j o u r n a l o f c l i n i c a l o r t h o p a e d i c s a n d t r a u m a 6 ( 2 0 1 5 ) 7 1 e7 3
period was 20 months. One patient was excluded from the study
due to drop out from follow up.
Results: Most of the patients of the study group were young (20-
30yrs old) males. 12 cases were of Tibia, 6 of Femur and 1 of Hu-
merus. In majority of patients the cause of Bone Gap was bone loss
in Compound Fractures resulting from Road Traffic Accident.
Treatment with C.H.A. Blocks along with autogenous bone graft-
ing showed Excellent results in 8 cases, Good results in 6 cases,
Fair in 4, and Poor in 1 case. The use of C.H.A. did not cause any
foreign body reaction and there was satisfactory healing in all Gap
Non-Union Cases. The average rate of union was approx. 22
weeks. The common complication that was seen was increased
drain collection in early post-operative period. Significant limb
length discrepancy was not seen in any case.
Conclusion: C.H.A. blocks along with autogenous bone grafting
has an excellent role in filling bone gaps and hence treating Gap-
Non Unions. The use of LCP prevents shortening, deformity and
joint stiffness by allowing early mobilization.
AT8. Flexor tendon repair rehabilitation protocols: A
randomized prospective trial of Kleinert protocol compared
with Duran protocol
S.P. Ahluwalia1, S. Pandey2, R. Sarad3, R.S. Boparai2
1
Maulana Azad Medical College, New Delhi, India; 2Government
Medical College, Amritsar, India; 3SGRDIMSR, Amritsar, India
Background: Human hand is a highly adaptable organ of pre-
hension, sensation, expression and communication. The whole
new concept of tendon healing has undergone a revolutionary
change but still the perfect suture and ideal mobilization tech-
nique eludes this generation of hand surgeons. This study was
undertaken to determine which flexor tendon rehabilitation pro-
tocol provides the best outcome after surgical repair
Methods: 30 patients of either sex with a flexor tendon injury were
operated by modified Kessler repair technique using Non-
absorbable monofilament (Prolene) sutures and were randomized
to the following protocols: passive flexion and active extension
protocols (Kleinert type protocols) and controlled passive motion
protocols (Duran type protocols). The functional outcome after
tendon repair were assessed by calculating total active range of
motion (TAM) as suggested by American Society for the Surgery of
Hand (ASSH).
Results: The Kleinert protocols exhibited the highest proportion of
digits with excellent or good results assessed by total active range
of motion (TAM) as suggested by American Society for the Surgery
of Hand (ASSH).The mean rate of rupture was lowest in the Duran
73
protocols and highest in the Kleinert protocols. No statistically
significant differences were found.
Conclusion: Surgical repair of flexor tendon requires an exact
knowledge of anatomy, careful adherence to some basic surgical
principles, sound clinical judgment, strict atraumatic surgical
technique and a well planned post operative programme. Both
Kleinert and Duran protocols result in low rates of tendon
rupture and acceptable range of motion following flexor tendon
repair.
AT9. Transarticular screw fixation for atlantoaxial instability
(MODIFIED Magerl's technique)
J. Singh, R. Bahadur, S.S. Dhatt
PGIMER, Chandigarh, India
Background: Symptomatic Atlanto-Axial instability needs stabi-
lization. Among various techniques for Atlanto-Axial fixation,
Magerl's technique remains gold standard. Traditionally, it com-
prises of Trans-Articular Screws and Posterior Wiring. The aim of
study is to evaluate clinical and radiological outcomes in subjects
with Atlanto-Axial Instability, operated using Trans-Articular
Screws and iliac crest bone graft, without Sub-Laminar wiring
(Modified Magerl's Technique).
Materials and methods: We retrospectively evaluated 38 subjects
with Atlanto-Axial instability, operated with modified technique.
Pain, fusion rates, neurological status and radiographic outcomes
were followed up. Final outcome was graded both subjectively and
objectively.
Results: Instability in 34 subjects was secondary to trauma, 3 due
to rheumatoid arthritis and 1 tuberculosis. Neurological deficit was
present in 17 subjects. Most common presenting symptom was
neck pain in 35 of 38 subjects. Postoperatively, residual neck pain
was present in 8 subjects. Neurological deficit persisted in only 7
subjects. Vertebral artery injury was seen in 3 subjects. None had
any neurological deficit or vertebral insufficiency. 3 cases had
nonunion. At follow up, subjectively, 24 subjects had good result, 6
fair and 8 bad result. On objective grading, 24 had good result, 11
fair and 3 bad result. Mean follow up was 41 months.
Conclusions: Trans-Articular screw fixation is an excellent tech-
nique for Atlanto-Axial complex fusion. It provides highest fusion
rates, and is important in subjects at risk for nonunion. Omitting
posterior wiring used with bone graft in traditional Magerl's
technique achieves equally good fusion rates and is an important
modification, avoiding complications of Sub-Laminar wire
passage.