Multiple extradural hematomas (EDH) >= 3 are an uncommon occurrence especially when they arise sequentially over a period of time. We present a case of delayed multiple EDH in a patient with trauma. A 31-year-old male presented to us with a moderate head injury (GCS-9). CT revealed diffuse axonal injury. He was electively ventilated and an intracranial pressure (ICP) monitor was placed. ICP increased over the next few hours. Repeat CT scan (8 hours after injury) revealed bilateral EDH (Right parietal and Left parieto occipital). He underwent emergency craniotomy and evacuation of both the EDH's. Subsequently a repeat CT scan (6 hours later) revealed a right parieto occipital EDH for which he underwent craniotomy and evacuation. Subsequently the patient made an uneventful recovery. Careful monitoring and appropriate management gives excellent results. We also review the relevant literature.
Rehabilitation following anterior cruciate ligament surgery continues to evolve, with the current emphasis being on immediate weight bearing
and range of motion, and progressive muscular strengthening, proprioception, dynamic stability, and neuromuscular control drills.
In this study we evaluate the functional outcome of Immediate full weight bearing mobilization following arthroscopic ACL (Anterior Cruciate
Ligament) reconstruction with quadrupled hamstring graft using endobutton and bioscrew.
With the advancement of fixation techniques immediate weight bearing mobilization after arthroscopic ACL reconstruction can give better
functional outcome and improved patient satisfaction. Although further large volume multicentric research is needed for establishing a
standardized rehabilitation protocol following arthroscopic ACL reconstruction, immediate weight bearing doesn’t cause any complications
and has better outcome as per our study.
Keywords: Arthroscopic reconstruction; ACL; Immediate weight bearing.
Background: Primary parathyroid adenoma is a diagnostic challenge especially in asymp-tomatic patients. We report a late diagnosed case of primary parathyroid adenoma in a patient who underwent bilateral total knee replacement. Case Presentation: A 65 year old female patient underwent bilateral Total Knee Arthroplasty (TKA) for tri-compartmental osteoarthritis. Since intra-operatively the bone was extremely soft, a metabolic workup was done. Serum calcium and parathyroid hormone was extremely high and phosphorus was low immediate post-total knee replacement. The DEXA scan of hip, spine, distal radius showed density less than -2.5 SD. Ultrasound scan and nuclear imaging was suggestive of parathyroid adenoma. Patient underwent focused parathyroidectomy of right inferior parathyroid after 1 month. Post parathyroidectomy, PTH, serum calcium and phosphorus levels reverted back to normal. At six months follow up after bilateral TKA, patient is walking without any symptoms. Conclusion: Delayed diagnosis of parathyroid adenoma, especially in arthroplasty surgeries, leads to intra-operative complications, but it can be avoided. Proper metabolic workup of all the arthroplasty cases and a multi-disciplinary approach is necessary.
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