Wooden stick penetration from the perineal region up to the thorax.

BACKGROUND: Penetrating injuries of the perineum are rare but very dangerous. Since the genitourinary and colorectal organs may be injured, how to evaluate surgical management of the injury is very important. METHODS: The present report presents a case of penetrating injury of the perineum by a wooden stick when the patient fell on the upright wooden stick from a tree. The three feet long stick entered the perineal region just left lateral to the anal opening. Upon reaching the thoracic cavity, it broke and only a foot stick was left in the subcutaneous plane. These injuries are potentially serious with risk of damage to multiple organs. Exploratory laprotomy was done, and bladder injury was repaired. The entry wound and the track of stick was thoroughly washed and allowed for secondary intention healing. RESULTS: The post operative period was uneventful and the patient recovered fully. CONCLUSION: Meticulous evaluation and surgical management of perineal injuries are the key to prevent devastating complications.

Road traffic accidents in hilly regions of northern India: What has to be done?

BACKGROUND: Road traffic accidents (RTA) are responsible for 1.2 million deaths worldwide each year. RTA will become the 3(rd) largest contributor to the global burden of diseases after ischemic heart diseases (IHD) and depression. We conducted a retrospective study on RTA in a tertiary center in the hilly district of Uttarakhand in India. METHODS: The number of RTA, pattern of RTA, the number of patients killed and injured, the pattern of injury causing death and disability, the severity of accidents, and the type of disability were noted from December 2009 to November 2011. The accident severity was calculated as the number of patients killed per 100 accidents. The methods for reducing the incidence of RTA were observed, and the role of policy makers was studied. RESULTS: The majority of deaths and disabilities in Uttarakhand were due to road traffic accidents in the hilly districts of the states. The most common cause of RTA was driving fault followed by defective roads. CONCLUSION: Proper designing of roads and minimizing the fault of drivers are essential to prevent road traffic accidents in hilly regions.

Traumatic loss of talus: a rare injury.

BACKGROUND: Traumatic loss of talus during a compound injury of ankle is an unusual injury. OBJECTIVE: We report a 55 years old woman who sustained an open ankle injury with complete extrusion of talus and loss at the injury site. METHOD: A tricortical bone graft was obtained from iliac crest and talar dimensions carved with 5 cm length and 3 cm height given by buttressing fibular graft between them. These grafts are made in the shape of talus by fixing them together with cortical screw and binding them together with Ethibond No. 5. By anterior approach ankle was opened and talar graft was placed in between the raw surfaces of tibia and calcaneus to facilitate ankle arthrodesis. RESULT: Patient had solid fusion at the ankle joint after 4 months with no pain on walking. CONCLUSION: The definitive treatment of this serious lower extremity injury remains controversial we have attempted this novel way of treatment as the patient was unable to afford talar prosthesis and facilities of allogenic bone grafts were not there.

Biological approach to treatment of intra-articular proximal tibial fractures with double osteosynthesis.

The treatment of intra-articular proximal tibial fractures is associated with complications, and much conflicting literature exists concerning the treatment of choice. In our study, an attempt has been made to develop an ideal and adequate treatment protocol for these intra-articular fractures. The principle of double osteosynthesis, i.e., lateral minimally invasive plate osteosynthesis (MIPO), was combined with a medial external fixator to treat 22 intra-articular proximal tibial fractures with soft tissue injury with a mean follow-up of 25 months. Superficial pin track infection was observed in one case, and no soft tissue breakdown was noted. Loss of articular reconstruction was reported in one case. Bridging callus was seen at 12 weeks (8 weeks-7 months). The principle of substitution or double osteosynthesis, i.e., lateral MIPO, was combined with a medial external fixator and proved to be a fairly good method of fixation in terms of results and complications.