Inferior Patella Dislocation due to Impaction in the Femoral Trochlea

Acute inferior dislocation of the patella is a rare presentation in trauma and orthopaedics. Type II is caused by direct upward force on the inferior pole of the patella when the knee is flexed impacting the superior pole osteophyte into the intercondylar notch. Impaction in the femoral trochlea is rarely reported. A 92-year-old lady presented with locked knee held in 85° of flexion with an abnormal knee contour. Radiographs demonstrated that the upper pole of the patella was impacted in the femoral trochlea with a fracture of a superior pole osteophyte. The extensor mechanism was intact. Closed reduction is achieved under strong opioid pain relief. The patient returned to her baseline knee function within 6 weeks. Closed reduction of an inferior patellar dislocation in elderly patients is aided by superior pole osteophyte fracture and facilitates early mobilization, and avoidance of general anaesthesia.

Download Full-text

Patella Dislocation with Vertical Axis Rotation: The “Dorsal Fin” Patella

Case Reports in Orthopedics ◽

10.1155/2015/328386 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

David Gamble ◽

Quentin Otto ◽

Andrew D. Carrothers ◽

Vikas Khanduja

Keyword(s):

Closed Reduction ◽

Soft Tissues ◽

Muscle Relaxation ◽

Vertical Axis ◽

Clinical Situation ◽

Patella Dislocation ◽

General Anaesthetic ◽

Minor Trauma ◽

Femoral Trochlea ◽

Dorsal Fin

A 44-year-old woman presented following minor trauma to her right knee. While dancing she externally rotated around a planted foot and felt sudden pain in her right knee. She presented with her knee locked in extension with a “dorsal fin” appearance of the soft tissues tented over the patella. This was diagnosed as a rare case of an intraarticular patella dislocation, which was rotated 90 degrees about the vertical axis. Closed reduction in the emergency room was unsuccessful but was achieved in theatre under general anaesthetic with muscle relaxation. Postreduction arthroscopy demonstrated that no osteochondral or soft tissue damage to the knee had been sustained. In patients presenting with a knee locked in extension with tenting of skin over the patella (the “dorsal fin” appearance), intra-articular patella dislocation should be suspected. Attempts to reduce vertical patella dislocations under sedation with excessive force or repeatedly without success should be avoided to prevent unnecessary damage to the patellofemoral joint. In this clinical situation we recommend closed reduction under general anaesthetic followed by immediate knee arthroscopy under the same anaesthetic to ensure that there is no chondral damage to the patella or femoral trochlea and to rule out an osteochondral fracture.

Download Full-text

Two Cases of Inferior Dislocation of the Patella with Impaction into the Femoral Trochlea of Osteophytes on the Superior Pole of the Patella

Case Reports in Orthopedics ◽

10.1155/2013/691739 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Shinji Yoshioka ◽

Yuji Arai ◽

Kazuya Ikoma ◽

Shinya Fujita ◽

Takanori Akai ◽

...

Keyword(s):

Femoral Trochlea ◽

Inferior Dislocation ◽

Superior Pole ◽

Dislocation Of The Patella

Download Full-text

Bi-columnar fixation of displaced distal humeral metaphyseal fractures in children: functional outcome assessment of 100 fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20194830 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1202

Author(s):

Mohamad Gouse ◽

Manoharan Muthulingam ◽

Nandakumar Rangarajan

Keyword(s):

Functional Outcome ◽

Closed Reduction ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Early Mobilization ◽

Functional Results ◽

Type Ii ◽

Supracondylar Fractures ◽

Fractures In Children ◽

Supracondylar Humerus Fractures

Background: Supracondylar fractures of the humerus are one of the commonest fractures encountered around the elbow in children. The treatment of these fractures continues to pose challenges even in this age of advancing orthopedics. These fractures have the propensity to go for malunion with cosmetic deformity. This study was done to evaluate the functional results of surgical management of supracondylar fractures of the humerus in children using closed reduction and percutaneous bi-columnar pinning technique.Methods: 100 patients with Gartlands type II, III and IV supracondylar humerus fractures were operated with closed reduction and pinning using K-wires. Patients were followed up at six weeks, twelve weeks and six months and final evaluation were done using the Mayo elbow performance score (MEPS).Results: In our study, there were 70 males and 30 female patients with mean age of 6.5 years. 85 cases were had fall on outstretched hand as mode of injury and rest following motor vehicle accident. Gartland type II fractures accounted for 10 cases; type III fractures accounts 88 cases and type IV was only 2 cases. Excellent to good results were seen in 80 cases as per the MEPS at 6 months follow-up.Conclusions: From our study, we could conclude that closed reduction and bi- column percutaneous pinning offers a reliable fixation which permits early mobilization and good functional outcome in displaced fractures. Increasing the number of wire will allow early mobilization and prevent stiffness.

Download Full-text

Clinical Study of 107 Hospitalized Patients with Peritonsillar Abscess

International Journal of Practical Otolaryngology ◽

10.1055/s-0041-1722857 ◽

2021 ◽

Vol 04 (01) ◽

pp. e11-e16

Author(s):

Risa Wakisaka ◽

Takumi Kumai ◽

Kan Kishibe ◽

Miki Takahara ◽

Akihiro Katada ◽

...

Keyword(s):

Clinical Study ◽

Initial Treatment ◽

Peritonsillar Abscess ◽

Laryngeal Edema ◽

Antibacterial Drugs ◽

Inferior Pole ◽

Duration Of Hospitalization ◽

The Right ◽

Superior Pole

AbstractWe conducted a retrospective analysis of the data of 107 cases of peritonsillar abscess treated at our hospital between January 2014 and December 2018. Data on age, sex, affected site, duration of hospitalization, method of drainage, presence/absence of laryngeal edema, antibacterial drugs used, and isolated bacteria were analyzed. Of the 107 patients, 71 were males and 36 were females; the median age was 44 years (range: 18–88 years).The left side was affected in 55 patients, the right side in 50 patients, and both sides in two patients. The abscess was localized in the superior pole in 71 patients, and in the inferior pole in 36 patients. Thirty-five patients had laryngeal edema, of which three underwent tracheotomy. Recurrence of the abscess was observed in 15 cases, with the recurrence developing within 3 months in 7 cases, and over a period of 3 years in 4 cases. As for the sensitivity of the causative bacteria to antibacterial drugs, 17% of the causative bacteria showed resistance to clindamycin, while none showed resistance to ampicillin/sulbactam (ABPC/SBT). We concluded that ABPC/SBT might be suitable for the initial treatment of peritonsillar abscess, and that we need to bear in mind the possibility of long-term recurrence.

Download Full-text

“COMPARATIVE STUDY OF DISTAL END RADIUS FRACTURE TREATED BY PERCUTANEOUS 5 PIN TECHNIQUE V/S CLOSED REDUCTION AND CASTING METHOD”.

10.36106/6900913 ◽

2021 ◽

pp. 29-31

Author(s):

Vibhor Khandal ◽

Ashwani Kumar Mathur ◽

Mohit Kumar ◽

Rajkumar Bairwa

Keyword(s):

Distal Radius ◽

Closed Reduction ◽

Soft Tissues ◽

Hand Function ◽

Early Mobilization ◽

Fracture Site ◽

Distal Radius Fractures ◽

Point System ◽

Casting Method ◽

Radius Fractures

Introduction: Distal end radius fractures crush the mechanical foundation of most useful tool, the hand. No other fracture has a such potential to devastate hand function, and no other metaphysis of bone is embraced by more soft tissues. Closed reduction and percutaneous pinning is one of the standard treatments for management of distal radius fractures, and its modication 'The percutaneous 5 pin technique improves the reliability of xation thus combining the benets of non-invasiveness as in casting and stability achieved is comparable to open reduction and plating. Material and method: This prospective study was done between December 2018 to December 2020 in department of orthopedics, including 60 patients with fracture of distal radius Among them 30 patients subsequently underwent ve pin xation and 30 patients were treated with closed reduction and casting method. Result: Radiological analysis of the data was done using Sarmiento's Modication of Lidstrom Criteria. Activities of daily life (ADL) were examined by using the demerit point system of Gartland and Wereley based on objective and subjective criteria, residual deformity and complications. Radiological parameters were assessed for at the end of 6months. There was signicant difference in all the three parameters i.e, Volar tilt, Radial length, Radial inclination between both groups at the end of 6 months. Closed reduction with ve pinning technique group had shown not only better but also statistically signicant anatomical reduction compared to other groups. Functional outcome was better in patients treated with percutaneous 5 pinning technique. Conclusion: The ve pin technique carries the advantage of early mobilization, DRUJ stability. Radio Ulnar pins and the pins across the fracture site provide enough stability to permit early mobilization leading to less post operative stiffness in joint. Although the study series is small and further research is essential to provide directions for treatment, it is safe to conclude that the ve pin technique is a technically less demanding, lessinvasive and an effective way of treating displaced distal radius fractures without severe articular or metaphyseal comminution

Download Full-text

DIABETIC STRIATOPATHY: A RARE PRESENTATION OF NONKETOTIC HYPERGLYCEMIA

10.36106/gjra/3609974 ◽

2021 ◽

pp. 108-109

Author(s):

Ranjan Mallick ◽

Shyam Sunder Hembram ◽

Ram Chandra Bhadra Chandra Bhadra

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type Ii Diabetes ◽

Western Europe ◽

Rare Complication ◽

Type Ii Diabetes Mellitus ◽

Type Ii ◽

Rare Presentation ◽

Acute Hyperglycaemia

Type II Diabetes Mellitus is one of the most common non-communicable diseases with innumerable & potentially life threatening complications. In 2017, approximately 462 million individuals were affected by type 2 diabetes corresponding to 6.28% of the world's population (4.4% of those aged 15-49 years, 15% of those aged 50-69, and 22% of those aged 70+), or a prevalence rate of 6059 cases per 100,000. Over 1 million deaths per year can be attributed to diabetes alone, making it the ninth leading cause of mortality. The burden of diabetes mellitus is rising globally, and at a much faster rate in developed regions, such as Western Europe. The gender distribution is equal, and the incidence peaks at around 55 years of age. Global prevalence of type 2 diabetes is projected to increase to 7079 individuals per 100,000 by 2030, reecting a continued rise across all regions of the world.[¹] . Two of the common complications due to acute hyperglycaemia are Diabetic Ketocidosis & Non ketotic hyperosmolar coma which are considered a spectrum of the same complication due to low circulating levels of insulin leading to impaired glucose metabolism by insulin dependant tissues with rising levels of anti-insulin hormones like glucagon, cortisol & catecholamines due to intracellular starvation resulting in hypergylcemia & fatty acid breakdown & ketonemia. Amongst the numerous complications of Type II Diabetes Mellitus, here we present a rare complication of acute hyperglycaemia and its radiological picture in the central nervous system. A 56 year old female patient with a history of Type II Diabetes Mellitus with Hypertension under long term medication came for a private consultation with a complaint of Right sided involuntary, random, irregular, inging and ailing, rapid, non-patterned movements for past 7 days. The patient was advised for an urgent MRI of Brain which demonstrated high T1 signal & low T2/FLAIR intensity with no diffusion restriction of DWI & ADC map in left sided putamen & head of caudate nucleus. We illustrated a rare classical nding of acute hyperglycemic effect on brain in a case of long standing Type II Diabetes Mellitus despite being on medications

Download Full-text