RESUMEN
Spinal cord injuries (SCI) are a significant burden on society, particularly affecting the working population. Traumatic SCI can result from violent confrontations, involving firearms, knives, or edged weapons. Although surgical techniques for these injuries are not well defined, surgical exploration, decompression, and removal of the foreign body are currently indicated for patients with spinal stab wound injuries with neurologic impairment. We present a case of a 32-year-old male patient who presented to the emergency department with a stab injury with a knife. Radiographs and CT scans revealed a broken knife blade with a midline trajectory in the lumbar spine, moving toward the vertebral body of L2 occupying less than 10% of the intramedullary canal. The patient underwent surgery, and the knife was successfully extracted without any complications. Post-operative MRI showed no signs of cerebrospinal fluid (CSF) leak, and the patient did not exhibit any sensorimotor deficit. The acute trauma life support (ATLS) procedure must be followed while treating a patient with penetrating spinal trauma with or without neurological impairment. After availing appropriate investigations, any attempt to remove a foreign object should be done. Although spinal stab wound injuries are uncommon in developed nations, they continue to be a source of traumatic cord damage in underdeveloped countries. Our case highlights the successful surgical management of a spinal stab wound injury with a good outcome.
RESUMEN
Background and objective Patellar fractures account for around 1% of all fractures. Conservative treatment is advised in patients without any incompatibility of articular surfaces or those with intact extensor mechanisms. More than a 2-mm articular gap due to fracture warrants surgical intervention. Tension band wiring (TBW) is a commonly used practice for fixation, However, there is still controversy about its effectiveness and complications arising due to the hardware. Modification of this technique by using K-wires has been considered a method of choice, but this technique is associated with complications due to K-wires. The Pyrford technique is a method for patellar fracture fixation by circumferential cerclage and anterior TBW. We employed the figure-of-eight configuration over the circumferential wire. This study aimed to analyze the outcomes of TBW of the patella without K-wires by assessing the rate of complication and functional outcomes. Materials and methods A total of 38 patients with OTA 34C type, simple and comminuted type of patella fractures aged between 22 and 70 years were treated with circumferential cerclage and figure-of-eight TBW. All patients underwent patellar fixation with cerclage and through direct purchase of SS wire via quadriceps and patellar tendon. Patients were followed up for one to three years. We analyzed differences in the range of motion, fracture reduction, fracture healing time, Bostman score for knee function, and complications. Results The mean age of the patients was 45 years. After TBW without K-wires, fracture healing and functional outcomes were satisfactory according to patient feedback and clinocoradiological examinations. Of note, 35 out of 38 patients (92%) had gained up to 90 degrees of active flexion at the end of one week. One patient (2.42%) developed a superficial infection. All fractures had achieved union at the end of 16 weeks. Malunion or nonunion was not noted in any of the cases. There was no case of implant removal. The average Bostman score at the 12-month follow-up was 28.5 ±1.5. The incidence of complications due to K-wire was nullified. Conclusion Based on our findings, the described method leads to better functional outcomes, decreasing hardware-related complications, and can be used in simple as well as comminuted fractures. The fracture healing and functional outcomes and rate of complications were satisfactory.