Central venous catheterization (CVC), now a common procedure, has several major complications. We assessed their incidence in a prospective study of 1303 cannulations done in the intensive care unit or operating theatre. Chest radiographs were obtained to verify proper catheter placement and to detect pneumothorax. Complications were arterial puncture in 68 (5.2%) patients, arrhythmias in 21 (1.6%), cardiopulmonary arrest in 1 (0.1%), and pneumothorax in 5 (0.5%). The tip of the CVC was incorrectly located in 149 (11.2%). The chest radiograph was a valuable method for detecting complications of central venous catheterization.
Treatment of reverse oblique trochanteric femoral fractures is still challenging. We present the results of our proximal nailing surgery performed for reverse obliquity intertrochanteric fractures using two lag screws and evaluated the quality of the reduction, operative time, complications and functional status of the patients. Fifteen patients with AO/OTA 31 A-A3 fractures were treated by proximal femoral nailing in our trauma centre. The mean Harris hip score was 74.66 (range 65-96) and the mean Barthel activity score was 15.71 (range 12-20). The mean duration of surgery was 48 minutes and the average consolidation time was 8.6 weeks. No intraoperative complications or postoperative technical failures and no stress shielding as evidenced by the lack of cortical hypertrophy at the level of the tip of the implant were detected. Intramedullary nailing with proximal femoral nails may be a good option in the treatment of reverse obliquity intertrochanteric fractures.
Purpose The appropriate management of supracondylar humerus fractures in children is frequently delayed due to various factors, and there is still no agreement on the treatment of choice. The purpose of this study was to evaluate the effects of delayed treatment of displaced supracondylar humerus fractures on the treatment results and complication rate. Methods A total of 31 children with supracondylar humerus fractures who had not received adequate treatment for their displaced fractures were included in this study. The conditions leading to delayed treatment mainly included severe swelling or skin problems around the elbow and the health facility problems unique to our district. The mean delaying time was 6 days (range 2-19 days). There were 24 males and 7 females with a mean age of 7 years (range 1-13 years). The fractures were classified as type III-A (n = 15; 48%) and type III-B (n = 16; 52%) according to Gartland. Surgical treatment consisting of sentiment manual reduction through a medial approach and percutaneous cross-pinning was applied to all. No image intensifier was used during the procedures. A long-arm splint was used for post-operative immobilization. Results The average hospital stay was 2 days (range 1-3 day) and the patients were followed clinically and radiographically for an average of 4 years (range 2-11 years). Pins were removed at the end of the third week post-operatively, at which time the range of motion exercises were begun. None of the patients required physical therapy and full functional recovery was achieved within 3 months in 29 (93.5%) patients and within 5 months in the remaining 2 (6.5%). Two (6.5%) preoperative nerve injuries (1 interosseous, 1 ulnar) were resolved spontaneously within 3 months post-operatively. At the final follow-up, 7 (22.5%) patients had cubitus varus deformity. Except for 2 (6.5%) pin-tract infections, which were resolved by oral antibiotics and pin removal, none of the patients had early or late complications, not even neurological deficit or myositis ossificans. Conclusions Delayed presentation of displaced supracondylar humerus fractures in children did not increase complication rates or unsatisfactory results following an open reduction. Medial approach and cross-pinning is an effective and reliable treatment method for these fractures.
The posterior cruciate ligament (PCL) avulsion fracture from its tibial insertion is a very rare condition in children. An isolated avulsion fracture of PCL in a child and its repair by open reduction and internal fixation with a screw is reported.
In this report we describe the successful cardiac surgery in a patient with haemophilia A. To undergo to triple on-pump coronary artery bypass grafting the level of factor VIII was estimated to be 100 %, during the operation and the first postoperative week. To reach this level, bolus therapy with B-domain deleted recombinant factor VIII was administered in a low substitution scheme. There was no bleeding complication. The patient discharged on the 14th postoperative day.
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