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   2015| July-December  | Volume 4 | Issue 2  
    Online since March 22, 2016

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Long term outcomes of neglected intracapsular fracture neck in young adults managed by modified double angle barrel plate (DABP) with intertrochanteric valgusosteotomy
S. P. S. Gill, Manish Raj, Pulkesh Singh, Dinesh Kumar, Jasveer Singh, Prateek Rastogi
July-December 2015, 4(2):35-44
Introduction: Fracture neck of femur in young adult have relatively higher incidence of complications such as nonunion, avascular necrosis (AVN) of femoral head, loss of fixation, screw cut-out, and delayed secondary osteoarthritis. Delayed presentation of these cases in developing countries such as India further compromises the outcome of these fractures. Situations like this in young adult lead to difficulty in fixation by simple cancellous screw because of lack of compression surface area. Replacement surgeries in these cases are a difficult choice in these patients; it is difficult to restrict squatting for lifelong due to social culture and lack of toilets. Now, days also preferences are given to head sparing surgeries and osteosynthesis. Materials and Methods: Cases were selected from the patients attending orthopedics outpatient department and emergency trauma center from August 2006 to August 2012. During this period, total 56 cases of neglected fracture neck femur came to our department. Of these 56 cases, 36 cases qualify for inclusion into this study. Of 36 cases, 22 were female and 14 were male with an age range from 22 years to 48 years and average age of 42 years. Average duration from injury to operative procedure was 4.9 weeks (34 days) and range from 2 weeks to 18 weeks. These cases were operated by modified double angle barrel plate (DABP) with intertrochanteric valgus osteotomy with one cannulated cancellous screw (CCS). Results: Total 36 cases were operated using DABP and trochanteric osteotomy. Final outcomes were evaluated using modified Askin and Bryan criteria. Of these 36 cases, 32 (88.8%) cases gave good to excellent results and completed their full follow-up. Rest four cases were unable to continue with same implant fixation. These were kept in failure group. These four cases showed failure due to loss of reduction, screw cut-out, and secondary collapse of femoral head after AVN. These cases further managed by replacement surgeries. Discussion: Neglected fracture neck femurs are not rare presentation in developing countries. Various modalities of treatment are fibular graft, iliac bone graft, multiple screws with fibular graft, muscle pedicle graft. In our case series, we had done combination of DABP with trochanteric osteotomy with CCS and achieved excellent to good results and this method can be used a primary method for management of neglected femoral neck fracture.
  6,165 4,500 1
Computed tomographic pattern of traumatic head injury at a tertiary hospital in Ibadan, South-Western Nigeria: A 10 year review
Ademola Joseph Adekanmi, Adenike Temitayo Adeniji-Sofoluwe, Millicent Olubunmi Obajimi
July-December 2015, 4(2):45-50
Background: The World Health Organization has projected that by the year 2020, head trauma from Road Traffic Crashes (RTCs) alone will be the 3 rd leading burden of diseases in developing countries. Computed tomography (CT) is the imaging modality of choice in acute traumatic head injury evaluation and provides an excellent guide to the care of the head injured patient. Aim: The aim of this study was to evaluate the computed tomographic pattern of head injury over a decade. Materials and Methods: This is a 10 year retrospective and descriptive study carried out at the University College Hospital Ibadan, a premier tertiary health institution, which serves as a referral center for cities and towns in South-West Nigeria. All patients with head injury referred to the Radiology Department for cranial CT investigation between January 2003 and December 2012 were recruited into the study. Results: Males accounted for 75.3% of the 2142 head trauma cases with an approximate male to female ratio of 3:1. The mean age of the patients was 34.4 years, and the median age was 32 years (age range: 1-92 years). Patients <39 years accounted for 64.4% of the cases. RTC was the most common etiologic factor accounting for 1,318 head injury cases. Cases due to assault were least seen in 131 (6.3%) of the study population. Abnormal CT findings were present in 77.6% of cases. Intracranial hemorrhage was demonstrated in 1390 patients and was the most common finding. Intraaxial bleeds were present in 60.9%, and the incidence of skull fracture was also high (50.9%). Conclusion: RTC remains the leading cause of head injury but now occurring at an increasing and alarming rate. The most common abnormal CT finding is intraaxial bleeds, followed by skull fractures and extraaxial bleed in decreasing order. A combination of these findings was also frequently recorded.
  6,581 1,910 -
Epidemiology of traumatic dental injuries in Tunisia: A prospective study
Ines Kallel, Imen Kallel, Nabiha Douki
July-December 2015, 4(2):51-56
Purpose: The aim of this study was to investigate the epidemiological characteristics of traumatic dental injury (TDI) in Tunisian patients. Patients and Methods: All the trauma patients who had attended the Department of Dental Medicine, Hospital, Sahloul, Sousse city, during 4 years (2009-2013), were included in this study. Age, sex, etiology, and, time between the TDI and dental cares were recorded. The type of trauma was identified according to Andreasen's classification. Data were evaluated using the Chi-square, ANOVA, and Student's t-test. Results: TDIs were higher among the age group of 11-20 years (35%), with more males being affected (sex ratio: 2.2:1). Falls was the most common etiological factor causing TDI (33%). The most frequent type of trauma is enamel-dentin fracture without pulp exposure (38%). Only 9% of patients sought dental care within 24 h of the injury.   A significant difference of the sex repartition between different trauma etiologies (P = 0.013) was found. Age group repartition and etiology of trauma was significantly associated (P = 0.007) (the most common etiology of TDIs in 11-20 years age group is fall). Conclusion: In this study, fall is the most common etiology of TDI and that the majority of patients sought dental treatment after more than 24 h of the injury.   Therefore, significant strategies of trauma prevention and immediate treatment of injuries such as awareness campaigns in primary schools, colleges for emergency attitudes to adopt in case of dental trauma including total dislocation are needed to change epidemiologic data to the better.
  5,327 627 1
Unilateral visual loss following assisted forceps vaginal delivery in a Nigerian neonate
Oluyemi Fasina, Mary Ogbenyi Ugalahi, Bolutife A Olusanya
July-December 2015, 4(2):63-65
Ocular injuries from assisted vaginal delivery have been reported in literature. Although retinal hemorrhages occur more frequently, severe sight-threatening injuries may also occur. We report a newborn baby with multiple ocular injuries and visual loss occurring after assisted forceps vaginal delivery.
  5,379 369 -
Maxillary central incisor impaction due to childhood trauma and orthodontic intervention
Ganesh Chinthan, Kiran Nagarahalli
July-December 2015, 4(2):57-59
The maxillary central incisors play an important role in smile esthetics. The absence of a central incisor can affect esthetics, phonetics, and function. Permanent maxillary central incisor impaction can occur due to supernumerary teeth, cyst, abnormal tooth bud position, trauma to the deciduous incisor in childhood, etc. The purpose of this article is to discuss maxillary central incisor impaction due to childhood trauma and orthodontic intervention in its management, with an example of a case treated by two-stage surgical exposure and orthodontic traction.
  4,858 444 -
Open globe injury with intraocular foreign body and traumatic cataract
Santosh Kumar
July-December 2015, 4(2):60-62
Penetrating ocular trauma is an important cause of visual loss in children and young adults. The fate of the traumatized eye depends on the treatment adopted, with early reporting and appropriate surgical management reducing the visual loss. With the use of modern diagnostic techniques, surgical approaches, and rehabilitation, many eyes can be salvaged with retention of vision. We report a patient who presented with sudden visual loss, corneal laceration, large foreign body, and who subsequently developed a traumatic cataract. Following a successful management, the patient's visual acuity improved from 1/60 at presentation to 6/9 at discharge.
  4,298 297 -
Perioperative ipsilateral extradural hematoma at the site of ventriculoperitoneal shunt burr hole
Snehjeet Hemant Wagh, Nilesh Balkrishna Bakale, Srikant Balasubramaniam, Devendra K Tyagi, Hemant V Savant
July-December 2015, 4(2):70-72
Ventriculoperitoneal (VP) shunt, a common neurosurgical procedure, has a long list of known complications associated with it. An unusual complication of VP shunt procedure is extradural hemorrhage (EDH), more common in children. Described here is a case of a 30 years old male with hydrocephalus due to posterior fossa tumor, who underwent shunt procedure for raised intracranial pressure but postoperatively developed extra-dural hematoma at the site of VP shunt burr hole which presented as hemiparesis. Craniotomy with evacuation of hematoma improved the hemiparesis.
  4,128 259 -
Challenges in the management of comminuted fronto-naso-ethmoidal fracture in a resource-limited environment
Abdulrazaq Olanrewaju Taiwo, Ramat Oyebunmi Braimah, Adebayo Aremu Ibikunle, Ali Lasseini
July-December 2015, 4(2):66-69
This report describes the challenges in the management of a comminuted fronto-naso-ethmoidal fracture secondary to road traffic crash (RTC) in a resource-limited environment. A 55-year-old homemaker referred from Federal Medical Centre with a 3 days history of trauma to the face following RTC. Examination revealed an oblique laceration extending from the right supraorbital region and over the frontonasal region to the left nasolabial fold with exposed comminuted and depressed frontal bone and naso-ethmoidal bone. She had wound exploration, elevation of depressed frontal bone, and soft-tissue repair under general anesthesia without a computed tomography scan.
  3,958 266 -