PPT FINAL AMIT SHUKLA (2).pptx FINAL (1).pptx

primary lrs application

1. PRIMARY LRS APPLICATION AS DEFINITE FIXATION IN GRADE – II AND GRADE- III OPEN FRACTURES OF LONG BONES : A PROSPECTOVE COHORT STUDY DR AMIT SHUKLA JUNIOR RESIDENT

2. Prof. Kumar Shantanu MS,MCH, Professor, Department of Orthopaedics KGMU, Lucknow Dr. Devarshi Rastogi MS Additional Professor, Department of Orthopaedics KGMU, Lucknow Dr. Arpit Singh MS Additional Professor, Department of Orthopaedics KGMU, Lucknow Dr. Ravindra Mohan MS Associate Professor,Department of Orthopaedics KGMU, Lucknow Dr. SHAILENDRA SINGH MS,FICS Additional Professor, Department of Orthopaedics KGMU, Lucknow

3. AIMS AND OBJECTIVES To study the functional outcome of Primary LRS Application in Grade-II and Grade-III Open Fractures of Long Bones

4. MATERIAL AND METHODS SOURCE OF STUDY: Department of orthopaedics King George Medical University, Lucknow STUDY SETTING : - Tertiary care centre (KGMU) STUDY DESIGN: Prospective cohort study SAMPLE SIZE: Sample size is calculated using the formula : Where p = 87.3% the proportion of excellent/good outcome according to HHS score among the cases (Ref. Cem Yalin Kilinc et al) q = 100 – p , Type I error α=5 %, for the significance level of 95%. Allowable error L = 10% absolute for detecting the results with 90% power of study, The sample size comes out to be = 42

5. SOURCE POPULATION All the patient with grade II, grade IIIa & grade IIIb open fracture of long bone in KGMU trauma centre & SGPGI All the patient has been managed by debridment followed by limb reconstruction system application INCLUSION CRITERIA Patients diagnosed with Grade II, Grade IIIa or Grade IIIb open fractures of long bones. Patients undergoing primary application of LRS as the initial stabilization procedure. Patients aged 11-60 yr s of age including both sexes who provide informed consent for participation and follow-up. EXCLUSION CRITERIA Patients with pathological fractures or pre-existing bone conditions that could affect healing. Patients with a history of previous surgery on the affected limb or those who are lost to follow-up. Patients with grade IIIc injury.

6. METHODOLOGY PREOPERATIVE ASSESSMENT - Preoperative Assessment of each patient falling in inclusion criteria was done by comprehensive clinical evaluation and imaging studies (X-rays) to determine the fracture type, extent of soft tissue injury, and then planned the surgical approach. Baseline data, including demographic information, mechanism of injury, comorbidities, and initial neurovascular status, was recorded. SURGICAL TECHNIQUE Preparation and Anaesthesia: All patients were managed under appropriate anaesthesia with standard perioperative protocols in place. LRS Application: A standardized protocol for the primary application of the LRS was followed. This includes proper debridement, irrigation, and stabilization of the fracture. Details such as pin placement, alignment correction, and stabilization technique were documented. Postoperative care were taken including antibiotic prophylaxis, wound management, and early mobilization protocols. Any adjunctive procedures (e.g., soft tissue coverage) were noted.

7. The functional and radiological outcomes were assessed using the Johner- Wruhs criteria over a minimum follow‐up period of 12 months OUTCOME ASSESSMENT Primary Outcome: The functional outcome were evaluated using the Johner- Wruh’s criteria postoperatively. This scoring system assesses parameters such as pain, gait, range of motion, and radiological union. Secondary Outcomes: Additional outcome measures will include time to union, complication rates (infection, non-union, malunion) and any need for revision surgery. Data Collection: Follow-up assessments performed at regular intervals using both clinical examinations and radiographic studies.

8. MASTER CHART

9. CASE1- 34Y/M ,H/O OF 2W -4W COLLISION

10. CASE2- 24Y/M ,H/O OF 4W -4W COLLISION

11. RESULTS

12. Age group Number of patients (n=42) Percentage ≤30 year 16 38.1% 31-40 year 7 16.7% 41-50 year 14 33.3% >50 year 5 11.9% Mean±SD 36.36±10.4 Table 1: Distribution of the studied patients based on age group

13. Gender Number of patients (n=42) Percentage Male 33 78.6% Female 9 21.4% Fracture Grade by GUSTILLO Number of patients (n=42) Percentage II 6 14.3% IIIA 21 50.0% IIIB 15 35.7% Table 2: Distribution of the studied patients based on gender Table 3: Distribution of the studied patients based on fracture grade

14. Bone Involved Number of patients (n=42) Percentage TIBIA 27 64.3% FEMUR 15 35.7% Pain Level Number of patients (n=42) Percentage None 15 35.7% Mild 14 33.3% Moderate 6 14.3% Severe 7 16.7% Table 4: Distribution of the studied patients based on bone involved Table 5: Distribution of the studied patients based on pain level

15. Table 6: Distribution of the studied patients based on limb shortening Limb Shortening (cm) Number of patients (n=42) Percentage 37 88.1% 0.5 3 7.1% 1 2 4.8% 1.5 0.0% 2 0.0% 3 0.0%

16. Complication Number of patients (n=42) Percentage Infection 10 23.8% Non-union/mal union 5 11.9% Table 7: Distribution of the studied patients based on complication Weight-Bearing Number of patients (n=42) Percentage PARTIAL 8 19.0% Full 34 81.0% Table 8: Distribution of the studied patients based on weight bearing

17. Time of union Number of patients (n=37) Percentage 7 months 2 5.4% 8 months 4 10.8% 9 months 13 35.1% 10 months 12 32.4% 11 months 6 16.2% Table 9: Time of union in month

18. Range of motion Mean±SD (n=42) Range KNEE FLEXION 132.3±13.8 90 to 140 ANKLE DF 12.8±7.0 0 to 20 ANKLE PF 43.5±3.1 35 to 45 Table 10:  Post-Treatment Range of Motion Outcomes  Deformity Number of patients (n=42) Percentage Yes 7 16.7% No 35 83.3% Table 11: Distribution of the studied patients based on deformity

19. Work/Activity Level Number of patients (n=42) Percentage Unable to return 7 16.7% Limited 7 16.7% Normal 28 66.7% Table 12: Distribution of the studied patients based on activity level

20. JOHNER WRUHS CRITERIA Number of patients (n=42) Percentage Poor 7 16.7% Good 26 61.9% Fair 9 21.4% Table 13: Functional Outcomes According to Johner-WRUHS Criteria

21. THANK YOU WORK TO DO… DISCUSSION AND CONCLUSION ARE PENDING TO WROTE…..