Reconstruction Plate Fracture: Mechanism and Recent Advances

Reconstruction plates with or without bone grafts are used to restore mandibular continuity, form and function following segmental resection of mandible. Fracture of reconstruction plate is observed in 2.9 % to 10% of cases reported in the literature excluding other complications. In this case, we report the fracture of stainless steel reconstruction plate used without bone graft and its management using locking reconstruction plate with non vascularised iliac crest graft following removal of the fractured plate. Review of literature describing incidence, pattern and causes of reconstruction plate fracture and its management is discussed.

To Assess the Safety and Efficacy of Misoprostol Administered Sublingually For Induction of Labour in Patient with PROM with Poor Bishop’s Score

Background: The management of PROM has often been adilemma in obstetrics. Different regimens are followed indifferent centres all over the world for management of PROM.This study is aimed to compare the safety and efficacy ofsublingually equivalent dose regimen administered vaginally forinduction of labour in patient with PROM with poor Bishop’sScore.Material & Methods: A prospective randomised controlled trialdone on 60 Patients of PROM admitted in labour room ofGovernment Medical College, Dungarpur, as per inclusion andexclusion criteria. Group 1- Received 25µg misoprostol,intravaginally 4 hourly up to maximum of 3 doses, placed inposterior fornix. Group 2- Received 25 µg misoprostol,sublingually 4 hourly up to maximum of 3 doses. Foetal heartand labour progress monitoring was done. Before every dose apervaginum examination was performed to assess the Bishopscore.Results: Our study showed that the foetal distress (foetal heartrate (FHR) abnormalities; FB<120bpm, FT >160bpm) wasmost common intrapartum complication in both groups(13.33% each). Mean induction delivery interval in sublingualgroup was 8.13±4.29 hours and in intravaginal group was7.31±4.11hours. Majority of women in both groups deliveredvaginally; 25 patients (83.33%) in intravaginal and 26 patients(86.66%) in sublingual group. 2 patients in intravaginal and 1patient in sublingual group had atonic PPH. However nopatient required blood transfusion. None had retained placenta.There was no maternal mortality.Conclusion: We concluded that both sublingual andintravaginal route of administration of 25µg misoprostol areequally effective in achieving favourable Bishop’s score,vaginal delivery rates, with comparable induction to deliveryintervals without increasing the caesarean rates and thepostpartum complications.