Firearm bullet settling into the lumbar spinal canal without causing neurological deficit: A report of two cases.

BACKGROUND: Uncertainty still exists regarding the treatment of the patients presenting with gunshot wounds to the spine. Neurological insults, cerebrospinal fluid fistula, infection, lead or copper toxicity, migration of bullets, and spinal instability are included among the common challenging issues. CASE DESCRIPTION: An 18-year-old woman was admitted with low back pain following a gunshot injury five days ago. She was neurologically intact. Radiological examinations showed that a bullet was settled in L4-5 disc space. The bullet was removed with a unilateral L4-5 partial hemilaminectomy and discectomy from the left side. The second case was of a 29-year-old man admitted with radiating leg pain on the right side following a gunshot injury from his left side of lower back four months ago. He had only positive straight leg raising test. Radiological studies showed two bullets, one was in the psoas muscle on the left side and the other was in spinal canal that had caused a burst fracture of the L5 vertebra. Following L5 laminectomy and bilateral L5-S1 facetectomy, the bullet was removed from the spinal canal and L5-S1 transpedicular posterior stabilization was performed. The postoperative period of both patients was unremarkable. CONCLUSION: Bullet settling into the lumbar spinal canal without causing neurological deficit may require surgical intervention. Removal of bullets provided not only pain relief in both the cases but also prevented future complications such as migration of the bullets, plumbism, and neuropathic pain and instability.

The effects of blood transfusion on renal functions in orthopaedic surgery.

OBJECTIVE: The effects of perioperative blood transfusion on renal functions have been studied in various studies. In this study, we investigated the effects of blood transfusion on postoperative kidney functions in patients who underwent orthopaedic surgeries. METHOD: Total 136 patients who were operated for several orthopedic pathologies between June 2013 and December 2014 were evaluated. The patients were divided into two groups according to the amounts of blood transfusion. Ninety five patients (69.8%) who were transfused less than 3 units were included in Group 1 and 41 patients (30.2%) who received 3 and more units of blood were included in Group 2. RESULTS: There were no statistical difference between the two groups in terms of preoperative gender, hypertension, diabetes mellitus, chronical renal failure and smoking habbits (P > 0.05). No statistical differences between the groups were seen in terms of postoperative hospital stay, pulmonary and other complications as well as mortality (P > 0.05). When the two groups were compared for blood parameters showing postoperative renal and other system functions, no statistical differences were detected (P > 0.05). CONCLUSION: Blood transfusion does not have negative effects on postoperative BUN and creatinine levels in patients operated for orthopaedic pathologies.

Debridement, antibiotics, irrigation, and retention (DAIR) of the prosthesis after hip hemiarthroplasty infections. Does it work?

PURPOSE: Debridement, antibiotic, and implant retention (DAIR) is an attractive treatment modality after hip hemiarthroplasty (HA) infections. Data about the success of the procedure after acute onset infections is lacking. The aim of this study was to analyze the clinical outcome and associated risk factors. METHODS: A multicenter, retrospective cohort study was designed, including 39 patients with acute onset prosthetic infection who had undergone debridement and irrigation with prosthesis retention. The primary outcome measure was infection eradication without prosthesis removal. We also analyzed how the success rate was influenced by the length of the interval between implantation of the prosthesis and the beginning of the treatment. RESULTS: The overall success rate was 41%. Sedimentation rate over 60 mm/h and the longer duration (2 weeks) after prosthesis implantation were found as factors negatively influencing the success rate. CONCLUSIONS: Our results indicated limited success to DAIR- treated patients with infected HA. The high failure rate of DAIR treatment after 2 weeks from the implantation should be taken into consideration.

Simultaneous double interphalangeal joints dislocation in a finger in a teenager.

BACKGROUND: Simultaneous dislocation of the proximal and distal interphalangeal joints of the same finger is a rare event. In literature simultaneous double interphalangeal dislocation in the same finger has been reported only one case in a skeletally immature patient which was a fourteen year old male. Our case was twelve years old which is the youngest case in the literature that has been reported. CASE DESCRIPTION: A 12-year-old male injured his right ring finger while playing football. Examination revealed a stepladder deformity. There was no sign of neurovascular damage. Radiographs showed dorsal dislocation of both the proximal and distal interphalangeal joints. Reduction of the double dislocation was easily achieved by simple longitudinal traction. The finger was splinted in the intrinsic plus position for 3 weeks and active range of motion was then allowed. LITERATURE REVIEW: The most prevalent cause of injury was a sport accident. The left hand was less often involved than the right hand. The finger most often injured was the little finger followed by the ring finger, middle finger and the index finger. Closed reduction is the treatment of choice if there is no soft tissue interposition that prohibits the procedure. In most cases, longitudinal traction was sufficient for closed reduction. CLINICAL RELEVANCE: We report the second case of simultaneous proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints dislocations in one finger in a 12-year-old non-athletic boy; which is the youngest case in the literature, managed by closed reduction and early mobilization, with excellent outcome.