A Comparative Study Between Plate Fixation and Intramedullary Fixation for Displaced Mid-Shaft Clavicle Fractures in Adults.

Introduction: Clavicle fractures are frequently encountered by orthopaedic surgeons. Though multiple treatment techniques have been described in literature, open reduction and internal fixation with plating and intramedullary nailing are preferred in adults. This study analyses the functional outcome, complications, duration of bony union of mid-shaft clavicle fractures treated with plate fixation versus intramedullary fixation. Materials and methods: A quasi-experimental study was conducted on 38 patients with mid-shaft clavicle fracture aged between 18 to 60 years at a tertiary care centre in South India. Nineteen patients were treated by plate fixation and 19 patients underwent intramedullary nail fixation. Every alternate patient with mid-shaft fracture clavicle was treated with plate osteosyntheses or nailing. Results: The average age of presentation was 42 years in plate fixation and 31 years in nail fixation group. Robinson's classification type 2B1 was the most common type of fracture in both groups. The Visual Analogue Scale (VAS) score reduced significantly from pre-operative to postoperative day 1 in both the groups but there was no significant difference between the two groups. The Disabilities of the Arm, Shoulder and Hand (DASH) score at 6, 12 and 24 weeks reduced significantly in both the groups but showed no statistically significant difference between the two groups. However, intramedullary nail fixation group had a shorter duration of hospital stay and showed an earlier improvement in the DASH score during the first six months after surgery. Complications included implant loosening (three patients) in plating group and implant failures (two cases) in nailing group. Conclusion: There is a role for surgical intervention for certain cases of displaced and comminuted clavicle fracture in order to avoid malunion or non-union and their potential long-term sequelae. Both the surgical modalities of plating, and nailing provide good functional outcome and allow early return to occupational activities.

A giant parietal wall hematoma: unusual complication of laparoscopic appendectomy.

Laparoscopic appendectomy is an established procedure in the treatment of appendicitis. Complications of the procedure are related to the Veress needle and trocar insertions or pertain to actual operative procedures. Trocar-elated major bleeding is rare, and, if it occurs, is detected on the table or during the immediate postoperative period. Delay in recognition may lead to significant morbidity and mortality. We report a case of giant parietal wall hematoma in a 34-year-old female, presenting one week after discharge from the hospital. The hematoma was completely evacuated by exploration through paramedian incision, followed by an uneventful recovery.

An unusual foreign body in the bladder.

In spite of its inaccessibility, every conceivable object has been inserted into the urinary bladder. Such patients may have a psychiatric disorder with a sexual perversion or inquisitiveness (as in children) as the underlying cause. We report a case of an aluminum rod inserted into the urinary bladder by an adult male, which was removed successfully by surgery.

Modified mesh rectopexy: a study.

AIM: To evaluate the efficacy of modified mesh rectopexy for complete rectal prolapse. SUBJECT AND METHODS: In a prospective study between 1989-1998, 47 patients (25 males and 22 females) underwent modified mesh rectopexy using a "Cross-shaped" knitted monofilament polypropylene. They were followed up for a period of four years postoperatively. RESULTS: Anatomical repair was achieved in all patients. Preoperative constipation, a complaint in 22 patients, was relieved in 13 patients and need for laxatives decreased in another four. There were no new cases of constipation. Sexual functions were not hampered irrespective of gender. The complications included prolonged ileus (4 patients), faecal impaction (1), partial mucosal prolapse (2) and post-operative obstruction (2). There was no recurrence. CONCLUSION: This technique aligns the rectum, avoids excessive mobilisation and division of lateral ligaments thus preventing constipation and preserving potency. We recommend this technique for patients with complete rectal prolapse with up to grade 1, 2 and 3 incontinence based on Browning and Parks classification.

Primary hypertrophic tuberculosis of the pyloroduodenal area: report of 2 cases.

Tuberculosis of the stomach and duodenum is rare in patients with pulmonary tuberculosis. Primary involvement is even rarer. Two cases of primary tuberculosis of the localised to the pyloro-duodenal area are presented. The most common symptoms are non-specific leading to a difficulty in establishing a pre-operative diagnosis. A high degree of suspicion is therefore required for its diagnosis and to differentiate it from more frequent causes of gastric outlet obstruction such as chronic peptic ulcer disease and gastric carcinoma. The treatment of gastric tuberculosis is primarily medical with anti-tuberculous drug therapy. The role of surgery lies in the cases with obstruction following hypertrophic tuberculosis. The surgery done is usually a gastroenterostomy. With the relative rate of extra-pulmonary tuberculosis increasing, tuberculosis of the pyloro-duodenal area should be considered in the differential diagnosis of gastric outlet obstruction.

Selective transplenic decompression of oesophageal varices by distal splenorenal and splenocaval shunt.

The usefulness of selective transplenic decompression of oesophageal varices by distal splenorenal shunt and splenocaval shunt was evaluated in the control of gastrointestinal haemorrhage in patients with portal hypertension of varied aetiology. (Decompression was successful in 69 out of 78 cases.) It was shown that it is superior to total portosystemic shunts, as the incidence of encephalopathy was very low compared with the data from our series of portocaval shunts. The operative mortality has been progressively lowered and has now reached levels comparable with portocaval shunt. Distal splenorenal shunt when performed as an emergency procedure to arrest bleeding has limited usefulness but when performed as an elective or prophylactic procedure its results are comparable with those of portocaval shunt without the untoward complications such as encephalopathy. A modified selective decompression of varices has been described in which the distal end of the splenic vein is anastomosed to the inferior vena cava. Though no long term follow-up studies are available, we believe that this shunt is likely to prove superior to distal splenorenal shunt as it has both the advantages of the distal splenoral and the haemodynamic advantage of end-to-side portocaval shunt. We conclude that in patients with portal hypertension of varied aetiology, who have not had a haemorrhagic episode but in whom varices have been demonstrated or who have had one episode of haemorrhage from varices, the splenocaval shunt when feasible or the distal splenorenal shunt offers the optimal method of management at present in India.