Laryngeal Trauma Managed with Titanium Mesh Fixation: A Rare Case Report.

Laryngeal fractures are though uncommon they can be potentially life threatening. Comminuted laryngeal cartilage fractures are difficult to manage and various fixation techniques have been described in literature. Outcome results of fixation with different materials can be varied. We report a case of 27 years old male who sustained laryngeal cartilage fracture following accidental fall. Patient underwent emergency tracheostomy and early surgical repair of fractured laryngeal thyroid cartilage with one of the newest techniques "titanium mesh fixation". After a month of surgery tracheostomy tube was removed and patient recovered with good laryngeal function. Titanium mesh fixation gave immediate effective fixation and stability to laryngeal fracture leading to good surgical outcome.

Study of Changes in Optic Nerve Sheath Diameter Following Tracheal Intubation Using Macintosh Laryngoscope or Fibreoptic-Guided Intubation Through Ambu Aura-I: A Randomised Controlled Study.

BACKGROUND: Neuroanaesthesiologists are faced with managing and optimising the intracranial pressure in the perioperative period. Laryngoscopy and tracheal intubation are known to increase sympathetic activity that is well tolerated by healthy patients but may be detrimental to many comorbid patients. We, therefore, hypothesised that airway management and tracheal intubation through Ambu Aura-I (Ambu, Baltorpbakken 13, Denmark) may be associated with lesser changes in optic nerve sheath diameter (ONSD) compared to conventional tracheal intubation and designed a study to ultrasonographically measure the changes in optic nerve sheath diameter following tracheal intubation using Macintosh laryngoscope or fibreoptic-guided intubation through Ambu Aura-I in patients receiving endotracheal anaesthesia. MATERIAL AND METHODS: This randomised controlled hospital-based clinical study was conducted on 60 patients divided into two groups: group 1 (n=30, tracheal intubation facilitated by direct laryngoscopy with Macintosh laryngoscope) or group 2 (n=30, fibreoptic-guided tracheal intubation through Ambu Aura-I), undergoing elective surgery under general anaesthesia requiring tracheal intubation. RESULTS: Baseline parameters before induction of anaesthesia were recorded for further comparison. Baseline ONSD at 3 mm behind the globe in both eyes (before induction of anaesthesia), both in transverse and the coronal plane, was measured by transorbital sonography with the patient lying in the supine position using a portable Sonosite Turbo-M ultrasonography (Fujifilm Sonosite, Bothell, USA) machine. End-tidal carbon dioxide concentration (EtCO2) was also recorded at this time. Observations of HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), oxygen saturation (SpO2), EtCO2, and ONSD measurements were recorded immediately and at three and five minutes after intubation, and complications were recorded. Data collected were tabulated, and statistical analysis was done using SPSS 22.00 for windows (SPSS Inc, Chicago, USA). The ONSD increase peaked at 4.19±0.35 and 4.16±0.31 mm in right and left eyes. Like in group 1, the ONSD decreased slightly to 4.06±0,29 and 4.05±0.29 mm in right and left eyes in group 2 at 10 minutes after intubation. The changes in ONSD when compared to baseline values (before intubation) were statistically not significant (p>0.05). Between-group comparison in ONSD in both the eyes at different time intervals was statistically not significant (p>0.05). CONCLUSION: We conclude that fibreoptic-guided tracheal intubation through Ambu Aura-I is not superior to tracheal intubation using direct laryngoscopy with Macintosh laryngoscope in terms of its effect on intracranial pressure, as measured ultrasonographically by optic nerve sheath diameter.

Comparative Study of the Management of Intertrochanteric Fracture Femur With Proximal Femoral Nail vs. the Dynamic Hipscrew With Derotation Screw in Elderly Population.

BACKGROUND: Intertrochanteric fractures can be treated, both by conservative and operative methods depending upon the status of the patient. The purpose of this study was to assess the functional outcome of intertrochanteric fracture of femur treated with dynamic hip screw (DHS) with de-rotation screw comparing and proximal femoral nail (PFN). METHODOLOGY: We compared 30 (male: 23, female: seven) cases of intertrochanteric fractures with a mean age of the population was 65 years and male to female ratio in was 2.75:1. Patients were recruited in this study having inclusion criteria of adults above 50 years of age, isolated intertrochanteric fractures of the AO Foundation/Orthopaedic Trauma Association (AO/OTA) type A1 and A2, fracture less than two weeks, and intertrochanteric fracture with or without distal extension. RESULTS: Post-operatively, patients treated by either of these two methods were statistically analyzed in terms of comparing advantages and disadvantages in terms of the time of fracture union and outcome of both above-mentioned procedures using Harris hip score. CONCLUSION: PFN gives better results than DHS with De-Rotation Screw-in intertrochanteric fractures in terms of the amount of blood loss during surgery, duration of surgery, early toe-touch weight-bearing, and Harris hip scores. There is no difference between the two modalities in terms of duration of hospitalization, fracture union, mortality and morbidity, and postoperative complications.

Telemedicine Versus In-Person Visits in Postoperative Care in Orthopedic Patients: Follow-Up Study From North India.

BACKGROUND: Telemedicine is improving healthcare delivery in orthopedic patients but the data regarding this are scarce from India, especially North India. METHODOLOGY: During this one-year prospective observational study, all patients with fractures of the upper end of tibia requiring surgical intervention and who consented to avail teleconsultation services were included. All these patients were assessed by patient satisfaction score pre-operatively. Patients were randomly assigned for post-operative care schedules of 5 and 14 days in telemedicine and inpatient visits during their follow-up period. RESULTS: A total of 50 patients were included and the satisfaction rating among the two groups was identical. The average patient satisfaction score (on a 10-point scale) was found to be 9.77 in the inpatient visits based on the one-on-one follow-up group and 9.79 in the telemedicine consultation group. CONCLUSION:  In orthopedics, the implementation of telemedicine can minimize the need for the patient to physically visit the outpatient department. The rates of response and overall patient satisfaction were high in the telemedicine group. However, more efforts should be made to address the limitations and problems of using telemedicine.

The Spectrum of Psychiatric Pathology in a Patient with Genetically Verified Huntington's Disease.

Psychiatric and behavioral disturbances are common in Huntington's disease (HD) and contribute significantly to its morbidity and mortality. We herein present the case of a 43-year-old woman with genetically verified HD, whose deteriorating psychiatric condition necessitated multiple inpatient psychiatric hospitalizations and featured a clinical spectrum of neuropsychiatric disturbances classically associated with HD. This paper reviews the literature concerning Huntington's psychopathology and provides an illustrative case example of its clinical nature.