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Introduction Tibia fractures are children's most typical lower limb fractures affecting their general and mental well-being. This study aims to evaluate the management and outcomes of displaced tibia fractures. Methods A retrospective study was conducted to review children up to 16 years of age with displaced tibia shaft fractures who received treatment in our department from January 2011 to December 2021. Fractures managed in the operating theatre and patients who completed follow-up until fracture healing were included in the study. Treatment procedures were assessed, and outcome was measured by hospital stays, complications and revision procedure incidences. Results The study included 74 patients (75 fractures, including one re-fracture). The patient's ages ranged from 2 to 16 years (median age: 11 years). Seven patients sustained open fractures (Gustilo I, II). Tibia diaphysis was the most common site of involvement. A total of 43 patients were treated by manipulation under anaesthesia and cast. Surgical fixation was directly proportional to increasing age (p<0.05). Overall, 74% of patients were treated by fixation when age was >10 years. Three patients needed conversion of casting to surgical fixation. One patient had re-fracture following a secondary injury after six months of initial tibia shaft fracture treated by casting. Five patients had complications, including delayed union, pin site and surgical site infections. Antibiotics were adequate to manage infections except in one patient who needed debridement. The average hospital stay was three days. The median number of follow-up X-rays was 4. The planned removal of all flexible nails, and the circular frame was done between 2 and 15 months, except for one that had delayed union. All the patients underwent clinical and radiological union at the end of the follow-up. Conclusion The treatment plan was dependent on the individual need of the patient and the fracture pattern. Children older than 10 years were more likely to undergo surgical fixation. The majority of fractures were treated by manipulation and cast in operating theatres. Better logistic support in the emergency department could reduce the burden on the operating theatre.
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QUASI-EXPERIMENTAL DESIGN PURPOSE: Compare intra and postoperative parameters, surgeons' satisfaction, and cost-effectiveness between general anesthesia (GA) and spinal anesthesia (SA) on patients undergoing surgery in the lumbar spine surgery. OVERVIEW OF LITERATURE: Surgery on the lumbar spine is the commonest surgical procedure among all spinal surgical practices. Both the GA and SA are shown to be suitable techniques for performing the surgery safely. GA is used most frequently. But, SA became increasingly more popular because it allows the patient to self-position thereby reducing various complications associated with GA in a prone position. METHODS: A total of 64 patients from June 2016 to July 2019 who underwent either discectomy, laminectomy, or lamino-foraminotomy for herniated lumbar disc or canal stenosis in 1 or 2 levels were included. During the study period, 32 patients were non-randomly selected for each of the GA and SA groups. The heart rate (HR), mean arterial pressure (MAP), blood loss, total anesthetic time, surgeons' satisfaction, analgesic requirements, cost of the procedure, and hospital stay were recorded and compared. RESULTS: In the context of demographic characteristics, baseline HR, or MAP, no significant differences were noted between SA and GA groups. Mean anesthetic time, mean PACU time, mean doses of analgesic requirement, cost of anesthesia, and the surgeon's satisfaction was significantly lower in the SA Group (P < 0.05). The blood loss, duration of operation, and hospital stay were not significant too. No major Intra and postoperative complications were reported nor were significant differences found in either series. CONCLUSION: Safety and efficacy of SA in comparison to GA were similar for the patients undergoing surgery on the lumbar spine. Notable advantages of SA include shorter anesthesia duration, fewer drug requirements, relative cost-effectiveness, and fewer complications rate. Successful surgery can be performed using either anesthesia type.
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BACKGROUND: Tuberculosis (TB) of the spine is a common site of osseous TB, accounting for 50%-60% of cases. Spinal TB still occurs in both developed and developing countries. The diagnosis of spinal TB is difficult and it commonly presents at an advanced stage. Delays in establishing diagnosis and management result in complications such as spinal cord compression and spinal deformity. METHODS: A total of 582 patients with TB of the cervical, thoracic and lumbar spine with moderate to severe cord compression were studied. Variable degrees of neurological deficit with deformity were treated from January, 2003 to July, 2014. Thoracotomy along with anterolateral decompression and autogenous strut bone grafting with simultaneous fixation by screws and rods were performed in 113 cases. Posterior decompression, posterior interbody and posterolateral fusion by bone graft with stabilization by transpedicular screws and rods were done in the remaining 469 cases. Appropriate anti-TB drugs were given to all patients for 18-24 months. The follow-up period was 3 months to 10 years. RESULTS: The average age was 32.5 years. All patients survived surgery. There were 7 cases of superficial infections (1.2%) whilst there were 4 cases (0.7%) of deep infections. Revision surgery was performed in 6 patients (1.0%). Implant failure occurred in 4 cases (0.7%) whilst malposition of screws occurred in 12 cases (2.1%). Perioperative bleeding complications were reported for 4 patients (0.7%). Neurological improvement occurred in all patients except for 2 cases (0.3%). Preoperatively, the majority of patients (n=221, 38%) were classified with Class A on the American Spinal Injury Association (ASIS) neurological impairment scale. This was significantly reduced postoperatively to 0.4%. CONCLUSIONS: For patients with spinal TB anterior debridement, auto graft bone fusion, anterior or posterior fixation appears to be effective in arresting disease, correcting kyphotic deformity and maintaining correction until solid spinal fusion.
