Irreducible Overlapping Pubic Symphysis Dislocation Managed with Distraction Osteotomy of the Contralateral Superior Pubic Ramus: A Rare Case Report.

INTRODUCTION: Overlapping pubic symphysis dislocation (OPSD) or a locked pubic symphysis is a compression of the pelvic ring with the intact pubis trapped into the contralateral obturator foramen. Reduction can be difficult and contralateral suprapubic osteotomy is a good way to address the irreducible OPSD. The technique has only been discussed thrice in the available literature. CASE REPORT: We report the case of a 26-year-old man who had his right pubic ramus entrapped within the contralateral obturator foramen, having an overlap of >4 cm with associated ipsilateral sacroiliac joint (SI joint) disruption and urethral injury. When all the maneuvers of closed and instrumented open reduction failed, we performed a superior pubic ramus osteotomy on the left side and unlocked the incarcerated right pubic ramus. The osteotomy site was stabilized with a 6-hole recon plate and SI joint was stabilized with a 6.5mm percutaneous sacroiliac screw. The patient underwent delayed urethral repair at 10 weeks after the index surgery. At 3-year follow-up, the patient did not report any pubic discomfort, urinary and sexual problems. CONCLUSION: Locked OPSD is a rare injury and is frequently associated with sacroiliac and urethral injuries. Distraction osteotomy of the contralateral superior pubic ramus is a viable option for irreducible cases.

Preparatory phase for clinical trials of COVID-19 vaccine in Nepal.

Public health data suggested a rapid rise in COVID-19-confirmed cases in Nepal along with increased deaths. There has been a wide variation in clinical outcomes of this disease. Control of this pandemic depends on the availability of vaccines or drugs for SARS-CoV-2. Thus, viral and human genetics/genomics and immunology are necessary to understand whether these factors will affect clinical trials of vaccines in Nepal.

Single long midline incision versus two small incision techniques in treatment of Schatzker type V and type VI tibial plateau fractures--a comparative study.

Tibial plateau fractures had been treated with single long midline incision technique traditionally. But recently two-incision technique is becoming popular Tibial plateau fractures are generally classified according to the method developed by Schatzker. Schatzker types V and VI fractures are high-energy fractures often accompanied by other injuries and complications, such as postoperative inflammation, wound problems and infections. It was a prospective randomised study where 56 patients with Schatzker types V and VI were included in the study group. Alternatively all were allocated in the two groups ie, two small incision and one midline incision. Two incision was better than single midline incision in terms of posteromedial collapse, postoperative infection, skin necrosis. Operative fixation of complex fractures of the tibial plateau remains quite difficult and is associated with postoperative functional limitations in a large percentage of patients. Dual plating through an anterolateral and posteromedial approach is recommended in fractures complicated by a significantly displaced posteromedial fragment or depression of the medial articular surface.

Management of pathological fracture in patients with primary hyperparathyroidism.

Primary hyperparathyroidism due to parathyroid adenoma is sporadic in nature and seldom symptomatic. Patients usually present with pathological fractures. The objective of this study was to diagnose primary hyperparathyroidism in patients presenting with pathological neck of femur fractures, detection of the adenoma or ectopic tissue, removal of the tissue, and treatment of the fracture. All patients presenting with pathological fracture neck of femur, with clinical features suggestive of hyperparathyroidism were investigated for blood calcium, alkaline phosphatase, parathyroid hormone. If found to be raised patients underwent nuclear scan for detection of primary hyperparathyroidism. Primary hyperparathyroidism (usually parathyroid adenoma) when found was excised. After 2 weeks fixation of fracture was done. Follow-up at 6 weeks, 12 weeks, 6 months, 1 year were done. Time to radiological union, functional assessment and other systemic complaints were noted. Nine patients were included in the study as they presented with pathological fracture due to hyperparathyroidism. All except 1 were due to parathyroid adenoma. Excision of the tumour with early fracture fixation lead to quick rehabilitation of the patient. All fractures united. Hyperparathyroidism is asymptomatic in many patients, and may present only with a fracture. Orthopaedicians should keep this possibility in mind while diagnosing these cases, failure to which may result in disastrous complications.

Transportal versus transtibial drilling technique of creating femoral tunnel in arthroscopic anterior cruciate ligament reconstruction using hamstring tendon autograft.

Drilling of femoral tunnel by transtibial technique is widely used in arthroscopic anterior cruciate ligament (ACL) reconstruction. Recent studies suggest in this technique graft is placed in non-anatomical position leading to instability. If the femoral tunnel is drilled through an anteromedial portal (transportal technique), graft can be placed more anatomically leading to better knee stability theoratically. The purpose of this study is to compare the clinical outcome of transtibial technique and transportal technique for drilling of femoral tunnel in arthroscopic ACL reconstruction using hamstring tendon autograft. All patients operated between January 2009 and September 2011 were approached for eligibility. Blinded assessment of IKDC score, Lachman test, pivot shift test, time of recovery from surgery were obtained from both the transtibial and transportal groups. The transportal group shows significantly better IKDC score, higher anteroposterior knee stability by Lachman test and lower recovery time from surgery.

An evaluation of operative management of displaced volar Barton's fractures using volar locking plate.

Volar Barton's fractures are common but more convincing treatment methods are still controversial. Malunion can cause serious disability. Twenty-six consecutive patients were treated with open reduction Internal fixation using volar locking plate. Records of 21 cases were available for follow-up for a mean period of 18 months (range 12-34 months). All 21 fractures healed within 8 to 14 weeks (mean 9.3 weeks). The wrist function was satisfactory in 90.4% cases (19 out of 21 patients). This surgical technique can provide high success rate. Locking plate has better efficacy in terms of immediate stability, maintaining anatomic reduction and early mobilisation.