Complications of interosseous infusion resulting in a diagnostic dilemma.

Successful revival of a patient with cardiac arrest need vigilant effort on behalf of whole team but sometimes missing a small thing can create disaster. Here we present a case of 58 years old obese lady who was revived from a cardiac arrest secondary to septic shock. Obstruction due to proximal ureteric stone was relieved with JJ stent insertion. She required renal replacement therapy and invasive ventilation. Fever and inflammatory blood markers improved and she woke up after 6 days in intensive care unit (ICU). She developed another episode of sepsis but this time it was her shoulder that was hurting. Initially it was thought to be an iatrogenic skeletal injury during aggressive cardiopulmonary resuscitation (CPR) but radiographs came out to be normal. Magnetic resonance imaging (MRI) created more confusion by showing septic arthritis with proximal humeral osteomyelitis and gas formation. MRI suggested that it might be the sequelae of an intraosseous line insertion. All documented records were silent regarding the intraosseous line insertion. Resuscitation team was contacted and inquired. They confirmed the insertion of intraosseous line insertion during initial resuscitation which was removed after securing peripheral vascular access and before transferring the patient to ICU but they forgot to document. Her shoulder joint was washed out and debrided arthroscopically. She made a safe recovery without any other problem.

Innovative Method of Traction in a Bilateral Diaphyseal Femur Fracture in a Polytrauma Below-Knee Amputee.

While diaphyseal femoral shaft fractures are common, it is uncommon to see this injury in leg amputees. Traditionally, these fractures are internally fixed using a fracture table with reduction obtained by traction and adequate rotation exerted on a slightly abducted extremity. Special considerations need to be given in the management of patients with leg amputations. We report the case of a 24-year-old gentleman with bilateral diaphyseal femoral shaft fractures and a previous right below-knee amputation, who was transferred to our centre following a road traffic collision. We highlight important planning that needs to be undertaken for appropriate positioning, ease of reduction, and fracture fixation. We have reviewed the literature to highlight the methods that have been previously described and our use of skeletal traction through the amputation stump that can be utilised by other surgeons in challenging situations like this.

Treatment of comminuted proximal humerus fractures with shoulder hemiarthroplasty in elderly patients.

This retrospective study was done to find out the outcome of hemiarthroplasty of the shoulder following comminuted proximal humeral fractures in 20 elderly patients. Their average age was 77.6 years. The average follow-up was 33 months. All patients were reviewed in the outpatient clinic using the Constant Score. The median Constant Score was 47.5. None of the patients had severe pain. Four had moderate and 16 had no or mild pain. Range of movement was not good. The activities of daily living were significantly reduced in patients with moderate shoulder pain. Sixteen patients (80%) were satisfied with the outcome of the management of their shoulder injury. Radiological assessment showed malrotation of the prosthesis and ectopic ossification in one patient each. Osteolysis around the greater tuberosity was noted with three isoelastic prostheses. Seven patients showed proximal migration of the prosthesis although there was no significant difference in functional results. Complications included fatal pulmonary embolism in one patient. Overall, hemiarthroplasty of the shoulder gave good pain relief but there was only moderate functional improvement.