International Journal of Burns and Trauma最新文献

Chordoma is an uncommon malignant bone tumour of low metastatic potential, the commonest site of which being sacrum. We intend to report two cases of giant sacrococcygeal chordoma managed surgically. The first patient presented with natal cleft swelling since past 3 years which on examination had a size of 12*10*14 and was mildly tender, non reducible, non pulsatile and non fluctuant. The swelling had a variegated surface and extended from sacral region till 2 cm above anal verge. The second patient presented with low backache with radiation to the left lower limbs along with numbness in posterior aspect of left thigh. Physical examination in the second patient was near similar to that in first case except the decreased perianal sensation with otherwise normal neurology in the second patient. The imaging and histopathology was consistent with sacroccocygeal chordoma in both cases. Both patients underwent wide margin resection with preservation of both S2 and right S3 roots. Effective management of sacrococcygeal chordoma requires early diagnosis, accurate preoperative staging, definitive and adequate surgical resection with proved tumour-free cut margins while in those declining surgery, radiotherapy can be considered as an alternative.

Purpose: The effects of residual displacement on the functional outcome of the patient are not distinctly known and the acceptability criteria of residual displacement of the pelvic ring remain disputed. The purpose of this study is to evaluate the effect of residual displacement on functional outcome in pelvic ring injuries.

Materials and methods: A total of 49 patients with pelvic ring injuries (both operative and non-operative) were followed up for six months. Anteroposterior (AP), Vertical and rotational displacements were measured at admission, after surgery and at six months. Resultant displacement (vector addition of AP and vertical displacement) was taken for comparison. Displacement was graded as excellent, good, fair and poor according to Matta's criteria. Functional outcome assessment was done at six months using Majeed score. Work adjusted Majeed score was calculated for non-working patients by taking the percentage score.

Results: We compared the means of residual displacement with functional outcome (Excellent/Good/Fair) and found that there was no significant difference between the groups in operative (P=0.33) or non-operative patients (P=0.09). This showed that patients with relatively higher residual displacement also had satisfactory functional outcomes. The functional outcomes were compared after dividing the residual displacement into 2 groups: <10 mm and >10 mm and no significant difference was found in outcomes for either operative or non-operative patients.

Conclusion: Up to 10 mm of residual displacement is acceptable in pelvic ring injuries. More prospective studies with a longer follow up are needed for determination of correlation between reduction and functional outcome.

Grisel's syndrome is a non-traumatic subluxation of the atlantoaxial joint following an inflammatory process in the upper respiratory tract. Patients with Down syndrome have higher risks of developing atlantoaxial instability. This issue is mainly due to low muscle tone, loose ligaments, and alterations to the bone in patients with Down syndrome. Accompaniment of Grisel's syndrome and Down syndrome was not perused in recent investigations. To our knowledge, only one case of Grisel's syndrome in an adult patient with Down syndrome has been reported. In this study, we present a case of Grisel syndrome in a 7-year-old boy with Down syndrome following lymphadenitis. A 7-year-old boy with Down syndrome was admitted to the orthopedic ward of Shariati hospital with a possible diagnosis of Grisel's syndrome and treated with mento-occipital traction for ten days. In this case report, we represent a child with Down syndrome with Grisel's syndrome for the first time. We also imitated a simple and applicable non-surgical treatment for Grisel's syndrome.

Introduction: Femoral neck fractures present a significant challenge for orthopedic surgeons, especially in young patients who want to preserve their natural femoral head. Conventional methods for fixing these fractures often lead to poor outcomes and high complication rates. The Biplane Double-supported Screw Fixation (BDSF) technique is a novel approach that involves placing screws in two planes simultaneously, creating a two-point support for the screws in the neck and head of the femur.

Methods: This study aimed to evaluate the effectiveness of the BDSF technique in treating femoral neck fractures in patients aged 20-60 years. A total of 28 patients with fresh femoral neck fractures (less than three weeks old) were treated with closed reduction and internal fixation using the BDSF method. The patients' functional outcomes were evaluated using the Harris hip score, and the radiographic outcomes of union, femoral neck shortening, screw back-out, and femoral head avascular necrosis (AVN) were also evaluated.

Results: The results showed that the BDSF technique is a safe and effective method for treating femoral neck fractures in young adults. Out of the 25 patients who were followed up for a mean time of 18 months (range 6-24 months), 20 (80%) achieved fracture union in a mean time of 5.2 months. Non-union occurred in five patients (20%), and AVN of the femoral head was observed in three patients (12%). Two patients experienced varus collapse, but their fractures united successfully.

Conclusion: The BDSF technique offers several advantages over conventional methods, including increased stability and improved fixation strength. It can be considered as an alternative to conventional methods for managing femoral neck fractures in young adults, with a low incidence of non-union and avascular necrosis and no cases of fixation failure or varus collapse.

Background: The COVID-19 pandemic has affected everyone's life. In India, the nationwide lockdown was enforced from March 25, 2020. It has significantly affected the healthcare delivery system. Both-bone forearm (BBFA) fractures are commonly encountered as an emergency. Surgical management with plate fixation is often the primary mode of management in adults and adolescents. During the first wave of the COVID-19 pandemic, follow-up of patients with BBFA fractures who had undergone surgery before the lockdown was severely affected. To understand the effect of lack of regular follow-up on the outcome of BBFA fracture patients, in this study, we assessed their radiological, functional, and clinical outcomes at least 12 months after surgery. This study examined if a lack of routine follow-ups in surgically treated BBFA fracture patients has any impact on their short-term outcomes.

Methods: We included 30 patients with BBFA fractures who were operated prior to the COVID-19 lockdown and assessed their radiological, functional, and clinical outcomes 12 months after surgery. Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, Patient-Rated Wrist Evaluation (PRWE) score, Grace and Eversmann's score, and Mayo Elbow Performance Index (MEPI) score were assessed subjectively. Fracture site tenderness, and wrist, forearm, elbow, and grip strength range of motion (ROM) were objectively evaluated. Radiological union was recorded using standard forearm anteroposterior and lateral radiography.

Results: At follow-up, 28 patients had union at the fracture site, and two patients had a nonunion. A significant reduction was observed in the mean ROM of the injured forearm compared with the uninjured forearm in supination (17.76% less), pronation (31.4% less), dorsiflexion (32% less), palmar-flexion (24.6% less), elbow flexion-extension arc (2.5% less), and grip strength (18% less). The percentage reduction in pronation and dorsiflexion was higher than that in supination and palmar-flexion, respectively. Grace and Eversmann's score was excellent in 16 patients, good in 4, acceptable in 7, and poor in 3 patients. The mean QuickDASH score was 6 ± 6.6. The mean PRWE and MEPI scores were 7 ± 4.5 and 87.16, respectively. The MEPI score was excellent in 21 patients, good in 6, fair in 2, and poor in 1 patient.

Conclusion: The clinical, functional, and radiological outcomes of adult patients with BBFA fractures who were treated with compression plating were satisfactory. Inadequate follow-up during the COVID-19 first wave in India had minimal to no effect on their short-term outcomes.

Cell therapy is actively used to treat skin defects, particularly burn lesions. The effectiveness of its application may depend on the appropriate choice of wound dressings used together with any cellular material. The aim of the study was to investigate the interaction of 4 hydrogel dressings used in clinical practice with human cells in an in vitro model to determine if their use in combination with cell therapy is possible. The effect of the dressings on the growth medium was assessed by considering the changes caused in the medium's acid-base equilibrium (pH) and viscosity. Cytotoxicity was determined by applying an MTT-assay and by direct contact methods. Cell adhesion and viability on the dressing surfaces were analyzed using fluorescence microscopy. Proliferative and secretory cell activity were determined concurrently. Characterized human dermal fibroblast cultures were used as the test cultures. Results: The tested dressings interacted differently with the growth medium and the test cultures. 1-day extracts of all dressings had almost no effect on the acid-base balance, but, after 7 days, the pH of the dressing Type 2 extract had sharply acidified. The viscosity of the media under the influence of dressings of Types 2 and 3 had also markedly increased. MTT-assays showed nontoxicity of all the 1-day-incubated dressing extracts, while incubation for 7-days resulted in extracts with evident cytotoxicity, which was reduced upon dilution. Cell adhesion to the surfaces of the dressings differed, being observed occurring on dressings 2 and 3, and to a limited extent on dressing 4. Cells under dressing 1 showed evident proliferative and secretory activity whereas the other dressings impaired either proliferation or secretion processes. These effects indicate that, in general, comprehensive studies including a variety of methodological approaches at the in vitro stage are needed to allow the selection of appropriate dressings if they are to be used in combination with cell therapy to act as cell carriers. Of those investigated, the Type 1 dressing can be recommended as a protective dressing for use after transplantation of cells into a wound defect area by some other method.

Introduction: tibial pilon fracture constitutes 5-7% of all tibial fractures. The treatment of choice is an open reduction with anatomical articular reconstruction and stable fixation. A relievable fracture classification is needed for the preoperative planning the surgical management of these fractures. Hence, we assessed the inter- and intra-observer variation of Leonetti and Tigani CT bases classification of tibial pilon fractures.

Materials and methods: In this prospective study, 37 patients aged between 18-65 years with an ankle fracture were included. All these patients underwent a CT scan for the ankle fracture, and the CT scan was further evaluated by 5 independent observers (Orthopaedic surgeon). A kappa value was determined for inter and intra-observer variation.

Results: Leonetti and Tigani's CT-based classification of the kappa values was 0.657 to 0.751, with a mean value of 0.700. The range of values for the intra-observer variation using Leonetti and Tigani CT-based classification on the kappa values was 0.658 to 0.875 with a mean value of 0.755. The P-value < 0.001 states that there was a significant agreement between the inter-observer and intra-observer classification.

Conclusion: Leonetti and Tigani Classification have shown substantial inter- and intra-observer agreement, and the "4B" subclass of Leonetti and Tigani CT-based classification showed a predominance in the present study.

Introduction: Intertrochanteric fractures are those that occur in the region spanning from the extracapsular basilar neck region to the region along the lesser trochanter proximal to the development of medullary canal. Low-energy falls account for 90% of fractures in people over the age of 50, with females having a higher prevalence. Intertrochanteric fractures in children and teenagers are caused by high-energy trauma. The aim of this study was to compare the functional and radiological outcomes as well as complications of intertrochanteric fractures treated with long proximal femoral nail (PFN) versus short proximal femoral nails.

Methods: The study was a clinical randomized prospective comparative study which included 30 (2 groups of 15 patients each, being treated with short and long PFNs respectively) skeletally mature patients with fresh (less than 3 weeks old) intertrochanteric fractures of femur AO/OTA 31-A1, AO/OTA 31-A2 or AO/OTA 31-A3 as per AO/OTA classification. Harris Hip score was used to compare the functional outcomes.

Results: The average age of patients in short PFN group (Group A) was 62.1 ± 15.77 years and in long PFN group (Group B), it was 54.1 ± 10.8 years. Male-female ratio in the study was 1.7:1. AO31A2 of AO fracture classification was the most common type of fracture in both the groups. The mean injury to surgery interval in Group A was 9.6 ± 4.45 days and in Group B, it was 6 ± 4.12 days. The mean operative duration in Group A was 68.6 ± 6.62 minutes and in Group B, it was 78.6 ± 7.35 minutes. The average time of union in Group A was 15.69 ± 2.72 weeks while that of Group B was 15.77 ± 2.05 weeks. The average Harris Hip score at final follow up in Group A was 81.0 ± 11.62 and in Group B, it was 80.3 ± 10.83. There was 1 case of implant failure in each group, which were re-operated. One case of screw back-out in Group A led to a varus collapse and had to be reoperated. One case of non-union was reported in Group B. One case of superficial wound infection was reported in each group.

Conclusion: The Proximal Femur Nail can be used as an efficient implant to manage per trochanteric fractures regardless of the length of the implant. However, the mean operative time was found to be lower when a short nail is used.

Surgical management of knee synovitis secondary to mild haemophilia, without any significant previous medical history and an adverse family history of haematological disorders, is arduous. Due to its rare occurrence, the diagnosis is often delayed or sometimes missed, leading to the grave and often lethal consequences in intraoperative and postoperative periods. Hardly isolated knee arthropathy due to mild haemophilia has been reported in the available literature. In this report, we present the management of a case of a 16-year-old male with isolated knee synovitis with undiagnosed mild haemophilia, who came to us with the first episode of knee bleeding. We elucidate the signs and symptoms, investigations, surgical management, and difficulties faced, especially during the postoperative period. This case report is presented to enhance awareness of the existence of this disorder and its management to prevent postoperative complications.

Background: Bleeding is a feared complication of antiplatelets (APTs) and oral anti-coagulants (OACs) use. Asians are at higher risk of bleeding from APT/OAC compared to Western population. Our study aims to investigate the impact of preinjury APT/OAC use on outcomes of moderate to severe blunt trauma.

Methods: This is a retrospective cohort study from Jan 2017 - Dec 2019 of all patients with moderate to severe blunt trauma. A 1:2 propensity score matching (PSM) analysis was performed to address for confounding factors. Our primary outcome was in-hospital mortality. Our secondary outcomes were severity of head injury and need for emergency surgery within the first 24 hours.

Results: There were 592 patients (APT/OAC n=72, no APT/OAC n=520) included in our study. The median age was 74 years in APT/OAC and 58 years in no APT/OAC. PSM resulted in 150 patients (APT/OAC n=50, no APT/OAC n=100). In the PSM cohort, more patients with APT/OAC use had ischemic heart disease (76% vs 0%, P<0.001). APT/OAC use was independently associated with higher in-hospital mortality (22.0% vs 9.0%, Odds ratio (OR) 3.00, 95% Confidence interval (CI): 1.05, 8.56, P=0.040) Severity of head injury (abbreviated injury scale in APT/OAC: 3.33 ± 1.53, vs 2.97 ± 1.43, P=0.380) and need for emergency surgery (APT/OAC 16.2% vs 11.0%, P=0.434) was comparable between APT/OAC and no APT/OAC.

Conclusions: Preinjury APT/OAC use was associated with higher in-hospital mortality. Severity of head injury and need for emergency surgery within 24 hours from admission were comparable between APT/OAC use and no APT/OAC use.