Outcome Analysis of Dual Plating in Management of Unstable Bicondylar Tibial Plateau Fracture - A Prospective Study

@#Introduction: Bicondylar tibial plateau fractures account for 10-30% of tibial plateau fractures. Despite recent advancements in the management of unstable bicondylar tibial plateau fractures, the outcomes are often poor. The present study aimed to evaluate the functional outcomes and complications of internal fixation of bicondylar tibial plateau fractures with the dual plating using two incisions. Materials and methods: The present study included 30 patients (26 males; 4 females, mean age 35.6 years; range, 19 to 65 years) with bicondylar tibial plateau fractures who were treated with dual plating between January 2017 to August 2019. Out of 30 patients, 5 patients had Schatzker type (V) and 25 patients had Schatzker type (VI) bicondylar tibial plateau fracture. All patients were treated with dual plating using two incisions. In all patient’s similar standard physical rehabilitation therapy was followed. All complications including intra and post-operative were assessed and recorded. The patients were followed-up for over 24 months. Functional outcomes were assessed with Rasmussen’s functional grading system, Oxford knee score, and range of motion of knee joint. Radiological outcomes were evaluated using Rasmussen’s radiological scoring system. Result: All fractures united with a mean time of 18 weeks. The average knee range of motion was 1.5° - 130° (range: 0° - 10° for extension lag, range: 100° -135° for flexion). Mean Rasmussen's functional grading score at the final follow-up was 26.75. All patients showed excellent or good radiographic results according to Rasmussen’s radiological scoring with a mean score of 8.5 (range 6-10). The postoperative radiographs showed mean MPTA was 84.3° and the mean PPTA was 6.2°. In the present study, complications were encountered in five patients. However, there were no cases of secondary loss of reduction, failure of the implant, malunion, or non-union. Conclusion: The surgical treatment of bicondylar tibial plateau fractures with dual locking represents a significant treatment option and provides rigid fixation in these fractures with good functional and radiological outcomes.

Spectral domain optical coherence tomography for measuring tear film meniscus height and its relationship with epiphora

Purpose: To evaluate the relationship between tear meniscus height (TMH) values measured by optical coherence tomography (OCT) and the severity of epiphora (Munk scoring). Methods: In this prospective cross-sectional study, consecutive patients with epiphora were studied. All patients underwent Munk epiphora scoring, lacrimal syringing, and detailed ophthalmological examination. Using OCT, the TMH (i.e., the line intersecting level of tear meniscus and lower eyelid) values were calculated. The relationship between TMH and epiphora was analyzed by comparing TMH values across various grades of epiphora using Kruskal–Wallis test. Results: A total of 38 patients (56 eyes) were included. The mean age was 55 ± 11.1 years with equal distribution of males and females. The mean TMH values were 238 ± 141.3, 396.6 ± 159.5, 707.1 ± 288.8, and 809.5 ± 419.4 ?m in grades 1, 2, 3, and 4 of epiphora, respectively. A significant difference in TMH was found among grades 2, 3, and 4 (P = 0.0007). On post hoc analysis, only grade 2 was significantly different from grades 3 and 4 (P = 0.0008 and P = 0.002 respectively), but grades 3 and 4 were comparable (P = 0.62). Conclusion: Levels of TMH were found to increase with increasing severity of epiphora. TMH values were comparable in Munk grades 3 and 4.

A Corrosion Cast Study of Ramification Pattern of Portal Vein in Right Lobe of Human Liver.

Objectives: The aim of the study was to know the intrahepatic ramification pattern of portal vein in right lobe of liver & its variations. Methods: 25 human fresh livers were obtained after autopsy and studied by corrosion cast method. Polymeric granules of butyl butyrate were dissolved in acetone and 20% homogenous solution was made. Solution was injected into portal vein and the injected liver was placed in 10 %formal saline for 24 hours at room temperature (20°C) for polymerization of infused butyl butyrate solution. Maceration of liver tissue achieved by wholeorgan immersion in 1.8 N KOH solution at 68°C for 24 hrs. Each cast thus obtained was preserved in glycerin and details were studied. Results: The length of the right portal vein varies 0.5 to 1.8 cm (1.2 cm). The right portal vein bifurcated into second order branches - right anterior portal vein (RAPV) & right posterior portal vein (RPPV) in 87 % of the cases, while trifurcated in rest of 13 % of cases. The angle between the anterior and posterior division ranged from 58°-95 °. Anterio-superior (P8) branch shown three type of ramification - Bifurcation type (72 %), P8- one pedicle type (8 %) and P8- trifurcation type (20%). Anterio-inferior (P5max ) branch shown the three type of ramification pattern - P5 -common type (72 %), P5 – P8 anterior type (28 %) but P5 – P8 posterior type was not observed. Right Posterior Portal Vein has shown three types of ramification pattern - Type I-Fan shaped (64%),Type II (28 %) & Type III-Trifurcation type (8%). Conclusions: The findings of present study on hepatic vasculature have immense importance in the field of hepato-biliary surgeries like hepatic resection, segmentectomy and liver transplantation.

Hemoptysis in musical wind instrument players.

Three cases of haemoptysis amongst musical wind instrument players encountered in last five years are reported. None had an identifiable pathology in lungs. Detailed investigations including computed tomography of chest and fibreoptic bronchoscopy were normal. Turbulent airflow, frictional trauma to airways due to repeated blowing is proposed as the underlying aetio-pathogenesis.

Isolation and characterization of 5'-nucleotidase inhibitor from rat liver.

5'-Nucleotidase (EC 3.1.3.5) is widely distributed in nature. However, it could not be detected in rat liver, because of the presence of specific inhibitors. Such inhibitors were also found in other tissues of rat, but at lower concentrations than that in the liver. The inhibitor activity was enriched in the membrane fraction and was also present in the cytosol fraction. It was sensitive to treatment with 6M urea and trypsin, while heating in a boiling water bath for 10 min or dialysis reduced the activity only slightly. Gel filtration or Sephadex G-50 yielded two types of inhibitors. Inhibitor I inhibited brain 5'-nucleotidase while inhibitor II inhibited both the brain and liver enzymes. Inhibitor II on further purification on CM Sephadex C-25 yielded five fractions with inhibitor activity of which inhibitor IIC was electrophoretically homogeneous. It had a molecular weight of 8500 by SDS gel electrophoresis, was rich in basic amino acids and had a high proportion of beta structure. Interaction of the inhibitor with 5'-nucleotidase brought about modifications in the secondary structure of the inhibitor as seen from the circular dichroism spectrum.

Osteomyelitis: a rare complications of Salmonella senftenberg infection--a case report.

A case of chronic osteomyelitis is rare complication of salmonella senftenberg infection and is reported.