Introduction: Infection is the most prominent cause of delayed or non-union in tibial fractures because of the bone's sensitive subcutaneous location. Ilizarov external fixator application is regarded as the best approach for treating them because of several benefits. Analysis of the role of Ilizarov fixation in infected tibial non-union was the goal of this investigation and evaluating clinical & functional outcomes of infected tibial non-union. Materials and Methods: A Multicenter based non-randomized quasi-experimental prospective study was performed in Rajshahi Medical College Hospital, Rajshahi, Bangladesh. From 1st January 2015 to 31st December 2020. The study comprised a total of 61 (n=61) Tibial non-union patients treated with the Ilizarov fixator who also had an infection. ASAMI score criteria were used to evaluate the outcome. Results: The most common organism for infection was identified to be at Staphylococcus Aureus. The final follow-up showed that all but one patient had achieved union; one patient had to amputate due to infection and non-union. ASAMI score rating methodology for bone and function results rated the majority of patients as outstanding. Pin tract infections were the most prevalent problem discovered in this research. Conclusion: The Ilizarov external fixator is safe and successful for treating infected non-union of the tibia since it can offer a stable mechanical environment, bone transfer, rectify deformities, eradicate the infection, and allow patients to bear weight. Therefore, we still suggest it despite its disadvantages.
Small bowel injuries in general are uncommon after blunt abdominal trauma and are usually due to high-energy deceleration injuries, often in relation to motor vehicle accidents and affect fixed segments such as duodenum, duodeno-jejunal (DJ) flexure, proximal jejunum and terminal ileum. High morbidity and mortality are associated with this type of injury when the diagnosis is delayed. Untimely management of such injuries, especially transection of the DJ flexure, results in high-output entero-cutaneous fistula. In total, eight cases of DJ flexure transection with/without associated multiple injuries were reviewed retrospectively. For DJ flexure transection in all cases, the flexure was adequately mobilised, and end-to-end duodenojejunostomy performed with two-layer interrupted sutures. A large calibre nasojejunal tube was placed through the anastomotic site before completion to protect the anastomotic area from the proteolytic action of large volumes of upper gastrointestinal secretions. In case of associated injuries, appropriate procedures were done. In DJ flexure transection, a timely management by end-to-end anastomosis with administration of nasojejunal tube beyond the site of anastomosis is an alternate, simple and safe procedure in comparison to difficult procedures such as pyloric exclusion and gastrojejunostomy in patients with delayed presentation.
Background: Dearth of expertise to manage vascular trauma spiraled with delay in diagnosis and referral to tertiary care centers continue to plague a developing nation like India. The brachial artery is the commonest artery to be injured in extremity following trauma. Although the patients present late, revascularization to salvage the limb and to maintain its function is advocated. This retrospective study was done to evaluate the management and outcomes of brachial artery revascularization in patients with delayed presentation of traumatic brachial artery injury.Methods: Twenty-six patients of traumatic brachial artery injury who met the inclusion criteria during 1-year study period (August 2019 to July 2020) were included. Patients with iatrogenic vascular injury, severe vascular injury associated with massive orthopaedic neuromuscular injury (i.e., crush injury), mottled upper limb and injury to neck, chest, abdomen, lower limbs or any pseudoaneurysm were excluded. Data were analysed.Results: Amongst 26 patients studied, 24 (92.30%) patients had complete transection of the artery. Of these, 19 (79.16%) had primary repair in the form of end-to-end anastomosis and 7 (29.16%) underwent reverse interposition saphenous vein grafting. Two patients with partial laceration of brachial artery underwent primary (lateral) repair. Associated fracture of humerus was managed with internal fixation following revascularization. Four cases underwent end to end repair of median nerve. Majority, 22 (84.61%) had good functional outcome and 4 (15.38%) had satisfactory functional results. Limb salvage rates was 100%.Conclusions: Revascularization beyond warm ischemia time is still desirable to prevent limb loss. Traumatic neurological injury affects the functional outcome.
Mal-position of stent in coarctation of aorta is very rare but a major complication. Symptoms can worsen even more. We present here one such case where stenting done in some other institute in which we did an extra-anatomical bypass from ascending aorta to supracelial aorta successfully bypassing the coarct segment. This was an early approach without assistance of Cadiopulmonary (CP) Bypass. We conclude that this procedure should be done in centres where experienced operator and cardiac surgery back up is present. This was a good approach without assistance of CP Bypass.
Background: Carotid Body tumours (CBTs) are rare neuroendocrine tumours. Due to their proximity to vital structures
including major vessels and cranial nerves, Surgical excision requires meticulous dissection and any injury to major
vessels requires prompt repair. This study aimed to review our experience with the surgical management of Carotid Body Tumours. A Methods:
retrospective study was performed on 20 patients who underwent excision of carotid body tumours at Vardhaman Mahavir Medical college and
Safdarjung hospital, New Delhi between January 2003 to June 2022. Demographic data describing the presentation, preoperative and
intraoperative details, and postoperative complications reported were tabulated and descriptive statistical analysis was done A total of 20 Results:
patients were operated on. Complete resection was possible in all the patients. Vascular injury occurred in only 2 patients which were repaired
promptly. Cranial nerve injury was reported in only 1 patient which resolved on follow-up. There was no incidence of stroke or recurrence.
Conclusions: Periadventitial Excision is the treatment of choice for carotid body tumours and is a safe and effective procedure with minimal
intraoperative and postoperative complications.
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