Monteggia fractures are uncommon and frequently missed injuries in children. This article aims to study, in a systematic manner, the surgical management and complications of treatment of chronic radial head dislocations. After screening of relevant abstracts, a total of 28 studies were included in the systematic review. A narrative synthesis of various treatment modalities has been discussed. This article concludes that open reduction should be attempted unless dysmorphism of the radial head restricts it. Open reduction with ulnar osteotomy with or without annular ligament reconstruction is the most commonly performed procedure and is expected to result in reduced pain and elbow deformity.

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Purpose Facet tropism is defined as asymmetry between left and right facet joints and is postulated as a possible cause of disc herniation. In the present study, the authors used a 3-T MRI to investigate the association between facet tropism and lumbar disc herniation at a particular motion segment. They also examined whether the disc herniated towards the side of the more coronally oriented facet joint. Methods Sixty patients (18-40 years) with single level disc herniation (L3-L4, L4-L5, or L5-S1) were included in the study. Facet angles were measured using MRI of 3-T using the method described by Karacan et al. Facet tropism was defined as difference of 10°in facet joint angles between right and left sides. Normal disc adjacent to the herniated level was used as control. We also examined if disc herniated towards the side of more coronally oriented facet. Results Twenty-five herniations were at L4-L5 level and 35 at L5-S1. Statistical analysis was performed using the Fischer Exact Test. At L4-L5 level, 6/25 cases had tropism compared to 3/35 controls (p = 0.145). At L5-S1 level, 13/35 cases had tropism as compared to 1/21 controls (p = 0.0094). Of 19 cases having tropism, the disc had herniated towards the coronally oriented facet in six (p = 0.11). Conclusion The findings of the study suggest that facet tropism is associated with lumbar disc herniation at the L5-S1 motion segment but not at the L4-L5 level.

Reconstruction after wide excision by non-vascularized fibular graft is a viable alternative for giant cell tumors of the lower end of radius though it is a challenging procedure and may be accompanied by major complications.

Hypernatremia, defined as plasma sodium concentration >145 mEq/L, is frequently encountered in critically ill patients admitted to the intensive care unit (ICU). Hypernatremia indicates a decrease in total body water relative to sodium and is invariably associated with plasma hyperosmolality though total body sodium content may be normal, decreased, or increased. Hypernatremia usually occurs as a result of impaired thirst or access to water, with or without increased water losses from renal and extrarenal sources. Critically ill patients in ICU are at high risk of hypernatremia because of their inability to control free water intake as a result of sedation, intubation, change in mental status, and fluid restriction for various other reasons. In addition, excessive fluid losses from various renal or nonrenal sources and treatment with sodium containing fluids are commonly encountered in this population, predisposing them to hypernatremia. The consequences of hypernatremia result from osmotic movement of water across the cell membrane, leading to primarily intracellular and variable degree of extracellular volume depletion. The clinical features depend on severity and rapidity of hypernatremia development with abnormal cognitive and neuromuscular function in many cases and potential risk of hemorrhagic complications or death from vascular stretching and rupture in advanced cases. The management of hypernatremia focuses on judicious replacement of free water deficit to restore normal plasma osmolality as well as identification and correction of underlying causes of hypernatremia. Electrolyte-free water replacement is the preferred therapy though electrolyte (sodium) containing hypotonic fluids can also be used in some circumstances. Oral free water replacement guided by thirst is ideal though parenteral fluid replacement is usually necessary in critically ill ICU patients. Various calculations for estimating free water deficit are available and any can be used to guide initial fluid replacement therapy. Rate of correction depends on rapidity of hypernatremia development, though frequent monitoring of plasma sodium levels is essential to ensure appropriate response and to adjust the rate of fluid replacement to prevent the risk of cerebral edema from rapid correction of chronic hypernatremia. Free water requirements should be routinely assessed in ICU patients and judicious electrolyte and free water replacement prescribed for those at risk of hypernatremia.

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The global epidemic of type 2 diabetes demands the rapid evaluation of new and accessible interventions. This study investigated whether Aegle marmelos fruit aqueous extract (AMF; 250, 500 and 1000 mg/kg) improves insulin resistance, dyslipidemia and β-cell dysfunction in high fat diet fed-streptozotocin (HFD-STZ)-induced diabetic rats by modulating peroxisome proliferator-activated receptor-γ (PPARγ) expression. The serum levels of glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), homeostasis model assessment of β-cell function (HOMA-B), lipid profile, TNF-α and IL-6 were evaluated. Further, the TBARS level and SOD activity in pancreatic tissue and PPARγ protein expression in liver were assessed. In addition, histopathological and ultrastructural studies were performed to validate the effect of AMF on β-cells. The HFD-STZ treated rats showed a significant increase in the serum levels of glucose, insulin, HOMA-IR, TNF-α, IL-6, dyslipidemia with a concomitant decrease in HOMA-B and PPARγ expression. Treatment with AMF for 21 days in diabetic rats positively modulated the altered parameters in a dose-dependent manner. Furthermore, AMF prevented inflammatory changes and β-cell damage along with a reduction in mitochondrial and endoplasmic reticulum swelling. These findings suggest that the protective effect of AMF in type 2 diabetic rats is due to the preservation of β-cell function and insulin-sensitivity through increased PPARγ expression.

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