Post Graduate Student in M.S. (Orthopaedics)

From: Date : 15.11.2008.

DR. KANAKACHALAPATHI

Post Graduate Student in M.S. (Orthopaedics)

Department of Orthopaedics,

Vijayanagar Institute of Medical Sciences, Bellary.

To

The Principal,

Vijayanagar Institute of Medical Sciences,

Bellary.

THROUGH PROPER CHANNEL

Respected Sir,

Subject : Acceptance of registration and forwarding of my dissertation topic.

With reference to the above subject, I, the undersigned studying post graduate course in M.S. Orthopaedics has been allotted the dissertation topic “SURGICAL MANAGEMENT OF DIAPHYSEAL FRACTURES OF BOTH BONES FOREARM IN ADULTS BY LIMITED CONTACT DYNAMIC COMPRESSION PLATE - A PROSPECTIVE STUDY”, under the guidance of DR.G.V.GURUDUTH ,Professor, Department of Orthopaedics, VIMS, Bellary.

I request you to kindly forward the dissertation topic in the prescribed form to the University for approval.

Thanking you,

Yours sincerely,

Signature of the guide : (DR.KANAKACHALAPATHI)

(DR.G.V.GURUDUTH )

Professor of Orthopaedics,

Department of Orthopaedics,

VIMS, Bellary

From : Date : 15.11.2008.

The Professor and Head of the Department,

Department of Orthopaedics,

Vijayanagar Institute of Medical Sciences, Bellary.

To

The Registrar,

Rajiv Gandhi University of Health Sciences,

Bangalore.

THROUGH PROPER CHANNEL

Respected Sir,

As per the regulations of the University for registration of Dissertation topic, the following Post Graduate Student in MS Orthopaedics has been alloted the dissertation topic as follows by the Official Registration Committee of all qualified and eligible guides of the Department of surgery.

NAME / TOPIC / GUIDE
DR.KANAKACHALAPATHI
Post Graduate Student in
M.S. Orthopaedics,
VIMS, Bellary. / SURGICAL MANAGEMENT OF DIAPHYSEAL FRACTURES OF BOTH BONES FOREARM IN ADULTS BY LC DCP- A PROSPECTIVE STUDY / DR.G.V.GURUDUTH
Professor of Orthopaedics, Department of Orthopaedics, VIMS, Bellary.

Therefore, I kindly request you to communicate the acceptance of the dissertation topic allotted to the postgraduate student at an early date.

Thanking you,

Signature of the guide: Yours faithfully,

DR.G.V.GURUDUTH DR.D.PRABHANJAN KUMAR

Professor of Orthopaedics, Professor and HOD,

Department of Orthopaedics, Department of Orthopaedics,

VIMS, Bellary. VIMS, Bellary.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.

ANNEXURE – II

SYNOPSIS FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / Name of the candidate and Address
( In Block letters ) /

DR.KANAKACHALAPATHI

POST GRADUATE STUDENT IN M.S. ORTHOPAEDICS,
VIMS, BELLARY – 583104.
2 / Name of the Institution / VIJAYANAGAR INSTITUTE OF MEDICAL SCIENCES, BELLARY
3 / Course of study and subject / M.S. in ORTHOPAEDICS
4 / Date of admission to the course / 06 – 06 – 2008
5 / Title of Topic:
“SURGICAL MANAGEMENT OF DIAPHYSEAL FRACTURES OF BOTH BONES FOREARM IN ADULTS BY LIMITED CONTACT - DYNAMIC COMPRESSION PLATE: A PROSPECTIVE STUDY”
6 / Brief resume of the intended work:
6.1 Need for the Study:
The supporting skeleton and articulations of the upper extremity serve to position its terminal unit, the hand, in space. In the adult, exacting management of diaphyseal fractures of the radius and ulna is necessary to ensure forearm motion. These injuries can even be viewed as intra-articular fractures with the forearm "joint" providing supination and pronation. Unsatisfactory treatment can lead to loss of motion as well as muscle imbalance and disability of hand function1.
Diaphyseal fractures of the radius and ulna present specific problems in addition to the problems common to all fractures of the shafts of long bones. In addition to regaining length, apposition, and axial alignment, achieving normal rotational movement is necessary if a good range of pronation and supination is to be restored. This is achieved by open reduction and internal fixation using limited contact dynamic compression plate2.
The term limited contact dynamic compression plate(LC-DCP) stands for a new approach to plate fixation, reduced trauma to the bone, preservation of blood supply, avoidance of stress raisers produced at implant removal and improved healing3.
So, this study has been taken up to evaluate the results of open reduction and internal fixation of the diaphyseal fractures of both bones of forearm with LC-DCP in adults.
Hence the present study.
6.2 Review of Literature :
For thousands of years, the only method of treatment of fractures was some form of external splintage. Egyptians used linen bandages, as splintage material. But material commonly used was wood.4
In olden days, surgeons merely used to fix two bone fragments in an approximate alignment, which resulted in mechanical failure owing to metal reaction as well as to the inadequate design of screws and plates.5
Smith and Sage in 1957,reported a series of 555 fractures fixed with the use of intramedullary nails.Kirshner wires,rush pins,square nails are used in the past. The use of square nails has an added advantage of securing stability when it is inserted in the round medullary canal. The disadvantage of intramedullary nailing is rotational stability may not be adequate,the radial bow is straightened6.
The dynamic compression plate (DCP) was developed in 1969 by “Perren” et al. and used successfully in humans by Allgower et al. in the same year. Its spherical geometry not only allowed self-compression but also enabled the maintenance of a congruent fit between the screw and the plate hole at different angles of inclination. Thus, the plate was mere adaptable to different situations of internal fixation and could fulfill all the different plate functions.3
In 1990, Perren S. M. et al developed the “LIMITED CONTACT DYNAMIC COMPRESSION PLATE” to release the new concept of biological internal fixation7.
The LC-DCP is the technically a further development of the DCP. The symmetrical self-compressing plate hole and deletion of the elongated distance between the innermost screw holes makes the LC-DCP more versatile for use in any fracture type. Grooves on the undersurface of the LC-DCP serve three purposes:
(i)  Improved blood circulation by decreased damage to contact between plate and bone.
(ii)  Allows for a small bone bridge beneath the plate at the most critical area, which is otherwise weak due to a stress concentration effect.
(iii)  More even distribution of the plate than in conventional plates.7
Matter P and Burch HB (1990) reported 120 fractures of both bones forearm treated with LC-DCP and reported a union of 97%. They concluded that LC-DCP fixation of fracture both bones forearm is best from the point of union and has got less number of complications fractures of the forearm.8
Leung F and Chow SP (2003) carried a trial comparing the LC-DCP with pc-fix for forearm fractures. Their study concluded plating as the best method of fixation for diaphyseal fractures of the forearm. Despite the differences in the concept of fracture fixation these two implants appear to be equally effective for the treatment of diaphyseal forearm fractures.9
6.3 Objectives of study :
* To determine the demographic (age and sex distribution) of our patients with
fracture both bones forearm.
* To study the advantages of LC-DCP
* To study the union rates and functional outcome of open reduction and
internal fixation of fracture both bones forearm with LC-DCP.
* To compare the results with those in literature.
7. / MATERIALS AND METHODS:
7.1 Source of data :
The Patients admitted to the Department of Orthopaedics at Vijayanagar Institute of Medical Sciences, Bellary with both bones fractures forearm in adults during the period from JULY 2008 to SEPTEMBER 2010 are selected. All the patients who will be operated during this period are included in the study. Those patients who are above the age of 18 years of age and managed surgically are included in the study.
7.2 Method of Collection of Data:
( Including the sampling procedure if any )
The study will be conducted at the Department of Orthopaedics, VIMS, Bellary during the period from JULY 2008 to SEPTEMBER 2010 . The complete data is collected from the patients in a specially designed Case Record Form (CRF) by taking history of illness and by doing detailed clinical examination and relevant investigations.
Finally after the diagnosis the patients are selected for the study depending on the inclusion and exclusion criteria. Post operatively all the cases are followed for the minimum period of 6 months.
Inclusion Criteria:
a) Those patients who are above 18 years and managed surgically are included in the study.
b) Patients of both the sexes are included in the study
c) Patients with closed diaphyseal fractures of both bones of forearm
d) Patient fit for surgery
Exclusion Criteria:
a)  Those patients who are below 18years
b)  Patients not willing for surgery
c)  Open fractures
d) Patients medically unfit for surgery
Evaluation: The results are evaluated with Anderson’s criteria for forearm bone fractures.
7.3 Does the study requires any investigations or interventions to be conducted on patients or other humans or animals? If so please describe briefly.
Yes, In our study the following investigations are conducted in each patients. All the patients included in the study are investigated thoroughly with
1. Routine blood investigations ( Complete blood Count, Random blood sugar,
blood urea , serum creatinine )
2. Urine routine ( Albumin, Sugar, Microscopy )
3. Radiological examination pre operatively are done.
x rays of forearm with elbow and wrist
-AP view
-Lateral view
Radiological examination will be repeated post-operatively and at the end of 6 weeks, 12 weeks and 6 months intervals.
Patients will be followed up at 6 weeks, 12 weeks and at 6 months.
7.4 Has ethical clearance been obtained from your Institution in case of 7.3 ? YES, Ethical clearance has been obtained from VIMS INSTITUTIONAL ETHICS COMMITTEE, Bellary.
8 / List of References.
1.  Jupiter JB, Kellam JF, Browner Skeletal Trauma Basic Science, Management and Reconstruction, 2nd ed, Saunders, An Imprint of Elsevier,1998;pp1421
2.  Andrew H. Crenshaw Jr, Edward AP, Canale: Campbell's Operative Orthopaedics, 11th ed., Mosby,2008; pp 3425-26
3.  Perrens M, Allgower M, Brunner H, Burch HB, Cordey J, Ganz R et al. The concept of biological plating using the limited contact dynamic compression plate (LC-DCP). Injury 1991; 22 (1): 1-41.
4.  Sevitt, Simon. Primary repair of fractures and compression fixation. Chap-10 in bone repair and fracture healing in man. Churchill Livingstone, Edinburgh, 1981; pp 145-156.
5.  Thakur AJ. Bone plates. Chapter-4 in The elements of fracture fixation, Churchill
Livingstone, New Delhi, 1997; pp 57-79.
6.  Kulkarni V S, Kulkarni`s Textbook of Orthopaedics and Trauma,2nd ed., Jaypee,2008;pp1969.
7.  Perren SM, Klaue K, Pohler O, Predieri M. Steinems, Gautier E et al. Limited contact dynamic compression plate (LC-DCP). Arch Orthop Trauma Surg 1990; 109 (6): 304-310.
8.  Matter P, Burch HP. Clinical experience with titanium especially with LC-DCP systems. Ach Orthopaedics trauma Surgery 1990; 109: 311-13.
9.  Leung, Frankie, Shew-Ping Chow. A prospective, randomized trial comparing the LC-DCP with the point contact fixator for forearm fractures. J BONE JOINT SURGERY 2003; 85A (12): 2343-48
9 / Signature of the candidate :
10 / Remarks of the guide :
11 / Name and Designation of :
( In Block Letters)
11.1 Guide: / DR.G.V.GURUDUTH
Professor of Orthopaedics,
Department of Orthopaedics,
VIMS, Bellary.
11.2 Signature
11.3 Co – Guide, if any
11.4 Signature
11.5 Head of the Department / DR.D.PRABHANJAN KUMAR
Professor and Head of the Department,
Department of Orthopaedics,
VIMS, Bellary.
11.6 Signature
12 / 12.1 Remarks of Chairman and Principal
12.2 Signature