Two Cases of Ipsilateral Posterior Hip Dislocation and Shaft Femur Fracture and Management.

Introduction: The incidence of ipsilateral fracture of the shaft of the femur and dislocation of the hip are extremely rare injuries. However, the incidence of complex fractures is increasing day by day due to an increasing variety of traumatic mechanisms. This type of injury constitutes various diagnostic and treatment difficulties for the surgeon. Such injuries should be managed on an urgent basis for better functional outcomes. Case Report: We hereby describe two such cases: First case hip was reduced using external fixator pins, stabilization of the shaft femur fracture was done with an external fixator and the second case hip was reduced with bone holding clamps and the shaft femur fracture was fixed with interlocking nail. Conclusion: Fixator-assisted closed reductions are the first line of treatment in the management of posterior dislocation hip complicated with ipsilateral femoral shaft fractures. If closed reduction fails, fracture site can be opened and direct forces can be applied to the proximal femur to aid hip reduction with minimum complications.

Ipsilateral Knee Dislocation and Ankle Fracture Dislocation.

Introduction: A dislocated knee is a potential limb-threatening injury. Simultaneous dislocation of knee and ankle joint in an ipsilateral limb is a very rare pattern of injury. A few cases of ipsilateral hip and knee dislocation were described in literature. Rare injury such as posterior dislocation knee with ipsilateral ankle fracture dislocation cases was also presented. However, lateral dislocation of knee along with the same side ankle fracture dislocation is a rare scenario. To the best of our knowledge, these two simultaneous lesions do not seem to have been reported previously. Immediate management of such injury is to reduce both joint and stabilization with external fixator and definitive surgery in the second stage when soft-tissue condition allows. Case Report: We describe a rare case of a 37-year-old farmer having injury to his right leg with tiller machine. Lateral right knee dislocation and right ankle fracture dislocation reduced in the emergency department. In emergency OT, external fixator applied for knee and ankle stabilization. When swelling subsides in ankle, fracture fixation is done with plates and screws. Knee fixator is kept for 6 weeks then knee physiotherapy started. Conclusion: Dislocation of any joint is treated as an orthopedic emergency. Simultaneous dislocation of knee and ankle joints in an ipsilateral limb is a challenging situation for even the experienced surgeon. The outcome of such patients varies with associated injuries and time took for relocation and meticulous physical examination, with a high index of clinical suspicion is needed in diagnosing and management of such cases.

Application of Modest Hypothermia in Patients with Acute Traumatic Cervical Spine Injury: A Pilot Study.

Introduction: This prospective randomized controlled study aimed to examine the role of modest systemic hypothermia in individuals with acute cervical spinal cord injury (SCI) regarding neurological improvement. Studies have shown that the application of hypothermia is safe and that it improves neurological outcomes in patients with traumatic spine injury. Hypothermia helps in decreasing a secondary damage to the cord. Methods: Twenty cases of acute post-traumatic cervical SCI with AISA were selected and randomly divided into two treatment groups: Group A-Hypothermia with surgical decompression and stabilization; and Group B-Normothermia with surgical decompression and stabilization. American Spinal Injury Association (ASIA) motor and sensory scores were evaluated at presentation; post-surgery; and at a 2-week, 6-week, and 12-week follow-up. Results: At the final follow-up, the change in ASIA motor scores of Group A was 46 (11.5-70.5) and Group B 13 (4.5-58.0), whereas ASIA sensory scores were 118 (24.75-186.5) and 29 (15.25-124.0) in Group A and Group B, respectively. ASIA scores between the two groups were statistically significantly different at a 2-week follow-up (ASIA motor p=0.04, ASIA sensory p=0.006), showing early improvement in the hypothermia group. There was no significant difference between the two groups on further follow-up. Conclusions: Hypothermia can be applied safely to subjects with acute SCI. Our study showed that hypothermia was beneficial in the early improvement of functional outcomes in acute cervical SCI.

Mycobacterium tuberculosis Infection of the Spine Secondary to Oxygen - Ozone Therapy for Prolapse Intervertebral Disc: A Scoping Review.

Introduction: Ozone therapy is one of the evolving, yet far from conclusive, alternative minimally invasive treatment option in the management of herniated disc in the cervical and lumbar spine. It causes the decrease in the volume of herniated disc by dehydration. Case Report: We hereby present the first reported case of Mycobacterium infection of the spine secondary to ozone therapy with the aim to caution the surgeons regarding the complications of intradiscal ozone therapy. Conclusion: Lack of proper, adequate, and recommended precautions if not taken can inoculate the varied microorganisms into the intradiscal space leading to devastating and unforeseen complications.

Digital Ischemia Following Brachial Artery Cannulation in a Polytrauma Patient: A Case-Based Discussion of Etiopathogenesis and Management.

Iatrogenic digital ischemia following inadvertent intra-arterial injections is well documented. Most of the culprit drugs are used for sedation or in general anesthesia. Proper understanding of the causative factors and pathophysiology is of utmost importance for adequate treatment. There have been conflicting evidences in the numerous studies and theories proposed regarding pathophysiology. We scoped the available literature to find out the cause of digital ischemia in one of the patients presented to us but could not find a convincing answer. Due to incomplete understanding of the pathophysiology, there is no specific treatment protocol. Most important is vigilance regarding risk factors, knowledge of typical medications, immediate recognition of the situation, assessment of the disease progression, anticoagulation, symptomatic treatment, and specific therapy (which varies from case to case) are mainstay of treatment. Further research is warranted to understand the etiopathogenesis so that proper treatment protocol could be established.

A Highly Unusual Clinical Presentation and Imaging Appearance of a Rare Diseases: Melorheostosis.

INTRODUCTION: Melorheostosis, on its own, is an extremely uncommon disease. It is non-hereditary, sclerosing bone lesion affecting the adjacent soft tissues. Long bones are commonly involved. About 50% of the cases are evident before 20 years of age. It is gradually progressive and involves the adjacent soft tissues resulting in pain, fibrosis, joint contractures, and limb length discrepancies. Various forms of clinical presentation such as hemimelic, monomelic, mono-ostotic, and polyostotic have been described in the literature. Similarly there are different radiological varients like classical, osteoma , osteopathic striatae , and myositis ossificans.. Treatment is mainly palliative. CASE REPORT: We describe a highly unusual and extensive involvement of the lower limb in a Melorheostotic patient of 35 years of age with a deformity and limb length discrepancy. X-rays are like that of myositis ossificans and mixed type of pattern with extensive involvement from the pelvis to the toe. There is also intra-articular extension of melorheostosis mimicking synovial chondromatosis. The patient is in our close follow-up and physiotherapy guidance. Such an extensive involvement, along with para-articular and intra-articular involvement, is very rare. CONCLUSION: Melorheostosis can extensively involve the whole of the limb right from the pelvis to the digits. It can also extend into the joints producing intra-articular loose bodies. Para-articular soft-tissue masses are also common. Radiologically, it can have a mixture of patterns described in the literature. Close follow-up of the patient is essential so as to provide palliative treatment, deal with the deformities, and to assess the progression of the diseases.