Hospital Stay of Patient: Supracondylar and Intercondylar Fractures of the Distal Femur

 

Singh Sanat*, Thakur Amit K., K.K. Singh, Shrivastava, P.K. and  Netam Sujata.

Govt. Medical College, Jagdalpur ( Bastar ) – 494001 INDIA.

ABSTRACT:

Back ground: Over all, India reported 418 accidental deaths a day in 2009 an increased by 7.3 % compared to 2008 as per National Crime Records Bureau’s annual report of deaths and suicides across the country. Objective: To assesstime taken from accident to discharge from the hospital. Study design: Cross sectional Setting: Indoor Orthopedic and ward of a tertiary hospital Sample Size: Thirty patients of both sexes of the fracture of lower femur (supracondyler and intercondyler) admitted in a tertiary hospital. Statistical Analysis: Simple proportion. Findings: 36.66% of patients were operated on or before five days of accident, only 13.33% patients were operated after two weeks this may because of the associated injury or medical complications like diabetes and/or hypertension, 50% of the patients discharge from the hospital on or before seven days of the operation, only 6.7% patients took more than 35 days in their discharge. Conclusion: there is an urgent need to conduct Continuous Medical Education (C.M.E) all concerned on “rational use of drugs “to put a full stop on development of resistance against the drugs otherwise patients have to suffer a lot and the treatment will be beyond the reach of the most of the patients which ultimately harm all concerned irrespective of caste, creed, colour, religion, profession rich or poor.

 

KEYWORDS: Rational use of drugs, Superbug, Resistance.

 

INTRODUCTION:

Supracondylar and intercondylar fractures of the distal femur historically have been difficult to treat. These fractures often are unstable and comminuted. Before the development of techniques and implants ot provide stable fixation, these fractures was treated conservatively such as traction and cast bracing. In the 60’s nonoperative treatment methods, such as traction and cast bracing produced better results than the operative treatment because of the lack of adequate internal fixation devices.

With the advent of AO method of fixation, better and more reliable internal fixation devices have become available for treatment of these fractures.

 

A previous generation, dazzled by the discovery of X-rays and the transformation it brought about in the diagnosis and treatment of fractures came to rely implicitly upon its findings and all too often made radiological appearance the only criterion of success. The subsequent invention and universal adoption of metallic internal fixation focused attention upon exact reduction even where its achievement was unnecessary and means of obtaining it actually harmful and while it facilitated earlier recovery it sometimes even prevented it.

 

All fractures are inevitably associated with soft tissue damage and in high velocity injury the surgeon has to deal with the explosive effects of deceleration which is spread far beyond the fractures revealed by a radiograph. Success of failure in the treatment of trauma after all depends upon the powers of resilience, recuperation and regeneration of these radiolucent tissues.

Femoral condyles are also commonly fractured by the subject falling from a height or sustaining a crush injury when the knee is flexed. If there is severe displacement of the fractures or if the knee is dislocated the injury may be complicated by compression or rupture of the popliteal vessels. Reduction of the displacement by manipulation, fraction or open operation usually restores the circulation to the foot, but it is occasionally necessary to explore the popliteal fossa and repair or ligate the vessels.

 

MATERIAL AND METHODS:

One hundred patients admitted in an Orthopedic ward of a medical college hospital were taken as samples. Variables e.g. time taken from injury took place to the operation was performed in days and the patients remain admitted in the hospital after operation in weeks. The data was collected in a pre drawn pre tested proforma .Analysis was conducted and presented in tabular form. Statistical analysis was done in form of simple proportion.

 

Seinsheimer (2) gave the following classification for fractures of the distal femur:

Group     1 - A       :              Un-displaced crack

                                             Supracondylar fracture

               1 - B       :              Un-displaced comminuted

                                             Supracondylar fractures

Group     2 - A       :              Displaced supracondylar                                                                  fracture

               2 - B       :              Displaced comminuted

                                             Supracondylar fractures

Group     3 - A       :              Fracture medial Condyle

               3 - B       :              Fracture lateral Condyle

               3 - C       :              T - Y inter-condylar fractures

Group     4 - A       :              Displaced fracture lateral                                                                 epicondyle

               4 - B       :              Comminuted fracture of                                                                  articular end femur with                                                                    medial displacement

               4 - C       :              Comminuted fracture of                                                                  articular end femur with                                                                    lateral displacement

               4 - D       :              Displaced fracture medial                                                                epicondyle

 

Shelbourne gave following classification:

Type - I T or Y shaped intercondylar fracture

Type - II                Transverse fracture

Type - III              Oblique fracture

Type - IV              Spiral fracture

Type - V                Comminuted fracture with large                                                      fragments.

 

Muller’s classification updated by the AO group and adopted by the orthopaedic trauma association.

Type       A            -              Extra articular

               A1           -              Simple (two part)

               A2           -              Metaphyseal wedge

               A3           -              Metaphyseal complex                                                                      (comminuted)

Type       B            -              Partial articular (uncondylar)

               B1           -              Lateral condyle (fracture in                                                                            sagittal plane)

               B2           -              Medial condyle (fracture in                                                                            sagittal plane)

               B3           -              Frontal (fracture in coronal                                                              plane)

Type       C            -              Complete articular                                                                            (Biocondylar)

               C1           -              Articular simple and                                                                         metaphyseal simple

                                             (T or Y fracture pattern)

               C2           -              Articular simple and                                                                         metaphyseal multi-                                                            fragmentary

               C3           -              Multi-fragmentary articular

 

Fairbank (3) divided condylar fractures of the femur which can in general be divided into: -

(i)      The complete ‘mush’ where a poor result will follow any treatment.

(ii)    Y – Shaped fracture.

(iii)   Isolated fracture of one condyle usually the lateral which is forced upwards and is often rotated.

 

FINDINGS:

On analysis of the collected data it was revealed that average age of patients was 40 years and the male to female ratio was 2.3: 1.On further analysis (Table –I ) shows that maqximumj proportion of cases (36.66 % ) who were injured took 0 to 5 days for the operation while 30.00 % took 6 to 10 days followed by 20.00 %from 11 to 14 days. In 13.33 %cases operation was conducted even after 2 weeks. (Table –II) reveals that 50.00 % of the cases were discharged from the hospital on or with in 7 days of their admission, followed by 30.00%, those took 8 to 14 days while 10 .00% were discharged within 15 to 21 days. Table further shows that 6.67 % patients waited in the hospital for discharge even more than 30 days .Only 3.33 % were discharge from the hospital within 22 to 28 days .

 

 

Table – I: Duration from injury to operation

Duration in Day

Number of Patients

Percentage (%)

0 - 5

11

6.67

6 - 10

9

30

11 - 14

6

20

> 2 weeks

4

13.33

Total

30

100.0

 

 

 

Table – II: Duration of postoperative hospitalization

Duration in Day

Number of Patients

Percentage (%)

0 - 7

15

50

8 - 14

9

30

15 - 21

3

10

22 - 28

1

3.33

29 - 35

-

-

> 35

2

6.67

Total

30

100.0

 

 

INTERPRETATION:

Most of the patients were operated within 1to 2 weeks of injury .Patients who sustained compound injuries were operated earlies when their condition become stable .Many patients were having some medical illnesses like Diabetes and hypertension, which required proper management before Surgery.

 

Being a Government hospital, having excessive work load it was not possible to operate these patients immediately after admission .In the present study most of the patients were discharged from the hospital within two weeks after Surgery. Patients in whom any complication was noted were first treated and then make discharged. A few patients were discharged later because of associated injuries which required longer hospitalization.

 

High end antibiotics should be used with discretion. It’s important that before starting broad spectrum therapy, cultures should be taken so that the therapy can be tailored down to focused, narrower spectrum antibiotics within 48 hours (4) .Random popping of pills would make people immune to the last available antibiotic’s generation .It is of utmost important that antibiotics are prescribed judiciously .The time has come now to curb down irrational use of antibiotics. This will ensure that people will not gain resistance to the antibiotics.

 

Self-prescription, overuse of drugs increases resistance risk (4) Development of drug resistance in bacteria is a tussle between science and nature. While an antibiotic kills bacteria or slows down their growth, natural selection equips them in developing traits which aid survival and reproduction. Natural selection, a key mechanism of evolution, is also one of the main processes which creates genetically-heritable traits or characteristics which pass from one generation to the next.

 

If a group of bacteria is exposed to some antibiotic, it is possible that a few of them will possess a better survival and reproduction mechanism than the others. This information stored in a bacterum’s gene (unit of heredity) can pass process can ultimately result in the development of complete resistance against the particular antibiotic in all members of the group. If a bacterium carries several resistance genes then it becomes multi-resistant, commonly known as a ‘superbug’.

 

It is generally observed that a larger duration of exposure to an antibiotic increases the risk of development of resistance. The wide-spread use of antibiotics has played an important role in evolution of the drug resistant bacterium. Apart from being used as medicine for humans, antibiotics are also used on farm animals either to treat diseases or for promoting growth, which increase the exposure of bacteria to the drug.

 

Inappropriate treatment , overuse, self-prescription, failure in completing the prescribed course and misuse – like taking antibiotics to treat common colds, which is actually a viral infection – result in the undue exposure of bacteria to the drug  facilitating the evolution of antibiotic-resistant population. It is also observed that the inappropriate disposal of pharmaceutical industry waste may result in environmental pollution with broad spectrum antibiotics helping bacteria develop resistance.

 

From above observations and discussions the authors reached to the conclusion that an awareness drive of the community about the various aspects of the disease particularly early diagnosis and prompt and complete treatment which will be help full in complete cure of the disease and thus there will be a check on the prevention of recurrence and chronicity of the infection. Similarly there is an urgent need to conduct Continuous Medical Education (C.M.E) at regular interval of all concerned on “rational use of drugs “to put a full stop on development of resistance against the drugs otherwise patients have to suffer a lot and the treatment will be beyond the reach of the most of the patients which ultimately harm all concerned irrespective of caste, creed, colour, religion, profession rich or poor.

 

ACKNOWLEDGEMENT:

The authors express their cordial thanks to Mr. Anand Singh Kanwar, Lab-Technician, Dept. of Community Medicine, Govt. Medical College, Jagdalpur (C.G.) for his neat and excellent typing.

 

REFERENCES:

1.       Garg Narendra K. Evaluation of the impact of emesis and emesis plus purgation therapy; Research J. Pharmacology and Pharmacodynamics: 2 (2) March – April 2010; 201-202.

2.       Seinsheimer ,Frank III –Fracture of the distal Femur; Clin. Ortho; 153:169 -179:1980.

3.       Fairbank, T. J. – Condylar fractures of the knee joint, Surg. Gynaec. and Obst. 57; 658-667, 1933.

4.       Superbug highlights need for antibiotics policy; The Times of India, New Delhi, Tuesday, 17th August, 2010; pp-07.

5.       Bansal A.K. and Chandorkar R.K. Impact of I.C.D.S. on morbidity due to Nutritional deficiency Diseases amongst Tribe and Non Tribe Children; Research J Science and Tech.; 2009: 1(2); 82-84.

6.       Bansal A.K. and Chandorkar R.K. (1993) knowledge, Belief and Practice: A study of Tribal mothers about feeding of infants; Tribal Health Bulletine (ICMR); Vol. – 2, No. – 3 and 4: 1-2.

7.       Bansal A.K., Agarwal Ashok K. and Govila A.K. (1998-99) Status of girl child amongst Tribal and Non Tribal in the unreached rural India; J. Ravi Shankar uni; Vol. – 11-12, No.-B (Science) 31-36.

8.       Bansal A.K.; Health of the Tribal and Non Tribal Elderly; Souvenir International Union for Health Promotion and Education, Meeting of Board of Trustees and Conference; 2-7 April, 2000, Mysore, India; pp-113.

 

Received on 25.05.2009

Modified on 20.06.2011

Accepted on 29.06.2011                                               

© A&V Publication all right reserved

Research J. Pharmacology and Pharmacodynamics. 4(2): March - April, 2012, 108-110