Modified stoppa approach versus ilioinguinal approach for anterior acetabular fractures; a systematic review and meta-analysis

Modified Stoppa approach was introduced as an alternative to ilioinguinal approach for management of anterior fractures of acetabulum in order to reduce complications of the latter. However, the efficacy of either approach over other is not well established. The aim of this meta-analysis is to compare the efficacy of modified stoppa and ilioinguinal approach in the management of acetabular fractures in terms of a] quality of reduction achieved b] complication rates c] functional outcomes d] operative time e] intra-operative blood loss

Methods: Databases of PubMed, EMBASE and Cochrane registry of controlled trials were taken into consideration for studies on modified Stoppa approach versus Ilioinguinal approach group for the treatment of anterior acetabular fractures. Dichotomous variables were presented as risk ratios [RRs] /Odds Ratio [OR] with 95% confidence intervals [CIs], and continuous data was measured as mean differences, with 95% CIs

Result:Four studies involving 375 patients were included in this meta-analysis. Out of those 375 patients, 192 were managed with ilioinguinal approach and 183 were managed with modified Stoppa approach. Anatomical reduction was significantly higher in Stoppa group [p=0.052, RR=1. 19 [1.02, 1.37], p=0.90, I2=0%]. The complication rate was significantly higher in the Ilioinguinal approach as compared with the Stoppa approach [p=0.01, RR 0.63 [0.44 to 0.91], p=0.73 [I2=0%]. The operative time was significantly shorter with modified Stoppa approach [MD 48.79 [-80.29 to -17.30], p=0.002]. No significant differences were found between the two groups in terms of their functional outcomes [p=0.63, RR 0.96 [-0.80 to 1.15], p=0.56, I2=0%] and blood loss [MD=-212.89 [-476.27 to 50.49] p=0.06, I2=71%]

Conclusion: Anterior acetabular fractures, if operated with the modified Stoppa approach were found to have better reduction and lower complication rates with less operative time, when compared to ilioinguinal approach. No significant difference in terms of blood loss was found in both the groups. Further higher quality randomized controlled trials are needed to verify our results

Dynamic hip screw with locking side plate: a viable treatment option for intertrochanteric fracture / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Dynamic hip screw (DHS) is recommended for the fixation of stable intertrochanteric fractures. Its postoperative cut-out rate ranges from 1% to 6%. In osteoporotic bone, normal screws in DHS blade provide less anchorage compared to locking screws. This study aims to compare DHS with locking side plate and conventional side plate.</p><p><b>METHODS</b>Fifty consecutive patients with intertrochanteric fractures were randomly allocated for fixation with a standard DHS (group A) and locking DHS (Combi plate, group B). We compared the clinical and radiological outcomes for the conventional DHS and locking DHS in intertrochanteric fractures. Functional outcome was evaluated using the Parker mobility score.</p><p><b>RESULTS</b>Coxa valga was found more frequently in group A than in group B (12% vs. 0%, P=0.42). Coxa vara showed the same trend (12% vs. 8%, P=0.81). Rate of restoration of postoperative neck-shaft angle within 20° of sound side was higher in group B (8% cases) than in group A (4% cases, P=0.98). The rate of anteversion angle restoration within 10° of sound side was also higher in group B (100% vs. 88%, P=0.85). The average lag screw slippage in group A and group B was 3.2 mm and 4.2 mm, the average fracture union duration was 17.1 weeks and 16.4 weeks, and the mean Parker score was 5.6 and 5.8 respectively. Screw cut-out was seen in one patient in group A. No cut-out was seen in any of the patient in group B. No patient developed deep infection, avascular necrosis, deep vein thrombosis or any other significant complications.</p><p><b>CONCLUSION</b>The present study demonstrated that treating intertrochanteric fracture with a locking DHS allows sound bone healing and is not associated with any major complications. Although this report is promising, it should be interpreted with caution because only a prospective study with a large sample size would allow definitive conclusion.</p>

Epidemiology of patients admitted to a major trauma centre in northern India / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Trauma in India is an increasingly significant problem, particularly in light of rapid development and increasing motorization. Social changes are resulting in alterations in the epidemiology of trauma. The aim of the study was to assess the various epidemiological parameters that influence the cause of injury in the patients admitted to a major trauma centre in northern India.</p><p><b>METHODS</b>An observational study of 748 patients chosen by random assortment was carried out over a period of 1 year (August 2008 to July 2009). Age, sex, injury type and pattern were noted. Injury mode of upper and lower limbs was also noted.</p><p><b>RESULTS</b>Injuries occur predominately in the age group of 15-30 years. Males incurred more injury with male to female ratio of 6:1. The most vulnerable group was motorcycle users. Among the injured, farmers were the most commonly involved. Blunt injuries (94.92%) were much more common than penetrating injuries. Among patients with head injury, two-wheeler related accidents were the most common (40.3%). Most spinal cord injuries were caused by falls from height (51.09%). Most lower limb fractures were simple type. Compound fractures of the lower limb were more common than upper limb fractures.</p><p><b>CONCLUSION</b>Strict enforcement of traffic rules, combined with improved infrastructure and behavior change can decrease the burden of road traffic accidents in India and other developing countries. This study could assist in raising the profile of road traffic accidents as a public health problem which needs to be addressed as a preventable cause of mortality and morbidity, and planning appropriate interventions for this major challenge. Preventive strategies should be made on the basis of these epidemiological trends.</p>

Delayed migration of K-wire into popliteal fossa used for tension band wiring of patellar fracture / 中华创伤杂志(英文版)

Breakage of K-wires and stainless steel wires which are used for fracture fixation is not uncommon, but migration is rare. We report a case of migration of broken K-wire used for patella tension band wiring to the popliteal fossa. The broken hardware was removed surgically. We would like to suggest that K-wire and wire fixation used for treatment of patellar fractures can migrate into the posterior compartment of the knee and cause clinical symptoms. Close clinical and radiological follow-up after internal fixation to identify the presence of hardware breakage or movement and removal of wires once fracture has united can avert such complications.

Orthopaedic surgeon's nightmare: iatrogenic fractures of talus and medial malleolus following tibial nailing / 中华创伤杂志(英文版)

Intramedullary interlocking nailing is the gold standard for treatment of tibial shaft fractures. The growing use of intramedullary nailing has resulted in an increased number of tibial nailing in daily clinical practice. Despite adequate surgeon experience, tibial nailing is not without complications if proper techniques are not followed. A case of iatrogenic talar neck and medial malleolus fractures during intramedullary nailing of tibia in a 24-year-old male is reported. It is believed to be caused by forceful hammering of insertion zig with foot dorsiflexed. To the best of our knowledge, no such case has been reported in the literature. It is possible to reduce the risk of this complication by adoption of preventive measures.

Osteomyelitis of Scapula with Secondary Septic Arthritis of Shoulder Joint in a Six Month Old Child

We report a case of delayed diagnosis of osteomyelitis of the scapula extending to glenoid, with secondary septic arthritis of glenohumeral joint in a 6-month-old female infant. We performed urgent arthrotomy of the shoulder joint through an anterior approach with drainage of pus from the scapula through a posterior approach and prescribed intravenous antibiotics. Diagnosis was delayed as the patient initially presented with pneumonia, for which she was treated in the neonatal intensive care unit; at that time, all medical efforts were directed toward saving her life. Had the diagnosis been made earlier, septic arthritis of the shoulder might have been prevented. Diagnosis of septic shoulder arthritis is rare and difficult, requiring a high index of suspicion.

Anterior dislocation of shoulder in eclampsia: a case report / 中华创伤杂志(英文版)

This case report presents a 25-year-old female patient with anterior dislocation of right shoulder secondary to seizures as a complication of eclampsia. This is an unusual mechanism of injury, but similar to other uncontrolled muscular contractions caused by electroconvulsive therapy, etc. To the best of our knowledge only one such case has been reported in the English literature. Closed reduction under general anaesthesia was successfully achieved. High suspicion in patients complaining of pain over shoulder joint is necessary for early diagnosis of this condition.

Spontaneous atraumatic dislocation of sternoclavicular joint in Reiter syndrome / 中华创伤杂志(英文版)

Reactive arthritis or Reiter's syndrome characteristically affects the joint of the lower limb in an asymmetrical pattern. Usually it does not affect the axial skeleton or upper limbs. Although cases of atraumatic atlantoaxial subluxations have been reported, no case of spontaneous sternoclavicular dislocation in Reiter's syndrome has been reported. This paper describes a case of a 26 year old male patient who developed a spontaneous posterior sternoclavicular joint dislocation. No attempt of reduction was made and the patient was managed conservatively with good results.

Nonunion of forearm fracture: a rare instance in a toddler / 中华创伤杂志(英文版)

When compared to adults, pediatric fractures unite readily and nonunion is quite rare. Nonunion is often associated with open fractures, operative interventions, infection, pediatric osteogenesis imperfecta and neurofibromatosis. There are only a few studies and reports mentioning nonunion following conservative ma- nagement of closed pediatric fractures. We report here a case of an eighteen-month-old child who developed nonunion following treatment of fracture of both forearm bones with cast and was successfully treated with plating. To the best of our knowledge, this is the youngest reported case of nonunion following conservative management of closed diaphyseal pediatric fracture.

Traumatic posterior hip dislocation in a 16-month-old child: a case report and review of literature / 中华创伤杂志(英文版)

Traumatic posterior hip dislocation is an uncommon injury in children, constituting less than 5% of paediatric dislocations. In a younger child (less than 5 years), minor trauma such as a slip or fall from a low height may cause a hip dislocation, whereas in an adolescent a dislocation is usually caused by a major trauma such as motor vehicle accident. In this case report we present a rare case of traumatic hip dislocation in a 16-month-old girl. Early detection and closed reduction ensured good outcome in our case. A high index of suspicion is necessary to achieve satisfactory reduction within six hours of dislocation because reduction after this period will greatly increase the risk of complications.