Difficulty in diagnosis of nasopharyngeal carcinoma.

Due to difficult anatomical position nasopharyngeal carcinoma (NPC) is always challenging problems both from the diagnostic and therapeutic corner. A 24 years old lady came to our Department of Otolaryngology and Head-Neck Surgery with the complaints of epistaxis, right sided neck swelling, nasal obstruction and headache. On digital palpation Nasopharyngeal mass was found. We took biopsy from nasopharynx under indirect vision but report was not conclusive. Then we did CT scan, nasendoscopy. Nasendoscopy showed bilateral ethmoidal polyp with nasopharyngeal mass. We took biopsy from the nasopharyngeal mass and confirmed the diagnosis.

Functional Outcome of Subtrochanteric Femoral Fracture Fixation by Intramedullary Interlocking Surgical Implant Generation Network Nail.

Subtrochanteric femoral fractures are one of the common fractures encountered in today's Orthopaedic practice. High stress leads implant failure and produce varus collapse. From the perspective of biomechanics, intramedullary fixation has unique advantage which can better distribute stress and acting load-sharing implants. Biomechanically proximal wide canal and short segment provide less optimal fixation by conventional intramedullary nails. Intramedullary nail by Surgical Implant Generation Network (SIGN) has proximal interlocking that gain purchase through femoral neck and provide improved stability for proximal part. The aim of this study was to evaluate the functional outcome of subtrochanteric fractures fixation by intramedullary interlocking SIGN nail. This prospective study was conducted from July 2016 to June 2018 at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) through non randomized purposive sampling. Total 31 patients, aged above 18 years irrespective of sex with closed subtrochanteric fractures were included. Patients with pathological fracture, multiple injuries were excluded from the study. The mean age of the patients was 42.61±19.59 years with range 18-80 years. Most common fractures were Seinsheimer type III (51.6%) and average follows up 42.39 weeks (24-48 weeks). Union rate 93.55% with delayed union 6.45% and no nonunion. Functionally most of patient started early partial (77.42%) and full (64.52%) weight bearing with 61.29% have full knee ROM and 83.9% without limb shortening. Maximum patients regained walking (83.87%) and squatting (90.32%) and return to preinjury state (80.65%) of activities. Evaluation of outcome by Modified Harris Hip Score showed excellent (70.97%), good (22.58%), fair (3.23%) and poor (3.23%) thus satisfactory outcome were 93.55%. This study concludes that intramedullary interlocking SIGN nail is a safe and reliable implant for the treatment of subtrochanteric fractures with excellent functional outcome.

Result of Subtrochanteric Femoral Fracture Fixation by Intramedullary Interlocking Surgical Implant Generation Network (SIGN) Nail.

Treatment of sub-trochanteric femoral fractures is a challenge to orthopaedic surgeons. High incidence of fixation failure and nonunion is due to thick cortical bone deserves special consideration of surgical treatment. Intramedullary nail by Surgical Implant Generation Network (SIGN) shows promising results in comparison to conventional fixation method because of its better strength, accuracy and surprisingly better results in infection and non-union. The aim of this study was to assess the rate and time taken for union of fractures by SIGN nail and determine peri-operative parameters. This prospective study was conducted from July 2016 to June 2018 at National Institute of Traumatology and Orthopaedic rehabilitation (NITOR) through non randomized purposive sampling. Total 31 patients, aged above 18 years irrespective of sex with closed subtrochanteric fractures were included. Patients with pathological fracture, multiple injuries were excluded from the study. Union status evaluated by Radiographic Union Score for Tibial (RUST) fracture where antero-posterior and lateral radiographs (X-ray) based assessment of healing of the four cortices done. The individual cortical scores were added to give a total score 4 being the minimum indicating fracture is definitely not healed and 12 being the maximum score indicating that the fracture is definitely healed. The mean age of the patients was 42.61±19.59 years with range 18-80 years. Majority of patients were male (68%) and most of injury (68%) due to road traffic accident with common fracture were Seinsheimer type III (51.6%). Average hospital stay period was 16.39 days and average follows up 42.39 weeks (24-48 weeks). Time taken for union was 14.16 weeks (11-28 weeks). According to RUST scores fracture union rate 93.55% with delayed union 6.45% and no nonunion. There was one patient with superficial wound infection, one unaccepted shortening and with no implant failure. This study concludes that intramedullary interlocking SIGN nail is a safe and reliable implant for the treatment of subtrochanteric femoral fractures.