Chronic subdural hematoma (CSDH) has been treated by a variety of surgical approaches like twist drill craniostomy (TDC), burr hole craniostomy (BHC), craniotomy, etc. There are large variations in cure rates and recurrence rates among the surgical options in literature and like all surgical techniques, there is a paucity of well-designed trials to sort out the issue. It is an accepted fact of surgery that the least invasive approach will often be the best approach. We set out with the hypothesis that TDC is as safe and as effective as BHC for CSDH treatment. A prospective randomized controlled trial for 100 patients was done to compare the results of TDC and BHC (both with drain) in patients of unilateral CSDH. Recurrence rate was the primary outcome variable evaluated. A strict clinic-radiological criteria was used to avoid ambiguity in the study. Forty-eight patients underwent TDC and 52 patients underwent BHC. Mortality was 2% (patients in low GCS), and 2% unexpected mortality occurred (unrelated causes). Complication rate was 14% overall and was similar in both groups. Overall outcome (primary and secondary) was comparable across both groups with no significant difference. Cost, invasiveness and duration of surgery was significantly less in the TDC group. The cure rate, recurrence rate, mortality and morbidity of TDC with drain is significantly similar to that of BHC with drain for treatment of defined patients of unilateral sub-acute and chronic subdural hematoma. The cost, duration and invasiveness of TDC surgery is significantly less than that for BHC surgery.
We work at one of the busiest trauma centers of the country and deal with more than 200 cases of extradural hematomas per year. The striking frequency of the association of motor deficits with extradural hematomas prompted us to take up this study and delineate the factors that could lessen the morbidity by decreasing the convalescence of the affected patients. We primarily found that the association between EDH and motor deficits was common, and early intervention resulted in faster recovery of motor power, (70% in patients operated within 24 hours of trauma, and 53.3% in patients operated after 24 hours of trauma. recovered complete power within 4 weeks.) We concluded a clinically significant association of extradural hematomas and concurrent motor deficits, and found that timely intervention in patients presenting with mild head injury enabled us to achieve complete recovery of motor power. Contributing factors included the concurrence of signs of herniation and associated parenchymal injuries.
Deep burns of the scalp and skull can be caused by high-voltage electrical injuries. Electrocution can occur while working and illegal handling of the lines. Compared to conventional burns, these injuries are characterized by an increased morbidity and mortality. We encountered an unusual case of high-voltage electrical burn of the head causing charring of scalp, bone and dura with herniation of infected brain matter.
Background: Inter-condylar fracture distal humerus in adults often pose a challenge to orthopaedic surgeons because of the complex anatomy, fracture pattern and limited bone stock of this region. Adequate exposure of the articular surface of the distal humerus and elbow joint is essential for operative stabilisation of complex distal humerus fracture. Various operative approaches have been recommended to access this difficult region which includes triceps splitting, triceps reflecting and trans-olecranon approaches though each approach has its own advantage & disadvantage. Olecranon osteotomy approach provides better visualization of complex intra-articular fractures, enabling accurate reduction and fixation. Aim of this study:To assess the functional outcome of intercondylar humerus fracture with olecranon osteotomy approach. Study design: prospective study Material and methods: Sixty patients of inter-condylar fracture humerus fulfilling the inclusion criteria were treated with internal fixation with various implants with olecranon osteotomy via posterior approach. Preoperative and postoperative radiograph measurements were taken and fractures were classified according to the AO system. All patients were operated through posterior trans-olecranon approach. Elbow exercises were started at third postoperative week. Patients were followed at three weeks and thereafter monthly, with clinical examination and x-rays. Results: The average ROM on follow up after 6 weeks was flexion up to 140 o and extension upto 5 o of elbow flexion. No cases of olecranon or distal humerus non-union were reported. Conclusions: Posterior surgical approach with olecranon osteotomy provides optimal exposure of the intra articular aspect of distal part of humerus and among them olecranon osteotomy gives the best exposure of the articular surface and there by better reduction and internal fixation which in turn gives better stability and good range of motion as compared to other approaches.
The farms can be a dangerous working place especially for children. Children spend most of their time there with their parents in the fields and it is where accidents happen. Approximately 200,000 children in India suffer from head injury every year and majority can be prevented. Head injury from the winnowing fan blades is rare among children and limited data is available in the literature. We present the, mechanism of injury, clinico-radiological findings, the management and preventive measures that can be taken for head injuries that occur due to the winnowing fan. Keywords: children, winnowing fan blade, head injury prevention.
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