OR3_OA_Sanjay 1 edit

Variations in the arterial pattern of the upper limb are very common as observed in many cadaveric and angiographic studies. Knowledge of variations in the origin and course of the radial artery is important because they are used for many diagnostic procedures as well as vascular and reconstructive surgeries like coronary angiography, percutaneous coronary intervention and coronary artery bypass surgery. During routine dissection in our institute, we observed a case of high origin of the radial artery in a 33 year old male cadaver. It was found to be unilateral; on left side, radial artery was taking origin from 3 part of the axillary artery at the lower border of pectoralis minor before the origin of subscapular artery and anterior circumflex humeral artery. It had a superficial course in the arm crossing the median nerve from medial to lateral side. The further course of this superficial radial artery in the forearm was normal and it terminated by forming a deep Palmar arch in hand. These variations may be of great clinical implications for vascular and plastic surgeons and radiologists. Superficial course of radial artery makes it vulnerable to accidental injuries and elevates the risk of bleeding. ABSTRACT Background: An pen fracture with exte sive s ft tissue defects still remains ne of the most delicate and challengi g problems in trauma surgery. Severe bone and soft ti sue injuries produced by high velocity trauma have become one of the common causes of morbidity and mortality all over the world. The pr venti n of infection and n n-u i n in open fr ctures h s changed ramati lly over the last 15-20 years mainly as a result of improved plastic surgery techniques, but also because orthopedic surge ns have bec me m re aware of the importance of debridement and early soft tissue cover and ar now less absorbed by the minutiae of fracture fixation. The goal in the prevention of infection an non-union in compound fractures is to preserve the limb that is more functional than an amputated li b with prosthesis. Achieving this goal requires the current and timely management of both the bone and oft tissue defects. Various methods are followed with their adv ntages a d drawbacks. The main aim is to study the different modalities of prevention of infection and non-union in compound fractures and to present our experience of primary soft tissue covers in the prevention of infection and non-union in compound fractures. Methods: In a prospective study conducted in the department of orthopedics of Guntur Medical College/ Government General Hospital, Guntur, Andhra Pradesh, 60 cases of open fractures from September 2010 to Oct 2012 were admitted. All the cases were treated as per protocol with thorough debridement and early skeletal stabilization and wound coverage, bone grafting whenever necessary and finally fracture loading in cast or ilizarov. Plastic Surgeons were involved early in all the flap covers. Cardiothoracic and Vascular Surgeons were involved in Grade IIIC injuries. Patient was followed up regularly every 4 to 6 weeks and fracture union was tested radiologically and clinically. Status of the soft tissue cover was noted. When sufficient union was present, fixator was removed and the limb was put in below knee functional cast brace. Patients were called up for regular followups to review the progress. On follow up assessment was done recording the status of the wound, clinical and Radiological evidence of fracture union, range of mobility at knee and ankle joints, function of the limb and complications. Results: Out of 60 cases selected for the study age ranging from 1 year to 70 year, maximum cases 33.33% were in the age group of 21-30 years and 45 patients (75%) were male and 15 (25%) were female group. Most of the injury was due to RTA which were 48 cases (82.5%). 15 cases (25%) were in Type I, 12 cases (20%) were in type II and 36 cases (55%) were in type III Gustilo-Anderson classification. As per anatomical distribution, 42 cases (70%) involved tibia, 8 cases (13.33%) involved femur, 6 cases (10%) involved humerus and 4 cases (6.67%) involved forearm bones. Skeletal stabilization was done by plaster in 6 patients (10%), external fixation in 36 patients (60%) and by internal fixation in 18 patients (30%). Primary closure was done in 10 cases (16.67%), delayed primary closure was done in 7 cases (11.67%), split skin grafting was done in 27 cases ( 45%), flap coverage was done in 8 cases (13.33%) and in 8 cases (13.33%) wound were left open and they healed. Complications included in the study were pin tract infection in 9 cases (15%), equines in 5 cases (8.33%), knee stiffness in 4 cases (6.67%), toe clawing in 2 cases (3.33%), Non union in 6 cases (10%), chronic osteomyelitis in 4 cases (6.67%) and shortening in 5 cases (8.33%). There was no neurovascular damage, compartmental syndrome, failure of fixation or amputation. Overall result in our study was excellent in 30 patients (50%), good in 20 patients (33.33%), fair in 6 patients (10%) and poor in 4 patients (6.66%) Conclusion: From our study we concluded that majority of the compound fracture seen in leg and are due to road traffic accident. Males are more commonly involved than females. Most of the fractures are Type III Gustilo-Anderson. The External fixator is useful apparatus for early stabilization and early wound coverage in type III fractures. Internal fixation given excellent results in Type I & II fractures, similar that of closed fracture. Early debridement and wound coverage is the single most determinant of the fracture out come. Dynamization is useful for early union of fracture. Bone grafting is useful in case of delayed union for union of fractures. Complications like joint stiffness are best compared to conservative methods.