Vol 8 | Issue 2 | July-December 2022 | page: 06-12 | Kenzie Kao, Mohammed Alsabri
DOI: https://doi.org/10.13107/ti.2022.v08i02.027
Authors: Kenzie Kao [1], Mohammed Alsabri [2]
[1] Saba University School of Medicine, Saba, Dutch Caribbean, Netherlands. [2] Department of Emergency Medicine, Al-Thawra Modern General Teaching Hospital, Sana’a City, Yemen.
Address of Correspondence
Dr. Mohammed Alsabri,
Department of Emergency Medicine, Al-Thawra Modern General Teaching Hospital, Sana’a City, Yemen.
E-mail: alsabri5000@gmail.com
Abstract
Hypothesis: Early administration of tranexamic acid (TXA) reduces mortality in patients suffering from acute traumatic brain injury (TBI).
Methods: A structured search of PubMed and CENTRAL from inception until July 1st, 2022 was carried out seeking RCTs comparing the effects of TXA administration to placebo in patients suffering from TBI. The primary outcome tested was 28-day all-cause mortality. Secondary outcomes included intracranial hemorrhage growth and thromboembolic events.
Results: Eight RCTs involving a total of 14,714 patients met the inclusion criteria; 7573 patients received TXA while 7141 patients received a placebo. There were 1415 patient deaths (18.7%) in the TXA group and 1410 patient deaths (19.7%) in the placebo group. None of the included studies reported a significant reduction in 28-day all-cause mortality, however, they all shared positive trends toward superior outcomes in the intervention arms. Two of the included studies reported significant reductions in intracranial hemorrhage expansion in those patients treated with TXA, with four more studies reporting trends toward superior outcomes in the TXA groups. There was no evidence of increased incidence of thromboembolic events in the TXA groups in four of the five studies that reported relevant data, with one study representing 1.2% of total patients reporting an increased incidence of pulmonary emboli in the intervention group.
Conclusions: In patients suffering from acute TBI, early administration of TXA reduces intracranial hemorrhage growth and may have positive effects on mortality with no corresponding increase in thromboembolic events. Given these results, early administration of TXA in patients experiencing TBI is recommended in initial care.
Keywords: Tranexamic acid, Traumatic brain injury, Intracranial hemorrhage, Mortality, Disability
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| How to Cite this article: Kao K, Alsabri M | Efficacy and Safety of Tranexamic Acid Administration in Patients with Acute Traumatic Brain Injury: A Review of Current Literature | July-December 2022; 8(2): 06-12. https://doi.org/10.13107/ti.2022.v08i02.027 |
From The Editor’s Desk!!
/in Volume 4 | Issue 2 | Sep-Dec 2018Vol 4 | Issue 2 | Sep-Dec 2018 | page:1 | Ashok K. Shyam
doi- 10.13107/ti.2018.v04i02.066
Author: Ashok K. Shyam [1, 2].
[1] Indian Orthopaedic Research Group, Thane, Maharashtra, India.
[2] Sancheti Institute for Orthopaedics & Rehabilitation, Pune, Maharashtra, India.
Address of Correspondence
Dr. Ashok Shyam
Head of Academics, Sancheti Institute for Orthopaedics & Rehabilitation, Pune, Maharashtra, India.
Email: editor.trauma.international@gmail.com
We thank authors for their contribution in the September-December 2018 issue of Trauma International. This issue contains Original Articles on Bimalleolar Fractures with Various Modalities, Triage in Mass Casualty Incidents, Proximal Femoral Nail in Subtrochanteric Femur Fractures, and case reports on Lateral Elbow Dislocation, Rashless and Bilateral Symmetrical Lower Limb Gangrene, Combined
Rupture of Patellar Tendon, Anterior Cruciate Ligament, Medial Collateral ligament, and Lateral Meniscus. We appreciate efforts of the authors and hope for more contribution in the field of orthopaedic literature in the coming years.
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Fractures of the Calcaneus- An Illustrated Review
/in January-June 2023 | Volume 9 | Issue 1Vol 9 | Issue 1 | January-June 2023 | page: 05-17 | Balvinder Rana, Anand Pillai
DOI: https://doi.org/10.13107/ti.2023.v09.i01.032
Authors: Balvinder Rana [1], Anand Pillai [2]
[1] Department of Trauma and Orthopaedics, Wythenshawe Hospital, Manchester University Foundation Trust, Manchester, UK.
[2] Department of Trauma and Orthopaedics, Foot & Ankle Division, Wythenshawe Hospital, Manchester University Foundation Trust, Manchester, UK.
Address of Correspondence
Dr. Balvinder Rana,
Speciality Doctor, Department of Trauma and Orthopaedics, Wythenshawe Hospital, Manchester University Foundation Trust, Manchester, UK.
Email: anklefootsurgery@gmail.com
Abstract
Calcaneal fractures are rare injuries accounting for less than 2% of all fractures. There is considerable published literature on calcaneal fractures, but the optimum management has still not been defined clearly because of different fracture patterns, patient characteristics affecting outcome, soft tissue complications associated with surgical treatment and complex anatomy of the calcaneus making accurate surgical reconstruction difficult. New techniques such as minimally invasive surgery (MIS) have shown promise. In this illustrated pictorial review, we summarise the surgical anatomy, pathophysiology, treatment strategies including tips and tricks on surgical management and discuss the current literature for this complex injury.
Keywords: Calcaneus, fracture, calcaneal anatomy, calcaneal fracture management, outcome of calcaneal fracture, classification
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Our Experience about Two Cases of Surgical Management of Bilateral Clavicle Fractures
/in January-June 2023 | Volume 9 | Issue 1Vol 9 | Issue 1 | January-June 2023 | page: 23-25 | Magoire Dingamnodji, Valentin Andjeffa, Daniel Adendingue, Kotiyade Ngamai, Fandebnet Siniki, Naobe Emery, Sayouba Tinto
DOI: https://doi.org/10.13107/ti.2023.v09.i01.031
Authors: Magoire Dingamnodji [1], Valentin Andjeffa [2], Daniel Adendingue [2], Kotiyade Ngamai [1], Fandebnet Siniki [1], Naobe Emery [4], Sayouba Tinto [3]
[1] Renaissance University Hospital Centre of N’djamena, Chad.
[2] National Reference General Hospital of N’djamena, Chad.
[3] Yalgado Ouedraogo University Hospital Centre of Ouagadougou, Burkina, Faso.
[4] Military Training Hospital of N’djamena, Chad.
Address of Correspondence
Dr. Magoire Dingamnodji,
Department of Orthopedic and Traumatological Surgery, Renaissance University Hospital Centre of N’djamena, Chad.
E-mail: odialmagloire1989@gmail.com
Abstract
Bilateral clavicle fractures are rare injuries. Their management is a subject of controversery. Some authors advocate surgical intervention, while others recommend orthopedic treatment. Several surgical implants are used, including anatomical screws, reconstruction plates, Kirschner wires and external fixators. We would like to share our experience with osteosynthesis using one-third tubular plate in bilateral clavicle fractures. This about two patients. At the six-month follow-up, excellent anatomical and functional outcomes were achieved.
Keywords: Bilateral clavicle, Targeted plates, Surgical management.
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6. Woltz S, Duijff JW, Hoogendoorn JM, Rhemrev SJ, Breederveld RS, Schipper IB, Beeres FJ. Reconstruction plates for midshaft clavicular fractures: A retrospective cohort study. Orthop Traumatol Surg. Res 2016;102:25-9.
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Fixation of Acromion Fracture by Distal Radius Plate: A Case Report
/in January-June 2023 | Volume 9 | Issue 1Vol 9 | Issue 1 | January-June 2023 | page: 26-28 | Mohd Danish, Hemant Gupta, Ravi Kant, Vikas Singh
DOI: https://doi.org/10.13107/ti.2023.v09.i01.35
Authors: Mohd. Danish [1], Hemant Gupta [1], Ravi Kant [1], Vikas Singh [1]
[1] Department of Orthopaedics, Max Super Specialty Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India.
Address of Correspondence
Dr. Mohd Danish,
Department of Orthopaedics, Max Super Specialty Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India.
E-mail: danish.shan@gmail.com
Abstract
Acromion process fractures are as rare to happen and even rare to be treated surgically. Acromion acts as a stabilizer of shoulder joint through a number of ligaments and muscles attached to it. Although most of the acromion fractures are treated conservatively which may either be due to surgeon preference or lack of sufficient training in surgically treating these fractures. Our case is of a 54 years old, Male who presented to us after being referred from other hospital with Type II acromion process fracture who was treated surgically after the fracture was fixed by the unconventional distal end radius plate in place of usually used clavicular or recon plates. The patient yielded excellent Oxford shoulder score in the subsequent follow ups. Although the acromion fractures are not fixed by most of the surgeons and if at all they are fixed they usually use the conventional plates as mentioned for its fixation, but our case shows that even the distal radius plates can be used as a fixation device in such fractures with excellent rehabilitation results and almost no complications.
Keywords: Acromion, Fracture, Plate
References
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7. Operative treatment of scapular fractures: a systematic review. Lantry JM, Roberts CS, Giannoudis PV. Injury. 2008;39:271–283.
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Long-Term Outcomes Following Synthetic Patch Augmentation to Treat Rotator Cuff Tears
/in January-June 2023 | Volume 9 | Issue 1Vol 9 | Issue 1 | January-June 2023 | page: 01-04 | Florian Hess, JoEllen Welter, Laurenz Jaberg
DOI: https://doi.org/10.13107/ti.2023.v09.i01.031
Authors: Florian Hess [1], JoEllen Welter [1], Laurenz Jaberg [2]
[1] Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
[2] Department of Orthopaedic Surgery, Clinica Ars Medica, Gravesano, Switzerland.
Address of Correspondence
Dr. Florian Hess,
Department of Orthopaedic Surgery and Traumatology Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
E-mail: florian.hess@stgag.ch
Abstract
Background: Treatment of massive rotator cuff (RC) tears can result in re-rupture rates up to 94%, and some studies have detected re-ruptures occurring 3.5 years postoperatively. This study aimed to compare long-term clinical outcomes, measured at two time points, after massive RC tears with patch augmentation.
Methods: We performed 58 arthroscopic RC reconstructions augmented with a synthetic polyester patch between 2012 and 2014. 50 patients were available for long-term follow-up one and five years after surgery. We compared clinical outcomes (Constant-Murley score (CS) and subjective shoulder value (SSV)) to assess if the results were sustained over time.
Results: 86% (50/58) of the patients were assessed at the one- and five-year follow-up visits. The median CS one year postoperative reached 84 (interquartile range 76.5-90), and SSV was 95 (IQR 82.5-100). The median CS five years after surgery was 85 (IQR 81.5-91.5) and SSV was 95 (IQR 85-100). The clinical improvement between postoperative years one and five was statistically significant for CS (p=0.0013) and SSV (p<0.0001).
Conclusions: Rotator cuff repair with polyester patch augmentation achieved good clinical outcomes over the long term. Clinical improvement continued over time, with slightly more favorable results measured at the five-year follow-up visits.
Keywords: Massive rotator cuff tears, Augmentation, Patch, Shoulder, Arthroscopy
References
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2. Colvin AC, Egorova N, Harrison AK, Moskowitz A, Flatow EL (2012) National trends in rotator cuff repair. J Bone Joint Surg [Am] 94 (3):227-233.
3. Jain NB, Higgins LD, Losina E, Collins J, Blazar PE, Katz JN (2014) Epidemiology of musculoskeletal upper extremity ambulatory surgery in the United States. BMC Musculoskelet Disord 15:4.
4. Paloneva J, Lepola V, Aarimaa V, Joukainen A, Ylinen J, Mattila VM (2015) Increasing incidence of rotator cuff repairs–A nationwide registry study in Finland. BMC Musculoskelet Disord 16:189.
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6. Davey MS, Hurley ET, Carroll PJ, Galbraith JG, Shannon F, Kaar K, Mullett H (2023) Arthroscopic Rotator Cuff Repair Results in Improved Clinical Outcomes and Low Revision Rates at 10-Year Follow-Up: A Systematic Review. Arthrosc – J Arthrosc Relat Surg 39 (2):452-458.
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8. Shah NS, Suriel Peguero E, Umeda Y, Crawford ZT, Grawe BM (2022) Long-Term Outcomes of Massive Rotator Cuff Tear Repair: A Systematic Review. HSS J 18 (1):130-137.
9. Smolen D, Haffner N, Mittermayr R, Hess F, Sternberg C, Leuzinger J (2020) Application of a new polyester patch in arthroscopic massive rotator cuff repair-a prospective cohort study. J Shoulder Elbow Surg 29 (1):e11-e21.
10. Proctor CS (2014) Long-term successful arthroscopic repair of large and massive rotator cuff tears with a functional and degradable reinforcement device. J Shoulder Elbow Surg 23 (10):1508-1513.
11. Gerber C, Fuchs B, Hodler J (2000) The results of repair of massive tears of the rotator cuff. J Bone Joint Surg [Am] 82 (4):505-515.
12. Davidson J, Burkhart SS (2010) The geometric classification of rotator cuff tears: a system linking tear pattern to treatment and prognosis. Arthrosc – J Arthrosc Relat Surg 26 (3):417-424.
13. Bailey JR, Kim C, Alentorn-Geli E, Kirkendall DT, Ledbetter L, Taylor DC, Toth AP, Garrigues GE (2019) Rotator Cuff Matrix Augmentation and Interposition: A Systematic Review and Meta-analysis. Am J Sports Med 47 (6):1496-1506.
14. Ferguson DP, Lewington MR, Smith TD, Wong IH (2016) Graft Utilization in the Augmentation of Large-to-Massive Rotator Cuff Repairs: A Systematic Review. Am J Sports Med 44 (11):2984-2992.
15. Steinhaus ME, Makhni EC, Cole BJ, Romeo AA, Verma NN (2016) Outcomes After Patch Use in Rotator Cuff Repair. Arthroscopy 32 (8):1676-1690.
16. Smolen D, Haffner N, Mittermayr R, Hess F, Sternberg C, Leuzinger J (2019) Application of a new polyester patch in arthroscopic massive rotator cuff repair-a prospective cohort study. J Shoulder Elbow Surg.
17. Barber FA, Burns JP, Deutsch A, Labbe MR, Litchfield RB (2012) A prospective, randomized evaluation of acellular human dermal matrix augmentation for arthroscopic rotator cuff repair. Arthrosc – J Arthrosc Relat Surg 28 (1):8-15.
18. Gilot GJ, Alvarez-Pinzon AM, Barcksdale L, Westerdahl D, Krill M, Peck E (2015) Outcome of Large to Massive Rotator Cuff Tears Repaired With and Without Extracellular Matrix Augmentation: A Prospective Comparative Study. Arthroscopy 31 (8):1459-1465.
19. Mori D, Funakoshi N, Yamashita F (2013) Arthroscopic surgery of irreparable large or massive rotator cuff tears with low-grade fatty degeneration of the infraspinatus: patch autograft procedure versus partial repair procedure. Arthroscopy 29 (12):1911-1921.
20. Audenaert E, Van Nuffel J, Schepens A, Verhelst M, Verdonk R (2006) Reconstruction of massive rotator cuff lesions with a synthetic interposition graft: a prospective study of 41 patients. Knee Surg Sports Traumatol Arthrosc 14 (4):360-364.
21. Badhe SP, Lawrence TM, Smith FD, Lunn PG (2008) An assessment of porcine dermal xenograft as an augmentation graft in the treatment of extensive rotator cuff tears. J Shoulder Elbow Surg 17 (1 Suppl):35S-39S.
22. Giannotti S, Ghilardi M, Dell’osso G, Magistrelli L, Bugelli G, Di Rollo F, Ricci G, Calabrese R, Siciliano G, Guido G (2014) Study of the porcine dermal collagen repair patch in morpho-functional recovery of the rotator cuff after minimum follow-up of 2.5 years. Surg Technol Int 24:348-352.
23. Nada AN, Debnath UK, Robinson DA, Jordan C (2010) Treatment of massive rotator-cuff tears with a polyester ligament (Dacron) augmentation: clinical outcome. J Bone Joint Surg Br 92 (10):1397-1402.
24. Rotini R, Marinelli A, Guerra E, Bettelli G, Castagna A, Fini M, Bondioli E, Busacca M (2011) Human dermal matrix scaffold augmentation for large and massive rotator cuff repairs: preliminary clinical and MRI results at 1-year follow-up. Musculoskelet Surg 95 Suppl 1:S13-23.
25. Ciampi P, Scotti C, Nonis A, Vitali M, Di Serio C, Peretti GM, Fraschini G (2014) The benefit of synthetic versus biological patch augmentation in the repair of posterosuperior massive rotator cuff tears: a 3-year follow-up study. Am J Sports Med 42 (5):1169-1175.
26. Longo UG, Lamberti A, Maffulli N, Denaro V (2010) Tendon augmentation grafts: a systematic review. Br Med Bull 94:165-188.
27. Iannotti JP, Codsi MJ, Kwon YW, Derwin K, Ciccone J, Brems JJ (2006) Porcine small intestine submucosa augmentation of surgical repair of chronic two-tendon rotator cuff tears. A randomized, controlled trial. J Bone Joint Surg [Am] 88 (6):1238-1244.
28. Papalia R, Franceschi F, Zampogna B, D’Adamio S, Maffulli N, Denaro V (2013) Augmentation techniques for rotator cuff repair. Br Med Bull 105:107-138.
29. Phipatanakul WP, Petersen SA (2009) Porcine small intestine submucosa xenograft augmentation in repair of massive rotator cuff tears. Am J Orthop 38 (11):572-575.
30. Sclamberg SG, Tibone JE, Itamura JM, Kasraeian S (2004) Six-month magnetic resonance imaging follow-up of large and massive rotator cuff repairs reinforced with porcine small intestinal submucosa. J Shoulder Elbow Surg 13 (5):538-541.
31. Walton JR, Bowman NK, Khatib Y, Linklater J, Murrell GA (2007) Restore orthobiologic implant: not recommended for augmentation of rotator cuff repairs. J Bone Joint Surg [Am] 89 (4):786-791.
32. Henry P, Wasserstein D, Park S, Dwyer T, Chahal J, Slobogean G, Schemitsch E (2015) Arthroscopic Repair for Chronic Massive Rotator Cuff Tears: A Systematic Review. Arthroscopy 31 (12):2472-2480.
33. Shimokobe H, Gotoh M, Honda H, Nakamura H, Mitsui Y, Kakuma T, Okawa T, Shiba N (2017) Risk factors for retear of large/massive rotator cuff tears after arthroscopic surgery: an analysis of tearing patterns. J Orthop Surg Res 12 (1):140.
34. Miller BS, Downie BK, Kohen RB, Kijek T, Lesniak B, Jacobson JA, Hughes RE, Carpenter JE (2011) When do rotator cuff repairs fail? Serial ultrasound examination after arthroscopic repair of large and massive rotator cuff tears. Am J Sports Med 39 (10):2064-2070.
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A Simple Surgical Technique of Trans Articular K Wires Fixation Through Sinus Tarsi Approach for Treating Intra Articular Calcaneal Fractures : A Large Case Series
/in January-June 2023 | Volume 9 | Issue 1Vol 9 | Issue 1 | January-June 2023 | page: 18-22 | Sampat Dumbre Patil, Gurunath Wachche, Harsh R. Vyas, Rohil Singh Kakkar, Vaishali Dumbre PatilAddress of Correspondence
DOI: https://doi.org/10.13107/ti.2023.v09.i01.033
Authors: Sampat Dumbre Patil [1], Gurunath Wachche [2], Harsh R. Vyas [1], Rohil Singh Kakkar [1], Vaishali Dumbre Patil [3]
[1] Department of Orthopaedics, Sahyadri Super Speciality Hospital, Hadapsar, Pune, Maharashtra, India.
[2]Department of Orthopaedics, Dr. V M Government Medical College, Solapur, Maharashtra, India.
[3] Department of Radiology, Oasis Orthopaedic and Sonography Clinic, Hadapsar, Pune, Maharashtra.
Address of Correspondence
Dr. Harsh R. Vyas
Department of Orthopaedics, Sahyadri Super Speciality Hospital, Hadapsar, Pune, Maharashtra.
E-mail: drharshvyas333@gmail.com
Abstract
Introduction: Calcaneum fractures are the most common tarsal bone fractures accounting for 2% of all bone fractures and approximately 60 % of tarsal bone fractures. Management of intra-articular calcaneal fractures have evolved from conservative to open and minimally invasive surgeries till date. There are still some controversies in treating intra articular displaced calcaneum fractures and treatment modalities continue to evolve with different surgical techniques and implants. We present a large retrospective study series of a safe and simple technique of managing intra-articular calcaneum fractures through sinus tarsi approach and fixation with transarticular Kirschner wires with or without sustentacular screw.
Methods: This retrospective study was done from January 2016 to March 2019 and aimed to evaluate the radiological and functional outcomes in a series of 226 patients with displaced intra-articular fractures of calcaneum managed with a simple surgical technique treated with trans articular K wires with or without sustentacular screw through sinus tarsi approach. Statistical analysis was performed utilizing independent t-test using the p-value ≤0.5
Results: All 226 cases achieved union of fracture within 4 months of follow up and as per American Orthopaedic Foot and Ankle Society (AOFAS) scoring, 57.96% cases had excellent results, 23.45% cases had good and 18.58% cases had fair results respectively. Conclusion Fixation of displaced intra-articular calcaneum fractures with trans articular K wires with or without sustentacular screw through sinus tarsi approach is a soft tissue preserving surgical technique which restores the near normal biomechanics of the calcaneum.
Keywords: Calcaneum fractures, Heel injuries, Sinus tarsi approach, Minimally invasive surgery, Calcaneum fixation, K wire fixation
References
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7. Wu J, Zhou F, Yang L, Tan J: Percutaneous Reduction and Fixation with Kirschner Wires versus Open Reduction Internal Fixation for the Management of Calcaneal Fractures: A Meta-Analysis. Sci Rep. 20166, 30480-2016. 10.1038/srep30480
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12. Adhya, Bibek&Dhillon, Himmat&Dhillon, Mandeep&Dhillon, Sidak. (2020: Rehabilitation Protocols for Calcaneus Fractures. Journal of Foot and Ankle Surgery (Asia. 7:77-82. 10.5005/jp-journals- 10040-1131
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15. Tong, Leia; Li, Mingjingb; Li, Fanb; Xu, Jianb; Hu, Taob: A minimally invasive (sinus tarsi) approach with percutaneous K-wires fixation for intra-articular calcaneal fractures in children. Journal of Pediatric Orthopaedics B: November. 2018, 27:556-562. 10.1097/BPB.0000000000000532
16. Wallace SB, O’Neill D, Narayanan A, et al.: Low Risk of Wound Complications with Sinus Tarsi Approach for Treatment of Calcaneus Fractures. Foot & Ankle Orthopaedics. 5:2473011420-0048. 10.1177/2473011420S00484
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Morphometric Comparison of Distal Hamate Articular Surface with the Proximal Articular Surface of Middle Phalanges of Index, Middle, Ring and Little Fingers for Hemi-Hamate Arthroplasty
/in July-December 2022 | Volume 8 | Issue 2Vol 8 | Issue 2 | July-December 2022 | page: 13-16 | B Jagannath Kamath, Manesh Jain, Monish N
DOI: https://doi.org/10.13107/ti.2022.v08i02.028
Authors: B Jagannath Kamath [1], Manesh Jain [1], Monish N [1]
[1] Department of Orthopedic, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Address of Correspondence
Dr. Monish N
Department of Orthopedic, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
E-mail: monish1994n@gmail.com
Abstract
PURPOSE: The study is focused to compare the Distal Hamate articular Surface to the morphology of the base of middle phalanges of Index, Middle, Ring & little fingers.
METHODOLOGY: A Observational Paired T study was conducted. Patients with fractures of forearm or hand excluding any fractures in hamate and middle phalanges of Index , Middle, Ring & Little finger of both the upper limbs are subjected to Computed Tomography (CT) of hand and a 3D reconstructed image is obtained. Once the scans are collected, the below parameters will be determined using Radiant software.
RESULTS: At the end of this study ,we found that Majority of the patients who underwent CT Scans were noted to be between 31 and 50 years of age. Gender wise, males considered for the study were 24 (52%) and females were 25 (49%). The average hamate axial ridge angle was 69.18 and that of the ring finger middle phalangeal base was 80.23 (P < .05) Out of 50 patients the axial ridge angle of hamate was comparable with ring finger middle phalangeal base. The average distal hamate surface area was 1.04 and that of the middle phalangeal base was 1.00 (P < .05) The distal hamate articular surface area was comparable with the middle finger’s middle phalangeal base. The average sagittal inclination of distal hamate surface was 48.64 and that of the ring finger middle phalangeal base was 49.08 (P < .05) . The sagittal inclination of hamate was comparable with ring finger middle phalangeal base .
CONCLUSION: In literature very few radiological studies comparing the hamate and middle phalanx articular surfaces are reported. This study helps us in understanding the digit which is similar to hamate for undergoing Hemi Hamate Arthroplasty and usefulness of pre operative CT scan in further management of chronic proximal interphalangeal joint fracture dislocations. According to the results obtained from our study, we conclude that the Axial ridge angle and sagittal inclination of Middle Phalanx of Ring finger is in close approximation with Hamate . Articular Surface Area of Middle Finger is in close approximation with Hamate distal articular surface area.
Keywords: PIPJ- Proximal Interphalangeal Joint, ORIF- Open Reduction, Interal Fixation, CT- Computed Tomography, HHA- Hemi Hamate Arthroplasty
References
1.Drain J, Mehta S, Goyal KS. An analysis of hamate morphology relevant to Hemi-hamate arthroplasty. J Hand Surg Am [Internet]. 2020;45(7):657.e1-657.e6
2. Sollaccio DR, Navo P, Ghiassi A, Orr CM, Patel BA, Lewton KL. Evaluation of articular surface similarity of Hemi-hamate grafts and proximal middle phalanx morphology: A 3D geometric morphometric approach. J Hand Surg Am [Internet]. 2019;44(2):121–8.
3. Calva, D., Calotta, N., Lopez, J., Christopher, A., Magid, D., Demehri, S., & Lifchez, S. D. (2016). A simple pre-operative imaging method to assess donor and recipient anatomy in hemi-hamate arthroplasty for proximal interphalangeal joint reconstruction. Surgical and Radiologic Anatomy, 38(6), 699-704.
4. Ten Berg P, Ring D. Quantitative 3D-CT anatomy of hamate osteoarticular autograft for reconstruction of the middle phalanx base. Clin Orthop Relat Res [Internet]. 2012;470(12):3492–8.
5. McAuliffe JA. Hemi-hamate autograft for the treatment of unstable dorsal fracture dislocation of the proximal interphalangeal joint. J Hand Surg Am [Internet]. 2009;34(10):1890–4.
6. Calfee, R. P., Kiefhaber, T. R., Sommerkamp, T. G., & Stern, P. J. (2009). Hemi-hamate arthroplasty provides functional reconstruction of acute and chronic proximal interphalangeal fracture–dislocations. The Journal of hand surgery, 34(7), 1232-1241.
7. Capo JT, Hastings H 2nd, Choung E, Kinchelow T, Rossy W, Steinberg B. Hemicondylar hamate replacement arthroplasty for proximal interphalangeal joint fracture dislocations: an assessment of graft suitability. J Hand Surg Am [Internet]. 2008;33(5):733–9.
8. Barksfield RC, Bowden B, Chojnowski AJ. Hemi-hamate arthroplasty versus transarticular Kirschner wire fixation for unstable dorsal fracture-dislocation of the proximal interphalangeal joint in the hand. Hand Surg [Internet]. 2015;20(1):115–9.
9. Korambayil PM, Francis A. Hemi-hamate arthroplasty for pilon fractures of finger. Indian J Plast Surg [Internet]. 2011;44(3):458–66.
10. Podolsky DJ, Mainprize J, McMillan C, Binhammer P. Suitability of using the hamate for reconstruction of the finger middle phalanx base: An assessment of cartilage thickness. Plast Surg (Oakv) [Internet]. 2019;27(3):211–6.
11. Williams RMM, Kiefhaber TR, Sommerkamp TG, Stern PJ. Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft. J Hand Surg Am [Internet]. 2003;28(5):856–65.
12. Janssen, S. J., Ter Meulen, D. P., Hageman, M. G., Earp, B. E., & Ring, D. (2015). Quantitative 3-dimensional CT analyses of fractures of the middle phalanx base. HAND, 10(2), 210-214.
How to Cite this article: Kamath BJ, Jain M, Monish N | Morphometric Comparison of Distal Hamate Articular Surface with the Proximal Articular Surface of Middle Phalanges of Index, Middle, Ring and Little Fingers for Hemi-Hamate Arthroplasty | July-December 2022; 8(2): 13-16. https://doi.org/10.13107/ti.2022.v08i02.028
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A Comparative Study showing Elbow Kinematics in Radial Head Replacement Versus Radial Head Excision Versus Radial Head Fixation
/in July-December 2022 | Volume 8 | Issue 2Vol 8 | Issue 2 | July-December 2022 | page: 01-05 | Amit Yadav, Sagar Bansal, Mrinal Kambli, Shaswat Mishra, Devenshu Gupta
DOI: https://doi.org/10.13107/ti.2022.v08i02.026
Authors: Amit Yadav [1], Sagar Bansal [1], Mrinal Kambli [1], Shaswat Mishra [1], Devenshu Gupta [1]
[1] Department of Orthopaedics, Grant Medical College and Sir J. J. Group of Hospitals, Byculla, Mumbai, Maharashtra, India.
Address of Correspondence
Dr Sagar Bansal,
Senior Resident, Department of Orthopaedics, Grant Medical College and Sir J. J. Group of Hospitals, Byculla, Mumbai, Maharashtra, India.
E-mail: sagarbansal59@gmail.com
Abstract
Background: Radial head fractures are quite common with incidence 1.5-4% of all adult fractures. The management of these fractures depends upon age and type of injury
Aim: To compare the outcome in comminuted radial head fractures(Mason type III) based on mayo elbow scoring and handgrip strength test when managed with radial head excision, radial head fixation or radial head replacement
Material and Methods: We did a prospective comparative study comprising 60 patients between age 20-60 years with Mason type III radial head fractures. The patients were randomised using the admission day of the week placing 20 patients each in arthroplasty , excision and in the fixation group. The patients were followed up for 18-24 months postoperatively. Results were evaluated by the Mayo’s elbow performance and Handgrip strength score at 6 months and 18 months and were statistically evaluated by one-way ANOVA test.
Results: As per Mayo’s score at 6 months follow up, mean and standard deviation (SD) of the scores in arthroplasty was 83.25 and 11.50, for excision it was 76.25 and 11.38 & for fixation, it was 68.75 and 17.83 respectively. At 18 months follow up, mean and standard deviation was 90 and 12.56 for arthroplasty, 83 and 9.92 for excision & 76.25 and 21.69 for fixation respectively. As per handgrip strength score at 6 months follow up, mean and standard deviation of the scores in arthroplasty was 31.1 and 4.37, for excision it was 28.75 and 4.27 & for fixation, it was 27.15 and 5.94 respectively. At 18 months follow up, mean and standard deviation was 32.95 and 4.006 for arthroplasty, 30.7 and 4.06 for excision & 28 and 6.75 for fixation respectively. The difference between the results according to both Mayo’s score as well as Handgrip strength test was statistically significant (p < 0.05).
Conclusion: Our study shows that long and short-term results of radial head replacement are better than radial head excision and radial head fixation in comminuted radial head fractures based on mayo elbow scoring and hand grip strength score.
Keywords: Radial head fracture, Radial head replacement, Mason classification
References
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8. Yamaguchi K, Sweet FA, Bindra R, Morrey BF, Gelberman RH: The extraosseous and intraosseous arterial anatomy of the adult elbow. J Bone Joint Surg 79A:1653–1662, 1997.
9. Singh AK, Jidge A, Ramteke U, Venkateswaran N, Rokade H, Mulje SM, Mukherjee S, Kotian A. Functional Outcome of Elbow Kinematics in Radial Head Excision Versus Radial Head Replacement: A Comparative Study. Open Access Maced J Med Sci. 2019 May 15;7(9):1505-1508.
10. Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ. The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg Am. 2004 Aug;86(8):1730-9.
11. Ikeda M, Sugiyama K, Kang C, Takagaki T, Oka Y. Comminuted fractures of the radial head: comparison of resection and internal fixation. Surgical technique. J Bone Joint Surg Am. 2006 Mar;88 Suppl 1 Pt 1:11-23.
12. Swensen SJ, Tyagi V, Uquillas C, Shakked RJ, Yoon RS, Liporace FA. Maximizing outcomes in the treatment of radial head fractures. J Orthop Traumatol. 2019 Mar 23;20(1):15.
13. Sun H, Duan J, Li F. Comparison between radial head arthroplasty and open reduction and internal fixation in patients with radial head fractures (modified Mason type III and IV): a meta-analysis. Eur J Orthop Surg Traumatol. 2016 Apr;26(3):283-91.
14. Sinha S, Sarkar S, Singh A, Saraf SK, Rastogi A, Singh T. Radial Head Arthroplasty, Excision and Osteosynthesis in Complex Elbow Fracture-Dislocations in Young Adults: What is Preferred? Indian J Orthop. 2020 May 18;54(Suppl 2):260-269.
15. Heim U.[Combined fractures of the radius and the ulna at the elbow level in the adult. Analysis of 120 cases after more than 1 year]. Rev Chir Orthop Reparatrice Appar Mot. 1998 Apr;84(2):142-53.
16. Ring D, Quintero J, Jupiter JB. Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am. 2002 Oct;84(10):1811-5.
17. Herbertsson P, Josefsson PO, Hasserius R, Besjakov J, Nyqvist F, Karlsson MK. Fractures of the radial head and neck treated with radial head excision. J Bone Joint Surg Am. 2004 Sep;86(9):1925-30.
18. Shetty SK, Shetty A, Balan B, Ballal A, Rai HR, Hegde A. Excision Versus Fixation of the Radial Head: A Comparative Study of the Functional Outcomes of the Two Techniques. J Clin Diagn Res. 2017 Feb;11(2):RC01-RC03.
19. Bain GI, Ashwood N, Baird R, Unni R. Management of Mason type-III radial head fractures with a titanium prosthesis, ligament repair, and early mobilization. Surgical technique. J Bone Joint Surg Am. 2005 Mar;87 Suppl 1(Pt 1):136-47.
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Efficacy and Safety of Tranexamic Acid Administration in Patients with Acute Traumatic Brain Injury: A Review of Current Literature
/in July-December 2022 | Volume 8 | Issue 2Vol 8 | Issue 2 | July-December 2022 | page: 06-12 | Kenzie Kao, Mohammed Alsabri
DOI: https://doi.org/10.13107/ti.2022.v08i02.027
Authors: Kenzie Kao [1], Mohammed Alsabri [2]
[1] Saba University School of Medicine, Saba, Dutch Caribbean, Netherlands. [2] Department of Emergency Medicine, Al-Thawra Modern General Teaching Hospital, Sana’a City, Yemen.
Address of Correspondence
Dr. Mohammed Alsabri,
Department of Emergency Medicine, Al-Thawra Modern General Teaching Hospital, Sana’a City, Yemen.
E-mail: alsabri5000@gmail.com
Abstract
Hypothesis: Early administration of tranexamic acid (TXA) reduces mortality in patients suffering from acute traumatic brain injury (TBI).
Methods: A structured search of PubMed and CENTRAL from inception until July 1st, 2022 was carried out seeking RCTs comparing the effects of TXA administration to placebo in patients suffering from TBI. The primary outcome tested was 28-day all-cause mortality. Secondary outcomes included intracranial hemorrhage growth and thromboembolic events.
Results: Eight RCTs involving a total of 14,714 patients met the inclusion criteria; 7573 patients received TXA while 7141 patients received a placebo. There were 1415 patient deaths (18.7%) in the TXA group and 1410 patient deaths (19.7%) in the placebo group. None of the included studies reported a significant reduction in 28-day all-cause mortality, however, they all shared positive trends toward superior outcomes in the intervention arms. Two of the included studies reported significant reductions in intracranial hemorrhage expansion in those patients treated with TXA, with four more studies reporting trends toward superior outcomes in the TXA groups. There was no evidence of increased incidence of thromboembolic events in the TXA groups in four of the five studies that reported relevant data, with one study representing 1.2% of total patients reporting an increased incidence of pulmonary emboli in the intervention group.
Conclusions: In patients suffering from acute TBI, early administration of TXA reduces intracranial hemorrhage growth and may have positive effects on mortality with no corresponding increase in thromboembolic events. Given these results, early administration of TXA in patients experiencing TBI is recommended in initial care.
Keywords: Tranexamic acid, Traumatic brain injury, Intracranial hemorrhage, Mortality, Disability
References
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Management of a Polytrauma Case In a Resource-Constrained Hospital
/in July-December 2022 | Volume 8 | Issue 2Vol 8 | Issue 2 | July-December 2022 | page: 21-25 | Daniel Mossalbaye Adendjingue, S. Pascal Chigblo, Oswald Goukodadja, Adebola Padonou, Iréti Fiacre Tidjani, Aristote Hans-Moevi Akue
DOI: https://doi.org/10.13107/ti.2022.v08i02.0230
Authors: Daniel Mossalbaye Adendjingue [1], S. Pascal Chigblo [2], Oswald Goukodadja [2], Adebola Padonou [2], Iréti Fiacre Tidjani [2], Aristote Hans-Moevi Akue [2]
[1] Department of Orthopedic-Traumatology, National Teaching Hospital CHU-RN, N’Djamena-Chad. [2] Department of Orthopedic-Traumatology, National Teaching Hospital CNHU-HKM, Cotonou, Benin.
Address of Correspondence
Dr. Daniel Mossalbaye Adendjingue,
Department of Orthopedic-Traumatology, National Teaching Hospital CHU-RN, N’Djamena-Chad.
E-mail: dendjinguedaniel@gmail.com / adendjingue@yahoo.fr
Abstract
Introduction: The management of polytrauma patient should be beforehand and always in keeping in mind the damage control. the surgical treatment is secondary to the stabilization of the patient.
Clinical Case: we are reporting a 34 years old polytrauma patient from a motor vehicle accident. On physical examination, we noted : a severe brain injury, a closed articular fracture of right distal radius associated to a dislocation of distal radius and ulna distal joint, a closed bilateral fracture of both trochanters, an open communitive tibial fracture of proximal epiphysis methaphysis and diaphysis. The last one was classified as type IIIB of Gustilo and Anderson and associated to a closed fracture of the head and the neck of right fibula, a closed fracture of the right lateral malleolus. After patient stabilization, the head injury improves to normal Glasgow score on 8th day of admission. Necrosis of soft tissus and exposition of the tibia was noted. The surgical treatment was done on 2 stages due to financial issues. A bone synthesis of the trochanteric fracture was done only on the left and external frame as well as a muscle flap was done for the right tibial fracture on the 18th day. On the 42nd day a PAPINEAU technic associated to a proximal inter tibiofibular graft was done. The functional outcome of the orthopaedic treatment of the wrist was bad (malunion). That last complication was managed by a SAUVE KAPANDJI surgery (at 6 months) and the contracture (pronation and supination) at 12 months post trauma. The outcome was fair good despite patient financial issue and local complications that compromise an optimal surgical management and a delay. He resumes normal professional activities at about 2 years. At 5 years follow up, functional and anatomical results were satisfactory.
Conclusion: In a limited ressources’ setting, the management of lesions including a multiple fractures is a challenge for the practitioner and the injuried patient. A management taking into account social and economic ressources is mandatory to minimise sequelae. Keywords: Management, Polytrauma, Limited ressources.
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