Volume 5, Issue 1
Necrotizing Fasciitis: Fatal Evolution of Acral Melanoma
Characteristics of Effective and Safe Methods of Treatment for Fresh Fracture-Dislocations of the Proximal Humerus
PDF 452.58 KB
The study was aimed to assess the results of treatment for fracture-dislocations of the proximal humerus (PH) within different time frames for optimizing treatment tactics.
Patients and Methods
This retrospective cohort study evaluated clinical outcomes of 25 patients with fracture-dislocations of the PH (15 patients were analyzed for short- and medium-term results, and 10 – for long-term results). The follow-up period ranged from 1 to 9-years. All patients underwent: clinical examination, constant score assessment and shoulder X-ray examination. Clinical, radiological and statistical methods were used for analysis.
Assessment of the degree of initial displacement of tubercles and its impact on the results of treatment showed that significantly better results were obtained in case of displacement no more than 10 mm (p=0.041). Patients with displacement no more than 10 mm had an average score of 68.0±16.1 points (Mean=69.5), while those with displacement of the tubercle(s) exceeding 10 mm had an average score of 49.5±19.5 points (Mean=44). Analysis of the results of treatment showed that the delay in restoring normal anatomy of the PH or avoiding surgical interventions at all led to functional disorders of the shoulder joint. It was also demonstrated that neither patients, nor doctors were satisfied with the outcomes of the unipolar shoulder replacement (USR). Based on the results of the study, we proposed an algorithm for determining the tactics of surgical treatment in cases when a fracture-dislocation of the PH with complete dislocation of the fragment involving the articular surface of the humeral head is diagnosed.
The present study demonstrated some factors affecting the outcomes of treatment for fracture-dislocations of the PH. Current approaches for endoprosthesis replacement in these cases remain debatable and require further investigation.
Trauma; Fracture; Shoulder joint; Fracture-dislocation of the proximal humerus.
Pre-Debridement and Post-Debridement Culture in Open Fractures of the Extremities: A Comparative Study
PDF 421.75 KB
Due to contamination, open fractures are considered to be dangerous and thereby require proper management. Through a systematic review and meta-analysis, this study compares the literature on pre-debridement and post-debridement cultures derived from such fracture sites.
Data for this review was collected through various online sources such as dataBASE (EMBASE), medical literature analysis and retrieval system online (MEDLINE) and different citations provided the relevant data.
Twenty articles were included. The desired timing to examine the debridement was six hours post-injury (according to the six-hour rule). Antibiotics including ampicillin, penicillin, cefazolin, cefuroxime, and flucloxacillin were used in some patients. The use of Ancef I as an antibiotic during the starting hours of fracture helps to reduce the chances of infection in 1.4% of the infected patients. The infection rate was 3% in pre-debridement culture, while a 2% infection rate was found in post debridement culture. Gram-negative bacteria were responsible for pre-debridement infection, while gram-positive bacteria were responsible for post-debridement.
The pre-debridement infection rates are reduced as compared to post-debridement when treatment is initiated within a strict time interval and limited to the specific use of antibiotics. Treatment of gram-negative bacteria helps to reduce the bulk of infectious material and thereby reduces the infection rate.
Open fractures; Debridement; Pre-debridement; Post-debridement; Meta- analysis; Systematic review.
Lateral Tibial Plateau with Peroneal Nerve Entrapment is Unique Fracture in Diagnosis and Management
PDF 369.13 KB
A majority of tibial plateau fractures involve the lateral plateau. Posterolateral tibial plateau fractures are caused by a valgus force that impacts the posterolateral plateau against the lateral femoral condyle. We describe a unique case of a patient who sustained a lateral plateau fracture with posterior displacement behind a fractured fibular head, with entrapment of the peroneal nerve. This unusual fracture pattern required dual anterolateral and lateral approach for reduction and fixation.
Tibial plateau; High energy; Fracture; Peroneal nerve entrapment.
Magnet Expandable Rods a Promising Technology which can Lead to Catastrophic Failure
PDF 482.09 KB
In recent years, there has been a paradigm shift in the treatment of early-onset scoliosis. This change is manifested by a propensity to avoiding or delaying fusion surgeries due to their many potential shortcomings. Many surgeons gravitate towards conservative measures and growth-friendly implants such as magnetic expandable growing rods. Still, such interventions are not impeccable. This case report discusses 8-year-old girl with early-onset scoliosis managed with magnetic expandable rods after failing conservative management. The results were promising at first. However, catastrophic failure was diagnosed after multiple successful elongations necessitating discarding the system and changing the construct to conventional growing rods.
Magnet rods; Growing rods; Growth friendly procedures; Catastrophic failure; Early-onset scoliosis; Juvenile scoliosis; Scoliosis complications.