PurposeRubber bullets are considered a non-lethal method of crowd control and are being used over the world. However the literature regarding the pattern and management of these injuries is scarce for the forensic pathologist as well as for the traumatologist. The objective of this report was to add our experience to the existing literature.MethodsFrom June 2008 to August 2010 the Government Hospital for Bone and Joint Surgery Barzulla and the Department of Orthopaedics, SKIMS Medical College/Hospital Bemina Srinagar received 28 patients for management of their orthopaedic injuries caused by rubber bullets. We documented all injuries and also recorded the management issues and complications that we encountered.ResultsAll patients were males with an age range of 11–32 years and were civilians who had been hit by rubber bullets fired by the police and the paramilitary forces. Among them, 19 patients had injuries of the lower limbs and 9 patients had injuries of the upper limbs. All patients were received within 6 h of being shot.ConclusionOur findings suggest that these weapons are capable of causing significant injuries including fractures and it is important for the surgeon to be well versed with the management of such injuries especially in areas of unrest. The report is also supportive of the opinion that these weapons are lethal and should hence be reclassified.
Subtrochanteric fractures are fraught with certain anatomic, biologic and biomechanical challenges. Evolution of implants like the Gamma nail, fixed-angle nail plates, compression hip screws and dynamic hip screws with trochanteric stabilization plates underlines a persistent quest for a better implant. We studied the dynamic condylar screw DCS as an implant on a series of 30 consecutive patients with subtrochanteric fractures. Our purpose was to assess this implant as a panacea for subtrochanteric fractures. All cases of AO type A and B were anatomically fixed, whereas type C was biologically plated. The idea was to assess the applicability and adaptability of the DCS. Fractures in 29 cases united, with one patient suffering from an implant failure. There were 17 excellent, 5 good, 5 fair and 3 poor results. The DCS is a definite advance over previous methods of treatment; when combined with the utilization of biological fixation techniques for comminuted fractures, can be relied upon to treat all types of subtrochanteric fractures.
To evaluate the functional results of intramedullary nailing in diaphyseal both bone forearm fractures in children. Patients and Methods: 40 patients (30 males and 10 females) with an age group of 8-14 years were included in the study. Displaced diaphyseal fractures, fractures with loss of reduction (within first week) in casting, segmental fractures, and open fractures (Gustilo & Anderson type 1 & 2) were considered for intramedullary fixation. The fractures were reduced percutaneously by manipulating the fracture fragments & were stabilised by 2-2.5 mm flexible titanium intramedullary nails. Retrograde nailing of radius was done from the dorsal entrance site. Antegrade nailing of ulna was done from the lateral cortex of the olecranon. Patients were followed at two weeks, four weeks, six weeks, eight weeks and then at monthly intervals up to 9 months. Final follow up was done at 9 months and results were assessed clinically using Daruwalla criteria with restoration of forearm rotation. Results: In 31 (77.5%) cases, closed reduction and nailing was achieved using 2 to 2.5 mm flexible titanium nails while in 9 (22.5%) cases open reduction through limited incisions was done. In all patients fracture was united at an average of 8.1 weeks. In all patients, removal of implant was done at 6 months. Excellent results were in seen 38 (95%) patients & good results in 02 (5%) patients using Daruwalla criteria with restoration of forearm rotation. The complication reported were bursa formation in 7 (17.5%) patients, symptomatic prominent hardware in 5 (12.5%) patients, superficial radial nerve injury in 1 patient, wound related problems in 3 patients & refracture in 1 patient. Conclusion: Elastic intramedullary nailing is a safe and reliable method for internal fixation of displaced diaphyseal unstable forearm fractures with good to excellent functional results.
Introduction:The characteristic morphology of the proximal extremity of the femur and the muscle balance of the hip are factors that make weight bearing possible among patients. Restoration of neck shaft angle is as important as union because if neck shaft angle is not restored, it can lead to disability. Recent studies have been conducted with the intention of showing the relationship between fracture of the proximal extremity of the femur and the anatomical configuration of the hip. This study was a prospective one to evaluate neck shaft angle after DHS fixation in intertrochanteric fractures. Patients and Method: Prospective study done on 25 (13males and 12 females) patients who were operated by a single surgeon. Evaluation of neck shaft angle in non-fractured side and the restoration/change in neck shaft angle on the operated side after surgical fixation with DHS, radiographs taken with both hips in 15 degrees of internal rotation. Result: All fractures got united, average age of patients was 58 years, varus malunion in 2 cases and valgus in 4 cases. Average NSA on normal side was 136±4 and on operated side it was 126±4 degrees. Conclusion:The neck-shaft angle is the most important parameter after fixation of intertrochanteric fracture by DHS, we must preserve the near normal angel after fixation to avoid valgus and varus malunion.
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