Emergency medicine
Mohit Kumar Arora; Ela Madaan; Rajnand Kumar
Volume 6, Issue 1 , Winter and Spring 2020, , Pages 47-49
Abstract
Objective: Patella is a sesamoid bone which develops in the quadriceps tendon. It is an uncommon site for neoplasms. The most common primary tumors which involve patella are benign. These include chondroblastoma, giant cell tumor (GCT) and aneurysmal bone cyst. Malignant lesions are less common in patella. ...
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Objective: Patella is a sesamoid bone which develops in the quadriceps tendon. It is an uncommon site for neoplasms. The most common primary tumors which involve patella are benign. These include chondroblastoma, giant cell tumor (GCT) and aneurysmal bone cyst. Malignant lesions are less common in patella. These encompass metastasis, osteosarcoma and hemangioendothelioma. The most common complaint in patients of GCT patella is anterior knee pain. Early diagnosis and optimal management are necessary for improving survival rate in these patients.Case Presentation: The authors present a case report of GCT of patella in a 16-year old child. Incisional biopsy was done to confirm the diagnosis. Further radiological examination showed that the tumor involved almost whole of the patella. Hence, surgical management in the form of patellectomy and extensor mechanism repair was done to improve the outcome of the disease. The patient did not have any clinical or radiological symptoms at the end of the final follow up of 22 months.Conclusion: Primary tumor of patella is a rare entity. Benign tumors like GCT present only with anterior knee pain and should be included in the differential diagnosis of anterior knee pain. MRI is useful to determine the extent of involvement of tumor in the patella. Treatment may vary from curettage and bone grafting to total patellectomy with extensor mechanism repair
Trauma
Ganesh Singh Dharmshaktu
Volume 3, Issue 2 , Summer and Autumn 2017, , Pages 64-65
Abstract
Simultaneous combination of fracture of the lateral condyle and postero-medial elbow dislocation is a rare event and limited to few reports or case series in the literature. Rarity of the injury also necessitates judicious diagnosis and appropriate management to ensure optimal functional outcome. Various ...
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Simultaneous combination of fracture of the lateral condyle and postero-medial elbow dislocation is a rare event and limited to few reports or case series in the literature. Rarity of the injury also necessitates judicious diagnosis and appropriate management to ensure optimal functional outcome. Various authors have reported about the condition including the management which mostly includes surgical intervention. A report of one such injury pattern in an 8 years old male child with operative management and satisfactory outcome is presented to highlight the presence of this rare combination and adherence to standard treatment protocols to address them. The report is an addition to the limited resources available on similar fractures and highlights the importance of ruling out possible associated injuries in cases of elbow dislocations. A good fixation of lateral condyle fracture is instrumental to avoid late complications leading to poor functional outcome. The early and supervised rehabilitation also plays a role in ensuring successful return to activities of daily living.
Trauma
Gholamreza Faridaalaee; Bahman Naghipour; Sajjad Ahmadi; Seyed Hesam Rahmani
Volume 3, Issue 2 , Summer and Autumn 2017, , Pages 68-70
Abstract
Carotid artery thrombosis and concomitant brain infarction after blunt trauma are rare conditions. We report a 34-year-old woman with multiple traumas due to pedestrian car accident. At the time of initial visiting, she was somnolent and her Glasgow coma scale (GCS) score was 14. Initial vital signs ...
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Carotid artery thrombosis and concomitant brain infarction after blunt trauma are rare conditions. We report a 34-year-old woman with multiple traumas due to pedestrian car accident. At the time of initial visiting, she was somnolent and her Glasgow coma scale (GCS) score was 14. Initial vital signs (V/S) and brain computed tomography (CT) scan were normal. One day after admission to the emergency observation unit, GCS improved to 15 but right-sided hemiparesis occurred. Magnetic resonance imaging (MRI) showed brain infarction and Doppler sonography indicated internal carotid artery thrombosis. She was admitted in the Neurosurgery ward and underwent anticoagulant therapy. With appropriate treatment, the patient’s condition improved after 5 days of admission and she was discharged on oral warfarin treatment and close follow up. Although there is no ideal treatment for traumatic internal carotid artery thrombosis, it seems that in most cases anticoagulation therapy is the preferred method of treatment but in some patients surgical or endovascular revascularization is indicated.
Emergency medicine
Felice Mucilli; Pierpaolo Camplese; Guiseppe Cipollone; Decio Di Nuzzo; Luigi Guetti; Marco Perioletta; Mirko Barone
Volume 3, Issue 1 , Winter and Spring 2017, , Pages 11-17
Abstract
Objective: Thoracic trauma may be a life-threatening condition. Flail chest is a severe chest injury with high mortality rates. Surgery is not frequently performed and, in Literature, data are controversial. The authors report their experience in the treatment of flail chest by an extracortical internal-external ...
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Objective: Thoracic trauma may be a life-threatening condition. Flail chest is a severe chest injury with high mortality rates. Surgery is not frequently performed and, in Literature, data are controversial. The authors report their experience in the treatment of flail chest by an extracortical internal-external stabilization technique with Kirshner’s wires (K-wires).
Methods: From 2010 to 2015, 137 trauma patients (109 males and 28 females) with an average age of 58.89 ±19.74 years were observed. Seventeen (12.41%) patients presented a flail chest and of these, 13 (9.49%) with an anterior one. All flail chest patients underwent early chest wall surgical stabilization (within 48 hours from the injury).
Results: In the general population, an overall morbidity of 21.9% (n = 30 of 137) and a 30-day mortality rate of 5.1% (n = 7 of 137) were observed. By clustering the population according to the treatment (medical or interventional vs surgical), significant statistically differences between the two cohorts were found in morbidity (12.65% vs. 34.48%, P = 0.002) and mortality rates (1.28% vs. 10.34%, P = 0.017). In patients undergoing chest wall surgical stabilization, with an average Injury Severity Score of 28.3 ± 5.2 and Abbreviated Injury Score (AIS) of 8.4 ± 1.7, an overall morbidity rate of 52.9% (n = 9) and a mortality rate of 17.6% (n = 3) were found. Post-surgical device removal, in local anesthesia or mild sedation, was performed 42.8 ± 2.9 days after chest wall stabilization and no cases of wound infection, dislodgment of the wires or osteosynthesis failure were reported. Moreover, in these patients, an early postoperative improvement in pulmonary ventilation (ΔpaO2 and ΔpCO2: +9.49 and -5.05, respectively) was reported.
Conclusion: Surgical indication for the treatment of flail chest remains controversial and debated both due to an inadequate training and the absence of comparative prospective studies between various strategies. Our technique for the surgical treatment of the anterior flail chest seems to be anachronistic, but the aspects described, both in terms of technical features and of outcome and benefits (health, economic), allow to evaluate the effectiveness of this approach.