Publications by authors named "Harpal Singh Selhi"

9 Publications

  • Page 1 of 1

Soft tissue complications in distal tibial fractures managed with medial locking plates: A myth or reality?

J Clin Orthop Trauma 2017 Nov 3;8(Suppl 2):S90-S95. Epub 2017 Jul 3.

Department of Orthopaedics, Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana 141001, India.

Background: Distal tibial fractures are common injuries that are prone to complications and require careful management. The use of medial periarticular locking plates is an established modality in the treatment if these fractures. These plates are inserted using the minimally invasive plate osteosynthesis (MIPO) or open technique. Our study looks at the soft tissue complications associated with the use of medial locking plates in the management of these fractures.

Methods: This was a retrospective study carried out at a tertiary care university hospital in an urban setting. Forty four patients with distal tibia fractures treated with periarticular locking plates during a three year period were included in the study. Both closed and open fractures were included while those with an established non-union were excluded. Patient data related to inpatient stay, outpatient visits as well as readmissions was extracted from hospital records and analysed. Spanning external fixation was done if necessary and definitive fixation was done using medial locking plates with either MIPO technique or open reduction and internal fixation (ORIF) with biological technique. The sub cohort of patients with soft tissue complications was compared to the parent group.

Results: The study group included 44 patients (28M:16F) with 45 fractures with a median age of 42.6 years (range 18-65 years) followed up for a mean of 9.2 months (range 5-20 months). Domestic falls were the cause of injury in 61.4% (n = 27) of the fractures. The average time to union was 26.2 weeks (range 12-66 weeks). Out of these 45 fractures, soft tissue complications were seen in 22.2% of cases (n = 10) with road side accidents seen in 60% (n = 6) of cases. In four patients, there was difficulty in achieving primary wound closure and in five other cases wound dehiscence with exposure of implant was seen within 12 to 30 days of surgery. One patient required secondary suturing after readjustment for malreduction. No statistically significant difference was found in the parent cohort and the sub cohort with soft tissue complications with respect to the use of spanning external fixator, MIPO/ORIF technique or fibular fixation.

Conclusion: The incidence of soft tissue complications with the use of medial locking plates in distal tibial fractures may be more than what is currently reported in literature and further studies are required to shed more light on this subject.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcot.2017.07.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5681229PMC
November 2017

Early Results of a Geriatric Hip Fracture Program in India for Femoral Neck Fracture.

Geriatr Orthop Surg Rehabil 2015 Mar;6(1):42-6

Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Geriatric hip fractures are a challenging clinical problem throughout the world. Hip fracture services have been shown to shorten time to surgery, decrease the cost of admissions, and improve the outcomes. We instituted a geriatric hip fracture program for comanagement of these injuries by orthopedic and internal medicine teams at our hospital in India. From January 2010 till December 2011, 119 patients with a femoral neck fracture were treated with cemented modular hemiarthroplasty under this program using a cost-effective Indian implant. The cohort included 63 males and 56 females with a mean age of 70.7 years (range 55-98 years). Hypertension (n = 42) and diabetes mellitus (n = 29) were the most common comorbidities. The follow-up period ranged from 12 to 37 months with an average of 24 months. The surgery was performed within 24 hours of admission in 60.5% (n = 72) patients. The use of antiplatelet drugs was the most common reason for delay of surgery. The mean length of hospital stay was 10.4 days (range 3-24 days) with 77% (n = 92) of patients discharged within 1 week of admission. On follow-up, good to excellent Harris hip scores were seen in 88% of patients with 76% of patients returning to the preinjury ambulatory status. The mortality rate was 6% at 6 months follow-up and 10.9% at 2 years. Our study shows that a hip fracture program can be instituted in India. The program helped us in achieving the goal of early surgery, mobilization, and discharge from hospital with decreased mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2151458514567314DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318811PMC
March 2015

Ulnar styloid fracture in distal radius fractures managed with volar locking plates: to fix or not?

J Hand Microsurg 2014 Dec 7;6(2):53-8. Epub 2014 May 7.

Department of Orthopaedics, Dayanand Medical College and Hospital, Ludhiana, Punjab India.

Distal radius fracture is usually associated with ulnar styloid fracture. Whether to fix the ulnar styloid or not remains a surgical dilemma as some surgeons believe that their repair is imperative while others feel that they should be managed conservatively. This prospective study involved 47 patients with unilateral fracture of the distal radius who met the inclusion criterion and underwent open reduction and internal fixation with volar locking plates; 28 patients (12 males and females = 16) had an associated ulnar styloid fracture (Group A) while 19 (7 males; 12 females) did not have any ulnar styloid fracture (Group B). At the time of final evaluation both the groups were compared clinically by measuring the grip strength and range of motion around the wrist and the radiologically by measuring radial angle, radial length, volar angle and ulnar variance. Subjective assessment was done using DASH score and final assessment using Demerit point system of Saito. In Group A, average time for consolidation was 9.4 weeks, 17 patients developed non-union of the ulnar styloid, average DASH scores was 4.4 and according to Demerit point system of Saito, there were 78.5 % excellent, 17.9 % good and 3.6 % fair results; there were 2 cases of loss of reduction out of which one had persistent ulnar sided wrist pain. In Group B the average time for consolidation was 10.2 weeks, average DASH score was 3.8.and Demerit point system of Saito yielded 78.9 % excellent, 15.8 % good and 5.3 % fair results. There was one case of loss of reduction and one case of carpal tunnel syndrome which was managed conservatively. Both groups attained excellent range of motion, grip strength and well maintained the post operative radiological parameters. The comparison of clinico-radiological parameters in both groups was found to be statistically insignificant. To conclude, ulnar styloid fracture or its non union does not affect the outcome of an adequately fixed distal end radius fracture. We urge caution in electing operative treatment of non-united fracture of the ulnar styloid until better scientific report for treatment of pain associated with these fracture is available.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12593-014-0133-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235821PMC
December 2014

Osteosynthesis with long volar locking plates for metaphyseal-diaphyseal fractures of the distal radius.

Chin J Traumatol 2013 ;16(6):339-43

Department of Orthopaedics and Rehabilitation, Pt BD Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India.

Objective: Metaphyseal-diaphyseal fractures of the distal radius are a major treatment dilemma and orthopaedic surgeons have to pay due consideration to restoration of anatomy of distal radius together with rotation of the radial shaft and maintenance of radial bow and interosseous space. We performed this study to evaluate the clinic-radiological outcome of metaphyseal-diaphyseal fractures of the distal radius treated with long volar locking plates.

Methods: This prospective study involved 27 patients (22 males and 5 females) with metaphyseal-diaphyseal fracture of the distal radius. Their mean age was (30.12+/-11.48) years (range 19-52 years) and the follow-up was 26.8 months (range 22-34 months). All patients underwent open reduction and internal fixation with a long volar locking plate. According to AO/OTA classification, there were 7 type A3, 13 type C2 and 7 type C3 fractures. Subjective assessment was done based on the disabilities of the arm, shoulder and hand (DASH) questionnaire. Functional evaluation was done by measuring grip strength and range of motion around the wrist and the radiological determinants included radial angle, radial length, volar angle and ulnar variance. The final assessment was done according to Gartland and Werley scoring system.

Results: Postoperative radiological parameters were well maintained throughout the trial, and there was significant improvement in the functional parameters from 6 weeks to final follow-up. The average DASH scores improved from 37.5 at 6 weeks to 4.2 at final follow-up. Final assessment using Gartland and Werley scoring system revealed 66.67% (n equal to 18) excellent and 33.33% (n equal to 9) good results. There was one case of superficial infection which responded to antibiotics and another carpel tunnel syndrome which was managed conservatively.

Conclusion: Volar locking plate fixation for metaphyseal-diaphyseal fractures of distal radius is associated with excellent to good functional outcome, early rehabilitation and minimal complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2016

Lymphangioma presenting as juxta-articular swelling in children: a case series.

APSP J Case Rep 2013 14;4(2):30. Epub 2013 Jul 14.

Dayanand Medical College and Hospital, Ludhiana, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3754415PMC
September 2013

Dorsally comminuted fractures of the distal end of the radius: osteosynthesis with volar fixed angle locking plates.

ISRN Orthop 2013 8;2013:131757. Epub 2013 May 8.

Department of Orthopaedics, Dayanand Medical College and Hospital, Punjab, Ludhiana 141001, India.

Background. Dorsally comminuted distal radius fractures are unstable fractures and represent a treatment challenge. The objective of this study was to evaluate the functional and radiological outcome of dorsally comminuted fractures of the distal radius fixed with a volar locking plate. Patients and Methods. Thirty-three consecutive patients with dorsally comminuted fractures of the distal end of the radius were treated by open reduction and internal fixation with AO 2.4 mm (n = 19)/3.5 mm (n = 14) volar locking distal radius plate (Synthes, Switzerland, marketed by Synthes India Pvt. Ltd.). There were 7 type A3, 8 type C2, and 18 type C3 fractures. The patients were followed up at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Subjective assessment was done as per Disabilities Arm, Shoulder, and Hand (DASH) questionnaire. Functional evaluation was done by measuring grip strength and range of motion around the wrist; the radiological determinants were radial angle, radial length, volar angle, and ulnar variance. The final assessment was done as per Demerit point system of Saito. Results. There were 23 males and 10 females with an average age of 44.12 ± 18.63 years (18-61 years). Clinicoradiological consolidation of the fracture was observed in all cases at a mean of 9.6 weeks (range 7-12 weeks). The average final extension was 58.15° ± 7.83°, flexion was 54.62° ± 11.23°, supination was 84.23° ± 6.02°, and pronation was 80.92° ± 5.54°. Demerit point system of Saito yielded excellent results in 79% (n = 26), good in 18% (n = 6), and fair in 3% (n = 1) patients. Three patients had loss of reduction but none of the patients had tendon irritation or ruptures, implant failure, or nonunion at the end of an one-year followup. Conclusion. Volar locking plate fixation for dorsally comminuted distal radius fractures results in good to excellent functional outcomes despite a high incidence of loss of reduction and fracture collapse.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2013/131757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4045357PMC
June 2014

Outcome in patients with an infected nonunion of the long bones treated with a reinforced antibiotic bone cement rod.

J Orthop Trauma 2012 Mar;26(3):184-8

Department of Orthopedic Surgery, Dayanand Medical College & Hospital, Ludhiana, Punjab (India).

Objectives: This study looks at the treatment of 16 cases of infection in long bone fractures that had an adverse effect on healing. The goal was to find a method that may be effective in getting these most difficult injuries to heal. The use of reinforced antibiotic-impregnated bone cement rods was studied to see if this could be an effective form of treatment. The use of such devices makes sense because they provide stability that the fractures need for healing while also providing a high concentration of antibiotics locally. The concept was to reduce the amount of metal used for stability while still giving the fracture the correct milieu for healing.

Design: This was a retrospective analysis of 16 patients with infected nonunions of long bones. A protocol for the use of intravenous and per oral antibiotics was developed based on the type of bacteria found from cultures of the infected sites. All cases included operative débridement and stabilization with a reinforced antibiotic-impregnated bone cement rod.

Patients: The patient population was selected from all those who presented to the Department of Orthopaedic Surgery of Dayanand Medical College & Hospital, Ludhiana, India.

Main Outcome: Success was considered when the nonunion healed and the limb became functional.

Results: The infected nonunions were treated successfully in 14 of 16 cases. This represents an alternative to external fixation alone as a means of stabilizing nonunions while providing a high concentration of antibiotic locally for combating this most difficult problem.

Conclusions: The use of reinforced antibiotic-impregnated bone cement rods with appropriate surgical débridement and antibiotics may be an effective way of treating infected nonunions of long bones.

Level Of Evidence: Therapeutic Level IV. See page 128 for a complete description of levels of evidence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BOT.0b013e318225f77cDOI Listing
March 2012

Clinical evaluation of impingement: what to do and what works.

Instr Course Lect 2006 ;55:3-16

Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA.

Theories about the etiologies of anterior and lateral shoulder pain have changed greatly since "impingement disease" was first described. It is thought that such pain may be caused by contact between the rotator cuff and the acromion and coracoacromial ligament, but the exact pathophysiology of rotator cuff disease remains unclear. The shoulder is notoriously difficult to examine because of the variability of the physical findings in patients with rotator cuff disease. New concepts of impingement, such as coracoid impingement and internal impingement, have been advanced. Although no test is definitive for all causes of anterior and lateral shoulder pain, as the pathophysiology of these conditions becomes better understood the ability to evaluate them clinically also improves.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2006

Clinical evaluation of impingement: what to do and what works.

J Bone Joint Surg Am 2006 Feb;88(2):432-41

American Academy of Orthopedic Surgeons.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2106/00004623-200602000-00026DOI Listing
February 2006
-->