Electrolytes imbalance: a rare side effect of piperacillin / tazobactam therapy

Electrolytes imbalance has been reported with the use of several antimicrobials. We report a case of severe hypokalemia secondary to piperacillin/tazobactam in a patient with normal renal function and normal serum potassium level who had presented with a fractured neck of femur. The electrolytes abnormality was corrected once piperacillin/tazobactam was stopped. To our knowledge, this is the first case to describe an early severe hypokalemia induced by piperacillin/ tazobactam therapy in an otherwise healthy individual

Operative management of unstable thoracolumbar burst fractures

Operative management of unstable burst vertebral fractures is challenging and debatable. This study of such cases was conducted at the Aga Khan Hospital, Karachi from January 1998 to April 2003. All surgically managed spine injuries were reviewed form case notes and operative records. Clinical outcome was assessed by Hanover spine score and correction of kyphosis was measured for radiological assessment. The results were analyzed by Wolcoxon sign rank test for two related samples and p-value < 0.05 was considered significant. Ten patients were identified by inclusion criteria. There was statistically significant difference between mean pre-and postoperative Hanover spine score [p = 0.008]. Likewise, there was significant difference between mean immediate postoperative and final follow-up kyphosis, [p = 0.006]. Critical assessment of neurologic and structural extent of injury, proper pre-operative planning and surgical expertise can optimize the outcome of patients

Spontaneous atraumatic achilles tendon rupture in healthy individuals: biomechanical aspect

Achilles tendon rupture bilaterally secondary to predisposing factors such as steroid, fluoroquinolones, SLE, RA etc. Other factors are well-described in the literature but this is an extremely rare phenomenon in the absence of risk factors. Available reports in healthy athletes, all had history of severe trauma. We report an unusual presentation of bilateral and unilateral spontaneous rupture of Achilles tendon in healthy lifeguards without any marked trauma. Knowledge of training environment will alert the trainers, athletes and surgeons to recognise training environment at risk and take preventive measures

Scaphoid fracture with ipsilateral fracture dislocation of the metacarpals: a rare fracture pattern

Scaphoid fracture with ipsilateral metacarpal fracture dislocation is very rare. A unique case of this injury is reported. It is important to be aware of this fracture pattern so that appropriate evaluation and treatment can be instituted. Thorough clinical and radiographic examination at the initial presentation of the patient is the key to identify uncommon combination of injuries

Designer orthopaedic surgery in a patient with anti-vel antibodies

The authors present a rare case of anti-Vel antibodies in a patient who underwent a shoulder replacement with a custom designed procedure which involved combination of autologous blood pre-deposit, pre-operative haemodilution and resurfacing arthroplasty