients of high energy communited TPFs(Schatzker typeⅤandⅥ)were consecutively treated.1 All the patient had compromise of overlying skin *** were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were *** typeⅠ,Ⅱ,ⅢandⅣwere excluded from the *** survey was done and patient who had head injury,chest and abdominal injury,pelvic injury and contralateral limb injury and open fractures were excluded from the *** patients were also evaluated in terms of wound complications,axial and rotary alignment of limb,fixation failure,articular congruity and range of motion of the knees and post injury *** analysis was done using SPSS ***:Maximum follow-up period was 13 *** the fractures were united at final *** evaluation was done with the Tegner Lysholm knee scoring scale.2 Excellent results were found in 78%cases and good and fair results in 22%*** was significant correlation between range of motion and the Tegner Lysholm knee score(p<0.001,Pearson correlation coefficient=0.741).The correlation between the score and the radiographical union duration was significant(p=0.006,Pearson correlation coefficient=-0.554).Conclusion:A staged treatment plan allows healing of soft tissue envelope,with avoidance of dreadful complications such as compartment syndrome and chronic *** addition,a staged treatment strategy do

关键词： High energy fracture Tibial plateau fractures Staged treatment

Neglected lateral process of talus fracture presenting as a loose body in tarsal canal

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Chinese Journal of Traumatology 2011年第6期14卷 379-382页

作者： Kamal Bail Sharad Prabhakar nitesh gahlot Mandeep S Dhillon Department of Orthopedic Surgery PGIMER Chandigarh 160012 India

Lateral process fractures of talus are rare injuries with a potential to cause significant morbidity if misdiagnosed. The appropriate management of these fractures is still controversial and only a few reports are available on this subject. We presented a case of a 37-year-old male with neglected fracture on the lateral process of talus which was misdiagnosed at the time of injury. The patient presented to 7 months after misdiagnosis with a chronic ankle pain. Our case is unique in the sense that it is a rare case of neglected fracture on the lateral process of taluswhich presented as a loose body in sinus tarsi. However, a surgery with an excision of the loose body presented a satisfactory outcome along with 2 years＇ follow-up. To our knowledge, it ought to he the first case reported in the English literature. Through this case report, we highlight the importance of high index of suspicion for such rare bony injuries while evaluating trauma to the lateral side of ankle and discuss the principles of management of these fractures.

关键词： Joint loose bodies Subtalarjoint Talus

Removal of a bent tibial intramedullary nail： a rare case report and review of the literature

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Chinese Journal of Traumatology 2011年第2期14卷 107-110页

作者： Sameer Aggerwal Ashwani Soni Uttam C. Saini nitesh gahlot Department of Orthopaedics Post Graduate Institute of Medical Education & Research Chandigarh 160012 India

Intramedullary interlocking nailing is a gold standard for treatment of tibial shaft fractures. Bending of a nail secondary to trauma is a rare complication, which may be encountered in healed or unhealed tibial shaft fractures. Removal of such bent nail is always a challenge. We reported this case to discuss various techniques for removal of bent nails and to share our experience in removing a bent tibial intramedullary nail in a 30-year-old man, who was admitted in our department with re-fracture of the right tibial shaft due to a roadside accident two years after the initial surgical treatment. The intramedullary nail, bent by 30 degrees and visible on anterioposterior as well as on lateral radiographs, was firstly weakened by partially cutting the convex wall, then straightened by applying external force, and finally removed by using the standard nail removal method.

关键词： Fracture fivmton, intramedullary Tibial fractures Device removal

Use of gentamicin-loaded collagen sponge in internal fixation of open fractures

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Chinese Journal of Traumatology 2011年第4期14卷 209-214页

作者： Chaudhary Susheel Sen Ramesh Saini Uttam Chand Soni Ashwani gahlot nitesh Singh Daljit Department of Orthopedics Post Graduate Institute ofMedical Education and Research Chandigarh 160012India

Objective： To assess the outcome of immediate plate osteosynthesis via application of antibiotic impregnated collagen fleeces （gentamicin-collagen and an- tibiotic sponge） which gradually release antibiotic locally in the surgical treatment of open fractures presented to us 6 hours after injury. Methods： All cases were treated in our tertiary level trauma center and teaching hospital including 35 patients with open fractures who were treated by immediate open reduction and plate fixation from January 2008 to August 2010. Among them, 31 patients were available for adequate follow-up and assessment. All fractures were treated by irri- gation and debridement, immediate open reduction and plate fixation along with placement of antibiotic-releasing collagen fleeces around the plate just before closure of wound. Pa- tients were assessed to determine postoperative infection, delayed union or nonunion and development of other post- operative complications. It was hypothesized that immedi- ate plate osteosynthesis after thorough debridement and local antibiotics would give safe and acceptable clinical results in treatment of open fractures. Results： The 31 patients with adequate final follow-up were assessed at a mean time of 40 weeks （15-160 weeks）.Most fractures united primarily in an acceptable time period according to area of involvement. Local wound complica- tions （superficial infection and skin loss） were found in 3 patients （9.67%）. Deep infection was noted in 2 patients （6.45%）. None of these patients needed implant removal and both fractures united in due time. Delayed union was noted in 5 patients （16.13%）. No patient progressed to non- union or implant failure in long term follow-up. Excessive scarring was developed in 2 patients （6.45%）. Conclusions： Immediate plate osteosynthesis after adequate debridement and placement of collagen film eluting antibiotics locally produces excellent results regarding bone union and absence of deep infections and is a safe te

关键词： Fractures, open Debridement Fracture fixation, internal Collagen