PURPOSE: Pelvic fractures are severe injuries and are often associated with multiple system injuries, exacerbating the overall outcome. In India, the incidence of pelvic fractures is on a rise due to suboptimal roads and traffics but related literature regarding the overall epidemiology of these injuries is scarce and scanty. Our aim was to study the epidemiology of patients admitted with pelvic fractures at a level 1 trauma centre in India. METHODS: A 16-month (between September 2015 and December 2016) prospective observational study was carried out on trauma patients with pelvic fractures at a level 1 trauma centre of a tertiary care hospital. Demography of patients, mechanism of injuries and complications were recorded prospectively. RESULTS: We observed 75 patients who presented with pelvic fractures, where 56 were males and 19 were females. Mean age of the study population was 37.57 years. Road traffic accidents were the most common mode of injuries. Lateral compression injuries were the most common pattern. Associated injuries frequently encountered were lower extremities and acetabulum fractures, blunt abdominal trauma, urogenital injuries and head injuries. Out of the 75 patients, 52 were treated surgically and 23 were managed by conservative methods. Associated injuries of the extremities, head, abdomen and urogenital system indicated a longer hospital stay. CONCLUSION Pelvic fractures, although belong to a relatively rare trauma subset, cause a high morbidity and mortality with considerable burden on the economy. Proper road safety training and driving etiquettes along with its strict implementation in true sense and spirit are the need of the hour.
Accidents, Traffic ; prevention & control ; statistics & numerical data ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Cost of Illness ; Female ; Fractures, Bone ; economics ; epidemiology ; mortality ; Humans ; Incidence ; Length of Stay ; statistics & numerical data ; Male ; Middle Aged ; Pelvic Bones ; injuries ; Prospective Studies ; Tertiary Care Centers ; statistics & numerical data ; Time Factors ; Young Adult

Radial head and coronoid fractures without posterior dislocation of the elbow have not been recorded in the literature. There is no literature documenting the combined fractures of the radial head, capitellum and coronoid process together in the same elbow. This is a case report highlighting this combination of fractures in a 30 year old patient treated with open reduction and internal fixation of all three fractures. The patient was followed up for 28 months and had a good range of motion of the elbow without any instability. Thus such a triad with no ligamentous injuries could depict a bony variant of terrible triad and a mechanism for such an injury has also been explained.
Accidents, Traffic ; Adult ; Elbow Joint ; injuries ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Joint Dislocations ; diagnostic imaging ; surgery ; Male ; Radius Fractures ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed

Complications following supracondylar fracture of humerus are well-known. Pre- and post-operative complications have been documented in the literature. Neurovascular injury due to fracture fragments following this type of fracture is described. Iatrogenic brachial artery during surgical treatment of this fracture is unknown to the literature. So we report a rare case of iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus and try to create awareness to the surgeons that such injuries can occur with improper operative techniques.
Brachial Artery ; diagnostic imaging ; injuries ; Child ; Humans ; Humeral Fractures ; complications ; diagnostic imaging ; surgery ; Male ; Tomography, X-Ray Computed

Although fracture of the humeral shaft or dislocation of the shoulder joint is a common injury, a simutaneous injury is rare. We present such a case combined with head injury which took precedence over the skeletal injuries. The postoperative rehabilitation was slowed down by the head injury. This case report makes us aware of some problems when managing the patient with this rare injury and helps us understand the management options better. Also the need for proper follow-up and rehabilitation is emphasized.
Adult ; Craniocerebral Trauma ; complications ; Fracture Fixation, Internal ; Humans ; Humeral Fractures ; complications ; surgery ; Male ; Shoulder Dislocation ; complications

There are several well defined indications for surgical management of humeral shaft fractures. Operative procedures on the humerus are associated with their own complications. Iatrogenic brachial artery injury as a complication of humeral shaft plating has not been reported previously. We report a case of a 48 years old female, who received operation at a district hospital and was referred to us when the surgeon could not palpate the pulse. CT angiogram showed that there was segmental non-opacification of the brachial artery. There was distal reformation and the thrombosis was decided to be managed conservatively. We believe that the arterial injury was a result of improper surgical technique and the segmental block might be due to improper use of plate holding forceps. This case report makes us aware of a rare complication of operative management of humeral shaft fractures and that basic principles of surgery must be always followed to prevent such injuries.
Bone Plates ; Brachial Artery ; Fracture Fixation, Internal ; Humans ; Humeral Fractures ; surgery ; Humerus ; Iatrogenic Disease

OBJECTIVESurgical management options for femoral shaft fracture and ipsilateral proximal femur fracture vary from single-implant to double-implant fixation. Cephalomedullary fixation in such fractures has relative advantages over other techniques especially because of less soft tissue dissection and immediate postoperative weight bearing with accelerated rehabilitation. However, the surgery is technically demanding and there is a paucity of literature describing the surgical techniques for this fixation. The aim of the study was to describe the surgical technique of cephalomedullary fixation for femoral shaft fracture and ipsilateral proximal femur fracture.

METHODSSixteen cases (10 males and 6 females with a mean age of 41.8 years) of ipsilateral proximal femur and shaft fractures were treated by single-stage cephalomedullary fixation at tertiary level trauma center in northern India. The fractures were classified according to AO classification. An intraoperative record of duration of surgery as well as technical challenges unique to each fracture pattern was kept for all the patients.

RESULTSThe most common proximal femoral pattern was AO B2.1 observed in 9 of our patients. The AO B2.3 fractures were seen in 4 patients while the AO A1.2 fractures in 3 patients. Four of the AO B2.1 and 2 of the AO B2.3 fractures required open reduction with Watson-Jones approach. The mean operative time was around 78 minutes, which tended to decrease as the surgical experience increased. There was only one case of malreduction, which required revision surgery.

CONCLUSIONCombination of ipsilateral femoral shaft fracture and neck/intertrochanteric fracture is a difficult fracture pattern for trauma surgeons. Cephalomedullary nail is an excellent implant for such fractures but it requires careful insertion to avoid complications. Surgery is technically demanding with a definite learning curve. Nevertheless, a majority of these fractures can be surgically managed by single-implant cephalomedullary fixation by following basic surgical principles that have been summarized in this article.

Adult ; Female ; Femoral Fractures ; complications ; surgery ; Femoral Neck Fractures ; complications ; surgery ; Fracture Fixation, Internal ; methods ; Hip Fractures ; complications ; surgery ; Humans ; Male ; Middle Aged

There are several well defined indications for surgical management of humeral shaft fractures.Operative procedures on the humerus are associated with their own complications.Iatrogenic brachial artery injury as a complication of humeral shaft plating has not been reported previously.We report a case of a 48 years old femalewho received operation at a district hospital and was referred to us when the surgeon could not palpate the pulse.CT angiogram showed that there was segmental non-opacification of the brachial artery.There was distal reformation and the thrombosis was decided to be managed conservatively.We believe that the arterial injury was a result ofimproper surgical technique and the segmental block might be due to improper use of plate holding forceps.This case report makes us aware of a rare complication of operative management of humeral shaft fractures and that basic principles of surgery must be always followed to prevent such injuries.

Inferior dislocation of the hip is the ra- rest type in hip dislocation. Very few cases have been reported in the anglophonic literature, most of which involved the pediatric age group. Surprisingly, we came across a 30-year-old patient with a bilateral inferior hip dislocation. He had sustained a road traffic accident and the attitude of both hip joints was flexion and abduction. The diagnosis was confirmed by radiographs which revealed the long axis of the femur at an angle of 110 (right) degrees and 100 (left) degrees respectively away from the axis. Closed reduction under sedation was successfully performed. Skin traction for a period of 6 weeks was advised and the follow-up revealed an excellent result. We present the details of this case, the first of its kind along with a review of the literature, discussing the various modes and mechanisms of injury inducing inferior dislocation of the hip.
Accidents, Traffic ; Femur ; Hip Dislocation ; Humans ; Range of Motion, Articular ; Traction

Inferior hip dislocation is the rarest type among all hip dislocations. Very few cases have been reported in the English literature. Most of the earlier reported cases involves the pediatric age group. No single case series could be found in the English literature. We came across 4 cases of inferior hip dislocation with a varied age profile (range 10 to 56 years, mean 33.8 years). Patients with this disease usually complained of pain and kept the thigh flexed and abducted. The diagnosis can be confirmed by radiographs which reveal that the long axis of the femur varies in alignment with respect to the spine from parallel to an angle almost 90 degree away from the axis. In our series, closed reduction was successful in all patients, either under sedation or general anaesthesia. Skin traction for a period of 6 weeks was applied in all of them and follow-up revealed pain-free, stable and mobile hips. In this study we present the details of these cases along with a review of literature discussing the various modes and mechanisms that produce inferior hip dislocation.
Femur ; Follow-Up Studies ; Hip Dislocation ; diagnosis ; Humans ; Range of Motion, Articular ; Research Design ; Traction

Inferior hip dislocation is the rarest type among all hip dislocations.Very few cases have been reported in the English literature.Most of the earlier reported cases involves the pediatric age group.No single case series could be found in the English literature.We came across 4 cases of inferior hip dislocation with a varied age profile (range 10 to 56 years,mean 33.8 years).Patients with this disease usually complained of pain and kept the thigh flexed and abducted.The diagnosis can be confirmed by radiographs which reveal that the long axis of the femur varies in alignment with respect to the spine from parallel to an angle almost 90° away from the axis.In our series,closed reduction was successful in all patients,either under sedation or general anaesthesia.Skin traction for a period of 6 weeks was applied in all of them and follow-up revealed pain-free,stable and mobile hips.In this study we present the details of these cases along with a review of literature discussing the various modes and mechanisms that produce inferior hip dislocation.