Observational retrospective study of subaxial cervical spine trauma at tertiary care centre

The aim of this study is to compare between various treatment modalities available for treatment of subaxial cervical spine injuries due to trauma A total of 172 patients of subaxial cervical spine injuries were assessed retrospectively about their mode of injury, clinical course, definitive treatment given and its outcome. As the study was Descriptive and retrospective in nature involving only patient case files, statistical test is not applied to the study In our study 44 patients suffered from vertebral body fracture while 108 patients had spinal canal compromise due to other injuries. 16 patients had quadriplegia, 24 patients had grade 4 power in upper and lower extremities, and roots were involved in 46 patients. In 44 patients complete corpectomy was performed with placement of tricorticate graft taken from fibula, this graft was fixed in place with titanium plate and four screws.From this study it can be concluded that Patients treated with anterior approach had better outcome in relation to the fixation and fusion of the spine, reconstruction is more better in anterior approach.

Is It Possible to Perform Fifth Carpometacarpal Joint Arthroscopy? Cadaveric Study on Its Feasibility, Safety, and Potential Hazards in Portal Creation

Background Fifth carpometacarpal joint (CMCJ) fracture dislocation is a relatively rare injury and most will require operative treatment because of its unstable nature. Improper reduction and fixation lead to joint surface destruction, pain, and reduced grasping power. Intra-articular fragment reduction is often obscured by dorsally displaced ulnar fragment. Therefore, fifth CMCJ arthroscopy can be advantageous in assisting intra-articular fragment reduction. However, there is no detailed description of the portal landmarks or portals' relationship with adjacent important structures in the literature. Purposes To explore the feasibility and safety of fifth CMCJ arthroscopy, locations of the portals are examined in cadaveric hand specimens. Their proximity to important anatomical structures such as dorsal cutaneous branch of ulnar nerve (DCBUN), ring finger and little finger extensor digitorum communis (EDC), and extensor digiti minimi (EDM) is measured. Methods Fifth CMCJ arthroscopy is performed on 11 cadaveric hand specimens by specialist-level surgeon. The portals are marked and portal positions are further confirmed under the fluoroscopy. Then the cadaveric specimens were undergone anatomical dissection by specialist-level surgeon. During dissection, the spatial relationship between the portal positions and DCBUN, EDC to ring finger and little finger, and EDM is identified. The distance between the portals and the above important structures was measured in millimeters. Results DCBUN was consistently found between fourth metacarpohamate (4-MH) and fifth metacarpohamate (5-MH) portals, with it being closer to the latter (mean distance, 2.03 mm; range, 0–4.43 mm; standard deviation [SD], 1.09 mm). The closest tendon for 4-MH portal is ring finger EDC (mean distance, 2.65 mm; range, 0–5.89 mm; SD, 1.78 mm), while 5-MH portal and accessory portal were closest to EDC (mean distance, 1.88 mm; range, 0–3.69 mm; SD, 1.25 mm) and EDM (mean distance, 7.79 mm; range, 6.63–10.72 mm; SD, 1.49 mm), respectively. During the process of specimen dissection, we found no damage to the above structures after portal introduction. Conclusion The above findings support the use of fifth CMCJ arthroscopy, which can be used for assisted reduction in fifth metacarpal base fracture dislocation and hamate body fracture. Gentle soft tissue spreading technique during portal creation prevents injury to the important structure surrounding the portals. Level of evidence This is a Level V study.

Postoperative dysphagia caused by a delay in mandibular fracture treatment in a patient with severe intellectual disability: a case report

Background The postoperative complications of mandibular fracture include malocclusion, infection, nonunion, osteomyelitis, and sensorial mental nerve dysfunction. However, there are no reports regarding postoperative dysphagia as a complication of mandibular fracture. Herein, we report a rare case of postoperative dysphagia caused by delayed mandibular fracture treatment in a patient with severe intellectual disability. Case presentation A 46-year-old Japanese male patient with severe intellectual disability fell down and struck his chin. The patient was referred to our department 10 days after the accident. Upon examination, he could not close his mouth because of severe left mandibular body fracture. Open reduction and internal fixation was performed under general anesthesia 16 days after sustaining the injury, and normal occlusion was eventually achieved. However, the patient could not swallow well a day after surgery. He was then diagnosed with postoperative dysphagia caused by disuse atrophy of muscles for swallowing based on videoendoscopic examination findings. Adequate dysphagia rehabilitation could not be facilitated because of the patient’s mental status. Postoperative dysphagia did not improve 21 days after surgery. Therefore, percutaneous endoscopic gastrostomy was required. Conclusions The treatment course of the patient had two important implications. First, postoperative dysphagia caused by disuse atrophy may occur if treatment is delayed in severe mandibular body fracture. Second, in particular, if a patient with severe intellectual disability develops postoperative dysphagia caused by disuse atrophy, adequate dysphagia rehabilitation cannot be facilitated, and percutaneous endoscopic gastrostomy may be required. Therefore, early open reduction and internal fixation is required for mandibular fracture in a patient with severe intellectual disability.

UNUSUAL ANKLE FRACTURE: A LITERATURE REVIEW

Background:- Fractures of the talus are unusual, and talar body fractures in the sagittal plane are still rarer. Its treatment aims a crucial anatomic reduction to reimpose congruency of the ankle and decrease the risk of avascular necrosis by conserving any remaining blood supply. We present the case of a body talar fracture in the sagittal plane related to fracture of the medial malleolus in an adult. The mechanism of the fracture was, internal rotation, plantar hyperexion, and axial compression. We performed an open reduction and stabilization with two screws for the talus and screwed the medial malleolus. Material & Methods:- We included 30 patients in this study among which a 25 years old man presented in Department Of Orthopaedics, Mgmmch, Jamsehedpur, Jharkhand with a grossly expand and deformed right ankle. Radiographs revealed a displaced vertical fracture of the neck of the talus traversing through the body with vertical fracture of the medial malleolus and medial talar shift. Results:- Fractures of the talus have a relatively little incidence accounting for 0.3% of all bone fractures and 3% to 6% of all foot fractures.[1,2] Union of the fracture in such a case is extremely slow as it depends on a new blood supply growing into the avascular bone.[3] Hence, the fracture needs preservation for a long time, and non-weight bearing is recommended for three months or until the union has occurred. Malunion can produce substantial alteration in load across the ankle and subtalar joints and result in arthrosis. The reported case should have the best prognosis as it was closed and underwent immediate operative reduction with early signs of revascularization. After 13 months following the injury, the patient had the best range of movement with some pain. Conclusion:- Talar body fracture associated with ankle fracture is very rare. Still, the malleolar fracture that allows adequate visualisation, anatomical reduction, and appropriate fracture xation can give us hope to reduce complications.

Influence of Hyponatremia on Spinal Bone Quality and Fractures Due to Low-Energy Trauma

Background and Objectives: Hyponatremia is the most common electrolyte disorder in elderly and associated with increased risk of falls. Clinical studies as well as small animal experiments suggested an association between chronic hyponatremia and osteoporosis. Furthermore, it has been assumed that subtle hyponatremia may be an independent fracture risk in the elderly. Therefore, this study was designed to evaluate the possible influence of chronic hyponatremia on osteoporosis and low-energy fractures of the spine. Materials and Methods: 144 patients with a vertebral body fracture (mean age: 69.15 ± 16.08; 73 females and 71 males) due to low-energy trauma were treated in a level one trauma center within one year and were included in the study. Chronic hyponatremia was defined as serum sodium < 135 mmol/L at admission. Bone mineral density (BMD) of the spine was measured using quantitative computed tomography in each patient. Results: Overall, 19.44% (n = 28) of patients in the low-energy trauma group had hyponatremia. In the group with fractures caused by low-energy trauma, the proportion of hyponatremia of patients older than 65 years was significantly increased as compared to younger patients (p** = 0.0016). Furthermore, there was no significant gender difference in the hyponatremia group. Of 28 patients with chronic hyponatremia, all patients had decreased bone quality. Four patients showed osteopenia and the other 24 patients even showed osteoporosis. In the low-energy trauma group, the BMD correlated significantly with serum sodium (r = 0.396; p*** < 0.001). Conclusions: The results suggest that chronic hyponatremia affects bone quality. Patients with chronic hyponatremia have an increased prevalence of fractures after low-energy trauma due to a decreased bone quality. Therefore, physicians from different specialties should focus on the treatment of chronic hyponatremia to reduce the fracture rate after low-energy trauma, particularly with elderly patients.

Research on Control Mechanism of Surrounding Rock of Deep Gob-Side Entry Retaining

To address the large deformation of the surrounding rock of deep gob-side entry retaining under high stress, lithological characteristics of the surrounding rock and failure model of support body and their evolutionary processes are analyzed through field investigation and theoretical analysis. Failure mechanisms of surrounding rock and the technology to control it are studied systematically. The results show that the causes of the large deformation of the surrounding rock are weak thick mudstones with softening property and water absorption behavior, as well as its fragmentation, dilatancy, and long-term creep during strong disturbance and highly centralized stress states. The cross-section shape of the roadway after deformation and failure of the surrounding rock is obviously asymmetric in both the horizontal and vertical directions. Since the original system supporting the surrounding rock is unable to completely bear the load, each part of the supporting system is destroyed one after the other. The failure sequences of the surrounding rock are as follows: (1) roadway roof fracture in the filling area, (2) filling body fracture under eccentric load, (3) rapid subsidence of the roadway roof, and (4) external crack drum and rib spalling at the solid coal side. Due to this failure sequence, the entire surrounding rock becomes unstable. A partitioned coupling support and a quaternity control technology to support the surrounding rock are proposed, in which the roof of the filling area plays a key role. The technology can improve the overall stability of gob-side entry retaining, prevent support structure instability caused by local failure of the surrounding rock, and ensure the safety and smoothness of roadways.

Open Reduction and Internal Fixation of a Pediatric Talar Body Fracture using a Medial Malleolar Osteotomy – A Case Report

Introduction:Talus fracture injuries are rare and most literature pertains to fractures in skeletally mature adults. It is unusual for pediatric talus fractures to be treated operatively and is normally treated with immobilization. The location of the talus fracture required a medial malleolar osteotomy to facilitate exposure and reduction, which was fixed with temporary smooth K-wires. The authors were unable to identify a previous description of this technique in the literature. Case Report:An 11-year-old female was referred to our hospital due to polytraumatic injuries sustained in a roll-over MVC. A displaced fracture of the talus body was present. Due to the fracture location, a medial malleolar osteotomy was required for exposure. An open reduction and internal fixation was performed using subchondral minifragment screws under general anesthesia. The patient healed uneventfully, regained a normal gait and full, pain-free range of motion. Conclusions:Medial malleolar osteotomy with smooth K-wire fixation appears to be a safe method for gaining access to the talus when required for reduction and/or fixation of pediatric talus fractures. Keywords:Adolescent, talus fracture, osteotomy.

What is the onset mechanism of internal hernia after vertebral body fracture? A case of internal hernia secondary to traumatic vertebral fracture

A 67-year-old man who had been pinned between a basket crane and a tree complained of severe pain in his lower back and a decreased appetite. Laparotomy after decompressing the gastrointestinal tract revealed incarceration of an ileal loop within a fractured third lumbar vertebra. The damaged bowel was resected, and an end-to-end anastomosis was performed. Once the patient’s condition had stabilised, posterior lumbar fixation was performed. There were no abdominal complications or lower limb neurological deficits during the follow-up period. Enhanced CT and MRI had been helpful in making the diagnoses. Histopathological examination revealed the aetiology of the traumatic incarceration: the intestine had been pinched as the disc space closed, and the body attempted to return to its original state by exerting countertraction.