Open reduction for neglected traumatic hip dislocation in children and adolescents

Background: Neglected traumatic dislocation of the hip is extremely rare in children, and the preferred treatment remains unclear. In this study we studied the role of open reduction in neglected traumatic hip dislocation in children and adolescents as a modality of treatment.Methods: Eight patients with a neglected, traumatic dislocation of the hip received in the emergency department of GMC, Jammu were managed by open reduction. Types of dislocations, associated lesions, treatment methods, complications, and clinical and radiological outcomes were reviewed in the study.Results: All patients presented with limp and pain. Six patients had minimal difficulty in squatting while two had marked difficulty. Leg lengths were within 2 cm in 7 of 8 cases at follow-up, and only 1 patient had a discrepancy greater than 2 cm.Conclusions: Open reduction is a satisfactory treatment for neglected hip dislocation. It restores joint stability, range of motion and limb length.

Early fixation versus delayed fixation in cervical spine trauma patient with absent cough reflex in view of intensive care unit stay and cost effectiveness

Background: This study was conducted in GMC Jammu to evaluate ICU stay and cost effectiveness in patients with cervical spine trauma undergoing early fixation (within 24-72 hours after trauma) versus late fixation (delayed fixation after applying traction and waiting for return of cough reflex).Methods: Retrospective and prospective study was done by collecting data from admission register and patient follow-up during 2016-2019. 50 patients were admitted as cervical spine trauma, out of which 38 were operated upon and ten managed conservatively. 15 patients were operated within 72 hours of admission with absent cough reflex and 23 were put on cervical traction and operated upon after return of cough reflex.Results: Average ICU stay for 15 patients (4 females 11 males) immediately operated ranged from 10 to 15 days along with prolonged mechanical ventilation. Average ICU stay for 23 patients (16 males and 7 females) operated after returning of cough reflex ranged from 3-4 days with considerably decreased requirement of mechanical ventilation.Conclusions: Delayed fixation of cervical spine after returning of cough reflex shortens post-operative ICU stay and is considerably more cost effective than early fixation.

Closed reduction and percutaneous k-wire fixation for distal end radius fractures

Background: To evaluate radiological and functional outcome in fractures of the distal radius treated by K-wire fixation.Methods: Forty patients (16 males, 24 females) with different types of fractures of distal radius were treated. K-wire fixation was performed under axillary bolock or general anaesthesia. Anatomical  restoration was evaluated by postero-anterior and lateral radiographs obtained preoperatively and at 09 months of follow up to evaluate Radial Height (RH), Radial Inclination (RI) and Volar Tilt (VT). Functional outcome was evaluated using Mayo scoring system.Results: According to Mayo score 72.5% (n=29) of our patients had excellent to good outcome while as 17.5% (n=7) had fair outcome and 10% (n=4) patients had poor outcome.Conclusions: Kirschner wire fixation is an inexpensive procedure that  provides anatomic  reduction,  fracture  fixation,  and maintenance  of  reduction  with  an  adequate method of  immobilization.

Short term outcome of open reduction and internal fixation with plating in displaced intra articular calcaneal fractures

Background: Calcaneum fractures constitute the majority of the tarsal bone fractures worldwide. There is no gold standard consensus as of now for the management of the displaced intra articular calcaneal fractures. Open reduction and internal fixation with plating is one of the management options available.Methods: Authors studied the results of open reduction and internal fixation with plating in 22 calcaneal fractures in a study with a minimum follow up of 6 months. Outcome was studied using Maryland foot score.Results: Authors observed excellent results in 5 patients (22.72%), good results in 12 patients (54.54%), fair results in 4 patients (18.18%) and poor result in 1 patient (04.54%). Authors encountered wound infection in 1 patient (4.54%), heel varus in 1 patient (4.54%), heel broadening in 1 patient (4.54%), reduced range of motion at ankle in 2 patients (9.9%) and persistent heel pain in 1 patient (4.54%).Conclusions: Open Reduction and Internal Fixation (ORIF) with calcaneum plating, through an extensive lateral approach, for displaced intra articular fractures of the calcaneum is an effective treatment modality with very good results in experienced hands.