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1.  Non-union scaphoid: Four-corner fusion of the wrist 
Indian Journal of Orthopaedics  2010;44(2):208-211.
Background:
Four-corner fusion of the wrist is an option for management of non-union scaphoid with painful arthritis of the wrist. Various surgical techniques have been devised for four-corner fusion, with inconsistent results. We present our experience of four-corner fusion achieved using a standard H-plate, designed originally for anterior cervical plating.
Materials and Methods:
The study is a retrospective analysis of six cases of painful wrist arthritis resulting from nonunion of scaphoid treated by four-corner fusion, between 1996 and 2004. The average duration of follow-up was 5.8 years. Each patient was evaluated clinically according to the rating scales described by Bach.
Results:
The mean grip-strength calculated as a percentage of the uninvolved side was 47% pre-operatively, and 74% post- operatively at the final follow-up. The difference between the preoperative and postoperative ‘pain ratings’ and ‘activity ratings’ was found to be statistically significant (P<0.001). Mean time to fusion was 16.1 weeks. Dorsal impingement was the most common associated problem.
Conclusions:
H-plate, used for four-corner fusion, provides rigid fixation, ensures fusion, and is a good alternative to the available options.
doi:10.4103/0019-5413.61908
PMCID: PMC2856398  PMID: 20419010
Four corner fusion; Cervical H-plate; nonunion scaphoid
2.  Results of operative treatment of acetabular fractures from the Third World—how local factors affect the outcome 
International Orthopaedics  2007;33(2):347-352.
The objective of this study was to assess the outcome of operations on acetabular fractures from a developing country in the presence of locally available facilities. Sixty-three acetabular fractures were assessed at an average follow up of 52.94 months after operation. Twenty-six patients operated upon in the first three years and 37 operated thereafter were separately studied to discover the effect of the learning curve. Regarding the fractures, 47 of 63 (74.6%) had excellent/good results (Harris Hip Score>80). The complications included broken drill bit in eight patients (12.69%), deep infection and heterotopic ossification in five patients (7.93%), avascular necrosis and sciatic nerve palsy in two patients (3.17%) and implant failure in one patient (1.58%). The results collected during the learning curve were inferior in the complex fractures (p value<0.001). Complications were common in patients opting for local implants and in those operated after over 2 weeks delay.
doi:10.1007/s00264-007-0461-3
PMCID: PMC2899060  PMID: 17940767

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