Non-missile penetrating injuries of the spine accounted for 7% of all spinal injuries admitted to this Institute during the last 10 years. Young males were most commonly affected and 73% of the injuries involved the upper dorsal und cervical spine. They presented with varying degrees of neurological deficit. Plains x-rays revealed the bony injury and/or the retained foreign body satisfactorily. Myelography (with or without CT scan) was performed in patients with progressive neurological deterioration and those not responding to conservative therapy. Surgery remained the mainstay of treatment and improved neurological function in 7 out of 9 cases. Conservative management resulted in complications such as persistent CSF fistula, uncontrolled fulminant meningitis and septicaemia, with 100% mortality. Early surgical intervention is, therefore, recommended in all penetrating injuries of the spine.
An 11-year-old boy presented with pain in the back, urinary retention, paraplegia and loss of sensations below L1. Investigations revealed an intramedullary lesion. An intramedullary spinal cord abscess was found at surgery. The pus was evacuated and abscess was excised. Minimal recovery was seen following surgery. Early intervention and a high index of suspicion is required in such cases.
Intramedullary nailing is treatment of choice for diaphyseal fractures of tibia in adults. Infrapatellar medullary nailing usually done for diaphyseal tibial fractures but in metaphyseal fractures reduction become a challenge due to anterior deformity due to pull of patellar tendon. Suprapatellar nailing is becoming popular and route of choice for metaphyseal fractures because it is done in semiextended position which helps in good reduction and fixation. But the major disadvantage of this approach is the specific instrument sets and implants are very costly. In this study we used an innovative technique of suprapatellar nailing of fracture tibia which is very cost effective. No special instrument sets used, no jig used, protective sleeve and trocar are used from PFNA2 set and colour coded infrapatellar nail extractor used to introduce the nail in proper position.
A study was conducted on 25 cases of tibial fractures (between April 2021 to April 2022) in which RCT tibial nail introducer was used as a nail-positioner-cum-nail-introducer (Group 1) to treat the tibial fractures. The results of this study was retrospectively compared with 25 cases of tibial fractures treated by Dr. Thakur Innovative Technique of Suprapatellar Nailing of Tibia (between March 2020 to March 2021) in which infrapatellar-tibial-nail-extractor was used as nail-positioner-cum-introducer (Group 2). It was found that the surgical time and fluoroscopy time was slightly less in Group 1 compared to Group 2. But the nail could be kept in proper position by deroation while hammering was more easily and accurately done in Group 1 compared to Group 2. In both groups, the fixation was done by Dr Thakur Innovative Technique of Suprapatellar Nailing of Tibia and locking was done by free hand technique both proximally as well as distally.
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