Rajiv Gandhi University of Health Sciences



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

|1 |Name of the candidate and address ( in block letters) |: |DR SREE KRISHNA PATHURI |

| | | |Department of Orthopedics |

| | | |M.R. Medical College, Gulbarga |

| |Permanent address |: |DR SREE KRISHNA PATHURI |

| | | |S/O DR.P.RAVI KIRAN, 2-17/D-4, VENKAT NAGAR, KAKINADA, ANDHRA |

| | | |PRADESH-533003 |

|2 |Name of the institution |: |H.K.E. SOCIETY’S MAHADEVAPPA |

| | | |RAMPURE MEDICAL COLLEGE, |

| | | |GULBARGA – 585105 |

|3 |Course of study and subject |: |M.S. (ORTHOPAEDICS) |

|4 |Date of admission to the course |: |30TH may 2013 |

|5 |Title of Topic |: |A STUDY OF “SURGICAL MANAGEMENT OF FRACTURE SHAFT OF HUMERUS BY |

| | | |INTRAMEDULLARY INTERLOCKING NAILING” |

|6 |Brief Resume of the intended work |

| |6.1 |Need for the study |

| | | |

| | |Fractures of the humeral shaft are commonly encountered by orthopaedic surgeons accounting for approximately 5% of all |

| | |fractures.Conservative management has been very commonly used for many of the humeral fractures with good results. |

| | | |

| | |Most acute humeral shaft fractures can be treated using non operative methods but surgical treatment is recommended in cases |

| | |with |

| | |Segmental fractures, |

| | |In polytrauma patients(ipsilateral forearm, shoulder, elbow, lower extremity), |

| | |Nonunion, |

| | |Communited fractures, |

| | |Vascular injuries, |

| | |Open fractures, |

| | |Unacceptable alignment after closed reductions, |

| | |Pathological fractures and those with intraarticular extension. |

| | | |

| | |Plate biosynthesis is considered to be gold standard. Though it gives a high rate of union but has disadvantages like |

| | |increased risk of iatrogenic radial nerve palsy and providing less secure fixation on osteoporotic bone1,2. |

| | |Closed interlocking nail are load sharing devices, give a better biomechanical fixation. They provide absolute stability |

| | |because of locking thereby also providing rotational stability. They can be inserted using closed techniques thus avoiding |

| | |extensive soft tissue stripping needed for plating. They permit early mobilization of neighbouring joints. It minimally |

| | |violates fracture haematoma allowing healing of the fracture to proceed undisturbed. |

| | |Locking humeral nails were introduced for upper extremity hoping results would parallel clinical success as seen in lower |

| | |extremity fractures. Studies conducted have given varying results about the outcome after closed interlocking nailing for |

| | |fractures of shaft of humerus in terms of shoulder stiffness and union rate. Hence it has not enjoyed the unparallel success |

| | |as in lower extremity. This study is being conducted to see the efficacy of interlocking nails in fracture shaft of humerus. |

| |6.2 |Review of Literature |

| | |Demirel M, Turhan E, Dereboy F, Ozturk A studied antegrade nailing done on 114 cases of humeral shaft fractures were |

| | |evaluated in the period from 1995-2003. 42 patients had sustained multiple trauma and 22 fractures were open. 109 fractures |

| | |united primarily and 5 cases required DCP fixation with bone grafting. Time of union was 13 weeks. 105 patients had excellent|

| | |recovery of shoulder or elbow function. Conclusion drawn was that antegrade nailing in humeral shaft fractures was reliable |

| | |and also effective in multiply injured patients4. |

| | |Shyamsunder BN, Sharath KR in a clinical study from 2000-2002 of 41 patients with humeral shaft fractures treated by closed |

| | |undreamed antegradeinterlocking nailing reported it as an effective means of fixation of acute humeral fractures and is also |

| | |of special value in open humeral fractures due to lower incidence of infection. Shoulder stiffness is a significant problem |

| | |with antegrade nailing which can be minimized if care is taken to prevent proximal protrusion of nail and repair of the |

| | |rotator cuff properly3. |

| | | |

| | |Arpacioglu MO, Pehlivan O, Akmaz I, et al in their study forty three patients were treated with interlocking nail for humeral|

| | |shaft fractures. All fractures were closed except one. Nailing was performed by both open and closed technique. Union was |

| | |achieved in mean of 15.6 yrs. No surgery associated nerve injuries were encountered. No rotator cuff impingement was |

| | |encountered in whom nails were placed high in close proximity to the shoulder girdle. Functional results were excellent in |

| | |all patients at end of 3 months. They concluded that interlocking nailing provides adequate fixation and early mobilization |

| | |and functional results are good8. |

| | |Lin jin his study in 1998 data was collected on 48 acute humeral shaft fractures treated with locked nails and compared |

| | |retrospectively with 25 fractures treated with dynamic compression plating. Eventual union was achieved among all in the nail|

| | |group but one in the plate group. It was found union rate and time of union were not significantly different. In plate group |

| | |three fractures had complication rates was statistically significant. He concluded that locked nailing offers a less invasive|

| | |surgical technique and more favourable treatment results than plate fixation7. |

| | |Rommens PM, Verbruggen J, Broos P Lin his study from the period 1991-1993, 39 patients were treated with closed retrograde |

| | |interlocking nailing using Russell – Taylor humeral nails. Mean healing time was found to be 13.7 weeks; shoulder function |

| | |was excellent in 92.3% and elbow function in 87.2%. Functional end results was excellent in 84.6%, moderate in 10.3% and bad |

| | |in 5.1%. The complication rate was found to be acceptable and shoulder and elbow function recover rapidly in most cases6. |

| | |Habernek H, Orthner E in his study from 1989-1990 where 19 patients were treated for upper arm fractures using Seidel’s |

| | |locking nail system. The overall results were good with no cases of pseudoarthrosis, infection or radial nerve palsy. All |

| | |patients regained full shoulder movements with no evidence of rotator cuff lesions5. |

| | | |

| |6.3 |Objectives of the study |

| | | |

| | |To study the functional outcome after interlocking nail for fracture shaft of humerus. |

| | |To study the complications after treatment of fracture shaft of humerus with interlocking nail. |

| | |To study the time of union and the union rates. |

| | |4. To compare the results with similar studies done earlier. |

|7 |Materials and methods |

| |7.1 |Source of data |

| | |Patients with humeral shaft fractures to be admitted to Basweshwar hospital attached to MR MEDICAL COLLEGE, Gulbarga will |

| | |be taken up for study after obtaining the consent. |

| | | |

| | |This is a prospective study from September 2013 to September 2015 |

| |7.2 |Methods of collection of data |

| | |Adult patients (minimum of 20) with humeral shaft fractures will be selected after clinical and radiological analysis for |

| | |the study. They will be admitted, examined according to protocol, associated injuries noted and labouratory investigations|

| | |carried out in order to get fitness for surgery. An informed written consent will be taken. |

| | |A minimum of 20 cases will be studied. The number of patients with fracture shaft humerus satisfying the inclusion |

| | |criteria will not be large enough to take sample and study. |

| | |A proforma will be used to record the relevant data from individual patients. |

| | |Inclusion Criteria: |

| | |Patients aged more than 18 years. |

| | |Patients having fracture of shaft of humerus and being fit for surgery. |

| | |Exclusion criteria: |

| | |Patients aged less than 18 years. |

| | |Patient having an associated radial nerve palsy. |

| | |Patients who are medically unfit for surgery. |

| | |Patients having fractures classified > type II compound. |

| | |Does the study require any investigation or intervention to be conducted on patients or other humans or animals? if so |

| |7.3 |please describe briefly |

| | |Yes |

| | |The study requires basic blood investigations for obtaining fitness for surgery. It also requires radiological |

| | |investigations. Surgery will b performed on the patients after obtaining their informed and written consent. |

| |7.4 |Has ethical clearance been obtained from your institution in case of 7.3 ? |

| | | |

| | |Yes |

| 8 |List of References |

| |Andrew H,Crenshaw, Jr. , Edward A. Perez. “ Fractures of humeral shaft”, chapter 54 in Campbell’s Operative Orthopaedics. VolIII 11th|

| |edition S.TerryCanale, James.H.Beaty editors. Philadelphia, USA: Elsevier,2008, 3389-3400pp. |

| |Micheal.D.McKee. “Fractures of shaft of humerus”. In Bucholz RW, Heckman JD, Koval KJ editors. Rockwood and greens fractures in |

| |adults. Vol I, 6th edition Philadelphia, USA. Lippincott Williams and Wilkins; 2006; 1118-1160pp. |

| |Demirel M, Turhan E, Dereboy F, Ozturk A. “Interlocking nailing of humeral shaft fractures a retrospective study off 114 patients”. |

| |Indian J Med sci. 2005; 59: 436-442pp. |

| |Shyamsunder BN, Sharath KR. “The functional outcome of antegradeunreamed humeral interlocking nail in adults”. J orthopaedics, 2005; |

| |2(1)e2 |

| |Arpacioglu MO, Pehlivan O, Akmaz I, et al. “Interlocking intramedullary nailing of humeral shaft fractures in adults”. |

| |ActaOrthopTraumatol Turc,2003; 37(1):19-25pp. |

| |Lin J. “Treatment of humeral shaft fractures with humeral locked nail and compression with plate fixation”. J Tauma, 1998; |

| |44(5):859-64pp. |

| |Rommens PM, Verbruggen J, Broos PL. 1995 “Retrograde locked nailing of humeral shaft fractures”. JBJS(Br), 1995; 77-B: 84-9pp. |

| |Habernek H, Orthner E. “Locking nail for fractures of the humerus”. JBJS(Br), 1991; 73-B: 651-3pp. |

| | | |

|9 |Signature of Candidate | |

| | |Satisfactory, as intramedullary nailing is minimal invasive |

|10 |Remarks of guide |procedure. It requires c-arm and good surgical skill. |

| | | | |

|11 |11.1 |Name and designation of the Guide | |

| | | |DR. BUDAR SANJEEV REDDY |

| | | |M.S. (ORTHO); D’ ORTHO |

| | | |PROFFESSOR & HOD |

| | | |DEPARTMENT OF ORTHOPEDICS, |

| | | |M.R.MEDICAL COLLEGE, |

| | | |GULBARGA. |

| | | | |

| |11.2 |Signature | |

| | | | |

| |11.3 |Co- guide (if any) | |

| | | | |

| |11.4 |Signature | |

| | | |DR. BUDAR SANJEEV REDDY |

| |11.5 |Head of the Department |M.S. (ORTHO); D’ ORTHO |

| | | |PROFFESSOR & HOD |

| | | |DEPARTMENT OF ORTHOPEDICS, |

| | | |M.R.MEDICAL COLLEGE, |

| | | |GULBARGA. |

| | | | |

| |11.6 |Signature | |

| | | | |

|12 |12.1 |Remarks of the Chairman and Principal | |

| | | | |

| |12.2 |Signature | |

| | | | |

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