From The Editor’s Desk!!

Vol 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.


How to Cite the article: Shyam AK. From The Editor’s Desk. Trauma International. Sep-Dec 2018;4(2):1.

 


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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

Vol 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.

9. Rae PJ, Davies DR. Simultaneous rupture of the ligamentum patellae, medial collateral, and anterior cruciate ligaments: A case report. Am J Sports Med 1991;19:529-30.

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.


How to Cite this article:  Mittal N, Bohat R, Jindal A, Singhal A. A Rare and Atypical Case Report of Combined Rupture of Patellar Tendon, Anterior Cruciate Ligament, Medial Collateral ligament, and Lateral Meniscus Managed Operatively. Trauma International Sep-Dec 2018;4(2):17-19.

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Outcomes of Proximal Femoral Nail in Subtrochanteric Femur Fractures Through Medial Entry

Vol 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


References

1. Tencer AF, Johnson KD, Johnston DW, Gill K. A biomechanical comparison of various methods of stabilization of subtrochanteric fractures of the femur. J Orthop Res 1984;2:297-305.

2. Beingessner DM, Scolaro JA, Orec RJ, Nork SE, Barei DP. Open reduction and intramedullary stabilisation of subtrochanteric femur fractures: A retrospective study of 56 cases. Injury 2013;44:1910-5.

3. Herscovici D Jr., Pistel WL, Sanders RW. Evaluation and treatment of high subtrochanteric femur fractures. Am J Orthop (Belle Mead NJ) 2000;29:27-33.

4. Borens O, Wettstein M, Kombot C, Chevalley F, Mouhsine E, Garofalo R, et al. Long gamma nail in the treatment of subtrochanteric fractures. Arch Orthop Trauma Surg 2004;124:4437.

5. Connelly CL, Archdeacon MT. The lateral decubitus approach for complex proximal femur fractures: Anatomic reduction and locking plate neutralization: A technical trick. J Orthop Trauma 2012;26:252-7.

6. Saarenpää I, Heikkinen T, Jalovaara P. Treatment of subtrochanteric fractures. A comparison of the gamma nail and the dynamic hip screw: Short-term outcome in 58 patients. Int Orthop 2007;31:6570.

7. Richard SY, Derek JD, Frank AL. Reducing subtrochanteric femur fractures: Tips and Tricks, Do’s and Don’ts. J Orthop Trauma 2015;29:S28-33.

8. Johnson KD, Tencer AF, Sherman MC. Biomechanical factors affecting fracture stability and femoral bursting in closed intramedullary nailing of femoral shaft fractures, with illustrative case presentations. J Orthop Trauma 1987;1:1-1.

9. Kraemer WJ, Hearn TC, Powell JN, Mahomed N. Fixation of segmental sub- trochanteric fractures. A biomechanical study. Clin Orthop Relat Res 1996;332:71-9.

10. 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.

11. Brumback RJ, Toal TR Jr. Murphy-Zane MS, Novak VP, Belkoff SM. Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail. J Bone Joint Surg Am 1999;81:1538-44.

12. Benirschke SK, Melder I, Henley MB, Routt ML, Smith DG, Chapman JR, et al. Closed interlocking nailing of femoral shaft fractures: Assessment of technical complications and functional outcomes by comparison of a prospective database with retrospective review. J Orthop Trauma 1993;7:118-22.

13. Astion DJ, Wilber JH, Scoles PV. Avascular necrosis of the capital femoral epiphysis after intramedullary nailing for a fracture of the femoral shaft. A case report. J Bone Joint Surg Am 1995;77:1092-4.

14. Orler R, Hersche O, Helfet DL, et al. Die avaskula re Hu ftkopfnekrosealsschwerwiegende Komplikationnach Femurmarknagelungbei Kindern und Jugendlichen. Unfallchirurg 1998;101:495-99.

15. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51:737-55.

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.

17. Bednar DA, Pervez A. Intramedullary nailing of femoral shaft fractures: Re-operation and return to work. J Can Surg 1993;36:4646.

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.

21. Streubel PN, Wong AH, Ricci WM, Gardner MJ. Is there a standard trochanteric entry site for nailing of subtrochanteric femur fractures? J Orthop Trauma 2011;25:202-7.

22. Ansari Moein C, ten Duis HJ, Oey L, de Kort G, van der Meulen W, Vermeulen K, et al. Functional outcome after antegrade femoral nailing: A comparison of trochanteric fossa versus tip of greater trochanter entry point. J Orthop Trauma 2011;25:196-201.

23. Starr AJ, Hay MT, Reinert CM, Borer DS, Christensen KC. Cephalomedullary nails in the treatment of high-energy proximal femur fractures in young patients: A prospective, randomized comparison of trochanteric versus piriformis fossa entry portal. J Orthop Trauma 2006;20:240-6.

24. French BG, Tornetta P 3rd. Use of an interlocked cephalomedullary nail for subtrochanteric fracture stabilization. Clin Orthop Relat Res 1998;348:95-100.

25. Wiss DA, Brien WW. Subtrochanteric fractures of the femur. Results of treatment by interlocking nailing. Clin Orthop Relat Res 1992;283:231-6.

26. 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.

27. Streubel PN, Wong AH, Ricci WM, Gardner MJ. Is there a standard trochanteric entry site for nailing of subtrochanteric femur fractures? J Orthop Trauma 2011;25:202-7.

28. Prasarn ML, Cattaneo MD, Achor T, Ahn J, Klinger CE, Helfet DL, et al. The effect of entry point on malalignment and iatrogenic fracture with the synthes lateral entry femoral nail. J Orthop Trauma 2010;24:224-9.


How to Cite this article:  Memon R R, Bhavsar N M, Musa R A, Patel P R. Outcomes of Proximal Femoral Nail in Subtrochanteric Femur Fractures Through Medial Entry. Trauma International Sep – Dec 2018;4(2):20-25.

 


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Rashless and Bilateral Symmetrical Lower Limb Gangrene in a Patient with Meningococcal Meningitis

Vol 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.


References

1. Rouphael NG, Stephens DS. Neisseria meningitidis: Biology, Microbiology, and Epidemiology, in Neisseria meningitidis. New York: Springer; 2012. p. 1-20.

2. Sáez-Llorens X, McCracken GH Jr. Bacterial meningitis in children. Lancet 2003;361:2139-48.

3. Marc LaForce F, Ravenscroft N, Djingarey M, Viviani S. Epidemic meningitis due to group A Neisseria meningitidis in the african meningitis belt: A persistent problem with an imminent solution. Vaccine 2009;27 Suppl 2:B13-9.

4.  Funk A, Uadiale K, Kamau C, Caugant DA, Ango U, Greig J, et al. Sequential outbreaks due to a new strain of Neisseria meningitidis serogroup C in Northern Nigeria, 2013-14.PLoS Curr. 2014 December 29; 6: recurrents.outbreaks

5. Davis MD. Peripheral symmetrical gangrene. In: Mayo Clinic Proceedings. Toronto: Elsevier; 2004.

6. Hussain M, Sharma SR, Rupsi M. Peripheral symmetrical gangrene in meningitis. Ann Indian Acad Neurol 2014;17:140-1.

7. Singh J, Himanshu D, Nim RK, Dinkar A, Gupta KK. Meningitis with digital gangrene in meningococcal infection: An atypical presentation. J Clin Diagn Res 2016;10:OD03-4.


How to Cite this article:  Ajiboye Lo, Oboirien M, Galadima AB. Rashless and Bilateral Symmetrical Lower Limb Gangrene in a Patient with Meningococcal Meningitis. Trauma International Sep – Dec 2018;4(2):14-16.

 


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Open bilateral tibial shaft fracture: Case Report

Vol 4 | Issue 2 | Sept-Dec 2018 | page: 26-27 | Marta Santos Silva, Tiago Barbosa, Ana Ribau, Jose Muras.

doi- 10.13107/ti.2018.v04i02.073


Author: Marta Santos Silva [1], Tiago Barbosa [1], Ana Ribau [1], José Muras [1].

[1] Centro Hospitalar do Porto – Hospital Santo António, MD, Largo do Prof. Abel Salazar, 4099-001 Porto.

Address of Correspondence

Dr. Marta Santos Silva,

Centro Hospitalar do Porto – Hospital Santo António, MD, Largo do Prof. Abel Salazar, 4099-001 Porto.

E-mail: marta_sss_@hotmail.com


Abstract

Introduction: Leg shaft fractures are common, usually requiring a complex treatment, especially when they are open fractures.

Case Report: This case report describes the presentation, surgical approach, and complications of a 32-year-old man, who suffered a motorcycle accident, resulting in an open bilateral tibial shaft fracture (Type IIIA + Type IIIB Gustilo-Anderson classification) and right calcaneal Sanders Type IV fracture.

Conclusion: The clinical case illustrates the challenging treatment options, with an excellent clinical and radiological outcome.

Keywords: Tibial shaft fracture, Osteosynthesis, Arthrodesis, Pseudoarthrosis.


References

1. Hungria J, Mercadante M. Fratura exposta da diáfise da tíbiatratamento com osteossíntese intramedular após estabilização provisória com fixador externo não transfixante. Ver Bras Ortop 2013;48:482-90.

2. McMahon SE, Little ZE, Smith TO, Trompeter A, Hing CB. The management of segmental tibial shaft fractures: A systematic review. Injury 2016;47:568-73.

3. Papakostidis C, Kanakaris NK, Pretel J, Faour O, Morell DJ, Giannoudis PV, et al. Prevalence of complications of open tibial shaft fractures stratified as per the gustilo-anderson classification. Injury 2011;42:1408-15.

4. Melvin JS, Dombroski DG, Torbert JT, Kovach SJ, Esterhai JL, Mehta S, et al. Open tibial shaft fractures: I. Evaluation and initial wound management. J Am Acad Orthop Surg 2010;18:10-9.

5. Hutchinson AJ, Frampton AE, Bhattacharya R. Operative fixation for complex tibial fractures. Ann R Coll Surg Engl 2012;94:34-8.

6. Märdian S, Giesecke M, Haschke F, Tsitsilonis S, Wildemann B, Schwabe P, et al. Treatment of tibial non-unions – state of the art and future implications. Acta Chir Orthop Traumatol Cech 2016;83:367-74.

7. Melvin JS, Dombroski DG, Torbert JT, Kovach SJ, Esterhai JL, Mehta S, et al. Open tibial shaft fractures: II. Definitive management and limb salvage. J Am Acad Orthop Surg 2010;18:108-17.


How to Cite this article:  Silva M S, Barbosa T, Ribau A, Muras J. Open bilateral tibial shaft fracture: Case Report. Trauma International Sep-Dec 2018;4(2):26-17.

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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

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

1. Newman A. The supracondylar process and its fracture. Am J Roentgenol Radium Ther Nucl Med 1969;105:844-9.

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

3. Kolb LW, Moore RD. Fractures of the supracondylar process of the humerus. Report of two cases. J Bone Joint Surg Am 1967;49:532-4.

4. Laha RK, Dujovny M, DeCastro SC. Entrapment of median nerve by supracondylar process of the humerus. Case report. J Neurosurg 1977;46:252-5.

5. Talha H, Enon B, Chevalier JM, L’Hoste P, Pillet J. Brachial artery entrapment: Compression by the supracondylar process. Ann Vasc Surg 1987;1:479-82.

6. Fragiadakis EG, Lamb DW. An unusual cause of ulnar nerve compression. Hand 1970;2:14-6.

7. Natsis K. Supracondylar process of the humerus: Study on 375 caucasian subjects in Cologne, Germany. Clin Anat 2008;21:138-41.

8. Ivins GK. Supracondylar process syndrome: A case report. J Hand Surg Am 1996;21:279-81.

9. Barnard LB, McCoy SM. The supra condyloid process of the humerus. J Bone Joint Surg Am 1946;28:845-50.

10. Kessel L, Rang M. Supracondylar spur of the humerus. J Bone Joint Surg Br 1966;48:765-9.

11. Spinner RJ, Lins RE, Jacobson SR, Nunley JA. Fractures of the supracondylar process of the humerus. J Hand Surg Am 1994;19:1038-41.

12. Jelev L, Georgiev GP. Unusual high-origin of the pronator teres muscle from a struthers’ ligament coexisting with a variation of the musculocutaneous nerve. Rom J Morphol Embryol 2009;50:497-9.

13. Ay S, Bektas U, Yilmaz C, Diren B. An unusual supracondylar process syndrome. J Hand Surg Am 2002;27:913-5.

14. Pećina M, Borić I, Anticević D. Intraoperatively proven anomalous struthers’ ligament diagnosed by MRI. Skeletal Radiol 2002;31:5325.

15. Sener E, Takka S, Cila E. Supracondylar process syndrome. Arch Orthop Trauma Surg 1998;117:418-9.

16. Horak BT, Kuz JE. An unusual case of pronator syndrome with ipsilateral supracondylar process and abnormal muscle mass. J Hand Surg Am 2008;33:79-82.

17. Thompson JK, Edwards JD. Supracondylar process of the humerus causing brachial artery compression and digital embolization in a fast-pitch softball player. A case report. Vasc Endovascular Surg 2005;39:445-8.

18. Thomsen PB. Processus supracondyloidea humeri with concomitant compression of the median nerve and the ulnar nerve. Acta Orthop Scand 1977;48:391-3.

19. Mittal RL, Gupta BR. Median and ulnar-nerve palsy: An unusual presentation of the supracondylar process. Report of a case. J Bone Joint Surg Am 1978;60:557-8.

20. Tzaveas AP, Dimitriadis AG, Antoniou KI, Pazis IG, Paraskevas GK, Vrettakos AN, et al. Supracondylar process of the humerus: A rare case with compression of the ulnar nerve. J Plast Surg Hand Surg 2010;44:325-6.

21. Burczak JR. Median nerve palsy after operative treatment of intraarticular distal humerus fracture with intact supracondylar process. J Orthop Trauma 1994;8:252-4.


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

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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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

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

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

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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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