Comminuted intra-articular distal radius fractures (DRFs) present significant treatment challenges due to their complex morphology and tendency for post-traumatic arthritis. Volar plating alone may be insufficient to achieve and maintain reduction in dorsally displaced fractures. This prospective study evaluated the radiological and functional outcomes of dorsal-assisted volar plate fixation in dorsally displaced comminuted intra-articular DRFs. A total of 21 patients treated at a tertiary care trauma centre were enrolled. All underwent dorsal-assisted reduction followed by volar plating without dorsal instrumentation and were followed for a minimum of one year (mean follow-up: 19.6 ± 4.7 months). Radiological outcomes were assessed using radial height, radial inclination, volar tilt, and intra-articular step-off, while functional outcomes were measured using the QuickDASH and modified Mayo Wrist scores. The study was prospectively registered in the Department review board in department of Orthopaedic Surgery, PGIMER, under registration number DRB/Ortho/2023/49. The mean patient age was 38 years, with a male predominance (17/21; 80.9%). Most fractures (15/21; 71.4%) were AO type 2R3C3. Postoperative evaluation demonstrated restoration of wrist alignment with a mean radial inclination of 23.35°, radial height of 11.29 mm, and volar tilt of 6.70°, closely approximating the uninjured wrist. Functional outcomes improved significantly from two months postoperatively to the final follow-up (P < 0.001), achieving a mean QuickDASH score of 4.95 and a modified Mayo Wrist Score of 90. Only two patients experienced minor complications related to implant prominence. Dorsal-assisted volar plating is a safe and effective technique for managing dorsally displaced comminuted intra-articular distal radius fractures, providing excellent anatomical restoration and functional recovery with minimal complications. It offers a valuable surgical option where volar plating alone may be inadequate.

This study evaluates the efficacy of VELVERT, a novel antimicrobial dressing, compared to the standard Silver Sulfadiazine dressing in treating second-degree burns. Conducted at a tertiary burn care center, 63 patients were enrolled and randomized into two groups: VELVERT (n = 31) and Silver Sulfadiazine (n = 30). The primary outcomes measured were wound closure percentage and time to complete healing within 24 days, while secondary outcomes included infection control, pain relief, and adverse events. The study was registered with CTRI with the registration number CTRI/2020/12/029698 (https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NDY5MDc=&Enc=&userName=). Among 61 patients who completed the study, 87% (27/31) in the VELVERT group achieved complete wound healing compared to 63% (19/30) in the Silver Sulfadiazine group. The BWAT score, assessing wound healing, showed a decline from 31.66 ± 3.15 to 15.55 ± 4.42 in the VELVERT group and from 31.55 ± 3.35 to 16.18 ± 5.37 in the Silver Sulfadiazine group (P = 0.176). Both treatments were well tolerated, but VELVERT exhibited superior wound healing outcomes. These findings suggest that VELVERT may serve as a more effective alternative for second-degree burn treatment, offering improved healing rates. Further research with larger sample sizes is recommended to validate its clinical benefits over standard treatments.

Pediatric burn injuries present unique challenges due to children's physiological vulnerabilities. This article provides a detailed analysis of the nutritional management of an 11-year-old patient with extensive burns affecting 60% of total body surface area. The patient received intensive care in a specialized pediatric burn unit, highlighting the fundamental role of nutrition in counteracting catabolic states and muscle loss frequently observed in these cases. Nutritional strategies-including gastrostomy infusion, albumin supplementation, and protein-enriched diets-were carefully implemented to optimize energy intake and promote wound healing. The article also reviews the metabolic and immunological responses of burn patients, emphasizing the importance of early nutritional support to mitigate hypermetabolism and enhance immune defense. Key elements of nutritional assessment, such as energy requirement estimation and macronutrient composition, are explored. Furthermore, the role of micronutrient supplementation in accelerating wound healing and reducing infectious complications is underscored. The article concludes by highlighting the evolving landscape of pediatric burn care, stressing the importance of interdisciplinary collaboration and the integration of advanced technologies to achieve precise nutritional interventions. This case study provides valuable insights into optimizing nutritional strategies for pediatric burn patients and contributes to the advancement of pediatric critical care.

Background: Closed reduction and casting remain the gold standard treatment for tibial shaft fractures in children and adolescents. However, surgical intervention is indicated in cases of unstable fractures, open fractures, polytrauma, compartment syndrome, and fractures with severe soft tissue injury. The present study aimed to evaluate the safety and efficacy of Titanium Elastic Nailing System (TENS) in the management of compound tibial shaft fractures in children and adolescents. Methods: This retrospective study reviewed 18 cases of tibial shaft fractures treated with TENS from 2018 to 2021. Clinical outcomes were assessed based on fracture alignment, delayed union, non-union, infection, range of motion (ROM) of the knee and ankle, limb length discrepancy, and time to fracture union during follow-up visits. Outcomes were classified according to Flynn's criteria. Results: All patients achieved fracture union at a mean duration of 11.6 weeks, with full weight-bearing permitted at an average of 10 weeks. Limb shortening was observed in 4 patients. There were no cases of delayed union or non-union. At the final follow-up, 10 patients demonstrated excellent outcomes, while 8 had satisfactory outcomes. The most common complication was infection at the fracture site, observed in 6 patients. Conclusion: TENS is a safe, reliable, and effective treatment modality for compound tibial shaft fractures in children and adolescents. It facilitates rapid fracture healing with an acceptable complication rate.

Altered hip biomechanics following intertrochanteric fracture fixation can result in impaired mobility, decreased functional outcomes, and a reduced quality of life. Despite achieving optimal reduction and fixation, patients often fail to regain their pre-injury activity levels. This study aims to evaluate how changes in hip biomechanics after intertrochanteric fracture fixation using a proximal femoral nail impact the quality of life. This prospective cohort study, conducted from July 1, 2020, to June 30, 2022, included individuals aged 18 years and older with isolated intertrochanteric fractures managed using the Proximal Femur Nail Antirotation 2 (PFNA2). Clinical assessments included range of motion, pain levels, abductor strength, the modified Harris Hip Score (HHS), and the Parker and Palmer Mobility Score (PPMS) at 6 weeks, 3 months, and 6 months' post-surgery. Hip biomechanics were evaluated radiographically through parameters such as telescoping, tip-apex distance (TAD), neck-shaft angle, and femoral offset. These findings were correlated with functional scores and health-related quality of life (EQ5D-EuroQol 5 Dimension) score. Out of 47 eligible patients, only 30 could be followed up for six months due to the COVID-19 pandemic, and three patients died in the postoperative period. 25 of 33 patients were over 60 years old. Twenty-nine patients had unstable fractures. All patients had hypovitaminosis D, and 92% of patients had osteoporosis. Fracture union occurred in all cases, with a mean union time of 2.9 ± 0.8 months. Radiographic evaluation showed minimal changes in tip-apex distance and other hip biomechanical parameters (femoral offset, neck shaft angle, telescopy). Functional scores, including modified Harris Hip score and health-related quality of life (HRQOL) measures, improved significantly after surgery. However, at six months, these scores were lower than pre-injury levels. Walking ability varied considerably between age groups (< 60 years' vs > 60 years) at 6 weeks, but abductor strength did not differ significantly in subsequent follow-ups. Poor bone quality, characterized by osteomalacia and osteoporosis, is significantly associated with intertrochanteric fractures in Indian populations. The PFNA 2 nailing system effectively maintains reduction and prevents varus collapse. Functional outcomes and HRQOL improve over time with intramedullary fixation, yet patients seldom return to pre-injury levels, potentially influenced by recall bias.

The clavicle displays significant motion across all three anatomical planes, which poses challenges for achieving rigid internal fixation. While adding a second plate can increase construct stability, concerns exist about the potential compromise of the periosteal blood supply. This study evaluated the union rate, complications, reoperation rates, and functional outcomes of using an extra periosteal dual-plate fixation as an alternative to the conventional single-plate fixation for acute clavicle fractures at 1-year follow-up. In this prospective study (May 2023-May 2024), 25 patients with acute clavicle fractures underwent open reduction and internal fixation within four weeks of injury. Dual orthogonal plating was performed in all cases meeting inclusion criteria (midshaft or lateral-third fractures) and also in patients requiring revision after failure of a primary single plate. All procedures were extraperiosteal to preserve blood supply. Patients were followed for a minimum of one year. Outcome measures included radiographic union (regular interval X-rays) and functional recovery assessed by the Constant-Murley shoulder score. Complications and any reoperations were recorded. Institutional ethical approval was obtained and informed consent was taken from all patients. A total of 25 patients (7 females, 18 males; mean age 39.7 ± 10.0 years) were treated and followed for an average of 11.3 ± 4.1 months. Of these, 23 patients (92%) underwent dual plating primarily (20 midshaft [80%] and 3 lateral-end [12%] fractures), and 2 patients (8%) had dual plating as a revision after failed single plating. By final follow-up, all 25 fractures achieved full bony union with no cases of nonunion or implant failure. The average time to union was ≤3 months in 15 patients and >3 months in 10 patients; all delayed unions had healed by one year without additional intervention. Shoulder function improved steadily, with mean Constant-Murley scores of 76.2 ± 6.1 at 6 weeks, 83.5 ± 3.5 at 3 months, and 92.2 ± 3.0 at 6 months post-surgery. According to Constant score categories, 20 patients (80%) had "very good" shoulder function and 5 patients (20%) had "good" function at final follow-up. Complications were infrequent: 2 patients (8%) developed superficial wound infections (resolved with antibiotics), and 6 patients (24%) experienced implant prominence/irritation. No hardware breakage, loosening, or refracture occurred, and no patient required reoperation for hardware-related problems within the follow-up period. Dual-plate augmentation of acute clavicle fractures proved to be a reliable fixation strategy in this series, yielding a 100% union rate and a low incidence of complications. The application of a second plate in complex or highly unstable clavicle fractures did not adversely affect fracture healing or increase complication rates. In cases of failed single-plate fixation, revision with dual plating facilitated successful union and good functional outcomes. The primary drawback observed with dual plating was implant prominence in some patients, suggesting a need for further refinements to minimize hardware profile.

Skin burns can occur due to exposure to heat, chemicals, electricity, or sunlight, and can cause significant damage to the skin. Burns are classified based on their severity. Research has indicated that herbal extracts may help treat burns. This study aimed to assess the effectiveness of Stachys Lavandulifolia extract ointment in healing burn wounds in rats. In this study, the efficacy of Stachys Lavandulifolia ointment was evaluated in treating second-degree burns by comparing it with silver sulfadiazine ointment. The study involved preparing Stachys Lavandulifolia extract in 2% and 4% concentrations. Thirty Wistar rats were divided into six groups, including a negative control group, a positive control group, and groups treated with silver sulfadiazine ointment, Stachys Lavandulifolia extract at 2% and 4% concentrations, and Eucerin ointment. The study found that applying 2% Stachys Lavandulifolia ointment is effective in treating second-degree burns. Biochemical analysis revealed significant differences in tissue FRAPS levels between the normal control group and the groups treated with 2% Stachys Lavandulifolia, 4% Stachys Lavandulifolia, and 1% silver sulfadiazine ointment. Statistical analysis indicated that on day 21, the burn area in the 2% and 4% Stachys Lavandulifolia ointment groups was significantly smaller than in the positive control and Eucerin groups. The Stachys Lavandulifolia ointment, with its antioxidant ingredients, can potentially prevent oxidative damage, lower inflammatory factors, and speed up the healing process for burns.

The diabetic foot ulcer (DFU) is a common and serious complication of diabetes mellitus, which occurs in 15-25% of diabetic patients at some point in their lives. However, most of the Diabetic foot ulcers (DFUs) do not heal with conventional methods of wound care and progress to become chronic, non-healing ulcers with high morbidity, mortality, and economic stakes. Some of the recent techniques in the management of ulcers include Systemic Hyperbaric Oxygen Therapy (s-HBOT), Platelet-Rich Plasma (PRP), Vacuum-Assisted Closure (VAC) Therapy, and Negative Pressure Wound Therapy (NPWT) that aim at improving the ulcer healing rate and minimize the risks of amputation. This work intends to conduct a comprehensive meta-analysis of the effectiveness, healing time and effect on amputation of these advanced treatment modalities on management of DFUs. The present study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the reporting of systematic reviews and meta-analysis of randomized controlled trials. Information was obtained from 10 researches that considered different types of DFU treatment. The major end-points studied were rates of ulcer healing, time to heal and frequency of lower extremity amputations. The meta-analysis was conducted using R statistical software and the synthesis of results was done using forest and funnel plots. The pooled analysis showed that NPWT significantly improved ulcer healing rates (OR = 2.07, 95% CI: 1.09-3.05) and reduced time to healing (Mean Diff = -22 days, 95% CI: -41.60 to -2.40). HBOT, particularly s-HBOT, demonstrated a substantial reduction in amputation rates (OR = 0.08, 95% CI: -0.11-0.28). PRP also showed promise, especially in reducing healing time (Mean Diff = -25 days, 95% CI: -34.80 to -15.20), though with more variability across studies. The results of NPWT were found to be significantly superior for ulcer closure and reduced healing time making it the treatment of choice for DFUs. Compared to controls, both HBOT and s-HBOT were strikingly effective in averting amputations. PRP had the possibility of being used as supplementary treatment especially in treatment with regard to the aspect of promotion of healing. Collectively, these results suggest that it is possible to use such advanced therapies to enhance the treatment of DFU; however, more effort is required to refine the protocols of such therapies and determine the sources of a differential response.

Tracheal intubation (TI) is an essential skill for various healthcare providers, including emergency medicine specialists and anesthesiologists. The ramped position has been hypothesized to facilitate TI. In this study, we assessed the success rate of the semi-sitting position compared with the supine position in emergency intubation. In this double-blind clinical trial, 162 traumatic patients admitted to the emergency department at Al-Zahra Hospital were randomly assigned to three groups. Patients in Group I underwent TI in the supine position. Patients in Group II underwent TI in a semi-sitting position at a 25-degree angle, while Group III underwent TI in a semi-sitting position at a 35-degree angle. The Cormack-Lehane (C-L) grade and the number of intubation attempts were compared among the groups. Our findings showed a significant reduction in the number of intubation attempts in Groups II and III compared to Group I (P < 0.001). However, the semi-sitting positions (Groups II and III) were associated with a higher incidence of Grade III and IV C-L views, indicating poorer glottic visualization (P < 0.01). The semi-sitting (ramped) position improves the success rate of TI by reducing the number of intubation attempts. However, it significantly worsens glottic visualization, which may pose challenges during airway management. Further studies are needed to optimize patient positioning in emergency intubation.

Unstable intertrochanteric (IT) fractures, particularly in elderly patients with low bone mineral density, pose significant treatment challenges. Proximal femoral nail anti-rotation-II (PFNA-II) is widely used, but the optimal implant length (short vs. long) remains debated. The objective of this study was to compare the clinical and functional outcomes of short versus long PFNA-II implants in unstable IT fractures. A prospective comparative study was conducted at a tertiary hospital from November 2018 to November 2020. Adult patients (age ≥18) with recent (≤3 weeks) unstable IT femur fractures were included. Unstable fractures were defined by comminution of the posteromedial cortex, a compromised lateral wall (including reverse obliquity), or subtrochanteric extension. Patients with pathological fractures (other than osteoporosis), open fractures, polytrauma, pre-existing ipsilateral hip pathology, or non-ambulatory status were excluded. Patients were allocated to short PFNA-II (n=38) or long PFNA-II (n=40) groups based on the surgeon's intraoperative judgment (no randomization). All patients underwent standard reduction on a fracture table and fixation with PFNA-II. Postoperative mobilization and weight-bearing protocols were adjusted according to fracture stability and fixation quality. Outcome measures included fracture union time, complications, and the Harris Hip Score (HHS). Statistical significance was set at P<0.05. Both groups had similar demographics, fracture types, and surgical durations (P>0.05). Fracture union was achieved in 94.7% (36/38) of short-nail patients and 90% (36/40) of long-nail patients, with no significant difference in union rates or time to union (mean ~14 weeks, P>0.05). The short PFNA-II group demonstrated a significantly higher final HHS (87.2±7.1 vs. 82.3±7.8, P=0.03), with 89.5% achieving good/excellent outcomes vs. 62.5% in the long-nail group. Postoperative complications differed in pattern: anterior thigh pain was more frequent in short nails (15.8% vs. 2.5%), whereas mechanical complications (varus collapse >5°, helical blade lateral migration) were more common in long nails (15% vs. 5.3% varus collapse; 10% vs. 2.6% blade migration). However, overall complication rates were not significantly different between groups (P=0.17). No deep infections, implant breakage, or cut-out occurred in either group. PFNA-II fixation is effective for unstable IT fractures with high union rates and low major complication rates in both implant groups. Short PFNA-II nails yielded superior functional outcomes and fewer mechanical complications compared to long nails in similar unstable fracture patterns. These findings suggest that implant length plays a crucial role in optimizing patient outcomes. In most cases of unstable IT fractures, a short PFNA-II appears advantageous, though patient anatomy (e.g. extreme femoral curvature) and fracture morphology should be considered when selecting implant length.