International Journal of Surgery Case Reports最新文献

Introduction: Anterior fracture dislocation of the humerus with an anatomical neck fracture is an uncommon injury. These injuries pose a significant risk of devastating complications, such as avascular necrosis of the humeral head, due to the poor vascularization of the area, and stiffness resulting from prolonged immobilization.

Clinical presentation: We report a case of a 20-year-old female who was involved in a motor vehicle crash and sustained an anterior fracture dislocation of the humerus with an anatomical neck fracture. The injury was successfully managed with open reduction and internal fixation using a plate and screws. Given the rarity of this type of injury, this case provides valuable insights into its management and prognosis.

Discussion: Proximal humeral fractures are common injuries, although fractures at the level of the anatomical neck are less common in orthopedic traumatology. The management of these injuries is guided by factors such as fracture morphology, displacement, potential disruption to blood supply, bone quality, patient's age, and functional demands. Various surgical management strategies have been proposed, emphasizing early intervention to minimize the risk of complications.

Conclusion: This case aims to highlight the importance of the value of early operative intervention, good anatomic reduction with stable fixation, and the importance of early mobilization of the shoulder to achieve favorable outcomes and minimize complications such as stiffness in patients with this type of injury.

Introduction: Distal radius fractures are common among adults. Despite being a rare complication, occurring in only 0.2 % of the cases, non-union poses significant treatment challenges.

Presentation of case: In this article, we report the case of a 43-year-old male with a history of distal radius fracture resulting from a motorcycle accident. His initial treatment consisted of external fixation followed by a distraction plate and internal fixation with volar plate and screws. Due to plate breakage, he underwent refixation with a volar plate and autologous bone graft six months after the accident. However, five months after surgery, CT-scans showed a radius non-union. This led to a multidisciplinary approach involving orthopaedic and plastic surgery teams, where the patient underwent distal radius reconstruction using a free fibula flap. Postoperative recovery led to favourable outcomes with evidence of bony consolidation at six-month follow-up.

Discussion: Conventional techniques for distal radius non-union treatment may fall short in achieving bony continuity in a non-suitable soft tissue environment. Free vascularised fibular flap has emerged as a primary option for long bone reconstruction, offering advantages such as anatomical compatibility and immediate structural support.

Conclusion: This case highlights the efficacy of free fibular flap in addressing complex distal radius non-unions, providing an effective solution when simpler techniques have failed.

Introduction: A hemolytic transfusion reaction is the destruction of red blood cells caused by immunological incompatibility between the donor and the recipient, not only incompatibility but also, rarely, compatible blood transfusion, which may cause a hemolytic transfusion reaction. A hemolytic transfusion reaction occurs when the transfusion causes symptoms as well as clinical or laboratory indicators of increased red cell death.

Patient presentation: We present the case of a 27-year-old Gravida II Para I mother who was blood group AB positive with anaemia, hypotension secondary to antepartum hemorrhage, and a mentally conscious mother who was transferred to our obstetric emergency operation theatre. As she experienced bleeding on arrival, we assessed the patient's history and performed anaesthesia-related physical examinations, such as cardiovascular examination, respiratory examination, central nerve system examination, and airway examination. We followed the patient postoperatively until discharge from the hospital, and 12.9 g/dl hemoglobin, 36.3 % haematocrit, 402 × 10³ platelet count, and 0.9 mg/dl creatinine were detected. After satisfactory postoperative vital signs and laboratory results were obtained, the patient was discharged from the hospital after 3 days.

Clinical discussion: Acute hemolytic transfusion is a medical emergency with an estimated frequency of one per 70,000 blood product transfusions and an estimated fatality rate of five per 10 million RBC unit transfusions. Importantly, the traditional triad of fever, flank pain, and red or dark urine is uncommon. However, these symptoms may not be immediately visible if the patient is under anaesthesia; in such circumstances, seeping from venipuncture and dark urine caused by DIC and hemoglobinuria, respectively, may be the only observations.

Conclusion: Blood transfusion is performed in 0.5-3 % of women with obstetric hemorrhage and accounts for 1 % of all transfused blood products in high-income countries. Anesthesiologists face a significant issue in identifying the necessity for transfusion in patients with obstetric hemorrhage. Hemolytic reactions after blood transfusion are common during emergency patient management. For this reason, the World Health Organization has developed guidelines for early detection and management.