Does the Nottingham Hip Fracture Score Help Predict Which Patients Will Benefit From a Modern Modular Hemiarthroplasty for the Treatment of Intracapsular Proximal Femoral Fractures?

Introduction: Hemiarthroplasty for the management of intracapsular neck of femur fractures is common but current practice in the UK still varies regionally and individually. Guided by the National Institute of Health and Care Excellence (NICE) we have observed a move towards modern, modular prostheses such as the Exeter V40 Stem but the use of older, monoblock prostheses such as the Thompsons Hemiarthroplasty remains controversial. Use of the Nottingham Hip Fracture Scores (NHFS) can help surgeons stratify patients according to risk and select the most appropriate prosthesis to meet their individual needs. Materials and Methods: 765 hip hemiarthroplasties were analysed over a 28-month period at a single, high-volume, orthopaedic department in the UK. We calculated the NHFS and recorded the choice of prosthesis. Patients were then followed up for at least a year. Outcomes were mortality and change in residential status. Results: Six hundred and forty-six (446) patients were treated with monoblock prostheses (mean age=85.6; range 62-105). 319 patients received modular prostheses (mean age=81.0; range 61-98). Patients who were selected to receive a monoblock prosthesis were over twice as likely to be dead at a year (32.87% vs. 13.65%) and over twice as likely to require increased assistance with living (50.12% vs. 23.81%). Amongst patients with equivocal NHFS, those who receive a monoblock stem suffered worse outcomes in all but the very highest risk group, who experienced lower mortality (OR=0.71, CI 0.52-0.96) and change in residential status (OR=0.76, CI 0.58-0.99). Conclusion: Nottingham Hip Fracture Score (NHFS) can confer predictable outcomes in hip fracture patients treated with modular stems. Modular stems should be the default choice when performing hemiarthroplasties for intracapsular neck of femur fractures. However, in keeping with other studies, we found that in very old, frail, or co-morbid patients, modular stems are not associated with better survival or return to pre-morbid function.

Pelvic Binders in Trauma Patients - Are We Doing it Right?

Introduction: Pelvic fractures from high-energy trauma require immediate stabilisation to avoid significant morbidity and mortality. When applied correctly over the level of the greater trochanters (GT) pelvic binders provide adequate stabilisation of unstable pelvic fractures. The aim of this study was to identify the accuracy of placement of pelvic binders in patients presenting to the local Major Trauma Centre (MTC). Methods: A retrospective study was carried out to assess the level of the pelvic binders in relation to the greater trochanters of the patient-classified as optimal or sub-optimal. Results: An initial review of the computed tomography (CT) trauma series in 28 consecutive patients with pelvic binders revealed that more than 50% of the pelvic binders were placed above the level of the GT, reducing the efficacy of the pelvic binders. A regional educational and training day was held with a focus on pelvic fracture management. Following this, a review was conducted on the placement of the pelvic binder in 100 consecutive patients. This confirmed a significant improvement in the position of the pelvic binder by over 70%. Conclusion: Inaccurately positioned pelvic binders provided suboptimal stabilisation of pelvic fractures. With education and awareness, there has been an improvement in the accuracy of pelvic binder placement in trauma patients. This study has highlighted the need for regular audit of current practice, in combination with regular education and training.

Persistent Headache Caused by Post-Traumatic External Nasal Neuralgia: A Case Report

A 50-year-old female patient presented with a severe headache characterized by sharp pain localized in the right frontal area above the right eye. The patient’s right nostril was cauterized to stop a nosebleed one year prior to the start of the pain. Physical examinations revealed that the pain was aggravated by touch of the right lateral side of the nose and in severe attacks radiated to the maxillary frontal teeth. Blood tests, magnetic resonance image (MRI) and computer scanning (CT) scan images were all normal. The patient was diagnosed with post-traumatic external nasal neuralgia and symptoms were relieved and nearly resolved completely using a nasal cleanse and lubrication of the nose.

Primary Salivary Rhabdomyosarcoma in Childhood: A Rare Presentation

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in childhood. It is originated from embryonic mesenchyma and can arise anywhere in the body. Head and neck location accounts for 35% of all RMC locations. The parotid gland is very rarely affected. Because of this infrequent occurrence and the multiplicity of therapeutic means of management, we report a case a 5-year-old child which was diagnosed as parotid RMS.

Comparative Effects of Dental Treatment and Two Different Physical Therapy Interventions in Individuals with Bruxism: A Randomized Clinical Trial

Objective: To compare the efficacy of dental treatment and two different physical therapy interventions in individuals with bruxism. Methods: A total of 72 individuals with bruxism were randomly allocated to the massage (massage with stretching exercises), relaxation (relaxation with imagination therapy) groups (n=24 each; biweekly 40-min sessions over 6 weeks) or the dental group (n=24; direct restoration; two 2-h sessions 1 week apart). Primary outcomes included muscle pain and symptoms, and mandibular opening. Secondary outcomes included anxiety, stress, depression, oral health and sleep quality. Outcomes were evaluated at baseline, 6 weeks and 2 months post-initial intervention by a blinded assessor. Physical therapy interventions included individual sessions that lasted 40 min biweekly for 6 weeks and dental treatment, two 2-h individual sessions conducted a week apart. The level of significance established was α=5%. RESULTS: After 6 weeks, the improvement with difference among massage and relaxation groups and dental group was observed in muscle pain, symptoms, anxiety, stress, depression and sleep quality (p<0.001). Relaxation group exhibited significantly greater improvement in oral health than dental group (p<0.001). These effects were sustained for up to 2 months. Conclusion: Therefore, two physical therapy interventions are superior to dental treatment in the improvement of muscle pain, symptoms, anxiety, stress, depression and sleep quality in individuals with bruxism. Oral health improves more with relaxation with imagination therapy than with dental treatment.

Internet Addiction in Mexican Medical Students and Family Functioning

Introduction: Internet addiction is a deterioration in the control of the Internet, manifested in various cognitive, behavioral, and physiological symptoms. Internet addiction affects family functioning by generating problems in relationships with family members. The disturbed functioning of the family also makes individuals vulnerable to internet addiction. Objective: To determine the relationship between family functioning and internet addiction. Methods: A descriptive, cross-sectional, survey-type observational study was carried out on 358 students of the Faculty of Medicine of the Universidad Autonoma de Nuevo Leon, Mexico. to measure the presence of internet addiction. Result: A prevalence of 28% for internet addiction was found in medical students. Conclusions: This research found that following Olson's model, family functioning is not significantly related to internet addiction. The overall prevalence of internet addiction was higher than that found in other countries. Since the family plays an essential role in preventing internet addiction, it should be considered to reduce excessive Internet use.

Extraskeletal Intracranial Mesenchymal Chondrosarcoma: A Case Report

Mesenchymal chondrosarcoma (MCS) is a rare high-grade malignant tumor that affect young adults. The intracranial location is extremely exceptional. It is characterized by an undifferentiated mesenchymal cell, with islands of hyaline cartilage. This is a case of a 23-year-old young patient suffering from a generalized tonic-clonic seizures. The cerebral scanner objectified a hemorrhagic frontotemporal pass of 6x5x5 cm. The immunohistochemical and anatomopathological of the surgical specimen was in favor extraskeletal intracranial mesenchymal. The patient's progress was unfavorable due to tumor recurrence postoperatively. In this article, we discuss the clinical presentation, the diagnostic assessment, the therapeutic strategy as well as the prognosis of this rare pathology.

Neuroendocrine Carcinoma of Oral Cavity: A Case Report of an Unusual Presentation

Neuroendocrine carcinoma (NEC) are tumors affecting lungs in the first line. Extra-pulmonary locations are rare, and involvement of the oral cavity is uncommon. The therapeutic strategy of this clinically aggressive entity is not codified. Nevertheless, multimodal treatment combining surgery and radio-chemotherapy is associated with the best results in terms of local control and overall survival. We report a case of a 67-year-old patient, diagnosed with a NEC, the computed tomography (CT) of the facial mass objectified a jugal mass of 2x2.4 cm with two lymph nodes. The patient benefited from an excisional biopsy of the mass, and whose histological examination and immunohistochemical testing returned in favor of a small cell neuroendocrine carcinoma.

A Pyogenic Liver Abscess Leading to Massive Pleural Effusion: A Case Report

Pyogenic liver abscesses are common in tropical developing countries. They are typically present with right and upper abdominal pain; nevertheless, occasionally, we encounter atypical presentations. Here we present a rare case of complicated large liver abscesses caused by Klebsiella pneumonia, which manifests in massive pleural effusion in a young, healthy gentleman. The patient stayed ten days in the hospital for drainage and to receive appropriate antibiotics.

Conservative Management in Two Penetrating Fishbone Injuries: A Case Series and Literature Review

Foreign body ingestion is a regular medical referral. Patients present with different objects such as chicken bones, nails, coins, and fishbones. It is usually managed in causality and passes without any intervention. However, occasionally, we come across fishbone complications requiring intervention. We discuss the course and management of two case reports of fishbone injuries in different abdominal regions.