Management of diacapitular mandibular condyle fracture using a single lag screw fixation: case report / Manejo de fractura de cóndilo mandibular diacapitular mediante fijación con tornillo de tracción único: reporte de caso

Introduction: Mandibular fractures are the most common facial fractures affecting various anatomical sites of the mandible. Among the various mandibular fractures, management of condylar fractures remains a challenging task for surgeons. Case Report: We report the case of a 28 year old male patient who presented with pain in the chin and restricted mouth opening. Computed tomography revealed a sagittal fracture of the right condylar head with medial displacement of the fractured fragments. Management of diacapitular fractures includes open reduction and internal fixation of the right condyle using a single lag-screw. Results: The postoperative outcomes were favorable, where normal mandibular movements, desired dental occlusion and exact positioning of the condyle with rigid fixation were established thereby maintaining the shape of the condyle. Conclusion: Use of single lag screw fixation is highly recommended as it greatly supports the stabilized fracture fragments and also aid in prevention of fracture fragment rotation medially.

Introducción: Las fracturas mandibulares son las fracturas faciales más comunes que afectan a diversos sitios anatómicos de la mandíbula. Entre las diversas fracturas mandibulares, el manejo de las fracturas condilares sigue siendo una tarea desafiante para los cirujanos. Reporte del Caso: Presentamos el caso de un paciente masculino de 28 años que consultó por dolor en el mentón y restricción de la apertura de la boca. La tomografía computarizada reveló una fractura sagital de la cabeza condilar derecha con desplazamiento medial de los fragmentos fracturados. El tratamiento de las fracturas diacapitulares incluye la reducción abierta y la fijación interna del cóndilo derecho con un solo tirafondo. Resultados: Los resultados postoperatorios fueron favorables, donde se establecieron los movimientos mandibulares normales, la oclusión dentaria deseada y el posicionamiento exacto del cóndilo con fijación rígida manteniendo así la forma del cóndilo. Conclusión: Se recomienda encarecidamente el uso de una fijación con un solo tornillo de tracción, ya que soporta en gran medida los fragmentos de fractura estabilizados y también ayuda a prevenir la rotación medial de los fragmentos de fractura.

Wound Closure Using Adhesive Tapes in SRM Medical College, Potheri: A Case Study.

Introduction: The concept of using surface adhesive tapes to close surgical wounds antedates the development of satisfactory suturing techniques. But previously available wound adhesive tapes lacked adequate adhesive properties and led to the occurrence of associated skin irritation or maceration. Methods: A total of 30 patients who presented to Department of Surgery for elective and emergency surgical procedures were randomly selected, after getting informed consent. Wound adhesive tapes were used for skin closure. The patients were followed up in the immediate post-operative, 1 week, 4 weeks, and 3 months post-operative. Any complication such as wound gaping, wound infection, or skin irritation were noted. Cosmetic results were evaluated using modified Hollanders scale. Results: In our study, 90% of patients were male and rest were females. Wound infection occurred in 6.7% of the patients. This is increased compared to reports from older studies which is about 3-4% wound infection in sutured wounds is about 2-11% according to available literature. Wound infection rate in our study is within this rate and is comparable to that of suture closure. There was a significant association between the incidence of wound infection and presence of diabetes mellitus (DM). 2 out of 4 patients with Type 2 DM developed wound infection. There was no association between occurrence of wound infection and age of the patient or type of incision. The relative risk of sub-optimal closure in sutured wounds is 1-8%. In our study, the rate of suboptimal closure is 6.7% which falls within this range. There is a significant association between occurrence of wound infection and final cosmetic outcome. Conclusion: Wound adhesive tapes are effective alternatives for suture closure. Added advantages of reduced time consumption and cost of tapes compared to sutures were observed in our study.

Intra-abdominal Organ Injuries in Blunt Injury Abdomen in SRM Medical College, Potheri: A Prospective Study.

Introduction: Blunt Abdominal trauma is the most common caused by road traffi c accidents (RTA). It also occurs as a result of fall from a height, assault with blunt objects, industrial mishaps, sports injuries, bomb blast. Investigative modality can only supplement the clinical evaluation and cannot replace it in the diagnosis of blunt abdominal trauma. In spite of the best techniques and advances in diagnostic and supportive care, the morbidity and mortality remain at large. Purpose: To estimate the frequency of various intra-abdominal organ involved, assess the various mode of blunt abdominal trauma and clinical presentation and various available investigation, treatment and complications. Methods: This a prospective study conducted in SRM Medical College among patients presenting to the casualty and general surgery outpatient department with a sample size of 72. Results: Males (91.6%) outnumbered females (8.33%). RTA forms the most common mode of injury. The most common age group affected is 21-30 years. Majority of the population presented with pain abdomen. Focused assessment with sonography for trauma has picked up solid organ injury in 46 cases. Computed tomography abdomen was performed in 100% of the population and forms the core investigation of choice and becomes more important in dealing operative versus conservative management. For splenic injury, the most common surgery performed was splenectomy (26 cases). Multiple intra-abdominal organs were involved accounting for 9.7%. Wound infection is the most common post-operative complication. The study showed a mortality of 19%. Conclusion: Blunt injury abdomen with solid organ injury forms a considerable load of patients in our society and is usually less obvious. Early diagnosis, repeated clinical examination and use of appropriate investigations form the key in the management.

Primary omental torsion – A rare case report

Primary omental torsion occurs when the mobile thickened segment of the omentum rotates around a proximal fixed point in the absence of any association or secondary intra abdominal pathology and is reported rarely in literature. Our patient was a 55 year old postmenopausal woman who presented with acute abdominal pain on the right side for 3 days and was diagnosed to have primary omental torsion.

Incarcerated femoral cystocele – A rare case report.

Femoral hernia accounts for about 3-5% of all groin hernias. Incarceration and strangulation are more common with femoral hernia. Femoral hernia with bladder as content and its incarceration is reported very rarely in literature. Our patient is a 48 year old multiparous female who presented with left sided groin swelling with difficulty in micturition and was diagnosed to have incarcerated femoral cystocele.

Increased glycated hemoglobin level in non-diabetic nephrotic children is associated with oxidative stress.

Glycation and lipid peroxidation are spontaneous reactions believed to contribute to the pathogenesis of nephrotic syndrome. Possible interrelations of glycated hemoglobin with reduced glutathione and malondialdehyde were evaluated in nephrotic syndrome patients. Eighteen nephrotic syndrome patients and 15 healthy controls were enrolled for this study. Glycated hemoglobin, reduced glutathione, malondialdehyde and fasting glucose were analyzed for their correlation in both the groups. In nephrotic syndrome patients, while glycated hemoglobin and malondialdehyde levels were found to be significantly increased, glutathione levels decreased significantly when compared with controls. Glycated hemoglobin was found to have a significant positive correlation with malondialdehyde and a negative correlation with glutathione. Erythrocytes depleted of glutathione, by pre-treatment with 1-chloro-2, 4-dinitrobenezene, were found to have higher glycated hemoglobin levels when compared with erythrocytes incubated with glucose alone. These data suggest that glycated hemoglobin levels are closely associated with malondialdehyde and glutathione in nephrotic syndrome patients.