Percutaneous fixation of split fracture tibial plateau

Background: tibial plateau fractures represented only 1% of all fractures. If not appropriately treated, the consequences may be severe and have a great social impact. The management of the fracture depends on several factors such as fracture configuration, concomitant soft tissue injury, the patient's age, activity level and bone quality. Tibial plateau fractures may be divided into low energy or high energy fractures. Low energy fractures are common in older patients due to osteoporotic bone and are typically depressed fractures. High energy fractures are commonly the result of motor vehicle accidents, falls or sports-related injuries. Split tibial plateau fractures may be treated by closed reduction and percutaneous fixation using cancellous screws and washers, with very good results as recommended by many authors

Objective: the aim of this study was to evaluate the results of closed reduction under fluoroscopic control and percutaneous fixation with cancellous screws 6.5 mm and washers of split type of tibial plateau fractures

Methodology: twenty patients were included in this study; they were admitted to the Department of Orthopedic Surgery, Sayed Galal Hospital and luxor International Hospital, from October 2016 to April 2018. On admission all patients were assessed by history taking, clinical examination and radiological assessment. The mean age of patients in this study was 37.15 +/- 11.4 years. Age was ranged from 20 to 55 years. There were 13 males [65 %] and 7 females [35 %]. 11 patients [55 %] had right side tibial plateau fracture, while only 9 patients had left side tibial plateau fractures

Results: 12 [60 %] patients had traffic accidents as a mechanism of injury, 4 [20 %] were falling from height, 4 [20 %] had direct trauma. Associated fractures of the head of fibulae was present in two patients [10 %], other associated fractures were Colles' fracture [5%], femoral shaft fracture [5 %] and fracture tibia [5 %].The time till operation varied from two days to five days, but the majority of the cases were done within the first two to three days after admission. The mean duration of follow up was 6.5 +/- 2.86 months, ranging from six to eight months. After follow up period the result were assessed according to Rasmussen's grading system, eighteen patients [90%] had excellent results, and two patients [10 %] had good results

Conclusion: tibial plateau fractures represented only 1% of all fractures. If not appropriately treated, the consequences may be severe and have a great social impact. Early mobilization is an important factor in treatment of intra articular fracture, as immobilization result in death of chondrocyte. Percutaneous reduction and fixation technique is a simple procedure if facilitates, equipment and experience are available

Analysis of markers of cytotoxicitty and apoptosis in HCV

To determine the role of CD8+ T-cell responses and apoptosis in mediating liver injury in chronic hepatitis C, an analysis of cytotoxic CD8+ T-cell and apoptosis markers was performed in 70 patients with proven chronic hepatitis C and 30 controls. CD8+ T-cell responses to a panel of HCV proteins and peptides were performed in an Elispot assay. Apoptosis was detected by peripheral expression of Fas, Fas ligand and perforin as well as apoptosis of hepatocytes was also detected using transferase-mediated immunohistochemical d-UTP biotin nick labeling [TUNEL] and flowcytometry. Cytotoxic HLA A2 restricted responses were detected in 54 patients. The expression of Fas antigen, Fas ligand and perforin was significantly increased in patients compared with the control subjects. Immunohistochemical intracytoplasmic Fas expression and the apoptosis index of hepatocytes directly correlated to the necroinflammatory activity in the liver. A direct significant correlation was detected between the CD8+ T-cell responses and the apoptosis index. These results indicated that HCV- specific CD8+ T-cell responses and apoptosis can be detected in the majority of patients with chronic HCV and liver injury in chronic HCV is mediated through these responses

Hepatitis C virus genotypes among chronic hepatitis C Egyptian patients

Several studies revealed that there is certain geographical distribution of HCV genotypes. The aim of the present study was the detection of hepatitis C virus genotypes among Egyptian patients sufferring from chronic virus C hepatitis. Forty two patients diagnosed as chronic virus C Hepatitis were the subject of this study. The diagnosis was based on history taking, clinical examination, liver function tests, determination of virus C antibodies using second generation enzyme immunoassay [ELA-2]. Confirmatory testing for the anti-HCV seropositive results was done using the third generation line immunoassay. HCV RNA detection was done using PCR. Histopathological examination for liver biopsies was done for 22 cases. Genotypes of HCV were determined by line-probe assay. The results revealed that genotype 4 was found in 85% [36 cases] and coinfections of types 4 and 1 and 4 and 2 in 9.53% [4 cases] and 4.76% [2 cases] respectively. The severity of the disease tended to be worse in patients who had mixed infection