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Online ISSN Number 2455-538X
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Online ISSN Number 2455-538X
A Study about the Relationship between Vitamin D Level and Hip Fractures
/in Jan. - April 2019 | Volume 5 | Issue 1Vol 5 | Issue 1 | Jan-April 2019 | page: 7-9 |Albert Naveen Anthony, Joe Joseph Cherian, M J Saji.
Author: Albert Naveen Anthony [1], Joe Joseph Cherian [1], M. J Saji [2].
[1] Department of Orthopaedics, St. John’s Medical College Hospital, Sarjapur Road Koramangala, Bangalore. India.
[2] Department of Orthopaedics, Narayana Hridalaya Hospital, H.S.R. Layout, Bangalore.
Address of Correspondence
Dr. Joe Joseph Cherian,
Dept. of Orthopaedics, St. John’s Medical College Hospital, Sarjapur Road, Koramangala,
Bangalore – 560034 Karnataka State. India.
E-mail- cherianjoe71@gmail.com
Abstract
Introduction: Hip fractures are devastating injuries that most often affect the elderly and have a tremendous impact on both the healthcare system and society in general. The role of calcium and Vitamin D deficiency in bone metabolism is known and hence the necessity for further evaluation and studies to check its influence in hip fractures.
Method: A descriptive type of study was conducted between October 2012 and July 2014 in St. John’s Medical College and Hospital. Patients who fulfilled the inclusion criteria were included in the study. Once the diagnosis of hip fractures was made then following tests were done on day 1 of admission – Vitamin D (CLIA method), calcium, phosphate, and alkaline phosphatase.
Results: The study also showed that the incidence of the neck of femur fracture was comparable with intertrochanteric fractures. While neck of femur fractures was more common in female patients, while intertrochanteric fracture was common in male patients. These fractures were mainly seen in the age group between 61 and 70 years of age. The overall Vitamin D deficiency was 76% among all patients, with more predominance (84.6%) in female patients. Increased grades of fracture injury were seen in both fracture neck of femur and intertrochanteric fractures, when Vitamin D level was below 20 ng/ml
Conclusion: The prevalence of Vitamin D deficiency among hip fractures necessitates correction of its serum value in the body. The treatment of Vitamin D deficiency may decrease the incidence of hip fractures and result in milder grades of fractures. This may help in better management of hip fractures and reduce the financial burden of healthcare costs.
Keywords: Vitamin D, Vitamin D deficiency, Hip fractures
References
1. Hektoen LF, Saltvedt I, Sletvold O, Helbostad JL, Lurås H, Halsteinli V, et al. One-year health and care costs after hip fracture for homedwelling elderly patients in Norway: Results from the trondheim hip fracture trial. Scand J Public Health 2016;44:791-8.
2. Laird E, Ward M, McSorley E, Strain JJ, Wallace J. Vitamin D and bone health: Potential mechanisms. Nutrients 2010;2:693-724.
3. Bikle DD. Vitamin D and bone. Curr Osteoporos Rep 2012;10:151-9.
4. Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE, et al. Calcium plus Vitamin D supplementation and the risk of fractures. N Engl J Med 2006;354:669-83.
5. Shinkov A, Borissova AM, Dakovska L, Vlahov J, Kassabova L, Svinarov D, et al. Differences in the prevalence of Vitamin D deficiency and hip fractures in nursing home residents and independently living elderly. Arch Endocrinol Metab 2016;60:217-22.
6. Gorter EA, Hamdy NA, Appelman-Dijkstra NM, Schipper IB. The role of Vitamin D in human fracture healing: A systematic review of the literature. Bone 2014;64:288-97.
7. Lv QB, Gao X, Liu X, Shao ZX, Xu QH, Tang L, et al. The serum 25hydroxyvitamin D levels and hip fracture risk: A meta-analysis of prospective cohort studies. Oncotarget 2017;8:39849-58.
8. Ramason R, Selvaganapathi N, Ismail NH, Wong WC, Rajamoney GN, Chong MS, et al. Prevalence of Vitamin D deficiency in patients with hip fracture seen in an orthogeriatric service in sunny Singapore. Geriatr Orthop Surg Rehabil 2014;5:82-6.
9. de Jong A, Woods K, Suresh M, Porteous M. Vitamin D levels in hip fractures: Rationale and guidelines for rapid substitution therapy. ??? 2012;43:1624.
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Complicated Tibial Plateau Fractures in Young Patients: Functional Outcome with Dual Plating through two Incision Technique
/in Jan. - April 2019 | Volume 5 | Issue 1Vol 5 | Issue 1 | Jan-April 2019 | page: 28-31 |Abdul Qadir, Muhammad Muzzammil, Muhammad Tahir Lakho, Maratib Ali.
Author: Abdul Qadir [1],Muhammad Muzzammil [1], Muhammad Tahir Lakho [1], Maratib Ali [2]
1 Dept. Of orthopaedic surgery, Dr. Ruth K.M Pfau Civil Hospital Karachi – Pakistan.
2 Dept. Of orthopaedic surgery, Jinnah Postgraduate Medical Center, Karachi Pakistan.
Address of Correspondence
Abstract
Objective: Motorbike accidents contribute one of the most important factors of tibial plateau fracture among young populations in Karachi Pakistan. Most surgeons feel challenging to treatment complicated bicondylar fractures of the tibial plateau.This prospective study was designed to evaluate the functional outcomes of dual plating through a two-incisions technique for the fixation of complicated bicondylar tibial plateau fractures in young patients in Karachi Pakistan.
Methods: This prospective study includes 94 cases of Type V and VI tibial plateau fractures of young patient’s age range from 15 to 45 years, operated between January 2014 and December 2016 conducted in two public sector hospital of Karachi Pakistan (Jinnah Post Graduate Medical Center, Civil Hospital Karachi). Exclusion criteria include patients with multiple fractures on the same side or same bone, age >45 years, open contaminated fracture, open fracture,and patients with head injuries. All cases were operated either by lateral locking plate fixation by anterolateral approach or dual plating through double incisions. These all cases were followed for a minimum of 24 months radiologically and clinically. The statistical analysis was performed using software SPSS 20.0 to analyze the data.
Results: A total of 94 patients (45 Single Plating and 49 Dual Plating)were operated during the study period of 2 years. However, four patients (4 single plating and 0 dual plating) were lost during follow-up who could not be tracked. Both groups were somewhat similar in relation to the age, mechanism of injury, fracture pattern, and soft tissue injury. Preoperatively, there was a significant increase in surgical time with the dual plating group; however, the mean time of reduction between the two groups was not significant. The decision to put bone graft was at the choice of the operating surgeon and was an intra operative decision with 74 (78.7%) patients receiving the bone graft. Post-operatively, there was no immediate difference in between the groups considering thermal alignment and reduction. It took approximately 4–5 months for the fractures to get united. There was normal union,non union or implant failure seen among those patients. There were 10 cases with superficial infection in wounds of dual plating group which were treated with culture sensitive antibiotics for average 2 weeks, healed subsequently. There were three patients found having an incidence of deep infection in a double plating group, wherein 2 patients were positive with Staphylococcus aureus and 1 patient with Escherichia coli was isolated. Extensive wound irrigation and lavage with antibiotic cement beads were given. Repeated irrigation and lavage were done again after 2 weeks with the removal of beads followed by prolonged course of antibiotic therapy for 6 weeks after which the infection resolved.A total of 38 (77%) patients in a double plating group regained full flexion (135°) and full extension (0°) with a good alignment and no pain and instability as compared to single plating group, seen in 30 (66%) patients at follow-up.
Conclusion: Dual plating by two-incision method resulted in better functional outcome regarding limb alignment and range of movements at knee joint with an acceptable soft tissue complication rate in young patients.
Keywords: Complicated tibial plateau fracture, Young patients, Double incision, Dual plating.
References
1. Suriyawongpaisal P, Kanchanasut S. Road traffic injuries in Thailand: Trends, selected underlying determinants and status of intervention. Inj Control SafPromot 2003;10:95-104.
2. Yang BM, Kim J. Road traffic accidents and policy interventions in Korea. Inj Control SafPromot 2003;10:89-94.
3. Ghaffar A, Hyder AA, Masud TI. The burden of road traffic injuries in developing countries: The 1st national injury survey of Pakistan. Public Health 2004;118:211-7.
4. Chalya PL, Mabula JB, Ngayomela IH, Kanumba ES, Chandika AB, Giiti G, et al. Motorcycle injuries as an emerging public health problem in Mwanza city, North-Western Tanzania. Tanzan J Health Res 2010;12:214-21.
5. Egol KA, Koval KJ. Fracture of Proximal Tibia: Chapter 50, Rockwood and Greens “Fracture in Adults”. 6th ed., Vol. 2. Philadelphia, PA: Lippincott Williams and Wilkins; 1999.
6. Schulak DJ, Gunn DR. Fractures of tibial plateaus. A review of the literature. Clin OrthopRelat Res 1975;109:166-77.
7. Cotton FB. Fender fracture of the tibia at the knee. N Engl J Med 1929;201:989.
8. Koval KJ, Helfet DL. Tibial plateau fractures: Evaluation and treatment. J Am AcadOrthopSurg 1995;3:86-94.
9. Phisitkul P, McKinley TO, Nepola JV, Marsh JL. Complications of locking plate fixation in complex proximal tibia injuries. J Orthop Trauma 2007;21:83-91.
10. Dendrinos GK, Kontos S, Katsenis D, Dalas A. Treatment of highenergy tibial plateau fractures by the ilizarov circular fixator. J Bone Joint Surg Br 1996;78:710-7.
11. Young MJ, Barrack RL. Complications of internal fixation of tibial plateau fractures. Orthop Rev 1994;23:149-54.
12. Higgins TF, Klatt J, Bachus KN. Biomechanical analysis of bicondylar tibial plateau fixation: How does lateral locking plate fixation compare to dual plate fixation? J Orthop Trauma 2007;21:301-6.
13. Horwitz DS, Bachus KN, Craig MA, Peters CL. A biomechanical analysis of internal fixation of complex tibial plateau fractures. J Orthop Trauma 1999;13:545-9.
14. Jiang R, Luo CF, Wang MC, Yang TY, Zeng BF. A comparative study of less invasive stabilization system (LISS) fixation and two-incision double plating for the treatment of bicondylar tibial plateau fractures. Knee 2008;15:139-43.
15. Barei DP, Nork SE, Mills WJ, Henley MB, Benirschke SK. Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma 2004;18:649-57.
16. Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, Mavrogenis AF, Korres DS, Soucacos PN, et al. Complications after tibia plateau fracture surgery. Injury 2006;37:475-84.
17. Yoo BJ, Beingessner DM, Barei DP. Stabilization of the posteromedial fragment in bicondylar tibial plateau fractures: A mechanical comparison of locking and nonlocking single and dual plating methods. J Trauma 2010;69:148-55.
18. Moore TM, Patzakis MJ, Harvey JP. Tibial plateau fractures: Definition, demographics, treatment rationale, and long-term results of closed traction management or operative reduction. J Orthop Trauma 1987;1:97-119.
19. Stevens DG, Beharry R, McKee MD, Waddell JP, Schemitsch EH. The long-term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma 2001;15:312-20.
20. Zhang Y, Fan DG, Ma BA, Sun SG. Treatment of complicated tibial plateau fractures with dual plating via a 2-incision technique. Orthopedics 2012;35:e359-64.
21. Gosling T, Schandelmaier P, Muller M, Hankemeier S, Wagner M, Krettek C, et al. Single lateral locked screw plating of bicondylar tibial plateau fractures. Clin OrthopRelat Res 2005;439:207-14.
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Chronic osteomyelitis in Sarajevo, Bosnia-Herzegovina: Long-term health consequences of warfare
/in Jan. - April 2019 | Volume 5 | Issue 1Vol 5 | Issue 1 | Jan-April 2019 | page:14 -16 |Katherine O. Ryken, Semin Becirbegovic, Ismet Gavrankopetanovic, J Lawrence Marsh, Marin Schweizer.
Author: Katherine O. Ryken [1], Semin Becirbegovic [2], Ismet Gavrankopetanovic [2], J Lawrence Marsh [1], Marin Schweizer [1]
1 Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
2 Department of Orthopedics&Traumatology, University of Sarajevo ClinicalCenter, Sarajevo, Bosnia-Herzegovina
Address of Correspondence
Dr. Katherine O. Ryken,
University of Iowa Carver College of Medicine, Iowa City, IA
E-mail: kryken@montefiore.org
Abstract
Introduction: Chronic osteomyelitis (COM) is a severely debilitating disease, causing both physical and psychological repercussions for patients. It is particularly common in austere environments and areas of armed conflict. 1,2,3 The most common cause across all age groups is neglected penetrating wounds.4 Often overlooked, COM is one of the many lasting health effects of warfare. Deep infections of the bone following penetrating and blast injuries are common in regions plagued by conflict and cause major physical and social disability.
Materials & Methods: Patient records at the University of Sarajevo Clinical Center Department of Orthopedics & Traumatology were analyzed retrospectively between 2003 and 2013 of patients hospitalized with diagnosed COM.
Results: 155 patients were hospitalized at UCCS for the treatment of chronic osteomyelitis between 2003-2013. Mean age of patients at the time of hospitalization was 56 years. The most common medical comorbidity of patients was diabetes mellitus type 2. Unemployment among patients was 46.1%. The most common cause of COM in this cohort was intentional injury associated with the war between the years of 1992-1995 (46.2%). These were caused by sniper or gunshot wounds (25.4%), landmines or unexploded ordnance (37.7%), and mortar shell explosions (28.8%). The mean hospital stay among patients with COM at UCCS was 31.10 days, although this varied widely depending upon the severity of symptoms and the type of treatment required.
Conclusion: The health burden of chronic osteomyelitis persists for many years beyond the original. Chronic pain and disability contribute to a lifetime of repeated treatments, hospital stays, and high rates of unemployment. This study describes the current burden of COM upon the population of Sarajevo, as well as serving as a foreboding prediction of what can be expected in war zones for many years in the future.
Keywords: Bosnia-Herzegovina, Sarajevo, chronic osteomyelitis, war injuries, orthopedics, infectious disease, social medicine.
References
1. Ibingira, C. B. R. Chronic osteomyelitis in a Ugandan rural setting. East Afr. Med. J.80, 242–246 (2003).
2. Beckles, V. L. L., Jones, H. W. & Harrison, W. J. Chronic hematogenous osteomyelitis in children: a retrospective review of 167 patients in Malawi. J. Bone Joint Surg. Br.92, 1138–1143 (2010).
3. Yun, H. C., Branstetter, J. G. & Murray, C. K. Osteomyelitis in military personnel wounded in Iraq and Afghanistan. J. Trauma64, S163–168; discussion S168 (2008).
4. Baldan, M., Gosselin, R. A., Osman, Z. &Barrand, K. G. Chronic osteomyelitis management in austere environments: the International Committee of the Red Cross experience. Trop. Med. Int. Health TM IH19, 832–837 (2014)
5. Tice, A. D., Hoaglund, P. A. &Shoultz, D. A. Outcomes of osteomyelitis among patients treated with outpatient parenteral antimicrobial therapy. Am. J. Med.114, 723–728 (2003).
6. Casey, K., Demers, P., Deben, S., Nelles, M. E. & Weiss, J. S. Outcomes after long-term follow-up of combat-related extremity injuries in a multidisciplinary limb salvage clinic. Ann. Vasc. Surg.29, 496–501 (2015).
7. Beavis, J.P., Ryan, J.M. High Energy Transfer Missile Wounds in the Siege of Sarajevo and Their Relation to Mine Injuries. J. Conv. Weapons Destr.6, (2002).
8. Geiger, S., McCormick, F., Chou, R. &Wandel, A. G. War wounds: lessons learned from Operation Iraqi Freedom. Plast. Reconstr. Surg.122, 146–153 (2008).
9. Harris, P. A. et al. Research Electronic Data Capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support. J. Biomed. Inform.42, 377–381 (2009).
10. Spellberg, B. & Lipsky, B. A. Systemic antibiotic therapy for chronic osteomyelitis in adults. Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am.54, 393–407 (2012)
11. Conterno, L. O. & da Silva Filho, C. R. Antibiotics for treating chronic osteomyelitis in adults. Cochrane Database Syst. Rev. CD004439 (2009). doi:10.1002/14651858.CD004439.pub2
12. Murphy, R. A. et al. Multidrug-resistant chronic osteomyelitis complicating war injury in Iraqi civilians. J. Trauma71, 252–254 (2011)..
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A Rare and Atypical Case Report of Combined Rupture of Patellar Tendon, Anterior Cruciate Ligament, Medial Collateral ligament, and Lateral Meniscus Managed Operatively
/in Volume 4 | Issue 2 | Sep-Dec 2018Vol 4 | Issue 2 | Sept-Dec 2018 | page: 17-19 | Naveen Mittal, Robin Bohat, Ankush Jindal, Akash Singhal.
doi- 10.13107/ti.2018.v04i02.071
Author: Naveen Mittal [1], Robin Bohat [1], Ankush Jindal [1], Akash Singhal [1].
[1] Department of Orthopaedics, Government Medical College Hospital Chandigarh.
Address of Correspondence
Dr. Naveen Mittal,
#3732 Sector 46C, Chandigarh, India.
Email: Naveen.mital0501@gmail.com
Abstract
Introduction: Extensor mechanism disruption with other ligament injuries at knee is rare. Rupture of the patellar tendon (PT) usually occurs at the inferior pole of patella leading to proximal retraction of 3–5 cm due to contraction of quadriceps. The medial collateral ligament (MCL) is the most frequently damaged ligamentous stabilizer of the knee. MCL injuries do occur as isolated lesions or in combination with damage to other ligamentous structures (meniscus and/or cruciate ligaments). Non-operative treatment is reasonable for the second-degree and some third-degree tears, but when they occur in conjunction with meniscal tears, they are best treated by surgical repair. The incidence of meniscal tears with acute anterior cruciate ligament (ACL) injuries ranges from 50% to 70%. The risk of lateral meniscus (LM) injury is high in ACL deficient knee as a result of abnormal loading and shear stress. However, simultaneous rupture of both the PT, ACL, MCL, and LM is a relatively rare injury. Our is a case of a 60-year-old male with a history of roadside accident presenting with simultaneous PT, ACL, MCL, and LM injury. We managed the patient with acute repairing of the PT with Ethibond no.5 sutures protected with stainless steel wire and the MCL repaired with Ethibond no.5 sutures. The ACL was not repaired as the limited literature has shown high incidence of arthrofibrosis in acute repair (Shelbourne et al.). Complex tear of anterior horn of LM was seen and was shaved off. We were able to achieve full extension at 3 months. In conclusion, we want to highlight the rarity of such injuries favoring the immediate repair of PT and delayed repair of ACL for achieving optimal results. The use of our treatment algorithm may facilitate clinical decision-making in an attempt to restore stability, preserve ROM, and maximize return to activity.
Keywords: Patellar tendon, Anterior cruciate ligament, Medial collateral ligament.
References
1. Carroll BS, Cvetanovich G, Heyworth BE, Van de Velde S, Gill TJ IVth. Approach to management of the patient with the multiligament-injured knee. Harvard Orthop J 2013;15:54-64.
2. Gulabi D, Erdem M, Bulut G, Saglam F. Neglected patellar tendon rupture with anterior cruciate ligament rupture and medial collateral ligament partial rupture. Acta Orthop Traumatol Turc 2014;48:2315.
3. Kim DH, Lee GC, Park SH. Acute simultaneous ruptures of the anterior cruciate ligament and patellar tendon. Knee Surg Relat Res 2014;26:56-60.
4. Tsarouhas A, Iosifidis M, Kotzamitelos D, Traios S. Combined rupture of the patellar tendon, anterior cruciate ligament and lateral meniscus: A case report and a review of the literature. Hippokratia 2011;15:178-80.
5. Brunkhorst J, Johnson DL. Multiligamentous knee injury concomitant with a patellar tendon rupture. Healioorthopaedics 2015;38:45-8.
6. Cox CL, Spindler KP. Multiligamentous knee injuries–surgical treatment algorithm. N Am J Sports Phys Ther 2008;3:198-203.
7. Levakos Y, Sherman MF, Shelbourne KD, Trakru S, Bonamo JR. Simultaneous rupture of the anterior cruciate ligament and the patellar tendon. Six case reports. Am J Sports Med 1996;24:498-503.
8. Costa-Paz M, Muscolo DL, Makino A, Ayerza MA. Simultaneous acute rupture of the patellar tendon and the anterior cruciate ligament. Arthroscopy 2005;21:1143.
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10. Chow FY, Wun YC, Chow YY. Simultaneous rupture of the patellar tendon and the anterior cruciate ligament:a case report and literature review. Knee Surg Sports Traumatol Arthrosc 2006;14:1017-20.
11. Futch LA, Garth WP, Folsom GJ, Ogard WK. Acute rupture of the anterior cruciate ligament and patellar tendon in a collegiate athlete. Arthroscopy 2007;23:112-e1.
12. Merritt AL, Wahl CJ. Rationale and treatment of multiple-ligament injured knees: the Seattle perspective. Oper Techn Sports Med 2011;195:1-72.
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Outcomes of Proximal Femoral Nail in Subtrochanteric Femur Fractures Through Medial Entry
/in Volume 4 | Issue 2 | Sep-Dec 2018Vol 4 | Issue 2 | Sept-Dec 2018 | page: 20-25 | Rohan R Memon, Neel M Bhavsar, Rameez A Musa, Pankaj R Patel.
doi- 10.13107/ti.2018.v04i02.072
Author: Rohan R Memon [1], Neel M Bhavsar [1], Rameez A Musa [1], Pankaj R Patel [1].
[1] Department of Orthopaedics, Sheth VS General Hospital, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Rohan Memon,
Department of Orthopaedics,
Sheth VS General Hospital, Ahmedabad, Gujarat, India.
Email: rhnmemon222@gmail.com
Abstract
Introduction: Subtrochanteric Fractures Of Femur accounts for 10-34% of all hip fractures.Several Methods of treatment of this Fractures have been reported like DHS( Dynamic hip screw),Angled blade Plate,Proximal Femur Locking Plate and Intramedullary devices. Currently Intramedullary Devices like Proximal Femur Nail are used by many giving Satisfactory results in subtrochanteric femur fractures. In such situation as Suggested by Richardu et. al. [7] slight medial entry leads to valgus alignment which is desired along with the anatomical reduction while nailing subtrochanteric fractures. In the study conducted by perez et al. Suggested that slight more medial entry also protected abductors and caused no damage.
Purpose of the study: The purpose of this study is to evaluate the results of subtrochanteric femur fractures treated with long proximal femur nail with entry medial to the tip of greater trochanter from 2014 -2016 treated at VSGH
Materials and methodology: • Permission from ethical committee was taken • Patient data is collected from OOT register VSGH from 2014-2016 • All the patients of subtrochanteric femur fractures treated with long proximal femur nail through medial entry will be called for follow-up and data is collected as per the performa. Patients were followed up at 2 ,4 ,6 weeks and then monthly with clinical and radiographic assessment until fracture union.fracture union was considered when bridging callus was visible on 3 of 4 cortices on anteroposterior and lateral radiograph. Functional assessment will be done using Harris Hip Score.
Discussion: utilizing the tip of the trochanter as a starting point led to both varus and valgus malalignments [26] Using the Trochanteric Fixation Nail (TFN) with a lateral to the tip of the trochanter, starting point demonstrated 6.83° varus and a gap of 8.03 mm. A medial starting point resulted in 6.6° valgus with a mean gap of 3.88 mm and a tip starting point showed 0.3° varus and 3.56 mm of gapping26 Streubel PN [27] In his study concluded that the ideal entry point ranged from 16 mm medial to 8 mm lateral to the trochanteric tip (mean, 3 mm medial; standard deviation, 5 mm). In 70% of patients, the ideal entry point was medial to and in 23% lateral to the tip of the greater trochanter and the trochanteric tip represents the ideal starting point in only the minority of cases. Prasarn [28] in his study concluded that rigid femoral nails introduced through a lateral entry portal have been associated with a higher risk of iatrogenic fracture and malreduction. In the above conducted study, there was a valgus angulation at the proximal femur due to medial entry of the proximal femur nail
Conclusion: This study was conducted to analyze the results of Subtrochanteric fractures treated with this Proximal Femoral Nail through medial entry both radiological and functionally. In our series of 30 cases of Subtrochanteric fractures treated with Proximal Femoral Nail, 24 patients had Excellent to good outcome at their final follow-up. Poor outcome was seen in 02 patients. 2 of these patients had poor reduction intraoperatively. The mean Harris Hip score at their final follow-up was 80.76 which is comparable to international publications in the literature. On follow-up radiological examination at 6 months 10 patients had 2-4 degrees of valgus angulation,16 patients had 4-6 degrees of valgus angualtion and 4 patients had 6-8 degrees of valgus angulation with no varus collapse. From this sample study, we conclude that Proximal Femoral Nail through medial entry is a good method for the treatment of Subtrochanteric fractures of femur provided optimal reduction of the fracture and good positioning of the nail and screws are achieved.
Keywords: Proximal femur nail Subtrochanteric femur fractures Varus alignment Medial entry
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16. Dodenhoff RM, Dainton JN, Hutchins PM. Proximal thigh pain after femoral nailing. Causes and treatment. J Bone Joint Surg Br 1997;79:738-41.
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18. Ostrum RF, Marcantonio A, Marburger R. A critical analysis of the eccentric starting point for trochanteric intramedullary femoral nailing. J Orthop Trauma 2005;19:681-6.
19. Neher C, Ostrum RF. Treatment of subtrochanteric femur fractures using a submuscular fixed low-angle plate. Am J Orthop (Belle Mead NJ) 2003;32:29-33.
20. Wang J, Ma XL, Ma JX, Xing D, Yang Y, Zhu SW, et al. Biomechanical analysis of four types of internal fixation in subtrochanteric fracture models. Orthop Surg 2014;6:128-36.
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Rashless and Bilateral Symmetrical Lower Limb Gangrene in a Patient with Meningococcal Meningitis
/in Volume 4 | Issue 2 | Sep-Dec 2018Vol 4 | Issue 2 | Sept-Dec 2018 | page: 14-16 | Ajiboye Lo, Oboirien M, Galadima AB
doi- 10.13107/ti.2018.v04i02.070
Author: Ajiboye Lo [1], Oboirien M [2], Galadima AB [1].
[1] Department of Orthopaedic Surgeon, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
[2] Department of Usmanu Danfodiyo University
Address of Correspondence
Dr. Ajiboye LO,
Consultant Orthopaedic Surgeon,
UsmanuDanfodiyo University Teaching Hospital, Sokoto, Nigeria.
E-mail: ajiboyelo@yahoo.com
Abstract
Introduction: An atypical presentation of meningococcal meningitis in a 10-year-old boy with rashless and bilateral symmetrical lower limb gangrene reported to stress the unusual pattern of the presentation. Unusual presentation of meningococcal meningitis is scarce in the literature, and we are not aware any unusual presentation in our setting.
Case Report: A 10-year-old boy presented with bilateral lower limb gangrene following a week history of high-grade fever, chills, rigors, neck pain and stiffness, convulsions, headache, altered sensorium, anorexia, and vomiting with no associated history of skin rash. Examination revealed an acutely ill-looking boy that was febrile, pale, anicteric, cyanosed, and not dehydrated. The pulse rate was 120/min, blood pressure 90/50 mmHg, a respiratory rate of 26 cycles/min, and symmetrical bilateral lower limb dry gangrene up to midlegs with multiple patchy areas of skin necrosis/dermatitis (with eschars) up to mid-thigh noted with Glasgow coma scale of 12 (E3V4M5) and positive signs of meningeal irritations. The complete blood counts, erthyrocyte sedimentation rate, random blood sugar, and creatinine were deranged while cerebrospinal fluid from lumbar puncture showed features of bacterial meningitis. The diagnosis of meningococcal meningitis with bilateral dry gangrene of both feet and leg was made and was managed with fluid and blood resuscitation, intravenous antibiotics, bilateral above knee amputation, and other supportive care. The treatment and recovery were satisfactory.
Conclusion: Meningococcal meningitis may present in an atypical manner which may pose a diagnostic dilemma and delayed appropriate treatment.
Keywords: Rashless, Symmetrical lower limb gangrene, Meningococcal meningitis.
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