ABSTRACT
Background: Cerebrovascular accidents (CVA) are a major cause of mortality and morbidity in middle and elderly age-groups. It can be ischemic or hemorrhagic and thrombotic or embolic. Digital subtraction angiography (DSA) is a gold standard investigation for evaluating patients with CVA. Due to invasive nature of DSA, computed tomography angiography (CTA) has long been used as a primary noninvasive imaging tool to evaluated patients with CVA. Angiography can also be performed with magnetic resonance imaging, both with & without contrast.Introduction: CTA serves as a primary noninvasive imaging tool in evaluation of patients with CVA as nearly half of these patients do not have treatable underlying cause. Due to increasing awareness regarding the radiation exposure, contrast-induced nephrotoxicity and iodine-sensitivity, magnetic resonance angiography (MRA) is gaining more and more attention. Noncontrast MRA (NC-MRA) can be performed utilizing 3D-time of flight sequence which provides results comparable to that of CTA. Hence, we performed a study to evaluate comparable role of NC-MRA and CTA. Methods: Fifty patients with cerebrovascular accidents wereevaluated with CTA & NC-MRA in tandem on the same day. The results obtained were statistically evaluated and conclusions were drawn. Results & Conclusions: Detection of aneurysm in intracranial and stenoses in intracranial as well as extracranial vessels can be detected with good accuracy by NC-MRA. The results of NC-MRA was comparable to that obtained by CTA except in very small aneurysm (<3mm) and early stenosis (20-30%) which rarely affect immediate patient management. Hence, NC-MRA can be a good substitute to CTA especially in patients where iodinated contrast is relatively or absolutely contraindicated and in combination with routine protocol for stroke imaging.
ABSTRACT
Background: Fractures of the proximal humerus have been a challenge to orthopaedic sugeons with treatment modalities changing from time to time. Locking plates have revolutionised the treatment of these fractures. Currently proximal humeral locking plates (PHLP) and proximal humeral interlocking osteosynthesis (PHILOS) are two types of locking plates available for fixation of these fractures. Aim of this study was to evaluate the results of proximal humeral locking plate (PHLP) for Neers’s two and three part proximal humerus fractures. Material and methods: Neer’s two and three part fractures treated by open reduction and internal fixation with proximal humeral locking plate from August 2012 to April 2014 were retrospectively evaluated for complications, time to radiological union and final functional outcome using Constant Murley Score (CMS). Results: Twenty (12 male; 8 female) patients with 8 Neer’s 2-part and 12 neer's 3- part fractures managed by open reduction and internal fixation with proximal humeral locking plate (PHLP) with an average follow up of 23.2 months were evaluated. All the fractures united at an average of 16 (12 to 20) weeks. Eight complications were seen in 5 (25%) patients, namely, inadequate anatomical reduction (n = 1), superficial wound infection (n = 1), deep infection (n = 1), subacromial impingement (n = 1), axillary nerve neuropraxia (n = 1), adhesive capsulitis (n = 1) and secondary varus collapse (n = 2). There was no patient who developed avascular necrosis (AVN), non- unioun, primary or secondary screw perforation, implant failure and vascular injury. Average Constant-Murley Score at final follow up was 84.75 ± 11.6. 85% patients had very good and Good functional results. No patient had poor functional results. Conclusion: Proximal humeral locking plate (PHLP) is an excellent implant in Neer’s two and three part fractures of the proximal humerus. Complications can be minimized by meticulous Surgical technique and proper placement of screws and plate. In case of medial comminution, use of PHILOS with placement of medial support screws and bone grafting should be preferred to prevent varus collapse.