<p> RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA BANGALORE, KARNATAKA ANNEXURE – II PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION 1 Name of the Candidate and Address Dr. MRUTYUNJAYA TADAHAL (in Block Letters) C/o B.B. TADAHAL MAHANTESH NAGAR RAMDURG DIST: BELGAUM, PIN 591 123 2 Name of the Institution J.J.M. MEDICAL COLLEGE DAVANGERE – 577 004, KARNATAKA 3 Course of Study and Subject POSTGRADUATE DEGREE M.S ORTHOPAEDICS 4 Date of Admission to Course 31.05.2011 5 Title of the Topic “SURGICAL MANAGEMENT OF DIAPHYSEAL FRACTURE OF HUMERUS BY INTRAMEDULLARY INTERLOCKING NAIL IN ADULTS” 6 BRIEF RESUME OF THE INTENDED WORK: 6.1 Need for the study: Operative management of fracture shaft humerus can be with plate osteosynthesis or with interlocking nail1,2. As the interlocking nail can be introduced in a closed manner they preserve the fracture haematoma, providing early fracture consolidation with higher union rates and low infection rates. Interlocking nailing achieves rotational stability providing early mobilisation of the neighbouring joints1,5. But with antegrade nailing they do have a disadvantage of causing shoulder stiffness.5 In this study we have tried to analyse outcomes in terms of time for consolidation, union rates, functional results and complications of humeral shaft fractures managed with closed antegrade intramedullary interlocking nail.</p><p>6.2 Review of Literature In 1897, Nicolaysen described the principles of medullary fixations of fractures of long bones.12 In1907, Albin Lambotte, a Belgian surgeon regarded universally as the “FATHER OF MODERN INTERNAL AND EXTERNAL FIXATION “coined the term “OSTEOSYNTHESIS”.9 In 1918, Hey Groves demonstrated the technique of intramedullary nailing for fracture shaft of long bones. In 1939, Kuntscher of Hamberg used a long V-shaped nail, introduced from the end of bone across the fracture site without exposure of fracture fragments with the aid of guide wire under fluoroscopic guidance.14 In 1939, Rush has used Steinman pin in the medullary canal of long bones. In 1958, Dr. Muller along with a group of Swiss surgeons formed a study group the AO group also known as Asif-Asociation For Study Of Internal Fixation in English speaking countries.This group dedicated itself to research into osteosynthesis.17 In 1980, intramedullary fixation of fractures of shaft of humerus using ender nailing was done.3 In 1986, Brambock et al reported 63 humerus shaft fractures in patients with polytrauma which were stabilised with Rush nails or Enders nail. Results showed 94% of fractures united at an average of 10.5 weeks and 62% patient had excellent clinical results.3 In 1987, Hall and Pankowich reported a prospective series of 89 humerus shaft fractures stabilised with ender nails. The authors concluded that closed intramedullary ender nailing could be performed safely and effectively in selected humeral shaft fractures. In 1989, Siedel developed locking nail for the humerus. It has distal locking mechanism with fin fixation.8 In 1992, Russell et al introduced Russell-Taylor intramedullary interlocking nail. They reported 51 interlocked humerus nailing with 100% union rate in acute fractures.2 In 1993, Crolla et al reported Seidel interlocked humeral nailing in 46 patients and obtained satisfactory results with all the acute fractures uniting by 12 weeks. Conclusion was that Seidel nail is an effective addition to the current methods available for operative management of humerus shaft fractures. In 1994, Ikpeme treated 39 patients of humeral shaft fractures at various levels with intramedullary interlocking nail. All patients had excellent and satisfactory shoulder function. Pain was relieved in all pathological fractures. Shoulder pain encountered in a few patients where nailing was performed by antegrade route was mainly due to problems of proximal interlocking screws. In 1996, Redmond et al reported a retrospective study of 13 patients with pathological fractures of humerus shaft fractures stabilised by intramedullary interlocking nail by closed technique. The authors concluded that interlocking intramedullary nailing of the humerus for the pathological fracture provides immediate stability and can be accomplished with a closed technique, brief operative time and minimum morbidity with a resultant early return of function of extremity. In 2000, Jinn Lin et al reported 41 consecutive patients with 13 delayed and 28 non unions treated with humeral locked nails. They concluded that humeral locked nailing seems to be effective for humeral delayed or non-unions. It may be an acceptable alternative for fractures unsuitable for plate fixations, such as those with comminution, osteoporosis or a severely adhered radial nerve. In 2004, petsatodes et al studied the results of 89 patients with humeral shaft fractures ,in 37patients treated with antegrade locked nailing. They concluded that this method offers a dependable solution for the treatment of humeral shaft fractures especially in polytrauma patients and cases of segmental and pathological fractures. In 2005, Demirel M et al reported on a retrospective study of 114 patients treated with interlocking nail for humeral shaft fractures. Union was achieved in 109 patients. They concluded that antegrade locked nailing in humeral shaft fractures is reliable and also effective in multiply injured patients. In 2007, Thonse et al used antibiotic cement-coated interlocking nail for the treatment of infected non unionand segmental bone defects in 20 patients and achieved control of infection and stability of fracture to promote union, which has traditionally been provided by two separate procedures.</p><p>In 2008, Jin et al in an endeavour to improve post-operative shoulder function and pain after antegrade intramedullary nailing of humerus fracture, modified the surgical approach and entry point for the procedure. The upper end of the humerus was approached through the rotator cuff interval between supraspinatus and subscapularis.which makes the entry portal medial to conventional site. Additionally the upper end of the nail was cautiously buried deep in the head of the humerus below the articular cartilage.</p><p>6.3 Objectives of the Study: The purpose of our study is to  Study the functional outcome after interlocking nail for fracture shaft humerus.  To study time of union and union rates  Study the complications after treatment of fracture shaft of humerus with interlocking nail.</p><p>7. MATERIALS AND METHODS Our prospective study is a series of 20 cases of traumatic fracture of humeral shaft treated with closed antegrade intramedullary interlocking nailing. This study was conducted over a period of 2 years i.e., from July 2011 to September 2013.</p><p>7.1 Source of Data: Patients of both sex belonging to adult age group presenting with fracture shaft humerus to the Orthopaedic Department of Bapuji and Chigateri District Hospital attached to J.J.M. Medical College Davangere.</p><p>7.2 Method of collection of Data (including sampling procedures if any):  Sample size : 20 adult patients with: who are willing for surgery for surgery are admitted during the period of study. they are clinically and radiologically evaluated. Laboratory investigation will be carried out before surgery. Informed and written consent of the patient will be taken for the surgical management.</p><p>Inclusion Criteria: Patients were selected upon following criteria 1. Greater than 18 years of age 2. Diagnosed with fracture shaft of humerus and willing for surgery.</p><p>Exclusion Criteria:  Patients aged less than 18 years of age  Patients having an associated radial nerve palsy  Patients who are medically unfit for surgery.</p><p>Statistical Test: The collected data will be evaluated using appropriate statistical methods</p><p>7.3 Does the Study require any investigations or interventions to be conducted on patients or other humans or animals? If so please describe briefly. YES Investigations . Routine Investigations For All Cases Like</p><p>. Haemoglobin % . Total WBC Count, Differential WBC Count . ESR . Blood Grouping And Rh Typing . Bleeding Time And Clotting Time . Random Blood Sugar . Blood Urea . Serum Creatinine . HIV I & HIV II . HbsAg . ECG . Plain X Ray</p><p> Special Investigation </p><p>7.4 Has ethical clearance been obtained from your institution in case of 7.3? YES 8. LIST OF REFERENCES: 1. ldiaphyseal fractures: A preliminary report. Orthopedics 1991; 14:239-46. 2. McKee. Fractures of the Shaft of the Humerus. Rockwood & Green's Fractures in Adults, 6th Edition, Lippincott 2006: p. 1118-59 3. Wilson JN. Operative reduction of fractures. Chap-16 in Watson-Jones 4. Fractures and Joint Injuries. Vol I, 6th edition, B.I. Churchill Livingstone Pvt. Ltd. New Delhi 1992: p. 364-94. 5. Brinker MR, O’Connor DP. The incidence of fractures and dislocations referred for orthopaedic services in a capitated population. J Bone Joint Surg Am 2004; 86: 290-7. 3. Colton CL, Fernandez A, Holz U, Kellam JF, Ochsner PE. AO Principles of Fracture Management: AO Publishers; 2000: p. 1-7. 4. Klenerman L. Fractures of the shaft humerus. J Bone Joint Surg Br 1966; 48:105-11. 5. Zuckerman JD, Koval KJ. Fractures of the shaft of the humerus. Chap 15, In Rockwood and Green Fractures in Adults. 4th ed. Philadelphia, PA: JB Lippincott 1996: p. 1025-51. 6. Ghromley RK, Mroz R J. Fractures of humerus, End results after treatment. Surg. Gynaecol & Obst 1933; 60: 730. 7. Steward MJ, Hundley J. Fractures of humerus. A comparative study in methods of treatment. J Bone Joint Surg Am 1955; 37A: 681. 8. Stewart JDM, Hallet JP. Splinting and casting materials. Chapter 13: In Traction and orthopaedic appliances 2nd edition, New Delhi, B.I. Churchill Livingstone, 1993: p. 195. 9. Colton C. History of Osteosynthesis. Chapter 2. In: AO/ASIF Instruments and Implants. 2nd edition, New York: Springer- Verlag; 1999. p. 3-5 10. Caldwell JA. Treatment of fractures of the shaft of the humerus by Hanging Cast. Surg Gynecol Obst 1940; 70: 421-5. 11. Chandler RN. Principles of internal fixation. Chap-3 in Rockwood CA Jr. (edt.). Rockwood and Green's Fractures in Adults. Vol. 1 4th edition, Philadelphia. Lippincott Raven; 1996. p.159. 12. Thakur AJ. Bone Plates Chapter 4. In: The Elements of Fracture Fixation. New York: Churchill Livingstone; 1999.p. 57. 13. Henley MB, Chapman JR, Claudi BF. Closed retrograde Hackethal nail 14. Henley MB, Chapman JR, Claudi BF. Closed retrograde Hackethal nail stabilization of humeral shaft fractures. J. Ortho Trauma 1992; 6:18-24. 15. Holstein A, Lewis LB. Fractures of the humerus with radial nerve paralysis. J Bone and Joint Surg Am 1963; 45A (7): 1382-88. 16. Gilchrist DK. A stockinet Velpeau for immobilization of the shoulder Girdle. J Bone Joint Surg 1967; 49A: 750-1. 17. Sarmiento A, Kinman PB, Galvin EG, Schmitt RH, Phillips JG. Functional bracing of fractures of the shaft the humerus. J Bone Joint Surg 1977; 59A: 596-601. 18. Stern PJ, Mattingly DA, Pomery DL, Zenni EJ Jr., Kreig JK. Intramedullary fixation of humeral shaft fractures. J Bone Joint Surg 1984; 66A: 639-46. 19. Bell MJ, Beauchamp CG, Kellam JK, McMurty RY. The results of plating humeral shaft fractures in patients with multiple injuries: The Sunnybrook Experience. J Bone Joint Surg 1985; 67B: 293-6. 20. Brumback RJ, Bosse MJ, Poka A, Burgess AR. Intramedullary stabilization of humeral shaft fractures in patients with multiple trauma. J Bone Joint Surg 1986; 68A: 960-70. 21. Hall RF, Pankovich AM. Ender nailing of acute fractures of the humerus.A study of closed fixation by intramedullary nails without reaming. J Bone Joint Surg 1987; 69A: 558-67. 22. Seidel H. Humeral locking nail: A preliminary report. Orthopaedics 1989; 12:219-26. 23. Robinson CM, Bell KM, Court-Brown CM, McQueen MM. Locked nailing of humeral shaft fractures: experience in Edinburgh over a two year period. J Bone Joint Surg 1992; 74B: 558-62. 24. Ingman AM, Waters DA. Locked intramedullary nailing of humeral shaft fractures: Implant design, Surgical technique and Clinical results. J Bone Joint Surg 1994; 76B: 23-9. 25. Rommens PM, Verbruggen J, Broos PL. Retrograde locked nailing of humeral shaft fractures. 26. Redmond BJ, Bierman JS, Blasier RB, Michigan A. Interlocking Intramedullary nailing of Pathological fracture of the shaft of humerus. J Bone Joint Surg 1996; 78A (6): 891-6. 27. Chaurasia BD. The Arm. Chap 8 in Inderbir Singh (edt.). Human Anatomy. Vol. I. 2nd edition, New Delhi. CBS Publishers and Distributors 1989; 28. Stanley S. Muscle, Chapter 7. In: Gray’s Anatomy. 38th Ed., William PL, London: Churchill Livingstone, 2000, p. 737 29. Thakur AJ. The elements of fracture fixation. Churchill Livingstone 1997; 1: p. 81-104. 9. Signature of the Candidate</p><p>10. Remarks of the Guide This is a new study with the aim of studying complications and a outcome of the procedure. 11. Name & Designation(in block letters) 11.1 Guide Dr. G.C. BASAVARAJ M.S (ORTHO), FAS (USA) PROFESSOR AND UNIT CHIEF DEPARTMENT OF ORTHOPEDICS J.J.M. MEDICAL COLLEGE, DAVANGERE – 577004</p><p>11.2 Signature</p><p>11.3 Co-Guide (If any)</p><p>11.4 Signature</p><p>11.5 Head of the Department Dr. G. NAGARAJ M.S Ortho PROFESSOR & H.O.D DEPARTMENT OF ORTHOPEDICS J.J.M.MEDICAL COLLEGE, DAVANGERE-577004</p><p>11.6 Signature 12 12.1 Remarks of the Chairman & the Principal</p><p>12.2 Signature From: Dr. Mrutyunjaya Tadahal Post Graduate, Department Of Orthopaedics, J.J.M Medical College, Davangere.</p><p>To: The Principal, J.J.M Medical College, Davangere.</p><p>(Through Proper Channel)</p><p>Respected Sir, Sub: submission of proforma for registration of subject for dissertation. ------–</p><p>I am here with submitting my synopsis for registration of dissertation titled. Kindly forward this to RGUHS, Bangalore.</p><p>Thanking You,</p><p>Yours faithfully,</p><p>[Mrutyunjaya Tadahal]</p><p>Date : Place : Davangere</p>