Functional Outcome of Subtrochanteric Femoral Fracture Fixation by Intramedullary Interlocking Surgical Implant Generation Network Nail.

Subtrochanteric femoral fractures are one of the common fractures encountered in today's Orthopaedic practice. High stress leads implant failure and produce varus collapse. From the perspective of biomechanics, intramedullary fixation has unique advantage which can better distribute stress and acting load-sharing implants. Biomechanically proximal wide canal and short segment provide less optimal fixation by conventional intramedullary nails. Intramedullary nail by Surgical Implant Generation Network (SIGN) has proximal interlocking that gain purchase through femoral neck and provide improved stability for proximal part. The aim of this study was to evaluate the functional outcome of subtrochanteric fractures fixation by intramedullary interlocking SIGN nail. This prospective study was conducted from July 2016 to June 2018 at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) through non randomized purposive sampling. Total 31 patients, aged above 18 years irrespective of sex with closed subtrochanteric fractures were included. Patients with pathological fracture, multiple injuries were excluded from the study. The mean age of the patients was 42.61±19.59 years with range 18-80 years. Most common fractures were Seinsheimer type III (51.6%) and average follows up 42.39 weeks (24-48 weeks). Union rate 93.55% with delayed union 6.45% and no nonunion. Functionally most of patient started early partial (77.42%) and full (64.52%) weight bearing with 61.29% have full knee ROM and 83.9% without limb shortening. Maximum patients regained walking (83.87%) and squatting (90.32%) and return to preinjury state (80.65%) of activities. Evaluation of outcome by Modified Harris Hip Score showed excellent (70.97%), good (22.58%), fair (3.23%) and poor (3.23%) thus satisfactory outcome were 93.55%. This study concludes that intramedullary interlocking SIGN nail is a safe and reliable implant for the treatment of subtrochanteric fractures with excellent functional outcome.

Result of Subtrochanteric Femoral Fracture Fixation by Intramedullary Interlocking Surgical Implant Generation Network (SIGN) Nail.

Treatment of sub-trochanteric femoral fractures is a challenge to orthopaedic surgeons. High incidence of fixation failure and nonunion is due to thick cortical bone deserves special consideration of surgical treatment. Intramedullary nail by Surgical Implant Generation Network (SIGN) shows promising results in comparison to conventional fixation method because of its better strength, accuracy and surprisingly better results in infection and non-union. The aim of this study was to assess the rate and time taken for union of fractures by SIGN nail and determine peri-operative parameters. This prospective study was conducted from July 2016 to June 2018 at National Institute of Traumatology and Orthopaedic rehabilitation (NITOR) through non randomized purposive sampling. Total 31 patients, aged above 18 years irrespective of sex with closed subtrochanteric fractures were included. Patients with pathological fracture, multiple injuries were excluded from the study. Union status evaluated by Radiographic Union Score for Tibial (RUST) fracture where antero-posterior and lateral radiographs (X-ray) based assessment of healing of the four cortices done. The individual cortical scores were added to give a total score 4 being the minimum indicating fracture is definitely not healed and 12 being the maximum score indicating that the fracture is definitely healed. The mean age of the patients was 42.61±19.59 years with range 18-80 years. Majority of patients were male (68%) and most of injury (68%) due to road traffic accident with common fracture were Seinsheimer type III (51.6%). Average hospital stay period was 16.39 days and average follows up 42.39 weeks (24-48 weeks). Time taken for union was 14.16 weeks (11-28 weeks). According to RUST scores fracture union rate 93.55% with delayed union 6.45% and no nonunion. There was one patient with superficial wound infection, one unaccepted shortening and with no implant failure. This study concludes that intramedullary interlocking SIGN nail is a safe and reliable implant for the treatment of subtrochanteric femoral fractures.

Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries.

BACKGROUND: The safety and efficacy of antenatal glucocorticoids in women in low-resource countries who are at risk for preterm birth are uncertain. METHODS: We conducted a multicountry, randomized trial involving pregnant women between 26 weeks 0 days and 33 weeks 6 days of gestation who were at risk for preterm birth. The participants were assigned to intramuscular dexamethasone or identical placebo. The primary outcomes were neonatal death alone, stillbirth or neonatal death, and possible maternal bacterial infection; neonatal death alone and stillbirth or neonatal death were evaluated with superiority analyses, and possible maternal bacterial infection was evaluated with a noninferiority analysis with the use of a prespecified margin of 1.25 on the relative scale. RESULTS: A total of 2852 women (and their 3070 fetuses) from 29 secondary- and tertiary-level hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan underwent randomization. The trial was stopped for benefit at the second interim analysis. Neonatal death occurred in 278 of 1417 infants (19.6%) in the dexamethasone group and in 331 of 1406 infants (23.5%) in the placebo group (relative risk, 0.84; 95% confidence interval [CI], 0.72 to 0.97; P = 0.03). Stillbirth or neonatal death occurred in 393 of 1532 fetuses and infants (25.7%) and in 444 of 1519 fetuses and infants (29.2%), respectively (relative risk, 0.88; 95% CI, 0.78 to 0.99; P = 0.04); the incidence of possible maternal bacterial infection was 4.8% and 6.3%, respectively (relative risk, 0.76; 95% CI, 0.56 to 1.03). There was no significant between-group difference in the incidence of adverse events. CONCLUSIONS: Among women in low-resource countries who were at risk for early preterm birth, the use of dexamethasone resulted in significantly lower risks of neonatal death alone and stillbirth or neonatal death than the use of placebo, without an increase in the incidence of possible maternal bacterial infection. (Funded by the Bill and Melinda Gates Foundation and the World Health Organization; Australian and New Zealand Clinical Trials Registry number, ACTRN12617000476336; Clinical Trials Registry-India number, CTRI/2017/04/008326.).

Difficulty in diagnosis of nasopharyngeal carcinoma.

Due to difficult anatomical position nasopharyngeal carcinoma (NPC) is always challenging problems both from the diagnostic and therapeutic corner. A 24 years old lady came to our Department of Otolaryngology and Head-Neck Surgery with the complaints of epistaxis, right sided neck swelling, nasal obstruction and headache. On digital palpation Nasopharyngeal mass was found. We took biopsy from nasopharynx under indirect vision but report was not conclusive. Then we did CT scan, nasendoscopy. Nasendoscopy showed bilateral ethmoidal polyp with nasopharyngeal mass. We took biopsy from the nasopharyngeal mass and confirmed the diagnosis.

The effect of non-specific beta-blockade on metabolic and haemostatic variables during hypoglycaemia.

Several haemostatic and metabolic variables were monitored during insulin stress tests (ISTs), which were preceded by placebo, nadolol or propranolol ingestion for 10 days. Nadolol administration blocked the rise in plasma factor VIII: RAg concentrations, but no significant changes were observed in platelet aggregation/thromboxane A2 release. Propranolol administration reduced the significance, but not the magnitude, of the plasma factor VIII:Rag rise and also marginally inhibited platelet aggregation/TXA2 release. Both nadolol and propranolol inhibited the hypokalaemia of hypoglycaemia and retarded the recovery of plasma glucose concentrations, probably by inhibiting lipolysis (as indicated by serum nonesterified fatty acid concentrations). Both nadolol and propranolol often masked and delayed the onset of the symptoms of hypoglycaemia. Beta-blockers may exert beneficial effects by modifying haemostatic variables and by preventing hypokalaemia during stressful situations, such as hypoglycaemia or myocardial infarction, both in diabetics and in non-diabetics. However, any benefit must be balanced against the risk of masking, and possibly increasing the incidence of, hypoglycaemia in diabetics.

Amenorrhoea, body weight and serum hormone concentrations, with particular reference to prolactin and thyroid hormones in anorexia nervosa.

Twenty women with anorexia nervosa were investigated at varying stages during weight gain. Basal prolactin and TSH and prolactin responses to TRH were normal and unrelated to body weight. LH, FSH and 17 beta oestradiol were low in emaciated patients and rose with weight gain. There was no correlation between serum gonadotrophin and prolactin concentrations. T3 and T4 concentrations were low but T3 rose with weight gain during refeeding over 4-6 weeks, whereas T4 remained low. A positive correlation was found between the TSH response to TRH and body weight. The abnormalities in the hypothalamic-pituitary-thyroid axis were similar to those seen in a variety of chronic illnesses and appear to be unrelated to the amenorrhoea. The failure of restoration of normal function at least after short-term refeeding requires further investigation. It was concluded that the amenorrhoea in anorexia nervosa is not associated with changes in prolactin secretion but is determined primarily by changes in the hypothalamic-pituitary-gonadal axis. These changes are induced largely by nutritional factors but psychological factors may also be involved.