Management of Comminuited Intra/Juxta Articular Fracture of Distal Radius Using Bridging External Fixator

Background: Distal radius fractures are the third most common osteoporotic fractures and are frequently treated in emergency department. They have a trimodal peak of occurrence and there has been a significant increase in incidence of involvement in elderly females and young males. Management of these fractures comes with lots of treatment options and challenges to provide good functional outcome. This prospective study was done for the management of communited intra/juxta articular fractures of distal end radius using a bridging external fixator on 25 patients. The principle of ligamentotaxis was used for alignment of fracture fragments and wrist spanning external fixator was used to maintain the fracture reduction.Methods:25 patients of either sex with age group 16 to 80 years were taken from the orthopedic department. After proper primary care, cases were classified using Fernandez classification, and posted for surgery as soon as investigations and fitness were taken.Results:Patients involved in the study were in range of 16 to 78 years with 16 patients having dominant side with road traffic accident as leading cause.Radiological union was seen at an average of 7.3 weeks, 4 patients had superficial pin tract infection, 3 patients had stiffnes and a single case had malunion. Conclusions:Modified clinical scoring system of Green and O’Brien was used to evaluate the overall functional results which showed excellent to good results in 84% of cases. Hence, properly planned and executed bridging external fixator is an easy, cost-effective and reliable treatment modality through the “Principle of Ligamentotaxis”.

Scleral Buckling: A Review of Clinical Aspects and Current Concepts

Scleral buckling represents a valuable treatment option for rhegmatogenous retinal detachment repair. The surgery is based on two main principles: the closure of retinal breaks and the creation of a long-lasting chorioretinal adhesion. Buckles are placed onto the sclera with the purpose of sealing retinal breaks. Cryopexy is usually performed to ensure a long-lasting chorioretinal adhesion. Clinical outcomes of scleral buckling have been shown to be more favorable in phakic eyes with uncomplicated or medium complexity retinal detachment, yielding better anatomical and functional results compared with vitrectomy. Several complications have been described following scleral buckling surgery, some of which are sight-threatening. Expertise in indirect ophthalmoscopy is required to perform this type of surgery. A great experience is necessary to prevent complications and to deal with them. The use of scleral buckling surgery has declined over the years due to increasing interest in vitrectomy. Lack of confidence in indirect ophthalmoscopy and difficulties in teaching this surgery have contributed to limiting its diffusion among young ophthalmologists. The aim of this review is to provide a comprehensive guide on technical and clinical aspects of scleral buckling, focusing also on complications and their management.

Rotationplasty Salvage Procedure as an Effective Alternative to Femoral Amputation in an Adult With a History of Osteosarcoma: A Case Report and Review

Rotationplasty or Borggreve-Van Ness surgery is lower limb salvage surgery, indicated mainly in the management of femoral bone sarcoma and congenital femur malformations in children. It can also be an interesting surgery option for managing chronic osteoarticular infections, or in cases of non union when curative therapy is no longer an option, as an alternative to femoral amputation. The principle of this surgery is to remove the affected knee and to apply a rotation of 180° to the distal part of the lower limb in order to give the ankle the function of a neo-knee. With the help of an adapted prosthesis, the aim is to allow patients to resume their social and professional activities by keeping most of their lower limb, thus avoiding the known complications of amputation (ghost limb pain, proprioceptive deficit, psychological disorders). Nevertheless, this surgery is complex and exceptional, with vascular, infectious, and psychological risks - the chimeric aspect of the lower limb may cause significant ill-being for the patient. This article reports the case of a 38-year-old patient consulting for management of a complex septic distal femoral non-union following osteosarcoma considered as being in remission. The patient underwent rotationplasty surgery on his left lower limb, with very good functional results and no surgical revision to date. In light of this particular case, we propose a didactic overview of the literature data concerning this surgery, especially in adulthood.

Correlation Analyses of Clinical Manifestations and Variant Effects in KCNB1-Related Neurodevelopmental Disorder

Objective:Vitro functional analyses of KCNB1 variants have been done to disclose possible pathogenic mechanisms in KCNB1-related neurodevelopmental disorder. “Complete or partial loss of function (LoF),” “dominant-negative (DN) effect” are applied to describe KCNB1 variant's molecular phenotypes. The study here aimed to investigate clinical presentations and variant effects associations in the disorder.Methods: We reported 10 Chinese pediatric patients with KCNB1-related neurodevelopmental disorder here. Functional experiments on newly reported variants, including electrophysiology and protein expression, were performed in vitro. Phenotypic, functional, and genetic data in the cohort and published literature were collected. According to their variants' molecular phenotypes, patients were grouped into complete or partial LoF, and DN effect or non-dominant-negative (non-DN) effect to compare their clinical features.Results: Nine causative KCNB1 variants in 10 patients were identified in the cohort, including eight novel and one reported. Epilepsy (9/10), global developmental delay (10/10), and behavior issues (7/10) were common clinical features in our patients. Functional analyses of 8 novel variants indicated three partial and five complete LoF variants, five DN and three non-DN effect variants. Patient 1 in our series with truncated variants, whose functional results supported haploinsufficiency, had the best prognosis. Cases in complete LoF group had earlier seizure onset age (64.3 vs. 16.7%, p = 0.01) and worse seizure outcomes (18.8 vs. 66.7%, p = 0.03), and patients in DN effect subgroup had multiple seizure types compared to those in non-DN effect subgroup (65.5 vs. 30.8%, p = 0.039).Conclusion: Patients with KCNB1 variants in the Asian cohort have similar clinical manifestations to those of other races. Truncated KCNB1 variants exhibiting with haploinsufficiency molecular phenotype are linked to milder phenotypes. Individuals with complete LoF and DN effect KCNB1 variants have more severe seizure attacks than the other two subgroups.

Giant malignant Chondroid Syringoma: Case Report and Literature Review

Chondroitin syringoma, also known as cutaneous mixed tumor, is a rare type of sweat gland tumor, accounting for 0.01% to 0.1% of all primary tumors of the skin. The malignant form is extremely rare, with 41 cases described so far. It predominates in the trunk and distal extremities and affects women more frequently, with a 3: 2 rate 6,7. Patients may reach the health service with large lesions due to the fact of being slow-growing lesions and have a high rate of recurrence, requiring surgical treatment that may lead to extensive defects making complex reconstructions necessary. We present a case of malignant chondroid syringoma in an 80 years old male patient, with 29 years of evolution and unusual size. A reconstruction was performed with a muscular dorsal flap of the latissimus dorsi with good aesthetic and functional results, with no signs of recurrence after 8 months of follow-up. It is concluded that because it is a late diagnosis neoplasia, the surgical treatment ends up generating expressive defects. There for musculocutaneous should be considered as an option for reconstruction, aiming optimal functional and aesthetic restoration.

Surgery of cicatricial stage of choroidal neovascular membrane with autologous conditioned plasma

Purpose. To estimate the effectiveness of the cicatricial stage of choroidal neovascular membrane (CNM) surgery with retina fixation after retinotomy of paracentral areas with autologous conditioned platelet rich plasma (ACP) and without endolaser photocoagulation and silicone oil tamponade. Material and methods. 17 CNM patients aged 49 to 82 with visual acuity from 0.02 eccentric to 0.08 were operated. The operation consisted in 25-, 27+-gauge vitrectomy, removal of the posterior hyaloid membrane and the inner limiting membrane (in the presence of an epiretinal membrane), paracentral retinotomy, removal of the choroidal neovascular membrane via retinotomy, pneumoretinopexy, 2–3 layer instillation of ACP in the retinotomy area without endolaser photocoagulation and silicone oil tamponade, seamless closure of sclera- and conjunctivotomy with a layer of autologous conditioned plasma. Results. Full retinal reattachment and closure of the retinotomy opening in the late postoperative period was noted in all patients. No case of recurrent retinal detachment was recorded. Complete closure of sclera- and conjunctivotomy with no additional suture fixation was achieved in all cases. In the long-term period after the removal of the cicatricial choroidal membrane, visual acuity was 0.03–0.2. Conclusion. The modern surgery of the cicatricial stage of CNM using ACP to close the retinotomy defect after removal of cicatricial CNV without endolaser coagulation of the retina and silicone tamponade, followed by seamless blocking of the sclero- and conjunctivotomy with ACP produces excellent anatomical and functional results, minimizing the risk of postoperative complications.

A Clinical Case of Two-Stage Visual-Functional Rehabilitation of a Patient with Postinfectious Central Corneal Opacity in Combination with Mixed Astigmatism Using Laser Keratorefractive Surgery

Introduction: to evaluate the clinical and functional results of two-stage treatment in a patient with post-infectious Central corneal opacity combined with mixed astigmatism.Patient and methods. Patient N., 19 years old with postinfectious (postherpetic) Central corneal opacity, mixed astigmatism was examined and operated using two-stage corneal laser treatment. To determine the possibility of surgical treatment of the patient, a complex of General ophthalmology was performed (checking visual acuity near and far in natural conditions and in conditions of drug-induced mydriasis, IOP measurement, autorefractometry, examination of visual fields, A- and Bscanning, ophthalmoscopy with examination of the Central and peripheral areas of the fundus), as well as special (keratopography and Scheimpflug camera examination, optical coherence tomography (OCT) of the anterior segment of the eye with analysis of the epithelial map, quantitative assessment (Schirmer test-1) and qualitative (tear film rupture time) lachrymal products, assessment of the epithelium state when stained with vital dyes and infrared meibography) research methods. To determine the activity of herpetic infection, PCR diagnostics were performed. The follow-up period was 2 years.Results and discussion. To achieve high visual-functional rehabilitation while preserving the native lens, a two-stage treatment algorithm was developed using technologies of laser corneal refractive surgery. At the first stage, in order to regularize the ocular surface and eliminate Central corneal opacity, an inverted topographically oriented PRK was performed; at the second stage, residual refractive errors were corrected using topographically oriented FemtoLASIK technology.Conclusion. According to the results of a literature search and analysis of Internet resources, there were no previously recorded and published works using a similar two-stage method. Therefore, the described clinical case justifies the relevance and novelty of the goal and has an evidence-based Foundation for the use of a two-stage laser keratorefractive treatment system in the ophthalmological practice of visual and functional rehabilitation of patients with Central corneal opacity in combination with mixed astigmatism or hypermetropic refraction. The two-year postoperative follow-up period showed stable and high visual-functional results with no recurrence of the inflammatory process.

Analysis of long-term results of surgical treatment of acromioclavicular dislocation

Background. Acromioclavicular dislocation is a fairly common traumatic injury of the musculoskeletal system, and according to different authors varies from 2 to 26.1 % dislocations of other localizations, and is about 10 % of all acute injuries of the shoulder girdle, taking 3rd place after dislocations of shoulder and forearm. The social significance of this damage is determined by the occurrence mainly among young working-age men. The work was aimed to identify factors that cause unsatisfactory anatomical and functional results after surgical treatment of acromioclavicular dislocations. Materials and methods. This retrospective study (2015–2020) included 93 patients who had surgical intervention for acromioclavicular dislocation. Surgical stabilization of the acromial end of the clavicle was done by Hook Plate and by Weber technic. Results. The outcome of research shows that 49.5 % of cases had good results, 31.2 % — satisfactory, and 19.3 % — poor. There is a direct correlation between unsatisfying outcome and increased severity of the injury. The study found that 9.7 % of unsatisfying results were associated while using Weber’s technic in the Tossy II, while in Tossy III, it was 27.0 %. A similar correlation was found while using Hook Platе, in the case of Tossy II, unsatisfying results were in 15.8 % of cases and Tossy III — 29.4 %. Conclusions. The reason for the unsatisfying results of the surgical acromioclavicular dislocations treatment is the severity of damage and the absence of an algorithm for diagnosis and management of this injury. In Tossy III dislocations, the use of stabilization methods as Weber’s technic, Hook Plate, or suturing damaged acromioclavicular ligaments did not demonstrate satisfying effectiveness.

New Techniques in Hemorrhoidal Disease but the Same Old Problem: Anal Stenosis

Anal stenosis, which develops as a result of aggressive excisional hemorrhoidectomy, especially with the stoutly use of advanced technologies (LigaSure, Ultrasonic Dissector, Laser, etc.), has become common, causing significant deterioration in the patient's quality of life. Although non-surgical treatment is effective for mild anal stenosis, surgical reconstruction is unavoidable for moderate to severe anal stenosis that causes distressing, severe anal pain, and inability to defecate. The problem in anal stenosis, unlike anal fissure, is that the skin does not stretch as a result of chronic fibrosis due to surgery. Therefore, the application of lateral internal sphincterotomy does not provide satisfactory results in the treatment of anal stenosis. Surgical treatment methods are based on the use of flaps of different shapes and sizes to reconstruct the anal caliber and flexibility. This article aims to review the functional results, postoperative care, and complications of these methods.

Functional outcome assessment for surgical decompression of cervical spondylotic myelopathy

Background: Cervical spondylotic myelopathy (CSM) is one of the most common dysfunctions of spinal cord occurs due to degenerative changes in cervical spine disc and facet joints. It is a form of progressive spine disease including herniated disc and spinal cord stenosis which manifests as changes in gait, skilled hand movements, muscle strength, bladder dysfunction etc. Recent studies and trials have established that surgical decompression of cervical spinal is a cost-effective treatment modality which provide satisfactory functional recovery. This study aimed at the functional outcome of surgical decompression of CSM.Methods: The prospective study of 100 cases of cervical myelopathy for which decompressive surgery was done from August 2020 to August 2021. Results were analysed according to Nuricks and modified Japanese orthopedic association scoring system (MJOA).Results: Seventy one males and 29 females were included in this study with average age was 53 and average hospital stay was 3.55 days. Average pre-op Nurick score was 1.93, while score after 6 months and 1year were 1.44 and 1.15respectively. Average pre-op MJOA score was 13.63, while score after 6 months and 1 year were 14.58 and 15.74 respectively.Conclusions: The functional results of decompressive surgeries for cervical myelopathy are satisfactory. Both anterior and posterior approaches are recommended for multiple cervical myelopathy with comparable outcomes. DM and age was observed as the independent predictor for functional outcome, while, gender and level of disease got less significant predictive value.