SummarySubmental tracheal intubation is a simple, quick and effective alternative to oral and nasal tracheal intubation or tracheostomy in the surgical management of selected patients with craniomaxillofacial injuries. It has a low morbidity and it does not impede the surgical field, allowing for temporary maxillo-mandibular fixation (jaw wiring) intra-operatively, and nasal assessment, manipulation and bone grafting, either simultaneously or as an independent procedure. We report 12 cases utilizing this technique in this retrospective study, this includes 11 patients with midfacial fractures and associated base of skull fractures, and one patient who underwent an elective Le Fort III advancement. The techniques and indications for submental tracheal intubation are described.Keywords Anaesthesia: equipment; tubes tracheal. Intubation tracheal: submental; complications. Correspondence to: Mr M. Amin E-mail: michaelamin@doctors.org.uk Accepted: 6 February 2002 There are specific problems associated with airway management in patients with midface or panfacial fractures and possible base of skull fractures. Nasal tracheal intubation in these patients is controversial, particularly if performed without the benefits of a fibreoptic bronchoscope, because of the potential complications, including cranial intubation, epistaxis and intracranial or sinonasal infection [1][2][3][4]. Furthermore, comminuted midface or naso-orbito-ethmoidal complex fractures may cause a physical obstruction to the passage of a nasal tube and the tube may interfere with the assessment and reduction of these fractures [5]. It is often necessary during the reduction of facial fractures to establish dental occlusion and perform temporary maxillo-mandibular fixation (jaw wiring) intra-operatively. This precludes the use of an oral tube at this point in the procedure and may therefore necessitate a tube change.Tracheostomy is still considered the treatment of choice for patients with extensive craniomaxillofacial injuries and multisystem trauma and those who require long-term ventilatory support. However, it is associated with significant morbidity and complications such as haemorrhage, surgical emphysema, tube blockage, recurrent laryngeal nerve injury, tracheal stenosis and poor scar appearance [6].An alternative method of establishing an airway in patients who require maxillofacial surgery but who do not require long-term ventilatory support is to perform submental tracheal intubation, the technique being originally described by Hernández Altemir in 1986 [7]. This provides a secure airway and allows unimpeded surgical access to the oral cavity and midface, whilst avoiding the potential complications associated with nasal intubation and tracheostomy. MethodsTo perform this technique, the patient's trachea is intubated orally using an armoured tracheal tube. Prior to this the universal connector must be removed or cut off and replaced with a removable connector to allow easy detachment. Patients who are already intubated must have Anaesthesia, ...

IPC is the preferred method of thromboprophylaxis for TKA in Asian patients.

Objective: To compare the blood loss between intra-articular and intra-venous administration of tranexamic acid (TXA) in patients undergoing primary total knee arthroplasty. Design of study: It was a randomized controlled trial. Study duration and settings: This study was carried out at the Orthopedic Departments of Combined Military Hospital Lahore and Rawalpindi from Jan 2016 to March 2018. Methodology: Patients of both the genders were involved this study who had age in the rage of 40–80 years undergoing primary unilateral total knee arthroplasty for degenerative conditions like osteoarthritis and rheumatoid arthritis. These patients were randomly divided into two treatment groups. Patients in IA group received intra-articular tranexamic acid while those in IV group received intravenous tranexamic acid. From all the patients, a written signed consent was taken. Findings: Females were predominant with male-to-female ratio of 1:3.7. The mean age of the patients was 67.3 ± 8.2 years while the mean BMI was 30.9 ± 2.9 Kg/m2. Majority (n = 191, 95.5%) of the patients had osteoarthritis while remaining 9 (4.5%) patients had rheumatoid arthritis. There was no statistically significant difference between intra-articular and intra-venous administration of tranexamic acid in terms of mean post-operative hemoglobin (9.93 ± 1.14 vs. 9.87 ± 1.26 g/dL; p-value = 0.724), mean post-operative hematocrit (34.8 ± 1.66 vs. 34.73 ± 1.27%; p-value = 0.594), and mean fall in hemoglobin (2.27 ± 0.34 vs. 2.25 ± 0.30 g/dL; p-value = 0.587) and hematocrit (2.34 ± 0.94 vs. 2.46 ± 0.28%; p-value = 0.216). Conclusion: Intra-articular administration of tranexamic acid was found to be as effective and safe as intra-venous administration in reducing blood loss in primary total knee arthroplasty. Due to convenience, the use of intra-articular administration of tranexamic acid after primary TKA may be considered in future practice.

Objective: To demonstrate the effect of performing pie crusting on skin bridging two incisions used for open reduction and fixation to reduce wound complications compared to conventional wound closure. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Orthopedics and Trauma, Combined Military Hospital Rawalpindi from Jan to Nov 2020. Methodology: Forty-seven patients, managed primarily with open reduction and internal fixation for type-43 fractures per AO/OTA classification, were studied. Group-1 comprised patients in whom the pie crusting technique was used during the closure of the wound. Group-2 included patients in whom conventional closure of the wound was performed. Evaluation of complications in the presence or absence of superficial and deep infection and necrosis was done. The time from injury to surgery was 6 hours to 72 hours. Patients were followed for an average of 12 weeks. Results: In group-1 (pie-crust technique), there were 23 patients, whereas group-2 (classic wound closure) comprised 24 patients. In group-1, only 1 (4%) patient had a superficial infection, and no deep infection was reported. Whereas in group-2, six patients (25%) had superficial infection, and two patients (8%) had the deep infection. Conclusion: Results indicated that pie-crust technique significantly reduces the risk of superficial and deep wound complications compared to classic wound closure because it reduces skin tension and allows the drainage of subcutaneous fluids.

Objective: To study the effects of distal uniplanar locking and distal bi planar locking on union times in uncomplicated fractures distal shaft of tibia managed with an intramedullary interlocking nail. Study Design: Comparative prospective study. Place and Duration of Study: Department of Orthopedics and Trauma Combined Military Hospital Rawalpindi from Jan to Nov 2020. Methodology: Fifty-three patients having fractures distal shaft of tibia managed with intramedullary interlocking nail were studied. Twenty-nine patients were managed using two interlocking screws distally (uniplanar) in coronal plane (group-1). Twenty-four patients were managed with three bi planar screws comprising two coronal and one sagittal distal interlocking screw (group-2). Patients were followed every 4 weeks, and bone union time was assessed. Isolated closed fractures treated with closed reduction were included. Results: Patients treated with distal bi planar locking (group-2) had significantly reduced union time in weeks (11.25 ± 1.42) compared to uniplanar distal interlocking (group-1) (15.79 ± 1.80) (p<.001). Conclusion: Union time for distal tibia shaft fractures is significantly reduced when treated with distal biplanar locking; it can be attributed to increased stability of the construct.