Salmonella Typhi, first isolated in 1884, results in infection of the intestines and can end in death and disability. Due to serious adverse events post vaccination, whole cell killed vaccines have been replaced with new generation vaccines. The efficacy of Vi polysaccharide (ViPS) vaccine, a new generation, single-dose intramuscular typhoid vaccine was assessed in Nepal in 1987. However, despite the availability of ViPS vaccine for more than 25 years, Nepal has one of the highest incidence of typhoid fever. Therefore we collected information from hospitals in the Kathmandu Valley from over the past five years. There were 9901 enteric fever cases between January 2008 and July 2012. 1,881 of these were confirmed typhoid cases from five hospitals in the Kathmandu district. Approximately 70% of the cases involved children under 15 years old. 1281 cases were confirmed as S. Paratyphi. Vaccines should be prioritized for control of typhoid in conjunction with improved water and sanitation conditions in Nepal and in endemic countries of Asia and Africa.
Achilles tendon is the strongest and the thickest tendon of the human body. Due to its superficial location and stress, it has to face due to loading, the tendon is susceptible to injuries and ruptures. This is aggravated due to the precarious blood supply in the region and also age-related changes that occur in the tendon. Of the specific causes age-related and steroid induced tendinosis and sports injuries are the commonest mechanism of injury. Kite playing is a very common sport in the Indian subcontinent, which involves the use of a string (manja) often coated with powdered glass to fly the kite. Many grievous injuries are reported due to its use especially in two wheeler riders. However, to the best of our knowledge a kite thread injury causing Achilles tendon tear due to direct impact has so far not been reported. In this case series, we describe two cases that had such injury and a brief note on specifics of management of this case is described. How to cite this article Bagaria V, Nemade A, Joshi N. Achilles Tendon Rupture Secondary to Kite String (Manja) Injury: A Rare Etiology seen in Two Cases. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):90-93.
Purpose Distal tibia fractures comprise about 7%–10% of lower extremity trauma. Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of distal tibia fractures especially extra articular pilon fractures. Plating is fraught with complications of wound dehiscence and infection. There are limited studies which document outcomes in such cases using intramedullary interlocking nail. We intend to study the outcome and complications of extra articular distal tibial fractures treated with interlocking nailing. Methods This is a prospective study conducted in a tertiary care orthopaedic hospital in southern India. There are 147 patients of distal tibia extra-articular fractures managed by IM nailing with follow up of more than one year were included in this study. Only cases with fresh injury (less than 1 week), fracture below the isthmus, closed and open Gustilo Anderson type 1 and 2 fractures were included in the study. Patients were reviewed at 3, 6, 12 and 24 weeks after surgery and thereafter at one year and were assessed for clinical and radiological signs of healing, any complications, time to union and functional outcome. Results There were 102 males and 45 females (male/female ratio is 2.3:1) with a mean age of 38.96 (range 23–65) years. According to AO classification, there were 78 cases (53.06%) of 43-A1, 39 cases (26.53%) of 43-A2 and 30 cases of 43-A3 constituting 20.40%. The fracture united in all the patients at an average of 18 weeks (range 16–22 weeks), none of the patient in our series had a delayed or non-union. Two patients (1.47%) had the fracture united in mild valgus but it was well within the acceptable limits (<5°). The functional outcome was assessed in all the patients at final follow up using Olerud and Molander score all the patients fared an excellent to good score, there were no cases with poor score. Conclusion Intramedullary nailing is a viable option to treat distal tibial fractures with excellent outcome. Wound complications related to plating can be avoided but meticulous surgical technique is key to avoid malunion.
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