ABSTRACT
The management of spinal metastasis varies from patient to patient, depending on the type of lesion, stage of the disease, extension into the spinal canal, associated fractures, and life expectancy. We present a case of solitary metastasis with intact neurology in a 48-year-old lady who underwent a radical mastectomy for T2 N3 M0 breast carcinoma 34 months ago. Total en bloc spondylectomy in a neurologically intact patient is a challenging one. In all posterior approaches, there is a high chance of postoperative neurodeficiency. In our case, a combined approach seems to be a much safer procedure with easy accessibility to remove the total D8 vertebra.
ABSTRACT
INTRODUCTION: Asymmetric bilateral hip dislocations are very rarely reported in literature. We report a unique case of asymmetric traumatic bilateral hip dislocation in a 34-year-old male, describing the management and post-operative complications. CASE REPORT: A 34-year-old truck driver sustained injury to both his hips in a head on collision between two trucks while seated in the passenger seat. There was a delay in presentation at our institution as he was referred after 17 h of the trauma. After evaluation, he underwent closed reduction of both hips under intravenous anesthesia on the same day. The post-reduction assessment revealed a left-sided posterior wall fracture which was suspected due to the instability after reduction. Fixation of the fracture was done using two spring plates. The patient was followed up throughout his rehabilitation and thereafter when he resumed his occupation. Six months after the incident, the patient had pain-free, full range of motion of both hips. Three years after the surgery radiological investigations revealed changes suggestive of early avascular necrosis (AVN), however, the patient did not have any functional restriction. CONCLUSION: This is a case of bilateral asymmetric hip dislocation with left side posterior wall fracture. It is important to reduce the hip and also address the fracture as early as possible to prevent AVN.
ABSTRACT
BACKGROUND: Anterior plating is the treatment of choice in anterior pelvic ring fractures. In certain situations where pelvis fracture is associated with open wound, infection, abdominal injury or bladder injury - internal fixation with plate is contraindicated. Conventionally, external fixation is done in such cases. However, External Fixation is associated with pin tract infection, pin loosening, difficult wound care and less patient compliance. The present study was conducted to evaluate a possible 'middle path' between the two procedures. METHODS: A prospective study was conducted from July 2017 to December 2019.18 adult patients with risk of infection were treated with INFIX. The patients' data was collected on presentation, preoperatively, intra-operatively and post operatively. The patients were followed up with serial radiographs. Functional status was assessed using Iowa Pelvis Score. After radiological union, implant removal was performed. The patients were followed up for a minimum of 6 months after the removal surgery. RESULTS: The average age of patients in present study was 39.55 years with a male predominance. 16 out of 18 patients were polytrauma cases with ISS more than 15.50% patients had Lateral Compression type of fracture. Radiological union was seen at an average of 3.5 months. After removal, 78% patients had excellent outcome and 22% patients had good outcome. The complications observed were LFCN irritation (27.78%) and asymptomatic heterotopic ossification (22%). CONCLUSION: Present study concludes that INFIX produces excellent outcome in pelvis fractures with risk of infection where anterior plating is contraindicated.