Non-contact wound area assessment by digital planimetry using photo editing software.

To objectively assess wound healing utilizing a novel digital photo planimetry method. 58 wounds mostly of traumatic origin were studied. In method I (control or gold standard), a transparent plastic graph paper sheet with 2.5 mm squares was placed on the wound to trace the wound edges. This was scanned and analyzed in Adobe Photoshop (PS6) to estimate the area. In the novel method (method II), we clicked a photo with one-inch lines marked (on either side of the wound). This photo was similarly assessed in PS6. A two-sample t-test was used for analysis. Photos were clicked every third day. The time taken to calculate the resultant area was also noted. 484 photos and 1936 values were analyzed. The mean areas obtained were 10690 mm 2 and 10859 mm 2 respectively by methods I and II. The mean difference was 0.824%, 95% CI [-0.05, 1.60] and p = 0.923. The inter and intra- observer variation was < 2% for all readings. The time taken by the novel method was much lesser than the time-tested method (mean = 82 sec vs 178 sec; p < 0.01). The difference in area by the two methods is not statistically significant. The accuracy of both methods is therefore comparable. Our novel method is easier, more cost-effective, equally accurate, safer and reproducible in comparison with the transparency squares method, especially for flat or 2-dimensional wounds.

Ipsilateral simultaneous fracture of the trochlea involving the lateral end clavicle and distal end radius: a rare combination and a unique mechanism of injury.

Isolated trochlea fracture in adults is a rare surgical entity as compared to its capitellar counterpart. It has been only mentioned sporadically in the literature as case reports. Fracture of the trochlea is accompanied by other elbow injuries like elbow dislocation, capitellum fracture, ulnar fracture and extraarticular condylar fracture. Here we report a unique case of isolated displaced trochlea fracture associated with fractures of the lateral end clavicle and the distal end radius. We propose a unique mechanism for this rare combination of injuries: typical triad of injury, i.e. fracture of the distal end radius with trochlea and fracture of the lateral end of the clavicle. Nonoperative treatment is recommended for undisplaced humeral trochlea fractures; but for displaced ones, anatomical reduction and internal fixation are essential to maintain the congruous trochlea-coronoid articulation and hence to maintain the intrinsic stability of the elbow.

Functional and Radiological Outcomes of Miniature Plate Osteosynthesis in Metacarpal and Phalangeal Fractures of Hand: A Prospective Study.

INTRODUCTION:  There are several operative modes to address hand fractures to gain better anatomical and functional results including external fixator, percutaneous K-wire fixation, lag screw fixation, tension band wiring, intra-medullary nails or wires, and plate-screw fixation. We evaluated the results of plate osteosynthesis in fractures of metacarpals and phalanges in a prospective manner. MATERIAL AND METHODS:  A total 50 adults (19-60 years) of either sex having 58 fractures managed by miniature plate osteosynthesis and followed for a minimum six months (6-19), including metacarpal and phalangeal fractures (unstable or serial fractures), intra-articular fractures, fracture-dislocation of proximal interphalangeal and distal interphalangeal joints with joint incongruity or subluxation were enrolled while contaminated compound fractures, pathological fractures and cases of reimplantation were excluded from study. Clinical assessment was done using the American Society for Surgery of the Hand (ASSH), total active flexion (TAF), total active range of motion (TAM) score, and the Disabilities of the Arm, Shoulder, and Hand (quick DASH) score while sequential radiographs were done at each follow-up. RESULT: All the fractures had perfect union clinically as well as radiologically with a mean duration of six weeks while functional outcomes in reference to clinical scores were observed excellent and fair in all cases. None of the cases had any loss of reduction, loosening of the implant, or other major complications. CONCLUSIONS: Miniature plate fixation provides enough stability in metacarpal and phalanges fractures, thereby allowing immediate active movements, which leads to excellent functional outcomes and early return to normal activities.

Double floating arm injury in a child: a case report and review of the literature.

The combination of ipsilateral humeral fractures at three different levels namely proximal, shaft and supracondyle has been rarely defined in the literature. We present a case report on such a complex injury in a 10-year-old child after falling down from the second floor of his house while playing. To the best of our knowledge, no such case report exists in the English literature. We define it as double floating arm injury. Firstly, shaft of humerus was open reduced and fixed with 4.5 mm narrow dynamic compression plate. Then closed reduction and pinning of the supracondylar humerus under an image intensifier was obtained. Open reduction using deltopectoral approach to the proximal humerus was done and the fracture was fixed with three K-wires. Ipsilateral multiple fractures in children often result from high energy trauma. Immediate reduction and fixation is required. Usually surgeons need to treat simple fractures firstly, which makes the subsequent treatment of complex fractures easier.

Simultaneous bilateral trochanteric fractures---a report of four cases.

Simultaneous bilateral intertrochanteric fractures are very rare. There is a paucity of data in current literature documenting patients with such kind of hip fractures. It is severe and potentially life-threatening, associated with a high morbidity. The major determinants of successful outcome are high vigilance, early single stage stabilization and mobilization as well as management of associated comorbid conditions that may influence the long term rehabilitation of patients. Here we reported 4 cases of concurrent bilateral trochanteric fractures along with review of the literature. Our study aimed to discover its frequency, identify the injury mechanisms as well as factors present in the pathogenesis of these fractures, and outline the available treatment modalities.

Comparative evaluation and analysis of outcomes in non-idiopathic and idiopathic clubfeet with Ponseti method at a tertiary care centre of a developing country.

BACKGROUND: Idiopathic clubfoot (congenital talipes equinovarus, CTEV) is being managed worldwide by Ponseti method with high success rates, while for non-idiopathic clubfoot surgical interventions is being widely used with variable results. This study evaluated the effectiveness of Ponseti method in non-idiopathic clubfoot and compared the results with idiopathic clubfoot. METHODS: The paper evaluated the epidemiological incidence and demographic profile of non-idiopathic clubfoot in a tertiary centre of developing country. A total of 108 subjects with 85 having idiopathic (group I;125 feet) and 23 having non-idiopathic variety (group II;34 feet) were managed with Ponseti method and were followed for a mean duration of 38.33 (12-62) and 36.27 months (12-58) in group I and II respectively. The most common associations were meningomyelocele (MMC/spina bifida,5), arthrogryposis multiplex congenita (AMC,4), developmental dysplasia of hip (DDH,3) and Down's syndrome and amniotic band syndrome (2 each). RESULTS: Primary correction was achieved in both the groups in 98% and 87% in group I and II respectively, while recurrences of at least one deformity was observed in 11 (9%) and 12 (40%) feet in group I and II respectively. Favourable outcomes were noticed in 22 (65%) feet in non-idiopathic group and 12 feet (35%) underwent extensive soft tissue release as compared to 3 feet (2.4%) in idiopathic variety. CONCLUSION: Deformities improved significantly in non-idiopathic clubfeet with Ponseti methods although complete correction was not possible. Extensive surgical interventions were reduced in up to 35% feet in non-idiopathic variety and hence, it is recommended as primary treatment for all variety of clubfeet, irrespective of their etiology.

A Rare Presentation with Segmental Gap Non-union in Proximal Phalanx Fracture of Thumb in Child: A Case Report.

Introduction: Traumatic injuries of to hand are not uncommon in the pediatric population and most of them are managed by conservative means and rarely surgical intervention required. There is a very rare incidence of delayed union or non-union in these fractures and found a very few numbers of sporadic cases documented in English literature. Case Report: We described delayed presentation of post-traumatic gap non-union of proximal phalanx of thumb in a child who presented with severe disability of hand especially writing and grasping. He was managed as open reduction, tibial strut bone grafting, and internal fixation with crossed Kirchner wire and followed for a period of minimum of 2 years. The fracture united radiologically and healed well clinically, whereas functional outcomes were excellent. There was no difficulty in writing and activity of daily living with operated hand while having comparative cosmetic appearance to other hand. Conclusion: Non-union of phalanx fractures are very rare in the pediatric population whereas excellent clinical and functional outcomes can be achieved with adequate stable fixation and autologous bone grafting.

Quitline Activity in Rajasthan, India.

Quitline activity in Rajasthan, India is a voluntary activity of Rajasthan Cancer Foundation (RCF) since April 2013. To kick-off, it took the benefit of the State Government- PIRAMAL SWASTHYA (PS)1 collaborative 104 Health Information Helpline that existed already in public-private partnership. It is a reactive quitline that helps callers through the counselors and nursing staff trained specifically through the weekly sessions held by the first author, the RCF resource on quitline. Besides structuring of the scripts for primary intervention and follow-ups after 1 week, 1 month, 6 months and a year, he also monitors calls, advices and coordinates with the supervisors to manage and analyze the data base, and reports to the PS lead at the Jaipur Center on overall performance and to plan strategic communication with the State Government on its outcomes. The quitline has limitations of its informal existence through a voluntary effort of RCF, no specific resource allocation, suboptimal data management, minimal awareness in the masses due to poor IEC (Information, Education and Communication; except its efforts made by RCF in last 1 year through the government-run State TV and City Radio) and staff shortage and its attrition due to lack of plan for career advancement. Despite these challenges in the year 2013, the quit line has registered a quit rate (for complete abstinence) of 19.93% amongst 1525 callers. The quit rate were 58.01% (304/ 524) among the responders at the 3rd follow-up at 18 months (in September 2014)2. In view of an increase in quit rate by 5- 9 times over the prevailing quit rate in the former ever daily users [both smokers and the users of smokeless tobacco (SLT)], efforts are being made by RCF in concurrence with PS to have this cost-effective model established formally with optimal resource allocation in collaboration with willing agencies (the State and Central Governments and the International Quitline Agencies) and its replication in 4 more states where PS is collaborating with the respective state governments similarly (Assam, Chhattisgarh, Jharkhand and Karnataka).