synopsis hasan 1.doc

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SYNOPSIS for FCPS Part II

To evaluate the outcome of Type C fractures of distal Radius

managed with Volar LCP plates.

By

Dr. Sami RaaTR! "CPS ##

$rthopaedic Surgery

Supervisor

Prof. Shafiue %hmad Shafa&"CPS! %$ fellow '(ermany)

*ead! Department of $rthopaedic Surgery

Shai+h ,ayed "ederal Postgraduate -edical #nstitute!Lahore

INTRODUCTION


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Distal radius fractures represent approximately one-sixth of all fractures treated

in emergency departments. The incidence of this injury appears to be both gender and age

specific. There are three main peaks of fracture distribution: the first peak is in children

ages 5 to 14 the second is in males under age 5! and the third peak is in females o"er the

age of 4! years.

Distal radius fractures in the elderly may represent an insufficiency fracture associated

#ith all of the risk factors for osteoporosis.

The majority of osteoporotic fractures occur as the result of a fall #hile the majority of

injuries in the younger patients are secondary to motor "ehicle accidents and sports. $isk

factors for distal radius fractures in the elderly ha"e been studied extensi"ely. Decreased

bone mineral density female gender ethnicity heredity and early menopause ha"e all

been sho#n to be risk factors.

The optimal management of distal radius fractures has changed dramatically o"er the

pre"ious t#o decades from almost uni"ersal use of cast immobili%ation to a "ariety of

highly sophisticated operati"e inter"entions.OBJECTIVES

The study is eing underta+en so as to determine the est evidence

ased practice for the operative management of pro/imal femoral e/tra0articular

'su0trochenteric and pertrochenteric) fractures. The o1ective of the study is to

compare the outcome of two fi/ation methods of e/tra0articular pro/imal femoral

fractures y dynamic hip screw 'D*S) and pro/imal femoral nail 'P"2) in terms

of functional outcome. $utcome of the surgery will e measured at 3! 45! and 46

wee+s post0op in terms of functional outcome.

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"unctional outcome of the surgery which will e measured y -odified *arris

*ip Score47! and will e graded as e/cellent! good! fair or poor. 8/cellent and

good outcomes at 46 wee+s would indicate recovery of wal+ing aility.

RATIONALE

The study is eing conducted so as to determine the est practice for the

treatment of our local population with the availale resources considering there

are currently no reliale studies availale on the su1ect.

MATERIALS AND METHODS

ST9D: D8S#(2

% randomied clinical trial

PL%C8 $" ST9D:

Department of $rthopaedics! Shai+h ,ayed *ospital! Lahore after approval y

hospital ethical committee.

D9R%T#$2 $" ST9D:

#t will e completed in si/ months after the approval of the synopsis.

S%-PL8 S#,8

The sample sie was estimated y using ;< level of significance! 37< power of

test with e/pected outcome for wal+ing aility for P"2 and D*S =6.5.=


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Pt will e prepared for surgery and operation theatre will e ready for oth

procedures. Aust efore the surgery an envelope from two identical envelopes of

D*S and P"2 each will e randomly chosen and proceed with that surgery.

Incluson crt!ra

4) %ge 5; 3; yrs of oth se/es.

5) Type of fracture %ll e/tra0articular pro/imal femoral fractures 'pertrochenteric and

sutrochenteric) will e included in the study

E"cluson crt!ra

4) Patient unwilling to participate in the study

5) Patients with associated fractures of the lower lims! pelvis or the spine

>) Patients with pre0e/isting condition of the hips e.g. rheumatoid arthritis!

advanced osteoarthritis! infective arthritis! gouty arthritis! an+ylosing spondylitis etc

assessed y history and pre0op /0rays..

?) Patients unfit for surgery on the asis of pre operative evaluation

;) %ge less than 5; and more than 3; will e e/cluded

D%T% C$LL8CT#$2 PR$C8D9R8

%ll the patients etween 5; 0 3; years of age with e/tra0articular pro/imal

femoral fractures will e admitted in the orthopaedic department through

emergency department or $PD. Demographic data and history will e ta+en

relevant to the mode of in1ury and time since in1ury. %ll the patients will e

e/amined and diagnosis will e confirmed with radiographic e/amination. S+in

traction will e applied to the affected lim. Baseline investigations will e done

and fitness for anesthesia and surgery will e otained preoperatively. #nformed

written consent will e otained from all patients preoperatively for surgery

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including for research inclusion also. Pt will e prepared for surgery and

operation theatre will e ready for oth procedures. Aust efore the surgery an

envelope from two identical envelopes of D*S and P"2 each will e randomly

chosen and allocated to that particular group. %ll the patients will e operated on

ne/t regular list. %ll the patients will e operated on the fracture tale y the

researcher. Standard anteroposterior and lateral radiographs will e done in the

ward postoperatively. %ll patients will e given intravenous antiiotics

preoperatively and for few days post operatively. Drains will e removed after ?3

hours. Patient will e encouraged to moilie 4 5 days post0operatively. They

will e advised to commence weight earing with support as tolerated after 5

wee+s.

The patients will e seen at two wee+s post0op for wound chec+ and stitch

removal. "urther follow0up visits in outpatients department at 3! 45! and 46

wee+s. Variales of -odified *arris *ip Score will e recorded on every follow

up. Total score will e calculated and graded. "ailure of fi/ation will e reported

as a discredit to the procedure.

D%T% %2%L:S#S

%ll the data will e entered and processed in SPSS 4;.7

*arris *ip score will e presented y using mean E0 S.D for oth groups at 3!45 and 46 wee+s. Comparison for aove variales will e performed y using t0test or mannwhitney 90test depending on normality of date.(ender! functional outcome and complications will e processed y usingfre&uencies and percentages for oth groups.Comparison for these &ualitative variales will e performed y using Chi5 testand 0test for proportion.P0 Value F 7.7; will e considered statistically significant.

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PROFORMA

Comparative study of outcome of e/tra0articular pro/imal femoral

fractures treated with D*S and P"2

Case 2o.................. *ospital no GGGGGGGG

(roup...................... Date GGGGGGGGGG..

'(roup % patients treated with D*S! (roup B patients treated with P"2)

2ame.............................................................................%ge...........Se/................

%ddress.................................................................................................................

Profession.....................................................................

-ode of in1ury

Date of admission...................................Date of operation.................................

Date of discharge...................................Time of procedureGGGGGGGGG.

VARIABLES

Mo#f!# Harrs H$ Scor!

8ight wee+s Twelve wee+s Si/teen wee+s

Total score(rade

Functonal outco%! at &' (!!)s* poorEfairEgoodEe/cellent"inal wal+ing aility attained :E2

(


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Ann!"

Grading Scale F=7 Poor =7 =H "air 37 3H (oodH7 477 8/cellent

)


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*


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REFERENCES

4. (ulerg B! Duppe *! 2ilsson B. #ncidence of *ip "ractures in -almo! Sweden'4H;74HH4). Bone! 4HH>I 4? 5> 0 H.

5. Jannus P! $ar++ari A! Sievanen *! *einonen %! Vuori #! Aarvinen -.8pidemiology of hip fractures. Bone! 4HH6I 43 ;= 6>.

>. Carmen %. Brauer! -D! -arcelo Coca0Perraillon! -%I David -. Cutler! %llisonB. Rosen. Incidence and -ortality of *ip "ractures in the 9nited States. A%-%!577H I >75'4?) 4;=>04;=H

?. 8vans 8-. Trochanteric fractures. % review of 447 cases treated y nail platefi/ation. A Bone A Surg! 4H;4I >>0B 4H5.

;. Dousa P! Bartonice+ A! Aehlic+a D! S+ala0Rosenaum A. $steosynthesis of trochanteric fracture using pro/imal femoral nail. %cta Chir $rthop TraumatolCech! 5775I 6H 55 >7.

6. Pa1arinen A! Lindahl A! -ichelsson $! Savolainen V! *irvensalo 8.Pertrochanteric femoral fractures treated with a dynamic hip screw or a pro/imalfemoral nail. % R%2D$-#S8D ST9D: C$-P%R#2( P$ST0$P8R%T#V8R8*%B#L#T%T#$2. A Bone A Surg! 577;I 3=0B! =6 0 34.

=. Pavel+a T! -ate1+a A! Cerven+ova *. Complications of internal fi/ation y ashort pro/imal femoral nail. %cta Chir $rthop Traumatol Cech! 577;I =5 >??

;?.

3. Lavini "! Reni0Brivio L! %ulisa R! Cheruino "! Di Seglio PL! (alante 2!Leonardi K! -anca -. The treatment of stale and unstale pro/imal femoralfractures with a new trochanteric nail results of a multicentre study with theVeronail. ! 5773I >'4) 4; 0 55.

H. Aiang LS! Shen L! Dai L:. #ntramedullary fi/ation of sutrochanteric fractureswith long pro/imal femoral nail or long gamma nail technical notes andpreliminary results. %nn %cad -ed Singapore! 577=I >6 354 6.

47. *arris K*. Traumatic arthritis of the hip after dislocation and acetaular fractures treatment y mold arthroplasty. %n end0result study using a newmethod of result evaluation. A Bone Aoint Surg %m! 4H6HI ;4'?) =>= 0 ;;.

+
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Lavini%20F%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Renzi-Brivio%20L%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Aulisa%20R%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Cherubino%20F%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Di%20Seglio%20PL%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Galante%20N%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Leonardi%20W%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Manca%20M%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/18427919http://www.ncbi.nlm.nih.gov/pubmed?term=%22Lavini%20F%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Renzi-Brivio%20L%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Aulisa%20R%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Cherubino%20F%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Di%20Seglio%20PL%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Galante%20N%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Leonardi%20W%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Manca%20M%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/18427919

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