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.
Introduction: Only 15%–20% of the arterial injuries of the upper limbs are due traumatic axillary artery injury. Out of all ninety four percent are due to penetrating wounds, while the remaining 6% are caused by blunt traumas. Four cases with traumatic axillary artery injury are reported here. Materials and Methods: Four patients diagnosed with traumatic axillary artery injury underwent vascular repair presented between October 2019 and September 2020 are included in this study. Results: Fifty percent of patients presented with blunt trauma, whereas 50% with penetrating injury. Only one patient had associated bone injury. Hundred per cent of the patients had absent peripheral pulsation, while 50% of patients presented with warm upper extremity and normal capillary refill time. Seventy-five percent of patients involved had trauma to 1st part of axillary artery, whereas one patient suffered trauma to 2nd part. Two incisions, i.e. supraclavicular and infraclavicular incisions were taken to take proximal control of subclavian artery in two patients with trauma to 1st part of axillary artery. Only one patient underwent vascular repair with reverse saphenous vein graft, rest all patients underwent end-to-end axillary artery repair. Twenty-five percent of patients had associated brachial plexus injury and bone injury, respectively, which were taken care off along arterial repair. Hundred percent of the patients had good vascular outcome postoperatively. Conclusion: Patients presenting with trauma to periclavicular region must be thoroughly examined for associated axillary artery injury and if diagnosed with same must undergo prompt surgical exploration and arterial repair. For good proximal control, it is advisable to go for both supraclavicular and infraclavicular incisions in case of injury to 1st part of axillary artery.
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