RAJIV GANGHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE
KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / Name of the Candidate and Address(in block letters) / DR.ISHWAR MEENA
S/O MR. JAGMAL RAM MEENA
B-1211, UPVAN TOWER, UPPER GOVIND NAGAR, MALAD EAST, MUMBAI
MAHARASTRA.
2 / Name of the Institution / J.J.M MEDICAL COLLEGE&HOSPITAL,DAVANGERE-577004
3 / Course of Study and Subject / MASTER IN SURGERY, ORTHOPAEDICS
4 / Date of Admission to course / 06-05-2010
5 / Title of the Topic / “A CLINICAL STUDY OF PROMIXMAL FEMUR LOCKING COMPRESSION PLATE (LCP-PF) IN THE TREATMENT OF INTERTROCHANTERIC AND SUBTROCHANTERIC FRACTURES OF THE FEMUR”
6 / Brief Resume of the intended work:
6.1 Need for the study:
Peritrochanteric and intertrochanteric fractures most commonly affect the elderly and havea tremendous impact on the health care system and society in general. The incidence of peritrochanteric and intertrochanteric fracture is also increasing among young population, who suatain high energy trauma.
The problem in treating subtrochanteric fractures are malunion and delayed union. Factors responsible are high dtress concentration, unstable nature of the fracture, predominance of cortical bone and difficulties in getting biomechanically sound reduction because of comminution.
The present choice of treatment for subtrochanteric and peritrochanteric fractures is ORIF. Many internal fixation devices have been used in treatment of peritrochanteric and subtrochanteric fractures because of high incidence of complications reported after surgical treatment with each implant.Lack of satisfactory implant in surgical treatment of peritrochanteric and subtrochanteric fractures has lead to series of evolution in design of a perfect implant.
Locking compression plate-Proximal femur(LCP-PF) has been proven to be farr more efficient when compared to other implants in treatment of peritrochanteric and subtrochanteric fractures.
6.2 Review of literature:
Proximal femoral fractures are challenging. The treatment goal is to achieve anatomic reduction with a stable fracture fixation to allow early functional rehabilitation. Over the past decades, inter- and subtrochanteric fractures were predominantly treated by implants, such as the dynamic hip screw, dynamic condylar screw, angular blade plates or by cephalomedullary nails. However, the complication rate for unstable fractures treated with a dynamic hip screw or dynamic condylar screw plate has shown to be as high as 3% to 15%. Primary or secondary varus collapse and hardware failure by “cut-out” of the femoral head screw are the most frequently reported complications.6
Traditional blade plate fixation is a suitable option for the subtrochanteric femur fracture. However, this technique demonstrates a narrow margin for error, requiring precise plate placement in all planes.The development of the LCP introduced a new treatment option for unstable and highly comminuted fractures and for periprostheticfractures.Recently, a German group reported the successful use of a conventional LCP in children with intertrochanteric fractures.6
The PF-LCP offers the surgeon a greater degree of adjustment in plate placement decreasing the common flexion or extension deformity frequently seen with blade plate placement. The PF-LCP thus fulfills the role of a fixed angle device and achieves the same or greater degree of variability sought with the dynamic condylar screw while avoiding the need for excessive bone removal.6
XIA France et al.(2009) LCP between the nail plate through the thread lock on the stability of the fracture between the nail plate into the angle stability, rather than between the plate and bone surface friction. Same time, because LCP without periosteal stripping can minimize the damage on the fracture of local blood supply has played a role in biological plate is especially suitable for patients with osteoporosis, so the fixed method has little injury, reliable fixation, fracture healing rate. Advanced features, but due to application of this fixation system time is not long, its long-term efficacy and complications needs further observation and study.3
Zhu Jiang Lu et al.(2009) Concluded that lateral plate fixation for the treatment of trochanteric fractures can get a good curative effect, the use of anatomic LCP can reduce surgical trauma, reduced X ray exposure, the operation simple and wide indication.3
Sun JF et al.(2010)Minimally invasive approaches with LCP could treat the elder intertrochanteric fractures with the advantages such as minimal invasive, stable fixation and less blood loss.4
Chang-Wug et al. The MIPO technique with a locking plate provides an alternative metod for fixing subtrochanteric femur fracture,when IM nailing is inappropriate. This technique provides stable fixation, with a high union rate and minimal complication rate.5
6.3 Objectives of the study:
- To find out age sex and side incidence of peritrochanteric and subtrochanteric fractures.
- To analyse the anatomical and functional outcome of the treatment with LCP-Proximal femur.
- To testify the advantages and disadvantages of LCP-Proximal femur for peritrocanteric and suctrochanteric fractures.
7 / Material and methods
7.1 Source of data:
Patients presenting to the Orthopaedic department of chigateri general hospital and bapuji hospital, davangere, affiliated to J.J.M. MEDICAL COLLEGE, DAVANGERE in the period from September 2010 to September 2012.
7.2 Method of collection of data (including sampling procedure , if any):
Selection of cases: intertrochanteric and subtrochanteric fractures of the femur in patients, both males and females.
A minimum of 20 cases will be studied without any sampling procedure.
Inclusion Criteria:
•Age ≥ 18 years
• Both genders
•Patients with closed or type 1 open reverse oblique intertrochanteric fractures (AO 31 - A3) or subtrochanteric fractures (transverse fracture line, main fracture line maximum 5 cm distal from the lesser trochanter; proximal extension of fracture allowed)
•Signed written informed consent (by the subject or legal guardian) and agreement to attend the planned follow ups.
Exclusion Criteria:
•Pathologic fracture
•Any displacement of a femoral neck fracture
•Type 2 or 3 open fracture
•Active malignancy
•Inability to walk independently prior to injury
7.3 Does the study require any investigation or interventions to be conducted on the patients or humans or animals? If so, please describe briefly.
YES
The study requires
- Blood investigations
- X-ray and surgery
- Post operative X-rays also needed at regular intervals in the post operative period
Yes
8 / List of references:
1)Thomas A. Russel “Intertrochanteric fractures”, Chapter-48, Rockwood And Green, 7th Edition Vol.2, 1611.
2) Michael J. Gardner, Eric E. Johnson, Dean G. Lorich “Subtrochanteric Femur Fractures: Plate Fixation” ,Chapter 19, Master Techniques in Orthopaedic Surgery: Fractures, 2nd Edition, 283-285 pages
3)XIA France, Wu Xiang-wu, ZHU Chun-Bridge, Gold Yasukuni; “Intertrochanteric fracture treatment analysis of 102 cases” Chinese Journal of Bone and Joint injuries 2009 Aug.
4) SUN jf, Li ZB, Shen YY, Han B, Deng L, Gu MQ; “Minimally invasive treatment of intertrochanteric fractures with locking compression plate in elderly”. Zhongguo Gu Shang. 2010 May;23(5):337-9
5) Chang-Wug Oh, Jung-Jae Kim, Young-Soo Byun, “Minimally invasive plate osteosynthesis of subtrochanteric femur fractures with a locking plate; prospective series of 20 fractures” Arch Orthop Trauma Surg(2009) 129:1659-1665
6)Erik A. Hasenboehler, MD; Juan F. Agudelo, MD; Steven J. Morgan, MD; Wade R. Smith, MD; David J. Hak, MD, MBA; Philip F. Stahel, MD,“Treatment of Complex Proximal Femoral Fractures With the Proximal Femur Locking Compression Plate”.ORTHOPEDICS August 2007;30(8):618.
9 / Signature of Candidate
10 / Remarks of the Guide / HELPFUL IN REVERSE OBLIQUE TROCHANTERIC FRACTURE WHERE OTHER INSTRUMENTATIONS ARE NOT IDEAL.0
11 / Name & Designation of
(in block letters)
11.1 Guide
11.2 Signature
11.3 Co-Guide(if any)
11.4 Signature
11.5 Head of Department
11.6 Signature / Dr. NAGABHUSHANA D.M.M.S.(Ortho)
Professor
Department of Orthopaedics,
J.J.M. Medical College, Davangere-577004.
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Dr. G. Nagaraj M.S.(Ortho)
Professor & H.O.D
Department of Orthopaedics,
J.J.M. Medical College, Davangere-577004.
12 / Remarks of the Chairman & Principal
12.2 Signature