1.Management of neglected femoral neck fracture in above knee amputated limb: A case report.
Umesh MEENA ; Ramesh MEENA ; Balaji S ; Sahil GABA
Chinese Journal of Traumatology 2015;18(6):370-372
The treatment of an above knee amputee who has sustained a fracture of the femoral neck is a chal- lenging situation for both the orthopedic surgeon and the rehabilitation team. These fractures may be managed acutely either by reduction and internal fixation or by endoprosthetic replacement based on the same criteria as in any other patient with otherwise intact limbs.We present a neglected case treated successfully with valgus osteotomy. We conclude that these fractures should be treated with the same urgency and expertise as similar fractures in non-amputees as long-term survival and good quality of life can be expected.
Adult
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Amputation
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Femoral Neck Fractures
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diagnostic imaging
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surgery
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Fracture Fixation, Internal
;
methods
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Humans
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Leg
;
surgery
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Male
2.A bony foreign body found in a patient with no bony injury: a case report.
Devwart KAUSHIK ; Narendra JOSHI ; Rakesh KUMAR ; Shiv Kumar GOYAL ; Kamlesh KUMAR ; Sahil GABA
Chinese Journal of Traumatology 2014;17(6):367-369
Open fractures with bone loss are a common occurrence following high energy trauma. But usually the bone fragments are lost on the roadside and are not usable. We report a patient who was involved in a head-on collision between two wheelers and presented with a bone fragment embedded in his thigh. Radiological survey revealed no bony injury in that patient. Another patient, who presented at the same time, sustained a segmental fracture of shaft femur and was found to have lost a bone fragment that was similar to the one found in previous patient. CT scan with 3D reconstruction revealed this missing fragment to be the same as that found in previous patient. Both patients had a history of head-on collision while travelling on a two-wheeler. Present case report throws some highlights on the probable mechanism of injury.
Accidents, Traffic
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Bone and Bones
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injuries
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Foreign Bodies
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Thigh
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injuries
3.Role of Joshi's external stabilization system with percutaneous screw fixation in high-energy tibial condylar fractures associated with severe soft tissue injuries.
Ashish-Kumar GUPTA ; Rahul SAPRA ; Rakesh KUMAR ; Som-Prakash GUPTA ; Devwart KAUSHIK ; Sahil GABA ; Mahesh Chand BANSAL ; Ratan Lal DAYMA
Chinese Journal of Traumatology 2015;18(6):326-331
PURPOSEThe treatment of high-energy tibial condylar fractures which are associated with severe soft tissue injuries remains contentious and challenging. In this study, we assessed the results of Joshi's external stabilization system (JESS) by using the principle of ligamentotaxis and percutaneous screw fixation for managing high-energy tibial condylar fractures associated with severe soft tissue injuries.
METHODSBetween June 2008 and June 2010, 25 consecutive patients who were 17e71 years (mean, 39.7), underwent the JESS fixation for high-energy tibial condylar fractures associated with severe soft tissue injuries. Out of 25 patients, 2 were lost during follow-up and in 1 case early removal of frame was done, leaving 22 cases for final follow-up. Among them, 11 had poor skin condition with abrasions and blisters and 2 were open injuries (Gustilo-Anderson grade I&II). The injury mechanisms were motor vehicle accidents (n=19), fall from a height (n=2) and assault (n=1). The fractures were classified according to Schatzker classification system.
RESULTSThere were 7 type-V, 14 type-VI and 1 type-lV Schatzker's tibial plateau fractures. The average interval between the injury and surgery was 6.8 days (range 2-13). The average hospital stay was 13 days (range, 7-22). The average interval between the surgery and full weight bearing was 13.6 weeks (range 11-20). The average range of knee flexion was 121°(range 105°-135°). The normal extension of the knee was observed in 20 patients, and an extensor lag of 5°-8° was noted in 2 patients. The complications included superficial pin tract infections (n=4) with no knee stiffness.
CONCLUSIONJESS with lag screw fixation combines the benefit of traction, external fixation, and limited internal fixation, at the same time as allowing the ease of access to the soft tissue for wound checks, pin care, dressing changes, measurement of compartment pressure, and the monitoring of the neurovascular status. In a nutshell, JESS along with screw fixation offers a promising alternative treatment for high- energy tibial condylar fractures associated with severe soft tissue injuries.
Adolescent ; Adult ; Aged ; Bone Screws ; External Fixators ; Female ; Fracture Fixation ; methods ; Humans ; Length of Stay ; statistics & numerical data ; Male ; Middle Aged ; Soft Tissue Injuries ; surgery ; Tibial Fractures ; surgery ; Treatment Outcome