Impalement Injury to Thigh: A Case Report with Review of Literature.

INTRODUCTION: Impalement injuries are one of the rare presentations in the emergency department and present complex surgical challenges in management. Prompt transfer to tertiary centre, pre-operative planning, and multi specialty involvement is crucial in the management of such cases. CASE REPORT: We report a case of 18-year-old male who sustained impalement injury to thigh with an iron rod after falling from height. After quick assessment ofv ital parameters and ruling out major organ injury, wound extent was examined. In collaboration with vascular and plastic surgeons, the rod was successfully removed under direct vision. The patient recuperated without sequelae. CONCLUSION: One should not get distracted by the appearance of the impalement injuries. After initial resuscitation, full trauma evaluation should be carried out before attending to local injury. Minimal manipulation, extraction of impaled object in operation theater under direct vision, wound debridement, and administration of antibiotics to prevent wound infection are pearls of the management of impalement injury.

Outcome of total hip arthroplasty as a salvage procedure for failed infected internal fixation of hip fractures.

BACKGROUND: Failed infected internal fixation produces significant pain and functional disability. In infected internal fixation of hip fractures with partial or complete head destruction, total hip arthroplasty (THA) can be technically challenging; however, it restores hip biomechanics. The present study is to evaluate the results and assess the complications of THA following failed infected internal fixation of these fractures. MATERIALS AND METHODS: A retrospective review of prospectively collected data in a tertiary healthcare center was performed of 20 consecutive patients of THA following failed infected internal fixation operated between September 2001 and November 2007. There were 11 dynamic hip screw failures for intertrochanteric fractures, 6 failed osteotomies following transcervical fractures, and 3 failed screw fixations for transcervical fractures. RESULTS: The average age of the patients was 48.5 years (range 28-70 years) and the average followup period was 6.5 years (range 3.5-10.5 years). An indigenously designed cement spacer was used in a majority of patients (n = 15). The custom-made antibiotic impregnated cement spacer was prepared on-table, with the help of a K-nail bent at 130°, long stem Austin Moore's prosthesis (n=1), Charnley's prosthesis (n=1), or bent Rush nail (n=1). The antibiotic mixed cement was coated over the hardware in its doughy phase and appropriately shaped using an asepto syringe or an indigenously prepared spacer template. Nineteen of the 20 patients underwent two-stage revision surgeries. The average Harris hip score improved from 35.3 preoperatively to 82.85 postoperatively at the last followup. A significant difference was found (P < 0.0001). None of the patients had recurrence of infection. CONCLUSIONS: The results were comparable to primary arthroplasty in femoral neck fractures. Thus, THA is a useful salvage procedure for failed infected internal fixation of hip fractures.