Fracture Clavicle: Is Surgical Fixation a Better Treatment?

Background: Fractures of clavicle represent approximately 3–12% of all fractures treated by orthopedic surgeons. There hasbeen a debate over the years for the best treatment of midshaft clavicle fractures. Our study is intended to find both conceptualand practical guidance for precision treatment with an expectant favorable functional result.Materials and Methods: Out of 50 patients of clavicle fractures, 25 were treated conservatively and 25 were treated operativelyby locking plate fixation. Outcomes were assessed using the disabilities of the arm, shoulder and hand (DASH) score forfunctional assessment.Results: Functional and anatomical outcomes were found to be better in patients treated operatively with better DASH scorescompared to patients treated with clavicle brace and sling.Conclusion: Surgical fixation of fracture clavicle gives better functional outcomes and shorter time for union with betteranatomical reduction than non-operative treatment. Hence, we recommend surgical fixation with a locking plate is the standardof treatment in these fractures.

Treatment of Distal End Radius Fractures - By Various Modalities

Introduction: Fractures of the distal end radius represent approximately 16% of all fractures treated by orthopedic surgeons.Our study is intended to find both conceptual and practical guidance for precision treatment with an expectant favorable result.Materials and Methods: Atotal of 50 patients of distal end radius fractures were treated with cast immobilization, percutaneouspinning, external fixation, and volar locking plate fixation. Fernandez classification was used. Functional outcomes wereassessed using Demerit Point System of Gartland and Werley (modified). The anatomical evaluation was done by Lindstromcriteria (modified).Results: Functional outcomes depend on patient’s age, fracture anatomy, displacement, reducibility, stability, and articularincongruity of fractures. They are related more to the anatomical reduction than to the method of immobilization. Volar lockingplate is a safe and effective treatment for unstable and metaphyseal comminuted fractures.Conclusion: According to Fernandez classification, Type I fractures were the most common. The volar locking compressionplate fixation gives excellent functional and anatomical results than other modalities of treatment. Hence, we recommend volarlocking plate fixation is the best modality of treatment among others.

Arteriovenous malformation of the pancreatic head – difficulties in diagnosis and treatment.

A patient with pancreatic arteriovenous malformation who presented diagnostic and therapeutic difficulties is presented. The initial tests appeared to suggest inflammatory bowel disease, but the diagnosis was clinched by the finding of blood issuing from the ampulla of Vater. Repeated angiographic embolization did not obliterate the vascular malformation, and the symptoms eventually resolved after Whipple’s pancreaticoduodenectomy.

Factors affecting hemodynamic changes after reperfusion in liver transplantation

Background: The aim this retrospective study was to determine if the duration of cold ans warm ischemia times is related to the extent of these disturbances and also to identify other factores related to recipient's condition which may affect the severity of post reperfusion syndrome. Patients and methods: The authors studied the factors affecting hemodynamic changes after reperfusion in sixty-one patients submitted to liver transplantation at the University of Miami (Jackson Memorial Hospital) during the investigation period (August 1998-january 1999). The hemodynamic parameters monitored were heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary arterial pressure (MPAP), venous oxygen saturation (SVO2) and ASA status. All parameters were evaluted in three specific times: after skin incision (baseline, T1), 10 min. before reperfusion (T2), and 10 min. after reperfusion (T3). The statistical analyses were t-test for independent samples and ANOVA test. Results: All parameters changed significantly (p<0.0001) at T1 T2 and T3. No correlation was found between cold warm ischemia times and any of hemodynamic in our study and no correlation was found between gender and those parameters . Age was significantly correlated with the MAP at T2. MAP was decreased in older patients at T2. HR, MAP, CVP, PAP and CVO2 were significantly correlated with ASA classification (p<0,000033). Conclusions: No significant effects of cold and warm ischemia times on the hemodynamic intraoperative condition of the ILT were found. Furthermore, patients with a high ASA status were shown to b e at an increased risk of cardiovascular collapse after reperfusion