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A Rare Case Report of Lateral Elbow Dislocation without a Major Fracture, Complicated by the Presence of an Ipsilateral Supracondylar Process

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Vol 4 | Issue 2 | Sept-Dec 2018 | page: 11-13 | Vrettakos Aristeidis, Vampertzis Themistoklis, Dimitriadis Anastasios, Vavilis Theofanis, Antonoglou Georgios, Papastergiou Stergio

doi- 10.13107/ti.2018.v04i02.069

Author: Vrettakos Aristeidis [1], Vampertzis Themistoklis [1], Dimitriadis Anastasios [2], Vavilis Theofanis [3], Antonoglou Georgios [1], Papastergiou Stergios [1].

1Department of Orthopaedics, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece 2Olympion Therapeutirion, General Clinic of Patras, Patra, Greece 3Laboratory of Medical Biology – Genetics, Medical School, Aristotle University of Thessaloniki, Greece

Address of Correspondence

Dr. Vampertzis Themistoklis,
Department of Orthopaedics,
Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece.
Email: themisvamper@yahoo.com

Abstract

Introduction: Supracondylar processes are vestigial remnants in humans that are usually asymptomatic, serendipitous findings, but under certain conditions, they can complicate the clinical presentation of other pathological entities. We present the first case of an elbow dislocation and the complications arising from the presence of such a process.

Case Report: A 45-year-old female patient was admitted to our outpatient’s department after a fall on her outstretched right hand. The patient’s primary complaints were numbness and paresthesia mainly on her right thumb and index finger palmary, while she was also unable to perform any elbow movements. The elbow itself was edematous and painful on palpation. Radiographic evaluation revealed lateral dislocation of the elbow joint, accompanied by a chip fracture of the lateral condyle and a supracondylar process, 11 mm in length, over the medial epicondyle of the right humerus. Supplementary, a reduction in the radial pulse wave was noted. Reduction of the dislocated elbow was performed which restored the radial artery pulse wave, as confirmed by Doppler echography, but the neurological findings persisted. A posterior elbow splint was placed for 6 weeks, allowing gradually for acuter angle movements (90° in the 1st week, 45° in the 2nd week, 30° in the 3rd week, and full range of motion afterward). 6 months after the dislocation, the patient has a 10° extension lag, with full elbow joint stability restoration and is able to return to her occupation.

Conclusion: To the best of our knowledge, this is the first report in literature, of the involvement of a previously silent supracondylar process during a lateral elbow dislocation. Hereby, we advise the attending physicians to take into account such anatomical variations when considering diagnosis and treatment of elbow dislocations.

Keywords: Supracondylar process, humerus, lateral elbow dislocation, radial artery pulse wave, median nerve compression.

References

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2. Symeonides PP. The humerus supracondylar process syndrome. Clin Orthop Relat Res 1972;82:141-3.

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How to Cite this article:  Vrettakos A, Vampertzis T, Dimitriadis A, Vavilis T, Antonoglou G, Papastergiou S. A Rare Case Report of Lateral Elbow Dislocation without a Major Fracture, Complicated by the Presence of an Ipsilateral Supracondylar Process. Trauma International Sep-Dec 2018;4(2):11-13.

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Triage in Mass Casualty Incidents: Our Preparedness and Response – A Cross-sectional Study from a Tertiary Care Hospital, Karachi, Pakistan

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Vol 4 | Issue 2 | Sept-Dec 2018 | page: 6-10 | Muhammad Qasim Ali, Muhammad Muzzammil, Zehra Batool, Muhammad Saeed Minhas

doi- 10.13107/ti.2018.v04i02.068

Author: Muhammad Qasim Ali [1], Muhammad Muzzammil [2], Zehra Batool [3], Muhammad Saeed Minhas [2].

[1] Intern MBBS, Orthopedics ward 17, Jinnah Postgraduate Medical Centre, Karachi, Pakistan,

[2] Department of Orthopedics Ward 17, Jinnah Postgraduate Medical Centre, Karachi, Pakistan,

[3] Department of Orthopaedics, Medical Student Jinnah Sind Medical University, Karachi, Pakistan.

Address of Correspondence

Dr. Muhammad Qasim Ali,
Orthopedics ward 17, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
Email: m.qasim_ali@hotmail.com

Abstract

Background and Objectives:

Trauma is the major concern of the modern world. The ever-intensifying number of causalities being presented with the scarcity of resources, heavily burdens the emergency departments, which are the fundamental centers of a hospital. For a smooth flow and an efficient ER, implementation of a strong triage system with trained emergency staff personnel remains a dire necessity. The present study is aimed to review the awareness and implication of triage among emergency personnel, to evaluate the preparedness of emergency staff involved in the management of massive trauma casualties and highlight the self-identified deficiencies of the hospital and pre-hospital system.

Methods: A cross-sectional study was conducted to evaluate the preparedness, knowledge, and implication of triage by emergency room personnel at Accident and Emergency Department, Jinnah Postgraduate Medical Center, Karachi. The target population for the survey included casualty medical officers (CMOs), assistant casualty medical officers (ACMOs), nursing staff, and casualty operation theatre staff working in all three shifts morning, evening and night from December 2016 to February 2017.

Results: Of the 126 respondents questioned, 32% had no concept of triage. 70% of the respondents mentioned that they have never witnessed any patient already triaged brought to their ER indicating a poor onsite triage system. Only 23% (n = 29) received any training for triage before in past 5 years. Therefore, 97.61% emphasized the need of refresher training programs. On testing with standard scenarios of triage, it was investigated that 27 out of 126 participants answered all the questions correctly. No training drill or courses had been conducted for disaster management of the surveyed hospital.

Conclusion: Effective and early disposal of patients from accident and emergency needs trained triage team. Thus, it is imperative that training of ER personnel to be conducted as a continuous process. This study finding will be useful for planning future triage awareness programs in the form of classroom courses and hospital drills to curb mass casualties.

Keywords: Triage, Emergency personnel, Trauma, Bomb blast, Mass incidents.

References

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6. WHO|Road Traffic Injuries. Available from: http://www.who.int/violence_injury_prevention/road_traffic/en/. Last Accessed on 5thFeb 2017

7. WHO|Injuries and Violence. Available from: http://www.who.int/violence_injury_prevention/key_facts/VIP_k ey_facts.pdf?ua=1. Last Accessed on5thFeb 2017

8. Pakistan Institute of Peace Studies: PIPS Security Report 2016. Available from: https://www.pakpips.com/article/book/pakistansecurity-report-2016 [Last accessed on 2017 25th Jan].

9. Centre for Research and Security Studies: CRSS Annual Security Report 2016. Available from: http://www.crss.pk/wpcontent/uploads/2010/07/Annual-report-2016.pdf. (Last accessed on 25th Jan 2017)

10. Gazder, Uneb & Ahmed, Muhammad & Adnan, Muhammad. (2015). Spatial & Temporal Investigation of Road Accidents in Karachi.

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12. Tanabe PG, Travers DA, Rosenau AM, Eitel DR. Index Emergency
Severity Index. Version 4: Implementation Handbook. A.H.R.Q Publication No. 05 – 00462. Rockville, MD: Agency for Healthcare Research and Quality; 2005.

13. Siddiqui MA, Jawad A, Minhas S, Ansari A, Siddiqui A, Mehtab S. Pakistan: The new target of terrorism. Are Karachi’s emergency medical response systems adequately prepared? J Pak Med Assoc 2009;59:441-5.

14. At Least 17 Die in Karachi Train crash in Pakistan. BBC. 3 November 2016. Available from url : https://www.bbc.com/news/world-asia-37856299 [Last accessed on 2016 Nov 06].

15. Atleast 22 Killed and 65 Injured from Train Collision: Available from: https://www.geo.tv/latest/119554-Several-hurt-as-twotrains-collide-in-Karachi. (Last accessed on 2016 Nov 6)

16. Pakistan Shah Noorani Shrine Bomb Kills 52” BBC. Available from: http://www.bbc.com/news/37962741. [Last accessed on 2016 Nov 12].

17. Ashkenazi I, Kessel B, Khashan T, Khashan T, Oren M, Haspel J, et al. Precision of in-hospital triage in mass-casualty incidents after terror attacks. Prehosp Disaster Med 2006;21:20-3.

18. Malik ZU, Hanif MS, Tariq M, Aslam R, Munir AJ, Zaidi H, et al. Mass casualty management after a suicidal terrorist attack on a religious procession in Quetta, Pakistan. J Coll Phys Surg Pak 2006;16:253-6.

19. Zafar H, Jawad A, Shamim MS, Memon AA, Hameed A, Effendi MS, et al. Terrorist bombings: Medical response in a developing country. J Pak Med Assoc 2011;61:561-6.

20. YouTube. Bomb blast in Karachi (Benazir’s Return). Available from: http://www.youtube.com/watch?v=Gq95MA2FB0o. [Last added on 2007 Oct 19].

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22. Jonathan LB, David H. Disaster Medicine. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2007. p. 25.

23. Minhas MS, Mahmood K, Effendi J, Kumar R, Bhatti A. Terrorist bomb blasts: Emergency department management of multiple incidents. Trauma Int 2015;1:36-40.

24. Rehmani R. Disaster drill at a university hospital. J Pak Med Assoc 2005;55:28-32. 25. Anteau CM, Williams LA. The Oklahoma bombing-lesson learned. Crit Care Nurs Clin North Am 1997;9:231-6.

26. Ashkenazi I, Kessel B, Olsha O, Khashan T, Oren M, Haspel J, et al. Defining the problem, main objective, and strategies of medical management in masscasualty incidents caused by terrorist events. Prehosp Disaster Med 2008;23:83-9.

27. Leiba A, Blumenfeld A, Hourvitz A, Weiss G, Peres M, Laor D, et al. Lessons learned from cross-border medical response to the terrorist bombings in Tabba and Rasel-satan, Egypt, on 07 October 2004. Prehosp Disaster Med 2005;20:253-7.

How to Cite this article:  Ali M Q, Muzzammil M, Batool Z, Minhas M S. Triage in Mass Casualty Incidents: Our Preparedness and Response – A Cross-sectional Study from a Tertiary Care Hospital, Karachi, Pakistan. Trauma International Sep-Dec 2018;4(2):6-10.

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A Prospective Study of Surgical Management of Bimalleolar Fractures with Various Modalities

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Vol 4 | Issue 2 | Sept-Dec 2018 | page: 2-5 | Nandkishor B. Goyal, Sayyadshadab S. Jafri, Ashish Vinayak Patil, Aashish Babanrao Ghodke.

doi- 10.13107/ti.2018.v04i02.067

Author: Nandkishor B. Goyal [1], Sayyadshadab S. Jafri [1], Ashish Vinayak Patil [1], Aashish Babanrao Ghodke [1].

[1] Department of Orthopaedics, ACPMMC Dhule.

Address of Correspondence

Dr. Nandkishor B. Goyal,
Dr. Goyal Hospital, near Yellammuden Temple, Malegao, Dhule 424001.
Email: nandkishor596@gmail.com Dr. Nandkishor B.

Abstract

Ankle injuries should not be neglected because body weight is transmitted through it and locomotion depends on the stability of this joint. For this, we are conducting a prospective study of surgical management of bimalleolar fractures with various modalities. In our study, we surgically managed 36 patients and their functional assessment was done with Biard-Jackson scoring system. Excellent functional results are obtained with stable fixation of fractures. Tension band wiring was found to be better in internal fixation of medial malleolus as compared to screws fixation whereas lateral plating was best for fibular fractures. It was found that our results were coinciding with the literature.

Keywords: Biard-Jackson scoring, bimalleolar fractures, lateral plating, screw fixation, tension band wiring.

References

1. Marvin LS. Complication of fractures and dislocation of the ankle. In: EPPS, Charles H, editors. Complication in Orthopaedic Surgery. 3rd ed., Vol. 1. Ch. 23. Philadelphia, PA: J.B. Lippincott Company; 1994. p. 595-648.

2. Daly PJ, Fitzgerald RH Jr, Melton LJ, Ilstrup DM. Epidemiology of ankle fractures in Rochester, Minnesota. Acta Orthop Scand 1987;58:539-44.

3. Canale ST, Beaty JH. Campbell’s Operative Orthopaedics. 11th ed., Vol. 3. Philadelphia, PA: Mosby; 2008. p. 2043-66.

4. Burwell HN, Charnley AD. The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg Br 1965;47:634-60.

5. Colton CL. The treatment of dupuytren’s fracture-dislocation of the ankle. J Bone Joint Surg Br 1971;53:63-71.

6. Desouza LJ. Fractures dislocations about the ankle. In: Gustilo RB, Kyle RF, Templeman D, editors. Fractures and Dislocations. Vol. 2. Ch. 30. St. Louis: Mosby Year Book Inc.; 1993. p. 997-1043.

7. Beris AE, Kabbani KT, Xenakis TA, Mitsionis G, Soucacos PK, Soucacos PN. Surgical treatment of malleolar fractures. A review of 144 patients. Clin Orthop Relat Res 1997;341:90-8.

How to Cite this article:  Goyal N B, Jafri S S, Patil A V, Ghodke A B. A Prospective Study of Surgical Management of Bimalleolar Fractures with Various Modalities. Trauma International Sep-Dec 2018;4(2):2-5.

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A Neglected Case of Bilateral Hip Fractures and Other Fractures with Delayed Diagnosis of Hyperparathyroidism as Cause

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Vol 4 | Issue 1 | May – Aug 2018 | page: 38-41 | Sanjay Chhawra, Arun Kumar N Kambar, Ravi Gupta

doi-10.13107/ti.2018.v04i01.065

Author: Sanjay Chhawra [1], Arun Kumar N Kambar [1], Ravi Gupta [1].

[1] Department of Orthopaedics, Jaipur Golden Hospital , 2 Institutional Area ,Sec 3 Rohini Delhi 110085.

Address of Correspondence
Dr. Sanjay Chhawra
A-144 Gaytri Vihar Bagh Mughaliya, Bhopal. MP. India.
E-mail: sanjaychhawra@yahoo.com

Abstract

Introduction: Primary hyperparathyroidism is a disease characterized by hypercalcemia attributable to autonomous overproduction of PTH ParaThyroid Hormone.Primary hyperparathyroidism PHPT is prevalent in approximately 1% of adult population with F;M 3;1. The disease affects multiple systems –Musculosketal, CVS, G.Urinary, Abdomen and Endocrine. Primary hyperparathyroidism present with classic signs and symptoms of hypercalcaemia. Non-specific symptoms may include muscle weakness, thirst, polyuria, anorexia and weight loss along with pathological fractures.The treatment of choice is parathroidectomy after proper investigation.
Case Report: A 40 yrs Male presented with Pain, Swelling and Deformity over Bilateral Hip, Right Shoulder, Right Hand and Right Clavicular Region. Unable to bear weight since 1 year. Along with its General Complaint of Weakness, Joint Pain, Abdominal Pain with clinical syptoms and operated right sided hip after proper investigation patient was diagnosed Hyperparathyridism with B/L Hip fracture {unusual presentation }multiple fractures with implant failure .After Parathyroidectomy and regular follow fracture fixation was done later with calcium supplementation the outcome was satisfactory.
Conclusions: Repeatedly multiple fractures must be investigated with appropriate and precise routine serum biochemical along with PTH Vitamin D Thyroid profile to diagnose endocrine disorder as in this case diagnosed as Hyperparathyroidism.With Clinical examination of neck as specific site with extremities, deformities and systemic examination is essential. USG Neck as routine investigation for this disease. After parathyroidectomy and regular follow up is done. Afterwards fracture fixation is done as secondary procedure with adequate calcium and vitamin D correction give good prognosis better union with best possible outcome. This is rare presentation of PHPT with B/L Hip fracture and other fractures deformities is an excellent example of an endocrine disease that is best managed by a multidisciplinary approach and long term patient follow up.
Keywords: Primary Hyperparathroidism PHPT, Pathological fracture, PTH Parathyroid Hormone.

References

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How to Cite this article:  Chhawra S, Kambar AN, Gupta R. A Neglected Case of Bilateral Hip Fractures and Other Fractures with Delayed Diagnosis of Hyperparathyroidism as Cause. Trauma International May – Aug 2018;5(1):38-41.

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The Management of the Displaced Fracture Neck Femur by Dynamic Compression Hip Screw with Derotation Screw

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Vol 4 | Issue 1 | May – Aug 2018 | page: 29-33 | Wasudeo mahadeo Gadegone, Bhaskaran Shivashankar, Rajendra Chandak, Piyush Gadegone.

doi-10.13107/ti.2018.v04i01.063

Author: Wasudeo mahadeo Gadegone [1], Bhaskaran Shivashankar [2], Rajendra Chandak [3], Piyush Gadegone [4].

[1] GMC Chandrapur, Maharashtra, India.
[2] Iyer Orthopaedic Hospital, Solapur, India
[3] Chandak Nursing Home Nagpur Maharashtra India.
[4] Sion Hospital, Mumbai, India

Address of Correspondence
Dr. W.M. Gadegone,
Vivek Nagar Mul-Road Chandrapur 442402, Maharashtra, India.
Email: gadegone123@yahoo.co.in

Abstract

Introduction: The aim of the present study was to evaluate the outcomes of displaced intracapsuar fracture neck femur managed by dynamic hip screw (DHS) with derotation screw treated within ten days of injury in patients younger than 60 years.
Materials and methods: This was a prospective study, carried out between December 2010 to December 2016. A total of 42 patients younger than 60 yrs of age with displaced intracapsular fracture neck femur (Garden III and IV, Pauwels III, with the comminution) presenting to the hospital within 2-10 days were included in the study. Data analysis and statistical analysis was done by using SPSS using appropriate tests.
Results: There were 27 males and 15 females, age ranging from 21 to 60 years (mean42.4±10.2 years). There were twenty seven Garden III while fifteen fractures were Garden IV. In forty fractures (95.2 %) average time to union was 3.7 months [3-5 months]. Radiographic evidence of avascular necrosis was seen in four cases(9.5%) and two patients(4.7%) developed non-union of the fracture .There were no cut-outs and breakage of implant .Two patients developed isolated coxa vara ( 120-124°) with backing of screws. Mean shortening of the injured limb was 2 -4 mm in twenty four patients without any functional impairment. Functional results were evaluated by Harris Hip Score. Excellent results were achieved in thirty four (81%), good/fair in six (14.2%) and poor in two (4.8%)patients.
Conclusion: Dynamic Hip Screw (DHS) with derotation screw is a good implant for the fixation of the displaced fracture neck femur with excellent to good radiological and functional outcome.
Keywords: Fracture neck femur, transcervical/ subcapital fracture, cannulated cancellous screw, dynamic hip screw, avascular necrosis, nonunion.

References

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How to Cite this article:  Gadegone WM, Shivashankar B, Chandak R, Gadegone P. The Management of the Displaced Fracture Neck Femur by Dynamic Compression Hip Screw with Derotation Screw. Trauma International JMay-Aug 2018;4(1):29-33.

 

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Biological dynamic condylar screw fixation for management of Peritrochanteric hip fractures

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Vol 4 | Issue 1 | May – Aug 2018 | page: 25-28 | Ninad Ashok Godghate, Neha Ninad Godghate, Krishnamohan Ananda Saindane, Shriniwas Yemul, Shivraj Suryawanshi.

doi-10.13107/ti.2018.v04i01.062

Author: Ninad Ashok Godghate [1] , Neha Ninad Godghate [1], Krishnamohan Ananda Saindane [2], Shriniwas Yemul [3], Shivraj Suryawanshi [4].

[1] Consultant Grace Ortho Clinic Rajiv Nagar T-Point Wardha Road, Nagpur.
[2] FICS, Consultant, Suyog Hospital, Sakri road, Dhule.
[3] Ashwini Rural Medical College and Research Centre, Kumbhari, Solapur
[4] Consultant Orthopaedic Surgeon, Alexis Hospital Nagpur

Address of Correspondence
Dr. Ninad Godghate,
1, Satpute Layout, Somalwada, Wardha Road, Nagpur-440025
E-mail: drninadgodghate@gmail.com

Abstract

Introduction: Inspite of routine encounters, hip fractures have the capacity to perplex even experienced orthopaedic surgeons at times. Management of these fractures has evolved with time and soft tissue preserving techniques have gained importance. Through this study we have attempted to analyse the results of traditional dynamic condylar screw plate construct used in a biological manner for treatment of peritrochanteric hip fractures.
Material & Methods: 18 patients in the age group of 22 to 78 years with post traumatic unstable intertrochanteric or subtrochanteric fractures in a pre-operative normal limb were included. All cases were operated within 5 days of trauma and were advised non weight bearing mobilisation for 6 weeks.
Results: Union was achieved in all cases with average duration of 14.6 weeks. 14 patients regained pre-fracture activities.
0.5 cm lengthening was seen in 2 cases.
Conclusion: Biological plating with dynamic condylar screw plate construct is a good modality for treatment of peritrochanteric hip fractures. There is a learning curve like any other surgical technique and results can be improved over time with proper patient selection and planning.
Keywords: Biological, Dynamic condylar screw, unstable, Peritrochanteric fractures

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How to Cite this article:  Godghate NA , Godghate NN, Saindane KA, Yemul S, Suryawanshi S. Biological dynamic condylar screw fixation for management of Peritrochanteric hip fractures. Trauma International May -Aug 2018;4(1):25-28.

 

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