The delay in union was noticed in 1 patient with severe communition
and extensive soft tissue injury.
Karnezis et al (17) have showed that fractures with intra articular communition
is associated with restricted wrist palmar flexion, dorsiflexion, and increased patient rated wrist evaluation score.
11-13) Variables which are not in control of surgeon includes vascular damage from initial neck fracture, fracture classification, (14) quality of bone and posterior communition
(9) and delay in seeking medical attention.
Three dimenstional CT imaging was done particularly for subtrochanteric fractures to assess the level of communition
and entry point at the greater trochanter.
THE AMOUNT OF COMMUNITION
IS NOT A PROBLEM FOR USING THE GAMMA NAIL.
of greater trochanter: Communition
of greater trochanter leads to technical difficulty in passing nail and nail entry point may get lateralized, and tip of trochanter can get splayed.
Intra articular calcaneum fracture with communition
remains a challenge to the treating orthopedic surgeon.
The functional outcome of patella fractures depends upon such variables as age, severity of communition
, treatment modality adopted, accurate and stable restoration of articular congruity, post-operative management including early mobilization, etc.
Functional outcome is poor in patients > 60 years and this should be considered in patient selection along with communition
and bone quality.
Fully weight bearing was started at 8 weeks except for 4 patients who were non-compliant in following the physiotherapy, due to increased communition
and other comorbid condition.
It was probably due to communition
of underlying osteoporotic bone which may go impaction at the fracture site after reduction leading to varus malunion.
One patient in the interlocking nailing group had communition
at the fracture site during nail insertion.