Management of floating knees in adults: experience from tertiary hospital

Background: Floating knee is the term applied to the flail knee joint segment resulting from a fracture of the shaft or adjacent metaphysis of the ipsilateral femur and tibia. The fractures are often a result of high­energy trauma. Objectives: The aim of this study was to determine the pattern and distribution of these fracture types, mechanism of injury, associated injuries, method of treatment, complications, and the challenges encountered during the course of managing these patients. Patients and Methods: This is a retrospective study of all cases of floating knee injuries presenting to the Orthopedic Unit of Federal Medical Center and Surgery Department of Sir Yahaya Memorial Hospital all in Birnin Kebbi, Kebbi State, Northwest Nigeria, from January 2011 to December 2017. Data were extracted from the accident and emergency register, operation register, and patients' case folders. Data collected were analyzed using the Statistical Package for the Social Sciences for Windows version 22 (SPSS Inc. Chicago, Illinois, USA). Results: A total of 29 cases of floating knee injuries presented to the accident and emergency units. Males constituted 27 (93.1%) while females constituted 2 (6.9%). Motor vehicle accident was the most common mechanism of injury in 25 (86.3%) of the patients. The most common fracture type according to Fraser et al. classification is Type I which occurred in 12 (41.4%) of the patients. Conclusion: Floating knee injury occurs mostly in the productive age group. Head injury is the most common associated injury seen. This is mostly caused by motor vehicle accidents

Síndrome de Fraser: relato de caso nas vias lacrimais / Fraser Syndrome: case report in lacrimal system

A síndrome de Fraser é uma condição sistêmica caracterizada por criptoftalmo, sindactilia e anomalia da genitália, podendo se associar com alterações dos rins, do ouvido, do nariz, da laringe e do esqueleto. O criptoftalmo pode representar um achado isolado, representado por herança autossômica dominante, associado a outras anomalias congênitas, relatado como herança autossômica recessiva. Criança do sexo feminino, 9 meses, avaliada no ambulatório de vias lacrimais da Universidade Federal de São Paulo. Filha de pais consanguíneos. Ao exame, foram observados criptoftalmo total à esquerda, epífora em olho direito associada à secreção mucopurulenta, nariz em sela, implantação baixa das orelhas, malformação de conduto auditivo, aumento de grandes lábios e sindactilia de mãos e pés. A tomografia de crânio evidenciou braquicefalia ausência de septo pelúcido, proeminência dos ventrículos laterais, importante falha óssea na calota craniana, presença de afilamento do manto tecidual cerebral, fossa posterior pequena, desorganização do segmento anterior, afacia e descolamento total da retina.

Fraser syndrome is a systemic condition characterized by cryptophthalmos, syndactyly and abnormal genitalia, which may be associated with urinary tract, ear, nose, larynx and skeletal abnormalities. Cryptophthalmos can be an isolated finding (that has been reported as an autosomal dominant trait) or associated with other congenital anomalies (reported as an autosomal recessive disorder). Child, female, nine month of life, evaluated in the lacrimal setor of Federal University of São Paulo. Child of consanguineous parents. Her physical examination showed total unilateral cryptophthalmos (left side), epiphora (right side) with mucopurulent discharge, depressed nasal bridge, low set ears, atresia of the external auditory canal, prominent labia majora and syndactyly of the fingers and toes. Ocular ultrasonography showed brachycephaly, absence of septu pellucidum prominence of the lateral ventricles, a major bone defect in the skull, the presence of thinning of the mantle tissue of the brain,a reduced anterior-posterior ocular diameter, anterior segment disorganization, absence of the lens and total retinal detachment in the left eye.

A Wedge-Shaped Anterior Hairline Extension Associated with a Tessier Number 10 Cleft

A wedge-shaped anterior hairline extension is a very rare skin manifestation usually associated with congenital anomalies including a Tessier number 10 cleft. Other associated conditions are the Tessier number 9 cleft, the Fraser syndrome, and the Manitoba oculotrichoanal syndrome (MOTA syndrome). The Tessier number 10 cleft features include a coloboma of the middle third of the upper eyelid, and an eyebrow divided into two portions. The medial eyebrow portion may be absent and the lateral portion is angulated vertically, joining the hairline of the scalp. This creates a wedge-shaped anterior hairline extension. Herein we report on a case of a wedge-shaped anterior hairline extension associated with the Tessier number 10 cleft.

[Cerebro-oculo-nasal syndrome: a case report]

The most common congenital defect involving the face and jaws is cleft lip and palate. Exactly where they appear is determined by the locations at which fusion of the various facial processes failed to occur. The lip or the lip and palate together fail to close in approximately 1-1.5 in every 1,000 babies born. The presence of cleft lip and palate raises suspiscion to cerebro-oculo-nasal syndrome especially when accompanied by anophthalmia, mental retardation and hypoplasia of nares. In this article, one case of a 4-year-old boy with cerebro-oculo-nasal syndrome who had anophthalmia, median cleft lip and palate, a CNS defect and mental retardation has been reported. Discussion and Coclusion: Although anophthalmia is a rare congenital defect, its presence raises suspiscion to cerebro-oculo-nasal syndrome especially when accompanied by cleft lip and palate, mental retardation and hypoplasia of nares. Therefore, we can conclude that in patients with cleft of upper lip, hypoplasia of nares and anophthalmia, cerebro-oculo-nasal syndrome, must be considered. Since these abnormalities are also seen in Fraser syndrome the absence of digital and renal defects differentiates cerebro-oculo-nasal syndrome

The hidden eye: A case of cryptophthalmos

Methods: This is a report of a case of cryptophthalmos seen at the University of the Philippines-Philippine General Hospital (UP-PGH). Differential diagnosis and management options are discussed. Results: A 12-day old boy presented with no right palpebral fissure, eyelashes, or eyebrow. The skin overlying the right orbit was continuous from the forehead to the cheek. Under this skin was a 17 mm x 15 mm soft, round, movable mass anterior to the globe. The left upper lid was colobomatous with no eyebrow and fornix. The left cornea measured 9 mm x 6 mm with exposure keratitis and large ulcer. Ultrasound of the right orbit identified the presence of the right globe with normal posterior segment. Cranial computed tomography (CT) showed a cystic mass anterior to the right globe with absent lens. Visual-evoked response of the left eye established nonspecific severe optic-nerve damage, delayed visual-pathway maturation and visual-pathway affectation. Conclusion: Management of complete cryptophthalmos is difficult and requires separation of the lids and placement of mucous membrane grafts to allow for fitting of prosthesis. Reconstruction of the lid coloboma is necessary to prevent exposure keratitis. Genetic counseling is also important in the management of cryptophthalmos.