High D-dimer Level in Fracture Patient with Asymptomatic Covid-19: Dilemmatic Surgery Decision - A Serial Case Report

Introduction: SARS-CoV-2 is highly transmittable virus. D-dimer associated with high fatality rate in COVID-19 with pneumonia and fractures. COVID-19 make surgical decision more challenging. Thrombosis plays an important mechanism in severity of COVID-19 and could be measured through D-dimer level. Case illustrations: We report 4 fracture cases with asymptomatic COVID-19. 1st case diagnosed close fracture in right 1/3 distal cruris without pneumonia, D-dimer 2420 ng/dl. Surgery 20 days after trauma with decreased D-dimer level. 2nd case, was diagnosed with close fracture in the left cruris and right 1/3 middle of clavicle with pneumonia, D-dimer level 6670 ng/dl, decision obtained in 27 days after hospitalization with decreased D-dimer. 3rd case diagnosed open fracture in left 1/3 distal humerus with pneumonia, D-dimer level 1020 ng/dl. Surgery 32 days after trauma with decreased D-dimer. 4th case diagnosed open fracture in left 1/3 proximal humeral and left medial phalanx index finger with pneumonia. The D-dimer level 2830 ng/dl. Surgery was obtained 17 days after trauma with decreased D-dimer. Discussion: Pandemic creates gray zone in orthopedic surgery. D-dimer found increased in COVID-19 and fracture patients. Asymptomatic case can be operated on 10th day post positive result as long as the general condition is optimal. D-dimer also important in making the decision to perform surgery. D-dimer over 2500 ng/mL have greater risk for being VTE in fracture patients. Conclusion: The pandemic has creates a large gray zone. The strategies for decision making includes general condition and severity COVID-19 also D-dimer level. Keywords: D-dimer, COVID-19, Fracture, Surgery.

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Healing of open fracture of shoulder bone in owl

Veterinarski glasnik ◽

10.2298/vetgl0706351p ◽

2007 ◽

Vol 61 (5-6) ◽

pp. 351-357

Author(s):

Branislav Prokic ◽

Mirjana Lazarevic-Macanovic ◽

Branko Prokic

Keyword(s):

General Condition ◽

Surgical Procedure ◽

Open Fracture ◽

Operative Procedure ◽

Diagnostic Procedures ◽

Correct Choice ◽

Good Choice ◽

Long Bones ◽

Postoperative Course ◽

Professional Supervision

Curing and treatment of accidental injuries in birds that have the nature of complex, old and contaminated wounds demand maximum caution from the surgeon. Birds, in particular wild fowl, are sensitive to manipulation during examinations and the diagnosis of the injuries. The estimate of the complexity of an injury and the general condition of the patient are of key importance for the correct choice of diagnostic procedures, anesthesia, and the operative procedure. The implementation of ketamine and diazepam for general injection anesthesia provides possibilities for the unhindered executing of the surgical procedure. The implementation of Kischner needles and pins is a good choice for the fixation of long bones in birds. The postoperative course in the patient requires constant medical and professional supervision which must be followed to the letter.

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Navigating the gray zone: a guideline for surgical decision making in obstetrical brachial plexus injuries

Journal of Neurosurgery Pediatrics ◽

10.3171/2008.12.peds0885 ◽

2009 ◽

Vol 3 (3) ◽

pp. 173-180 ◽

Cited By ~ 31

Author(s):

James R. Bain ◽

Carol DeMatteo ◽

Deborah Gjertsen ◽

Robert D. Hollenberg

Keyword(s):

Decision Making ◽

Brachial Plexus ◽

External Rotation ◽

Elbow Flexion ◽

Complete Recovery ◽

Shoulder Abduction ◽

Active Movement ◽

Gray Zone ◽

Surgical Decision ◽

Surgical Decision Making

Object In the literature, the best recommendations are imprecise as to the timing and selection of infants with obstetrical brachial plexus injury (OBPI) for surgical intervention. There is a gray zone (GZ) in which the decision as to the benefits and risks of surgery versus no surgery is not clear. The authors propose to describe this category, and they have developed a guideline to assist surgical decision-making within this GZ. Methods The authors first performed a critical review of the medical literature to determine the existence of a GZ in other clinical publications. In those reports, 47–89% of infants with OBPI fell within such a GZ. Complete recovery in those reported patients ranged from 9 to 59%. Using a prospective inception cohort design, all infants referred to the OBPI Clinic at McMaster Children's Hospital were systematically evaluated up to 3 years of age. The Active Movement Scale scores were compared for surgical and nonsurgical groups of infants in the GZ to identify any important trends that would guide surgical decision-making. Results In the authors' population of infants with OBPI, 81% fell within the GZ, of whom 44% achieved complete recovery. Mean scores differed significantly between surgery and no surgery groups in terms of total Active Movement Scale score and shoulder abduction and flexion at 6 months. Elbow flexion and external rotation differed at 3 months. Conclusions There is compelling evidence that there is a group of infants with OBPI in whom the assessment of the risk/benefit ratio for surgical versus nonsurgical treatment is not evident. These infants reside within what the authors have called the GZ. Based on their results, a guideline was derived to assist clinicians working with infants with OBPI to navigate the GZ.

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Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus

Acta Orthopaedica et Traumatologica Turcica ◽

10.3944/aott.2012.2564 ◽

2012 ◽

Vol 46 (1) ◽

pp. 8-12 ◽

Cited By ~ 6

Author(s):

Ahmet Ozgur Yildirim

Keyword(s):

Nerve Injury ◽

Radial Nerve ◽

Humeral Fracture ◽

Distal Humerus ◽

Radial Nerve Injury ◽

Fracture Surgery

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Personal Experience of Daboia siamensis Envenomation

Case Reports in Medicine ◽

10.1155/2021/3396373 ◽

2021 ◽

Vol 2021 ◽

pp. 1-3

Author(s):

Tein-Shun Tsai ◽

Chun-Chieh Liu ◽

Po-Chun Chuang

Keyword(s):

Acute Kidney Injury ◽

Personal Experience ◽

Surgical Intervention ◽

Index Finger ◽

Kidney Injury ◽

Neurological Manifestations ◽

Local Effects ◽

Venomous Snake ◽

The Right ◽

D Dimer

Reports of envenomation induced by Daboia siamensis, a medically important venomous snake in Taiwan, are rare, and species identification might not be definitive. This article reports the complete course of a definite D. siamensis bite. The patient in this report was one of the authors who was bitten on the right palm near the base of the index finger by D. siamensis. The patient experienced local effects, neurological manifestations, and acute kidney injury. The laboratory analysis revealed elevated D-dimer and coagulopathy. The patient was administered 8 vials of antivenom and did not undergo surgical intervention or endotracheal tube intubation, but serum sickness occurred 8 days after antivenom administration. The horse immunoglobulin produced by the Centers for Disease Control, R. O. C. (Taiwan), against D. siamensis was effective and safe in the treatment of the patient. However, the best antivenom administration strategy remains unclear and requires further study.

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Unusual Microstructure in Shock-Compacted Graphite

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100069363 ◽

1970 ◽

Vol 28 ◽

pp. 474-475

Author(s):

Lucien F. Trueb

Keyword(s):

Mechanical Characteristic ◽

Compression Wave ◽

Gray Zone ◽

Flyer Plate ◽

Compacted Graphite ◽

The Impact

Crushed and statically compressed Madagascar graphite that was explosively shocked at 425 kb by means of a planar flyer-plate is characterized by a black zone extending for 2 to 3 nun below the impact plane of the driver. Beyond this point, the material assumes the normal gray color of graphite. The thickness of the black zone is identical with the distance taken by the relaxation wave to overtake the compression wave.The main mechanical characteristic of the black material is its great hardness; steel scalpels and razor blades are readily blunted during attempts to cut it. An average microhardness value of 95-3 DPHN was obtained with a 10 kg load. This figure is a minimum because the indentations were usually cracked; 14.8 DPHN was measured in the gray zone.

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Surgical Management of Patients With 22q11.2 Deletion Syndrome

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_pers-sig5-2019-0004 ◽

2019 ◽

Vol 4 (5) ◽

pp. 857-869

Author(s):

Oksana A. Jackson ◽

Alison E. Kaye

Keyword(s):

Surgical Management ◽

Preoperative Evaluation ◽

Preoperative Assessment ◽

22Q11.2 Deletion Syndrome ◽

Deletion Syndrome ◽

22Q11.2 Deletion ◽

Surgical Decision ◽

Obstructive Sleep ◽

Spine Abnormalities ◽

Speech Assessment

Purpose The purpose of this tutorial was to describe the surgical management of palate-related abnormalities associated with 22q11.2 deletion syndrome. Craniofacial differences in 22q11.2 deletion syndrome may include overt or occult clefting of the palate and/or lip along with oropharyngeal variances that may lead to velopharyngeal dysfunction. This chapter will describe these circumstances, including incidence, diagnosis, and indications for surgical intervention. Speech assessment and imaging of the velopharyngeal system will be discussed as it relates to preoperative evaluation and surgical decision making. Important for patients with 22q11.2 deletion syndrome is appropriate preoperative screening to assess for internal carotid artery positioning, cervical spine abnormalities, and obstructive sleep apnea. Timing of surgery as well as different techniques, common complications, and outcomes will also be discussed. Conclusion Management of velopharyngeal dysfunction in patients with 22q11.2 deletion syndrome is challenging and requires thoughtful preoperative assessment and planning as well as a careful surgical technique.

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