Traumatic posterior dislocation of hip associated with ipsilateral displaced femoral neck fracture is a rare injury. Moreover, the management of such patients evokes strong views regarding primary replacement or prese...Traumatic posterior dislocation of hip associated with ipsilateral displaced femoral neck fracture is a rare injury. Moreover, the management of such patients evokes strong views regarding primary replacement or preserving the femoral head. We presented a case of young adult with such an injury. He was operated upon with reduction of the dislocation and fixation of femoral neck fracture with the help of cancellous screws. Two years later, the fracture had united and the patient was asymptomatic. We further proposed the mechanism of injury for such a fracture and discussed the management in the changing trauma scenario of the developing world.展开更多
Purpose： Cerclage wire application has emerged as a potential therapeutic adjunct to intramedullary nailing for subtrochanteric fractures. But its popularity is plagued by the concern of possible negative effect on f...Purpose： Cerclage wire application has emerged as a potential therapeutic adjunct to intramedullary nailing for subtrochanteric fractures. But its popularity is plagued by the concern of possible negative effect on fracture zone biology. This study was intended to analyze the clinico-radiological outcome and complications associated with cerclage wire application. Methods： Retrospective analysis was performed on all the subtrochanteric fractures operated with intramedullary nailing between January 2012 and January 2016. After exclusion, 48 patients were available with an average follow-up of 20.8 months. Long oblique, spiral, spiral wedge or comminuted fracture configurations with butterfly fragments were particularly considered for cerclage wire appli- cation, which was employed by percutaneous cerclage passer in 21 patients. Assessment was done in terms of operation time, blood loss, quality of reduction, neck-shaft angle, follow-up redisplacement, union time, complications, and final functional evaluation by Merle d＇Aubigne＇-Postel score. Results： Average operation time and blood loss were significantly higher in cerclage group （p 〈 0.05）. However, cerclage use substantially improved quality of reduction in terms of maximum cortical displacement （p = 0.003） and fracture angulation （p - 0.045）; anatomical reduction was achieved in 95.23% of cases as compared to 74.07% without cerclage. Union time was shorter, although not statis- tically different （p - 0.208）, in cerclage group. Four patients in non-cerclage group developed non-union, 2 of them had nail breakage. No infection or any other implant related complications were reported with cerclage use. Conclusion： Minimally-invasive cerclage wire application has proved to be beneficial for anatomical reconstruction in difficult subtrochanteric fractures, whenever applicable, without any harmful effect on fracture biology.展开更多
Purpose:Hip fractures in elderly have a high mortality.However,there is limited literature on the excess mortality seen in hip fractures compared to the normal population.The purpose of this study was to compare the m...Purpose:Hip fractures in elderly have a high mortality.However,there is limited literature on the excess mortality seen in hip fractures compared to the normal population.The purpose of this study was to compare the mortality of hip fractures with that of age and gender matched Indian population.Methods:There are 283 patients with hip fractures aged above 50 years admitted at single centre prospectively enrolled in this study.Patients were followed up for 1 year and the follow-up record was available for 279 patients.Mortality was assessed during the follow-up from chart review and/or by telephonic interview.One-year mortality of Indian population was obtained from public databases.Standardized mortality ratio(SMR)(observed mortality divided by expected mortality)was calculated.Kaplan-Meir analysis was used.Results:The overall 1-year mortality was 19.0%(53/279).Mortality increased with age(p<0.001)and the highest mortality was seen in those above 80 years(aged 50-59 years:5.0%,aged 60-69 years:19.7%,aged 70-79 years:15.8%,and aged over 80 years:33.3%).Expected mortality of Indian population of similar age and gender profile was 3.7%,giving a SMR of 5.5.SMR for different age quintiles were:3.9(aged 50-59 years),6.6(aged 60-69 years),2.2(aged 70-79 years);and 2.0(aged over 80 years).SMR in males and females were 5.7 and 5.3,respectively.Conclusions:Indian patients sustaining hip fractures were about 5 times more likely to die than the general population.Although mortality rates increased with age,the highest excess mortality was seen in relatively younger patients.Hip fracture mortality was even higher than that of myocardial infarction,breast cancer,and cervical cancer.展开更多
<strong>Backgroun</strong><strong>d</strong><strong>:</strong> Obstructive sleep apnea (OSA) has cardiovascular, neurological, and social complications. Surgical treatment has the p...<strong>Backgroun</strong><strong>d</strong><strong>:</strong> Obstructive sleep apnea (OSA) has cardiovascular, neurological, and social complications. Surgical treatment has the potential to improve airway patency but when and which surgery should be done is a controversy. <strong>Aims and objective<strong>s</strong></strong><strong>:</strong> To estimate the site of obstruction in patients with OSAS and to assess the surgical results of the site (of obstruction) directed surgical treatment.<strong> Methodology: </strong>Twenty patients with OSAS were included in the study with Eight adults and Twelve children. It was a prospective study. All patients were assessed for the airway collapse and surgery was done accordingly. Repeat PSG was done after surgery for success rate after 4 months of follow up. <strong>Result:</strong> 17 patients successfully completed the follow-up. Four (50%) adults and Two (17%) children have grade I or II tonsils while Four (50%) of adults and Ten (83%) children have tonsil size grade III or IV. Seven (88%) adults and one (8%) of the children have adenoid hypertrophy up to grade II. One adult (12%) and nine children (75%) have grade III Adenoid size. Two children (17%) have Adenoid grade IV size. In Four patients retropalatal more than retroglossal collapse was found (50%). One patient (12%) had retroglossal more than retropalatal collapse other one had only retropalatal collapse, and the other one had retroglossal collapse. ESS (Epworth sleepiness scale) decreased postoperatively in both groups. There is a significant change in AHI with the median pre-op AHI being 40.19 to median post-op AHI being 11.35 with a p-value 0.017. Apnea-hypopnea index (AHI) in children pre-operatively was 12.98 (median) changed to 2.15 (median) which is statistically significant. Only one adult patient (12%) is surgically cured while in five patients (63%) surgical success achieved with a surgical success rate of 5/8 (63%). Whereas only one patient is surgically cured 1/8 (13%). Eight patients achieved su展开更多
Intracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fra...Intracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fracture table is a prerequisite to facilitate fracture manipulation, traction, reduction and fluoroscopy assessment. However, positioning the limbs of bilateral above-knee amputees for internal fixation of related proximal femoral fractures is a difficult task, which requires customized inventory for effective limb positioning and fracture manipulation. This study reported a rare case following a crush injury of bilateral lower limb in a road traffic accident, and described some technical tips of acute femoral neck fractures in bilateral above-knee amputation. The patient was managed with immediate guillotine amputation and later secondary wound closure followed by internal fixation of the right-sided femoral neck fracture with multiple cancellous cannulated screws.展开更多
Purpose: Fat embolism syndrome (FES) is systemic manifestation of fat emboli in the circulation seen mostly after long bone fractures. FES is considered a lethal complication of trauma. There are various case reports ...Purpose: Fat embolism syndrome (FES) is systemic manifestation of fat emboli in the circulation seen mostly after long bone fractures. FES is considered a lethal complication of trauma. There are various case reports and series describing FES. Here we describe the clinical characteristics, management in ICU and outcome of these patients in level I trauma center in a span of 6 months. Methods: In this prospective study, analysis of all the patients with FES admitted in our polytrauma intensive care unit (ICU) of level I trauma center over a period of 6 months (from August 2017 to January 2018) was done. Demographic data, clinical features, management in ICU and outcome were analyzed. Results: We admitted 10 cases of FES. The mean age of patients was 31.2 years. The mean duration from time of injury to onset of symptoms was 56 h. All patients presented with hypoxemia and petechiae but central nervous system symptoms were present in 70% of patients. The mean duration of mechanical ventilation was 11.7 days and the mean length of ICU stay was 14.7 days. There was excellent recovery among patients with no neurological deficit. Conclusion: FES is considered a lethal complication of trauma but timely management can result in favorable outcome. FES can occur even after fixation of the fracture. Hypoxia is the most common and earliest feature of FES followed by CNS manifestations. Any patient presenting with such symptoms should raise the suspicion of FES and mandate early ICU referral.展开更多
Intramedullary interlocking nailing is the gold standard for treatment of tibial shaft fractures. The growing use of intramedullary nailing has resulted in an increased number of tibial nailing in daily clinical pract...Intramedullary interlocking nailing is the gold standard for treatment of tibial shaft fractures. The growing use of intramedullary nailing has resulted in an increased number of tibial nailing in daily clinical practice. Despite adequate surgeon experience, tibial nailing is not without complications if proper techniques are not followed. A case of iatrogenic talar neck and medial malleolus frac- tures during intramedullary nailing of tibia in a 24-year-old male is reported. It is believed to be caused by forceful hammering of insertion zig with foot dorsiflexed. To the best of our knowledge, no such case has been reported in the literature. It is possible to reduce the risk of this complication by adoption of preventive measures.展开更多
Bipolar clavicular dislocation is rare,and therefore its management is contentious.With an increase of patient’s physical demand and a near-normal shoulder function,there has been a shift in the paradigm of its manag...Bipolar clavicular dislocation is rare,and therefore its management is contentious.With an increase of patient’s physical demand and a near-normal shoulder function,there has been a shift in the paradigm of its management from a conservative one to a stabilized one of anatomical open reduction.Proposed methods of fixation have also evolved with the advent of more biological fixation devices,which elude implant or fixation related complications.This case report highlights the salient features of this rare case and details the management options along with the benefits of biological anatomical repair and reconstruction.展开更多
BACKGROUND Assessing academic productivity allows academic departments to identify the strengths of their scholarly contribution and provides an opportunity to evaluate areas for improvement.AIM To provide objective b...BACKGROUND Assessing academic productivity allows academic departments to identify the strengths of their scholarly contribution and provides an opportunity to evaluate areas for improvement.AIM To provide objective benchmarks for departments seeking to enhance academic productivity and identify those with significant improvement in recent past.METHODS Our study retrospectively analyzed a cohort of orthopaedic faculty at United States-based academic orthopaedic programs.5502 full-time orthopaedic faculty representing 178 programs were included in analysis.Variables included for analysis were National Institutes of Health funding(2014-2018),leadership positions in orthopaedic societies(2018),editorial board positions of top orthopaedic journals(2018),total number of publications and Hirsch-index.A weighted algorithm was used to calculate a cumulative score for each academic program.This study was performed at a large,United States medical school.RESULTS All 178 programs included in analysis were evaluated using the comprehensive weighted algorithm.The five institutions with the highest cumulative score,in decreasing order,were:Washington University in St.Louis,the Hospital for Special Surgery,Sidney Kimmel Medical College(SKMC)at Thomas Jefferson University,the University of California,San Francisco(UCSF)and Massachusetts General Hospital(MGH)/Brigham and Women’s/Harvard.The five institutions with the highest score per capita,in decreasing order,were:Mayo Clinic(Rochester),Washington University in St.Louis,Rush University,Virginia Commonwealth University(VCU)and MGH/Brigham and Women’s/Harvard.The five academic programs that had the largest improvement in cumulative score from 2013 to 2018,in decreasing order,were:VCU,SKMC at Thomas Jefferson University,UCSF,MGH/Brigham and Women’s/Harvard,and Brown University.CONCLUSION This algorithm can provide orthopaedic departments a means to assess academic productivity,monitor progress,and identify areas for improvement as they seek to expand their academic contribut展开更多
BACKGROUND The exponential rise in Coronavirus disease 2019(COVID-19)cases has resulted in an increased number of patients requiring prolonged ventilatory support and subsequent tracheostomy.With the limited availabil...BACKGROUND The exponential rise in Coronavirus disease 2019(COVID-19)cases has resulted in an increased number of patients requiring prolonged ventilatory support and subsequent tracheostomy.With the limited availability of literature regarding the outcomes of COVID-19 patients with tracheostomy,we attempted to study the clinical characteristics and multiple parameters affecting the outcomes in these patients.AIM To determine all-cause mortality following tracheostomy and its association with various risk factors in COVID-19 patients.METHODS This retrospective study included 73 adult COVID-19 patients admitted to the ICU between 1 April,2020 and 30 September,2021 who underwent tracheostomy as a result of acute respiratory failure due to COVID-19.The data collected included demographics(age,sex),comorbidities,type of oxygen support at admission,severity of COVID-19,complications,and other parameters such as admission to tracheostomy,intubation to tracheostomy,ICU stay,hospital stay,and outcome.RESULTS This study included 73 adult patients with an average age of 52±16.67 years,of which 52%were men.The average time for admission to tracheostomy was 18.12±12.98 days while intubation to tracheostomy was 11.97±9 days.The mortality rate was 71.2%and 28.8%of patients were discharged alive.The mean duration of ICU and hospital stay was 25±11 days and 28.21±11.60 days,respectively.Greater age,severe COVID-19,mechanical ventilation,shock and acute kidney injury were associated with poor prognosis;however,early tracheostomy in intubated patients resulted in better outcomes.CONCLUSION Patients with severe COVID-19 requiring mechanical ventilation have a poor prognosis but patients with early tracheostomy may benefit with no added risk.We recommend that the timing of tracheostomy be decided on a case-by-case basis and a well-designed randomised controlled trial should be performed to elucidate the potential benefit of early tracheostomy in such patients.展开更多
Concomitant dislocation of the tar- sometatarsal and metatarsophalangeal joints of foot is an extremely rare injury. Such injuries presenting in a single or adjacent dual rays have been described in few cases previous...Concomitant dislocation of the tar- sometatarsal and metatarsophalangeal joints of foot is an extremely rare injury. Such injuries presenting in a single or adjacent dual rays have been described in few cases previously. We describe such an injury in adjacent three metatarsals of a polytrauma patient. These injuries are likely to be missed in the initial assessment of a polytrauma patient. These patients are at risk of an overlooked diagnosis but the consequences of missing this type of injury may be quite severe. This case is presented in view of its unique- ness along with possible mechanism of injury, the sequence of reduction and follow-up. Knowledge of such injury and its proper management may be useful to the trauma surgeons展开更多
BACKGROUND: The present study aimed to compare outcome of primary and secondary Illizarov's fi xator application as a treatment method for type III open tibial fractures in terms of nonunion and wound infection.ME...BACKGROUND: The present study aimed to compare outcome of primary and secondary Illizarov's fi xator application as a treatment method for type III open tibial fractures in terms of nonunion and wound infection.METHODS: This prospective study was done in a tertiary care center. Forty-eight type III tibial fractures were treated with Illizarov's apparatus between 2008 and 2011. The patients were divided into two groups depending on the treatment protocol, timing of wound closure and Illizarov's application, primary(n=28) and secondary(n=20).RESULTS: In the primary group, healing was achieved in all 28 patients. The median time to recovery was 24 weeks, and the median number of operations was 3. There were 6 patients with a bone defect. In the secondary group, complete recovery was achieved in 18 out of 20 patients. The median time to recovery was 30 weeks, and the median number of operations 5. There were 9 patients with a bone defect. The median time to recovery and the number of operations were signifi cantly smaller in patients undergoing primary operation. Union was 100% in the primary group and more than 95% in the secondary group. Chronic osteomyelitis persisted in one patient and below amputation was done in one patient in the secondary group.CONCLUSION: Primary wound closure and Illizarov's fixation required a smaller number of operations and shorter time to recovery than secondary wound closure and Illizarov's fi xation, mostly due to a signifi cantly less number of patients with a bone defect in the primary group.展开更多
Dynamic hip/compression screw （DHS/ DCS） is one of the most commonly performed surgeries in orthopaedic practice. Sliding barrel plate over the DHS/DCS lag screw is one of t.he very crucial and at times uncomfor- ta...Dynamic hip/compression screw （DHS/ DCS） is one of the most commonly performed surgeries in orthopaedic practice. Sliding barrel plate over the DHS/DCS lag screw is one of t.he very crucial and at times uncomfor- table and time consuming steps of DHS/DCS surgery espe- cially when it comes to inexperienced surgeons and residents. Also in developing countries where not all stan- dard instrumentation is always available, this crucial step becomes more time consuming. Here we present a case re- port of 58-year-old male patient with intertrochanteric fracture, in which we used a new device for insertion of barrel plate over DHS/DCS lag screw and found that a small DHS/DCS lag screw extension （sliding jig of barrel plate） can be very helpful to slide barrel plate over the DHS/DCS lag screw.展开更多
Background:Regional anaesthesia has been proposed to reduce intraoperative blood loss,duration of hospital stay and in-hospital complications with improved postoperative pain control.General anaesthesia is advantageou...Background:Regional anaesthesia has been proposed to reduce intraoperative blood loss,duration of hospital stay and in-hospital complications with improved postoperative pain control.General anaesthesia is advantageous for prolonged surgeries.We hypothesized that combined regional and general anaesthesia would offer advantages of both in pelvi-acetabular fracture surgeries.Methods:We identified 71 patients who underwent open reduction and internal fixation of pelvi-acetabular fractures from May 2012 to 2013 in our trauma centre.We excluded patients with incomplete records(n=4)and other injuries operated along(n=8).Hence,59 patients were divided into three groups:G group(general anaesthesia),R group(regional anaesthesia)and GR group(combined regional and general anaesthesia).Main outcome measurements studied were intraoperative blood loss,duration of hospital stay,duration of surgery and intraoperative and postoperative complications.Results:No differences were obtained in between the groups in terms of age,gender,Injury Severity Score,number of comorbidities,or duration from injury to surgery.No significant differences were found between the three groups for intraoperative blood loss,days of hospital stay and duration of surgery.Intraoperative and postoperative complications were also comparable between the groups(p>0.05).Conclusions:There is no specific significant advantage of the technique of anaesthesia on the observed perioperative complications in pelvi-acetabular fracture surgeries.展开更多
文摘Traumatic posterior dislocation of hip associated with ipsilateral displaced femoral neck fracture is a rare injury. Moreover, the management of such patients evokes strong views regarding primary replacement or preserving the femoral head. We presented a case of young adult with such an injury. He was operated upon with reduction of the dislocation and fixation of femoral neck fracture with the help of cancellous screws. Two years later, the fracture had united and the patient was asymptomatic. We further proposed the mechanism of injury for such a fracture and discussed the management in the changing trauma scenario of the developing world.
文摘Purpose： Cerclage wire application has emerged as a potential therapeutic adjunct to intramedullary nailing for subtrochanteric fractures. But its popularity is plagued by the concern of possible negative effect on fracture zone biology. This study was intended to analyze the clinico-radiological outcome and complications associated with cerclage wire application. Methods： Retrospective analysis was performed on all the subtrochanteric fractures operated with intramedullary nailing between January 2012 and January 2016. After exclusion, 48 patients were available with an average follow-up of 20.8 months. Long oblique, spiral, spiral wedge or comminuted fracture configurations with butterfly fragments were particularly considered for cerclage wire appli- cation, which was employed by percutaneous cerclage passer in 21 patients. Assessment was done in terms of operation time, blood loss, quality of reduction, neck-shaft angle, follow-up redisplacement, union time, complications, and final functional evaluation by Merle d＇Aubigne＇-Postel score. Results： Average operation time and blood loss were significantly higher in cerclage group （p 〈 0.05）. However, cerclage use substantially improved quality of reduction in terms of maximum cortical displacement （p = 0.003） and fracture angulation （p - 0.045）; anatomical reduction was achieved in 95.23% of cases as compared to 74.07% without cerclage. Union time was shorter, although not statis- tically different （p - 0.208）, in cerclage group. Four patients in non-cerclage group developed non-union, 2 of them had nail breakage. No infection or any other implant related complications were reported with cerclage use. Conclusion： Minimally-invasive cerclage wire application has proved to be beneficial for anatomical reconstruction in difficult subtrochanteric fractures, whenever applicable, without any harmful effect on fracture biology.
文摘Purpose:Hip fractures in elderly have a high mortality.However,there is limited literature on the excess mortality seen in hip fractures compared to the normal population.The purpose of this study was to compare the mortality of hip fractures with that of age and gender matched Indian population.Methods:There are 283 patients with hip fractures aged above 50 years admitted at single centre prospectively enrolled in this study.Patients were followed up for 1 year and the follow-up record was available for 279 patients.Mortality was assessed during the follow-up from chart review and/or by telephonic interview.One-year mortality of Indian population was obtained from public databases.Standardized mortality ratio(SMR)(observed mortality divided by expected mortality)was calculated.Kaplan-Meir analysis was used.Results:The overall 1-year mortality was 19.0%(53/279).Mortality increased with age(p<0.001)and the highest mortality was seen in those above 80 years(aged 50-59 years:5.0%,aged 60-69 years:19.7%,aged 70-79 years:15.8%,and aged over 80 years:33.3%).Expected mortality of Indian population of similar age and gender profile was 3.7%,giving a SMR of 5.5.SMR for different age quintiles were:3.9(aged 50-59 years),6.6(aged 60-69 years),2.2(aged 70-79 years);and 2.0(aged over 80 years).SMR in males and females were 5.7 and 5.3,respectively.Conclusions:Indian patients sustaining hip fractures were about 5 times more likely to die than the general population.Although mortality rates increased with age,the highest excess mortality was seen in relatively younger patients.Hip fracture mortality was even higher than that of myocardial infarction,breast cancer,and cervical cancer.
文摘<strong>Backgroun</strong><strong>d</strong><strong>:</strong> Obstructive sleep apnea (OSA) has cardiovascular, neurological, and social complications. Surgical treatment has the potential to improve airway patency but when and which surgery should be done is a controversy. <strong>Aims and objective<strong>s</strong></strong><strong>:</strong> To estimate the site of obstruction in patients with OSAS and to assess the surgical results of the site (of obstruction) directed surgical treatment.<strong> Methodology: </strong>Twenty patients with OSAS were included in the study with Eight adults and Twelve children. It was a prospective study. All patients were assessed for the airway collapse and surgery was done accordingly. Repeat PSG was done after surgery for success rate after 4 months of follow up. <strong>Result:</strong> 17 patients successfully completed the follow-up. Four (50%) adults and Two (17%) children have grade I or II tonsils while Four (50%) of adults and Ten (83%) children have tonsil size grade III or IV. Seven (88%) adults and one (8%) of the children have adenoid hypertrophy up to grade II. One adult (12%) and nine children (75%) have grade III Adenoid size. Two children (17%) have Adenoid grade IV size. In Four patients retropalatal more than retroglossal collapse was found (50%). One patient (12%) had retroglossal more than retropalatal collapse other one had only retropalatal collapse, and the other one had retroglossal collapse. ESS (Epworth sleepiness scale) decreased postoperatively in both groups. There is a significant change in AHI with the median pre-op AHI being 40.19 to median post-op AHI being 11.35 with a p-value 0.017. Apnea-hypopnea index (AHI) in children pre-operatively was 12.98 (median) changed to 2.15 (median) which is statistically significant. Only one adult patient (12%) is surgically cured while in five patients (63%) surgical success achieved with a surgical success rate of 5/8 (63%). Whereas only one patient is surgically cured 1/8 (13%). Eight patients achieved su
文摘Intracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fracture table is a prerequisite to facilitate fracture manipulation, traction, reduction and fluoroscopy assessment. However, positioning the limbs of bilateral above-knee amputees for internal fixation of related proximal femoral fractures is a difficult task, which requires customized inventory for effective limb positioning and fracture manipulation. This study reported a rare case following a crush injury of bilateral lower limb in a road traffic accident, and described some technical tips of acute femoral neck fractures in bilateral above-knee amputation. The patient was managed with immediate guillotine amputation and later secondary wound closure followed by internal fixation of the right-sided femoral neck fracture with multiple cancellous cannulated screws.
文摘Purpose: Fat embolism syndrome (FES) is systemic manifestation of fat emboli in the circulation seen mostly after long bone fractures. FES is considered a lethal complication of trauma. There are various case reports and series describing FES. Here we describe the clinical characteristics, management in ICU and outcome of these patients in level I trauma center in a span of 6 months. Methods: In this prospective study, analysis of all the patients with FES admitted in our polytrauma intensive care unit (ICU) of level I trauma center over a period of 6 months (from August 2017 to January 2018) was done. Demographic data, clinical features, management in ICU and outcome were analyzed. Results: We admitted 10 cases of FES. The mean age of patients was 31.2 years. The mean duration from time of injury to onset of symptoms was 56 h. All patients presented with hypoxemia and petechiae but central nervous system symptoms were present in 70% of patients. The mean duration of mechanical ventilation was 11.7 days and the mean length of ICU stay was 14.7 days. There was excellent recovery among patients with no neurological deficit. Conclusion: FES is considered a lethal complication of trauma but timely management can result in favorable outcome. FES can occur even after fixation of the fracture. Hypoxia is the most common and earliest feature of FES followed by CNS manifestations. Any patient presenting with such symptoms should raise the suspicion of FES and mandate early ICU referral.
文摘Intramedullary interlocking nailing is the gold standard for treatment of tibial shaft fractures. The growing use of intramedullary nailing has resulted in an increased number of tibial nailing in daily clinical practice. Despite adequate surgeon experience, tibial nailing is not without complications if proper techniques are not followed. A case of iatrogenic talar neck and medial malleolus frac- tures during intramedullary nailing of tibia in a 24-year-old male is reported. It is believed to be caused by forceful hammering of insertion zig with foot dorsiflexed. To the best of our knowledge, no such case has been reported in the literature. It is possible to reduce the risk of this complication by adoption of preventive measures.
文摘Bipolar clavicular dislocation is rare,and therefore its management is contentious.With an increase of patient’s physical demand and a near-normal shoulder function,there has been a shift in the paradigm of its management from a conservative one to a stabilized one of anatomical open reduction.Proposed methods of fixation have also evolved with the advent of more biological fixation devices,which elude implant or fixation related complications.This case report highlights the salient features of this rare case and details the management options along with the benefits of biological anatomical repair and reconstruction.
文摘BACKGROUND Assessing academic productivity allows academic departments to identify the strengths of their scholarly contribution and provides an opportunity to evaluate areas for improvement.AIM To provide objective benchmarks for departments seeking to enhance academic productivity and identify those with significant improvement in recent past.METHODS Our study retrospectively analyzed a cohort of orthopaedic faculty at United States-based academic orthopaedic programs.5502 full-time orthopaedic faculty representing 178 programs were included in analysis.Variables included for analysis were National Institutes of Health funding(2014-2018),leadership positions in orthopaedic societies(2018),editorial board positions of top orthopaedic journals(2018),total number of publications and Hirsch-index.A weighted algorithm was used to calculate a cumulative score for each academic program.This study was performed at a large,United States medical school.RESULTS All 178 programs included in analysis were evaluated using the comprehensive weighted algorithm.The five institutions with the highest cumulative score,in decreasing order,were:Washington University in St.Louis,the Hospital for Special Surgery,Sidney Kimmel Medical College(SKMC)at Thomas Jefferson University,the University of California,San Francisco(UCSF)and Massachusetts General Hospital(MGH)/Brigham and Women’s/Harvard.The five institutions with the highest score per capita,in decreasing order,were:Mayo Clinic(Rochester),Washington University in St.Louis,Rush University,Virginia Commonwealth University(VCU)and MGH/Brigham and Women’s/Harvard.The five academic programs that had the largest improvement in cumulative score from 2013 to 2018,in decreasing order,were:VCU,SKMC at Thomas Jefferson University,UCSF,MGH/Brigham and Women’s/Harvard,and Brown University.CONCLUSION This algorithm can provide orthopaedic departments a means to assess academic productivity,monitor progress,and identify areas for improvement as they seek to expand their academic contribut
文摘BACKGROUND The exponential rise in Coronavirus disease 2019(COVID-19)cases has resulted in an increased number of patients requiring prolonged ventilatory support and subsequent tracheostomy.With the limited availability of literature regarding the outcomes of COVID-19 patients with tracheostomy,we attempted to study the clinical characteristics and multiple parameters affecting the outcomes in these patients.AIM To determine all-cause mortality following tracheostomy and its association with various risk factors in COVID-19 patients.METHODS This retrospective study included 73 adult COVID-19 patients admitted to the ICU between 1 April,2020 and 30 September,2021 who underwent tracheostomy as a result of acute respiratory failure due to COVID-19.The data collected included demographics(age,sex),comorbidities,type of oxygen support at admission,severity of COVID-19,complications,and other parameters such as admission to tracheostomy,intubation to tracheostomy,ICU stay,hospital stay,and outcome.RESULTS This study included 73 adult patients with an average age of 52±16.67 years,of which 52%were men.The average time for admission to tracheostomy was 18.12±12.98 days while intubation to tracheostomy was 11.97±9 days.The mortality rate was 71.2%and 28.8%of patients were discharged alive.The mean duration of ICU and hospital stay was 25±11 days and 28.21±11.60 days,respectively.Greater age,severe COVID-19,mechanical ventilation,shock and acute kidney injury were associated with poor prognosis;however,early tracheostomy in intubated patients resulted in better outcomes.CONCLUSION Patients with severe COVID-19 requiring mechanical ventilation have a poor prognosis but patients with early tracheostomy may benefit with no added risk.We recommend that the timing of tracheostomy be decided on a case-by-case basis and a well-designed randomised controlled trial should be performed to elucidate the potential benefit of early tracheostomy in such patients.
文摘Concomitant dislocation of the tar- sometatarsal and metatarsophalangeal joints of foot is an extremely rare injury. Such injuries presenting in a single or adjacent dual rays have been described in few cases previously. We describe such an injury in adjacent three metatarsals of a polytrauma patient. These injuries are likely to be missed in the initial assessment of a polytrauma patient. These patients are at risk of an overlooked diagnosis but the consequences of missing this type of injury may be quite severe. This case is presented in view of its unique- ness along with possible mechanism of injury, the sequence of reduction and follow-up. Knowledge of such injury and its proper management may be useful to the trauma surgeons
文摘BACKGROUND: The present study aimed to compare outcome of primary and secondary Illizarov's fi xator application as a treatment method for type III open tibial fractures in terms of nonunion and wound infection.METHODS: This prospective study was done in a tertiary care center. Forty-eight type III tibial fractures were treated with Illizarov's apparatus between 2008 and 2011. The patients were divided into two groups depending on the treatment protocol, timing of wound closure and Illizarov's application, primary(n=28) and secondary(n=20).RESULTS: In the primary group, healing was achieved in all 28 patients. The median time to recovery was 24 weeks, and the median number of operations was 3. There were 6 patients with a bone defect. In the secondary group, complete recovery was achieved in 18 out of 20 patients. The median time to recovery was 30 weeks, and the median number of operations 5. There were 9 patients with a bone defect. The median time to recovery and the number of operations were signifi cantly smaller in patients undergoing primary operation. Union was 100% in the primary group and more than 95% in the secondary group. Chronic osteomyelitis persisted in one patient and below amputation was done in one patient in the secondary group.CONCLUSION: Primary wound closure and Illizarov's fixation required a smaller number of operations and shorter time to recovery than secondary wound closure and Illizarov's fi xation, mostly due to a signifi cantly less number of patients with a bone defect in the primary group.
文摘Dynamic hip/compression screw （DHS/ DCS） is one of the most commonly performed surgeries in orthopaedic practice. Sliding barrel plate over the DHS/DCS lag screw is one of t.he very crucial and at times uncomfor- table and time consuming steps of DHS/DCS surgery espe- cially when it comes to inexperienced surgeons and residents. Also in developing countries where not all stan- dard instrumentation is always available, this crucial step becomes more time consuming. Here we present a case re- port of 58-year-old male patient with intertrochanteric fracture, in which we used a new device for insertion of barrel plate over DHS/DCS lag screw and found that a small DHS/DCS lag screw extension （sliding jig of barrel plate） can be very helpful to slide barrel plate over the DHS/DCS lag screw.
文摘Background:Regional anaesthesia has been proposed to reduce intraoperative blood loss,duration of hospital stay and in-hospital complications with improved postoperative pain control.General anaesthesia is advantageous for prolonged surgeries.We hypothesized that combined regional and general anaesthesia would offer advantages of both in pelvi-acetabular fracture surgeries.Methods:We identified 71 patients who underwent open reduction and internal fixation of pelvi-acetabular fractures from May 2012 to 2013 in our trauma centre.We excluded patients with incomplete records(n=4)and other injuries operated along(n=8).Hence,59 patients were divided into three groups:G group(general anaesthesia),R group(regional anaesthesia)and GR group(combined regional and general anaesthesia).Main outcome measurements studied were intraoperative blood loss,duration of hospital stay,duration of surgery and intraoperative and postoperative complications.Results:No differences were obtained in between the groups in terms of age,gender,Injury Severity Score,number of comorbidities,or duration from injury to surgery.No significant differences were found between the three groups for intraoperative blood loss,days of hospital stay and duration of surgery.Intraoperative and postoperative complications were also comparable between the groups(p>0.05).Conclusions:There is no specific significant advantage of the technique of anaesthesia on the observed perioperative complications in pelvi-acetabular fracture surgeries.
