A Case Report of Bilateral Asymmetrical Traumatic Hip Dislocation - A Rare Presentation.

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.

Effectiveness of anterior subcutaneous internal fixation (INFIX) in the management of potentially infected pelvis fractures.

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.

Result of conservative management in central fracture dislocation of hip.

The central fracture dislocation of hip involves displacement of medial wall and superior weight bearing dome of acetabulum. The management of this type of fracture is to be planned after meticulous clinical and radiological planning of the personality of fracture along with status of the patient. Ideally displaced fracture should be treated by anatomic reduction, stable internal fixation and early non-weight bearing exercises. But considering the complications of open reduction and internal fixation we must take into account the "risk benefit equation" ie, to measure the benefit gained against the risk of surgery. Dynamic stress fluoroscopic examination under general anaesthesia was performed to assess the need for surgical treatment for central fracture dislocation of hip. Stable hips were treated nonoperatively, and unstable hips were treated by open reduction and internal fixation. Every patient had routine clinical and radiographic follow-up at one week, three weeks, six weeks, three months, six months, and one year after the injury and then on yearly basis. Harris' hip score was used for evaluation. Institutional review board approval was obtained prior to initiation of this study. All 14 patients in this study were evaluated radiologically and functionally for a minimum of two years after the injury (average 2 years; range 2 to 5 years) and were graded as excellent, good, fair and poor using the Harris' hip score. Excellent results were obtained in 6 cases (42.85%), good results in 3 cases (21.42%), fair results in 4 cases (28.57%) and poor result in one case (7.14%). Central fracture dislocation of hip is an intra-articular fracture of weight bearing joint, so it is supposed to be managed better by open reduction and stable Internal fixation followed by early movement. But with meticulous evaluation and selection of cases, proper conservative management gives comparable results to the open reduction and internal fixation group even in young patients where secondary congruency is achieved. To conclude conservative management is an effective modality of treatment in appropriate cases of central fracture dislocation of hip.

Use of fasciocutaneous flap for open-type III B tibial fractures--clinical experience and analysis.

Full thickness soft tissue defect over tibia is a big problem. Between December 2004 and July 2006, 20 patients of open Gustilo type IIIB tibial fractures were treated with fasciocutaneous flap after initial external fixation and control of infection done as evidenced by negative culture sensitivity test. The flap was chosen from the area between superior flexion crease of the calf at the popliteal fossa to the junction of the middle and inferior thirds of the posterior calf. The delay in flap surgery was mostly due to associated infection. Good results with satisfactory union were achieved in 85% cases. Infection occurred in 2 cases (10%). Marginal and full thickness necroses in this series were seen with sural flap; 2 cases (10%) developed partial necrosis of flap which was managed by skin graft and 1 (5%) developed full thickness necrosis. Fasciocutaneous flap helps in fracture union, control of infection and improves the functional outcome.

Change of patellar height with age and sex.

Patellar height is one of the important parameter in patellar stability. Growth spurt or excessive physical strain can lead to high-riding patella or patella alta. But this is not yet proved. This study was mainly targeted at eliciting the influence of age on Insall-Salvati index, one of the important index to measure patellar height. As the present study is meant for measuring the patellar height separately in male and female, it is also to find out the effect of gender on patellar height if any. The study was been conducted in North Bengal Medical College and Hospital among 93 subjects covering both adult and adolescent age groups. Patellar height of respective subjects was measured radiologically using Insall-Salvati Index; results were extrapolated for statistical analysis. It revealed that value of Insall-Salvati index was higher in adult compared to adolescent group but the difference was not statistically significant. Statistical tests shows no significant difference in Insall-Salvati index according to sex. While screening the athletes patella alta must be kept in mind as this can be associated with patellofemoral pain syndrome, chondromalacia patellae, knees with apophysitis of tibial tubercle (Osgood-Schiatter disease). Not only that, significant cause of recurrent patellar dislocation can be associated with patella alta