Use of calcaneal locking plate in surgical treatment of quadrilateral plate fractures of the acetabulum.

PURPOSE: Specialized devices for fixation of the acetabulum quadrilateral plate (QP) fractures may not be readily available in resource-constrained settings. In this article, we aim to explore the use of a 3.5-mm locking calcaneal plate in fixation of QP fractures. METHODS: Twenty-eight patients with QP fractures underwent surgery using the modified Stoppa approach. Follow-up at 12 months assessed fracture healing and functional outcomes using the Majeed pelvic outcome score. Descriptive statistics summarized patient demographics and fracture characteristics. Analysis of variance (ANOVA) and exact logistic regression explored associations between factors (age, AO/OTA classification, gender, and time to surgery) and Majeed scores. RESULTS: The mean age of patients was 42.71 years, with the majority being male (64.29%). All patients achieved bony union. Post-traumatic arthritis developed in three patients, while two patients experienced post-operative fracture redisplacement. Evaluation using the Majeed pelvic outcome score revealed generally favorable outcomes, with 32.14% achieving excellent, 39.29% good, 21.43% fair, and 7.14% poor outcome. Only an older age was associated with a worse outcome score (excellent/good versus fair/poor, odds ratio: 0.87, 95% confidence interval: 0.77, 0.96). CONCLUSION: Surgical management of quadrilateral plate fractures using 3.5-mm locking calcaneal plates demonstrates promising outcomes, particularly in resource-constrained settings, where specialized devices may be lacking.

Impact of delayed presentation and surgical management on radiologic and clinical outcomes of pediatric septic hip.

Background: Septic arthritis of the hip joint (septic hip) is the bacterial infection of the hip. Delayed treatment increases the risk of extensive joint damage, systemic infection, prolonged recovery, higher healthcare costs, and long-term disability. This study explores the repercussions of delayed surgical treatment in pediatric septic hip. Methods: In this observational study, pediatric patients diagnosed with septic hip between 2012 and 2021 were retrospectively selected from a major referral center in Shiraz, Iran. We collected clinical and radiological data, including Kocher score and determined Choi classification in follow-up radiographs. Multivariate logistic regression analysis was used to assess the impact of delay to surgery on the development of clinical sequelae and radiological deformities in the presence of potential confounders of age and Kocher criteria. Results: Out of 49 children with delayed presentation, 46 survived and entered the study. Mean delay from symptom presentation to admission was 12.67 ± 10.51 days, and mean delay from admission to surgery was 5.33 ± 6.47 days. Of the 46 patients, 28.26% developed clinical sequelae. The Choi classification revealed that 54.35% of patients developed no residual deformity. A multivariate logistic regression analysis indicated a statistically significant association between delay to surgery and the development of radiological deformities (adjusted odds ratio: 1.36, 95% CI: 1.14-1.64, p = 0.001). Additionally, a separate analysis revealed that each additional day of delay was associated with a 12% increase in the odds of clinical sequelae (adjusted odds ratio: 1.12, 95% CI: 1.03-1.22, p = 0.006). Sensitivity analyses confirmed the relationship of delay from admission to surgery in developing both outcomes. Conclusion: Delay in medical care and surgical management remains the most important factor affecting the outcomes of septic hip. The study underscores the critical role of timely surgical intervention in reducing complications in pediatric septic hip patients.

Impact of COVID-19 pandemic on trauma mortality patients: A retrospective observational study in an Iranian level 1 trauma center.

Background and Aims: The COVID-19 pandemic has reshaped the epidemiology of various clinical conditions, including trauma which is closely tied to social policies. This study examines and compares the characteristics of trauma mortality patients, and their initial prognostic trauma scores, in the pre-pandemic and pandemic periods. Methods: We conducted a retrospective observational study involving patients who passed away at a level 1 trauma center from July 23, 2018, to February 19, 2020 (prepandemic), and from February 20, 2020, to September 22, 2021 (pandemic). A subgroup analysis that matched 12 of the same months of the year in the two periods was also done. Patients who arrived deceased or passed away immediately upon arrival were excluded from data analysis. We collected and analyzed demographic and clinical data, employing the Abbreviated Injury Score (AIS), Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma and ISS (TRISS) to compare initial prognoses. Results: Our study encompassed 1128 patients, with 529 in the prepandemic group and 599 in the pandemic group. Demographic characteristics showed no significant differences in the number of patients in the two periods. Motor vehicle accidents remained the predominant injury mechanism in both periods. While the mean ISS increased insignificantly (22.80 vs. 22.91, p = 0.902), the mean RTS decreased (6.32 vs. 5.82), and TRISS increased (23.97% vs. 28.93%) during the pandemic (p < 0.05). Hospital length of stay decreased in the pandemic period (15.57 vs. 12.54 days, p < 0.05). Subgroup analysis revealed increased ISS, decreased RTS, and increased TRISS during the pandemic (p < 0.05). Conclusion: In conclusion, while overall demographics and injury mechanisms remained virtually unchanged, trauma patients during the pandemic displayed worse estimated clinical prognoses, particularly in physiological trauma scores. The heightened mortality rate was attributed to poorer clinical conditions of patients.

Mycobacterium tuberculosis-induced multiple tenosynovial masses with rice bodies: A case report.

Key clinical message: Tenosynovitis with rice bodies is a rare presentation, diagnosable by MRI. Surgical excision is the preferred treatment for tendon sheath masses containing rice bodies. The etiology was Mycobacterium tuberculosis in our case, highlighting the need to consider extrapulmonary TB in atypical presentations, ensuring effective treatment. Abstract: Rice body tenosynovitis is a rare clinical phenomenon with various etiologies. Inflammatory diseases such as rheumatoid arthritis and tuberculosis have been shown to be associated with this condition. Herein we report a 46-year-old male who presented with multiple masses of the dorsal and volar aspects of the left wrist. The masses did not cause significant pain or limitation of motion. Magnetic resonance imaging showed the presence of numerous hypointense bodies in the masses. During the surgical procedure, separate cysts originating from the synovitis of both the extensor and flexor compartments were identified along with white rice bodies within them. Masses were excised and Xpert MTB/RIF assay on the rice bodies was conclusive of M. tuberculosis (TB). The patient was discharged on anti-TB medications with no complication or recurrence after 1 year of follow-up.