Background: The study compared the pattern of consultation and the treatment outcome of maxillofacial patients referred by different orthopedic units. Materials and Methods: All consecutive major trauma patients referred from two orthopedic units to the maxillofacial unit of our institution, over a 4-year period, was retrospectively analyzed. Patients' demographics, time, and types of injury, the time interval between injury and maxillofacial consultation, time of treatment, and anesthesia requirement were obtained. Results: Of the 156 referred cases, there were 138 (88.5%) males and 18 (11.5%) females with a male: female ratio of 7.7:1. Their ages ranged from 12 to 66 years, mean 34.5 (9.89) years. Road traffic accident (n = 145; 92.9%) was the most common etiology. Mandibular (n = 87; 55.8%) and zygomatic (n = 30; 19.2%) fractures were the most predominant maxillofacial injuries. For the orthopedic injuries, lower limb fracture were the commonest (60.9%). Majority (n = 66; 91.7%) of patients co-managed with the Aminu Kano Teaching Hospital Team were seen within 24 h compared to a period of 4 days to over 1-week for patients referred from National Orthopedic Hospital (NOH). The mean period required to treat maxillofacial patients referred from NOH was significantly longer than for intra-hospital consultation (P < 0.001). Conclusion: Establishment of maxillofacial units in trauma and orthopedic hospitals will improve the overall management of the multiple trauma patients that may occasionally present with concomitant maxillofacial injuries.

Background: The role of oral and maxillofacial surgeons in the management of maxillofacial emergencies has been well recognized. The present study aimed to review the maxillofacial emergency practice in our institution, highlighting the pattern of maxillofacial conditions requiring emergency services, the gaps in our practice and factors that will improve it. Materials and Methods: The study was a 2-year retrospective review of patients managed at the accident and emergency (A/E) unit of our institution. Sources of clinical information were A/E register, patients' case folders and discharge summaries. These data were analyzed using Statistical Package for Social Sciences (SPSS) version 15.0 (SPSS Inc, Chicago, IL, USA). Results: Of the 549 patients studied, male accounted for 437 (79.6%), while female accounted for 112 (20.4%) giving a gender (male: female) ratio of 3.9:1. Fifty-five (10%) patients with sole maxillofacial injuries were attended to at the A/E unit and discharged home on the same day, while 494 (90%) patients required admission and further treatment. Ages of the subjects ranged from 2 months to 86 years with a mean age of 36.4 ± 27.1 years. Road traffic accident (RTA) had the highest frequency of A/E attendance (58.3%), with mandibular fracture being the commonest (41.6%). Debridement and suturing were the most performed procedure (44.0%). Conclusion: RTA related injuries and orofacial infections are common conditions, which frequently present at the A/E unit. Prompt access to quality maxillofacial care may help to reduce the attendant morbidity arising from the conditions.

Aim: To evaluate the functional outcome of distal humerus intercondylar fracture treated by open reduction and internal fixation. Methods: The prospective study of 42 patients with intercondylar humerus fracture treated at Sri Ramachandra Medical Centre between March 2010 and March 2014. The inclusion criteria were age above 19 years, Type C fractures of the distal humerus and closed fracture's. The exclusion criteria were extraarticular fractures of the distal humerus, unicondylar with intercondylar extension and open fractures. The rating system of the Mayo elbow functional scoring system was used. The patients were followed for a minimum of 1-year. Results: In 42 patients, 26 were males and 16 were females. In our series, we had 81% excellent/good results, 19% fair/poor result. We had complications in 7 patients. Two patients had early Kirschner-wire back out. One patient had an infection, and 4 patients had ulnar nerve neuritis. Conclusion: Meticulous surgical technique, stable internal skeletal fixation, and early controlled postoperative mobilization are critical factors for a successful outcome. Trans-olecranon approach with the patient in lateral position offers excellent exposure of the articular surface. Arc of motion was more important than the total range of motion. The clinical evaluation did not always correlate with the follow-up radiograph.

Context: In the developing countries, traditional bonesetters (TBS) continue to ply their trade, and they treat a large proportion of patients with fractures and dislocations. They are known in the hospital practice because of complications arising from their practice that present in the hospital. Aims: To look at the pattern of complications of TBS limb injuries management that presented at our center; factors influencing the decision to patronize TBS and treatment outcome of the complications. Subjects and Methods: A descriptive study designed to look at the TBSs complications that presented at our hospital between May 2011 and April 2014. Results: Forty-five patients were managed after TBS intervention. Road traffic crash accounted for 64.4% of their injury. Relations (47.8%) and friends (34.8%) influenced largely, decision to patronize TBS. Thirty-three (61.1%) went to TBS believing they have better outcome. Fracture nonunion accounted for the highest complication (53.3%). Most of the patients had operative intervention. Twenty-eight (68.3%) regained full limb functions, whereas 13 (31.7%) had impaired functions. Conclusions: Large percentage of the patients believed TBS have better outcome; and their complications were treated largely by surgery to regain limb functions.

Context: Pertrochanteric fractures of the proximal femur are a common occurrence among elderly patients. The two types of implants most commonly used for internal fixation of these fractures are dynamic hip screw (DHS) and proximal femoral nail (PFN). However, limited data exist showing comparison between these implants for the treatment of unstable pertrochanteric fractures which are more difficult to manage than the stable ones. Aims: The purpose of this study was to compare the outcome of management between both implants in the treatment of pertrochanteric fractures. Settings and Design: It is a prospective study done at Sri Guru Ram Das Institute of Medical Sciences. Amritsar (Punjab), India. Materials and Methods: Totally, 30 cases of unstable pertrochanteric fractures (Arbeitsgemeinschaft für Osteosynthesefragen [AO] type 31A2 and 31A3) were included and treated using PFN and DHS (15 cases each) from July 2011 to June 2013. Alternate allocation to each implant group was done. Follow-up was for about 6 months. Results were obtained with regard to operation time, blood loss, fluoroscopy, time to union, time to full weight bearing, and the requirement for revision surgery. Functional scoring was done using the Salvati and Wilson hip score. Statistical Analysis Used: Clinical and radiological data were analyzed using the statistical software epi-info version 3.5.1 released in August 2008. Results: Patients who underwent fixation by PFN had a shorter operation time, lesser blood loss, and returned to full weight bearing earlier than those who had DHS. However, more fluoroscopic exposure was recorded in PFN than DHS. Time to union was more or less the same. Patients who underwent PFN fixation had better Salvati and Wilson hip scores than those with DHS. Conclusions: In unstable pertrochanteric fractures, PFN definitely holds an edge over DHS.

Isolated posttraumatic adrenal hematoma is a very rare entity. Only, few cases have been reported in the literature. We present here 2 cases of isolated posttraumatic adrenal hematoma. Both the cases presented due to blunt trauma abdomen following road traffic accident with pain in the right flank. Contrast enhanced computed tomography abdomen showed adrenal mass with an attenuation of 62 HU and 68 HU which were compatible with traumatic adrenal hematoma. Both cases were managed conservatively.

Penetrating abdominal injury resulting from home accidents is rare. Only one such case was found in the English literature after online searching on PubMed. We report two cases of penetrating abdominal injury. The first was a 2-year-old girl who was brought into the emergency room (ER) with evisceration of most of the stomach through the left hypochondrium. She had fallen on a broken soft drink bottle; she was holding, after missing her steps. On examination, she had a penetrating injury in the left hypochondrium and a 1.5 cm perforation on the proximal aspect of the anterior wall of the stomach. She was explored within 3 h of presentation, during which the gastric perforation was closed eviscerated bowel returned into the peritoneum and primary wound closure achieved. The patient did well postoperatively. The second was a 9-month-old boy who was brought to the ER by parents on account of gut evisceration following injury from a soft drink bottle at home. He sustained injury from exploded soft drink bottle while crawling. Examination revealed a penetrating injury in the left upper quadrant with evisceration of small intestinal loops. He also had exploratory laparotomy within 4 h of presentation, during which intact abdominal viscera was found. Bowel loops were returned and primary abdominal closure done. Postoperatively, the patient did well. These cases are eye openers to an unusual form of domestic injury, exemplifying the potential hazards of soft drink bottles in the home. Awareness about this is pertinent.