RESUMEN
Glomus tumor is a painful benign neoplasm which arises from the glomus body. The glomus body is neuromyoarterial receptor responsible for regulating the peripheral skin blood flow and local temperature. The classical clinical symptoms of the glomus tumor are acute local pain, pin point tenderness and hypersensitivity to cold. The commonest location of the glomus tumor is the subungual region of the distal phalanx of the fingers and toes. We hereby describe a very rare case of extradigital glomus tumor in the interspace between the scapula and the posterior chest wall causing paroxysmal severe pain on the movement of the right shoulder. Being deep in location, the tumor was not clinically palpable or identifiable. The lesion was eventually located on MRI. Surgical resection of the tumor led to complete resolution of patient's symptoms.
RESUMEN
BACKGROUND: To study the comparison of conventional pneumatic and disposable silicone ring tourniquet in Total Knee Arthroplasty. MATERIAL AND METHODS: This is a prospective randomized control trial. We used conventional pneumatic tourniquet on one side of leg and disposable silicone ring tourniquet on the other side in consecutive 50 simultaneous bilateral TKR patients. Patients having peripheral vascular disease of the lower limb were excluded from the study. The patient demographics & characteristics are identical being the same patient with two different legs. We started the study with null hypothesis. An independent observer assessed the local tourniquet site pain (VAS score 1-10) and local tourniquet site skin reaction at 24 h and 48 h after the TKA. P value < 0.05 was considered significant. RESULTS: There were no local skin complication with disposable tourniquet (0%). 8 out of 50 patients in whom the conventional tourniquet was applied showed local bruising, and two patients had blister formation making the local skin site complication rate 20% (statistically significant, p value0.0196, chi-squared test). The VAS score at 24 h was 4.3 ± 1.5 for disposable tourniquet group as against 5.6 ± 2.1 for conventional tourniquet group (statistically significant, p value = 0.0152, t statistic test for comparison of means). The VAS score at 48 h was 2.1 ± 1.5 and 3.3 ± 1.2 for disposable tourniquet group and conventional tourniquet group respectively (statistically significant p value = 0.003, student's t-test). CONCLUSION: Use of disposable tourniquet has better outcome than the conventional tourniquet with minimal or no local complications. The advantages of the disposable tourniquet are: 1 less local pain, 2. no local skin problems, 3. accurate tourniquet pressure at the application site, 4.0% local contamination. Hence, we recommend use of the disposable tourniquet during the Total Knee Arthroplasty.
RESUMEN
OBJECTIVE: The purpose of our study is to study the usefulness of trochanteric reattachment plate in the management Vancouver type B 1 periprosthetic femur fractures. METHODS: We describe a case series of 15 (12 F: 3 M) Vancouver type B 1 fracture fixed with trochanteric reattachment plate with 3 years follow up. Patients with Vancouver A, B2, B3 and C fractures were excluded in the study. Clinical and radiological assessment of patients was done at 1, 3, 6, 9, 12, 24 and 36 months. The parameters evaluated were fracture union, Harris hip score and post-operative complications if any. RESULTS: Patients mean age was 74 years (range 58-84). Eleven patients were operated with cemented hemiarthroplasty while 4 patients had total hip arthroplasty done before. Operation time mean was 137.2 min and mean surgical blood loss was 522.66 ml. All the patients achieved radiological union of the fracture at mean of 14.13 weeks. Mean Harris hip Score was 82 at 36 months follow up. 13 out of 15 hips (86.67%) showed good clinical results and 2 patients (13.33%) showed fair result. All the patients returned to their pre injury activities of daily living. CONCLUSION: Operative fixation of Vancouver type B 1 periprosthetic fractures is a challenge for an orthopedic surgeon. Open reduction and internal fixation of these fractures using of trochanteric reattachment plate incorporating screws and cerclage wires through the plate provides good outcome in these patients. Use of this plate offers the surgeon stability against shearing as well as rotational forces.
