Anderson Classification Research Articles

Assessing the Nexus Between Landscape Degradation and Flooding in the Niger River Catchment, Southeastern Nigeria: A 40‐Year Geospatial Dynamics (1992–2022)

ABSTRACTThis paper examines the relationship between landscape degradation and flooding in the Niger River catchment of Onitsha, Nigeria, over a 40‐year period (1992–2022), focusing on changes in land use and land cover characteristics. Satellite images were preprocessed and classified using Anderson's classification technique. Erdas Imagine GIS software was adopted to carry out change analysis for each of the classes generated. The Landsat images for all the years (1992, 2002, 2012, and 2022) were acquired for the months of July (wet season) and December (dry season) and analyzed. The trends in seasonal changes in land use and land cover characteristics were prominent in the wet season. This was significantly seen in changes for water body and vegetative area. Built‐up areas and open spaces indicated a decrease during the wet season compared to the dry season. The notable changes occurred in water bodies and vegetation across the studied years, peaking in 1992 with 1628.82 ha for water bodies and 8993.79 ha for vegetation. In 2012, these values were 2040.93 and 8977.5 ha. The largest seasonal shifts were in vegetative areas in 2012 and built‐up in 2022. After analyzing the geospatial data according to the classifications, the study uncovers a notable link between landscape degradation and increased flood susceptibility. Notably, the findings highlight that shifts in these landscape features during the wet season significantly impact flood occurrence, emphasizing the critical role of landscape degradation in exacerbating flood risks in the region.

Open Ankle Fractures in Older Individuals: A Multi-center Study

The purpose of this study is to identify demographics, etiology, comorbidities, treatment, complications, and outcomes for older patients with open ankle fractures. Patients ≥60 years old who sustained an open ankle fracture between January 1, 2004 and March 31, 2014 at 6 Level 1 trauma centers were retrospectively reviewed. Univariate analysis using chi-squared or Student's t test was performed to identify associations between preoperative variables and 2 postoperative outcomes of interest: amputation and 1-year mortality. Multivariate analysis was performed using stepwise logistical regression to identify independent predictors of postoperative amputation and 1-year mortality. Of the 162 total patients, the most common mechanism of injury was a ground-level fall (51.9%). The most common fracture types were bimalleolar fractures (52.5%) followed by trimalleolar fractures (26.5%), with 41.5% of the fractures classified as Gustilo Anderson Classification Type 2 and 38.6% classified as Type 3A. The average number of surgeries required per patient was 2.1. Complications included: 15.4% superficial infection rate, 9.9% deep infection rate, and 9.3% amputation rate. The 1-year mortality rate was 13.6% and the overall mortality rate was 25.9%. Male gender and fracture type were found to be independent predictors for amputation after surgery (p = .009, .005, respectively). Older age and having diabetes were independent predictors for 1-year mortality after surgery (p = .021, .005 respectively). Overall, open ankle fractures in older individuals were associated with high rates of amputation and mortality.

A novel intervention for wound bed preparation in severe extremity trauma: Highly concentrated carbon dioxide bathing

IntroductionIn severe extremity trauma involving large tissue defects, early closure (e.g., free-flap surgery) of the defects is an essential step for good functional reconstruction; however, in some cases, early closure may be difficult. Highly concentrated carbon dioxide bathing, used to improve blood flow in ischemic limbs and skin ulcers, can also be applied in wound bed preparation for severe limb trauma. Patients and MethodsThe three cases in this study required an average of 13 weeks of highly concentrated carbonated bathing, which led to significantly better wound bed preparation, even in the exposed bone and tendon regions. ResultsWe successfully achieved good functional limb reconstruction in patients with deep burns and severe open fractures by reducing wound infection and facilitating good wound bed preparation. ConclusionsHighly concentrated carbon dioxide bathing was sufficient to prevent frequent wound infections, even in severe extremity trauma involving large soft-tissue defects such as deep crush burns and Gustilo Anderson classification ≥3b open fractures of the extremities. To our knowledge, such interventions have not been reported in the past and are valuable as new procedures for wound bed preparation in severe extremity trauma from both cost and wound infection control perspectives.

An Experience in Managing an open Fracture Shaft of the Femur Due to a Gunshot with Intramedullary Interlocking Nailing

Objective: To evaluate functional outcomes and complications in gunshot femur shaft fractures treated with intramedullary nailing primarily. Study Design: Prospective longitudinal study Place and Duration of Study: Department of Orthopaedic Combined Military Hospital, Nowshera, Combined Military Hospital Sialkot, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2016 to Dec 2021. Methodology: A total number of 53 cases of open fracture of the femur shaft due to gunshot were included in the study. After initial wound debridement, an X-ray was taken, and fractures were classified according to the Gustilo–Anderson classification. All fractures were fixed with titanium I/M I/L Nail in static mode by the same orthopaedic surgeon. Rehabilitation was instituted immediately after the operation, and the outcome was assessed in regards to infection, range of motion at the knee, full weight bearing and radiological union achieved. Results: Thirty-four (64.15%) patients had Type-1 fractures of the femur shaft, and 19(35.8%) patients had Type-2 fractures. Fracture union was observed in 47(88.67%) patients after three months and 6(11.32%) over the next five months. Complications were wound infections 5(9.44%), leg length discrepancy 4(7.53%), and non-union 2(3.77%) at six months. In these two cases, bone grafting was done, and union was achieved. Conclusion: Primary intramedullary (IM) is the preferred mode of treatment of Type 1 and 2 shafts of femur fractures if early good debridement is done. It avoids secondary procedures, has fewer complications and helps in early mobilization.

Factors affecting return to work time and functional outcome after low-velocity gunshot injuries related to foot in civilian population

BackgroundPurpose of this study was to identify factors affecting return to work time and functional outcomes after low-velocity gunshot injuries related to foot. Related complications are also analyzed. MethodThis study conducted as retrospective cohort study in tertiary care university hospital. Data on 26 patients obtained through retrospective database search. Type of causing weapon, anatomic location of wound, wound type according to Gustilo Anderson classification, extend of damage regarding injured structures, extend of soft tissue damage, duration of hospital stay, need of reconstructive surgery, return-to-work time, follow-up period and functional scores at final follow-up were recorded. Factors affecting functional outcome and return-to-work time were analyzed. ResultsTotal of 12 patients (46.2 %) experienced complications, with eight being deep soft tissue infections. The mean MFS score for the study group was 77.27 (±11.82). The mean MFS for the pistol group was 83.46 (±6.90), extent of soft tissue damage was an independent risk factor (OR 10.67, 95 % CI 1.70–66.72, p = 0.011) for poor outcomes. On average, patients took 10.12 months (±7.59) to return to work, the type of gun used was an independent variable associated with delayed return to work (OR 144, 95 % CI 8.04–2578.09, p = 0.011). ConclusionGunshot injuries related to foot can lead to a high rate of complications, loss of workdays, and permanent functional losses. Therefore, it is crucial to develop appropriate treatment plans and manage inevitable complications in these injuries. Level of evidenceLevel IV, Case series

Price for Care of Open Fractures of Limbs in the Surgical Emergency of the Brazzaville Hospital and University Center

Introduction: The aim of this work was to describe the emergency management of open fractures at the Brazzaville University Hospital (CHUB). Patients and Methods: this was a descriptive study with retrospective data collection from January 1 to December 31, 2022, in the surgical unit of the medical-surgical emergency department of the CHUB. All injured people hospitalized during the study period for recent open fractures whose initial treatment was carried out at the CHUB were included. The parameters studied were epidemiological, clinical, paraclinical and therapeutic. The GUSTILO Anderson Classification was used to assess the extent of skin lesions. Results: We collected 114 patients for 121 open fractures. There were 93 men (81.57%) and 21 women (18.43%), i.e. a sex ratio of 4.42. The average age was 32.4 ± 6.23 years, the etiologies were dominated by public road accidents (73.68%). The average consultation time was 4.45 hours. The pelvic limbs were affected in 80.99% of cases. Open fractures of both leg bones were the most frequent (75.20%). Type II fractures of the GUSTILO classification were in the majority (69.42%). There was one case of vascular involvement of the leg tripod and one case of radial nerve involvement. The average time for initial treatment was 8.36 ± 1.20 hours. Types I and II lesions required emergency suture before definitive treatment in 14.87% and 46.28% of cases respectively. The average time for definitive treatment was 22.91 hours. Osteosynthesis was performed in 86.78% of cases, cast immobilization with fenestration in 12.39% of cases and transfemoral amputation in 1 case. Internal fixation using an external fixator was the most frequent surgical indication (68.59%). Conclusion: Open leg fractures are very common traumatic injuries in our daily practice. Surgical treatment with an external fixator is the most commonly performed.

Anterior Segment Biometry in Primary Angle Closure Glaucoma Patients with Visual Field Progression: Comparison between Malays and Chinese.

To compare anterior segment biometry parameters in progress and non-progress primary angle closure glaucoma (PACG) among Malay and Chinese patients. A cross-sectional study was conducted between November 2015 and December 2016 involving 75 patients with PACG (43 Malays and 32 Chinese) who were recruited from a single glaucoma center in Malaysia. Ocular examination included anterior segment biometry measurements on the selected eye. Axial length (AL) and anterior chamber depth (ACD) measurement was done using a noncontact partial coherence interferometer (IOL Master, Carl Zeiss, Germany). Anterior chamber angle (ACA) was measured by Anterior Segment-OCT (Spectralis Heidelberg, Germany). Humphrey visual field (HVF) 24-2 analysis of the same eye was conducted and compared with the HVF when diagnosis was made. Progression of PACG patients was assessed according to the Hodapp, Parrish and Anderson's (HPA) classification, they were then divided into progress and non-progress groups. Comparison of anterior segment biometry parameters between Malay and Chinese PACG patients with and without progression was analyzed using independent T test. Multivariate ANOVA analysis was used to compare the anterior segment parameters between progress and non-progress PACG patients, with adjustment for age, gender, lens status, family history and presence of diabetes mellitus. Chinese PACG patients have significant shorter AL (22.18 mm ± 0.76) and narrower ACA (11.96° ± 6.00) compared to Malay PACG patients. Among the progress group, Chinese PACG patients have significant shorter AL, shallower ACD and narrower ACA compared to Malays. However, after controlling for confounding factors, there was significant difference in ACA between Malay and Chinese PACG. There was also no significant difference of ocular biometry measurement between Chinese and Malay patients in progress and non-progress group. There was racial influence in ocular biometry measurement in PACG patients. Chinese have significant narrower ACA compared to Malays. Serial AS-OCT monitoring is important in management of PACG. Neoh FP, Azhany Y, Siti-Azrin AH, et al. Anterior Segment Biometry in Primary Angle Closure Glaucoma Patients with Visual Field Progression: Comparison between Malays and Chinese. J Curr Glaucoma Pract 2023;17(1):3-8.

The Effect of Timing of Debridement and Surgical Intervention in Open Fractures on the Rate of Infection and Surgical Outcomes: A Prospective Study in a Tertiary Care Setup.

Introduction Open fractures remain one of the true orthopedic emergencies. Despite recent advances in orthopedic surgery, the management of compound fractures is still a challenge to an orthopedic surgeon. Open fractures are a result of high-speed injuries and are associated with several complications such as infections, non-unions, or sometimes an eventual amputation. Infection is the major problem associated with open fractures due to soft tissue damage, contamination, and neurovascular compromise. Presently, management of open fractures requires early aggressive debridement followed by limb salvage by definitive reconstruction or amputation, depending upon the extent and location of the injury. Early aggressive debridement of open fractures has always been the rule. However, it has been observed that open fractures managed even after six hours of injury fare well, and there are no definite guidelines available to decide the safe period of debridement following open fractures so as to prevent infection. The "six-hour rule" is a hotly debated topic with fervent perseverance of this dogma despite a gross lack of support from the literature. Objective The objective of this study was to analyze the relationship between the timing of operation/debridement on infection rates in open fractures, particularly if surgery is performed after six hours. Methods This is a prospective study of 124 patients (R=5-75 years) presenting with open fractures to the outpatient department (OPD) and emergency section of a tertiary care hospital from January 2019 to November 2020. Patients were divided into four groups based on the time to operation/debridement: groups A, B, C, and D, with patients operated within six hours, six to 12 hours, 12-24 hours, and 24-72 hours after injury, respectively. Infection rates were obtained based on the above data. ANOVA was applied using SPSS 20 software (IBM Inc., Armonk, New York). Results This study concludes that the infection rate for fractures treated in less than six hours was 18.75%; in the six to 12 hours group, it was 18.50%, and in the 12-24 hours group, it was 14.28%. The infection rate increased to 38.8% if surgery was performed after 24 hours of injury. On statistical analysis, the time to debridement was not found to be a significant factor. The infection rate in Gustilo-Anderson classification compound grade I was 2.7%, grade II 9.8%, grade IIIA 45%, and grade IIIB 61%. Also, in this study, the union rate in grade I was 97.22%, grade II 96.07%, grade IIIA 85%, and grade IIIB 66.66%. Thus, the degree of wound contamination and compounding gives a prognostic indication regarding the final outcome of the compound fracture. Conclusion Time to debridement is not a significant factor in the management of compound fractures, and these fractures can be safely debrided up to 24 hours after injury. Gustilo and Anderson's classification provides a prognostic indicator of the outcome of a compound fracture. Infection rates and non-union rates increase with increasing grades of compound fractures.

A study on the outcome of open tibial fractures managed definitively by external fixator

Introduction: High energy tibial diaphyseal open fractures are a common occurrence in modern times. In a resource strapped country like India, AO unilateral external fixator is a cheap, technically easier method for the definitive management of the same. The aim of the paper is to present the results of the treatment of 33 patients with open tibia fractures, as well as the complications that accompany the treatment of these fractures. Method: An observational prospective study was undertaken including all open diaphyseal tibia fractures with Gustilo Anderson classification Type II, IIIA, IIIB and Ganga hospital open injury severity score of 6-12. Patients underwent debridement, definitive fixation with exfix, and later Patellar Tendon Bearing Cast after removal. Outcome was measured by the Association for the Study and Application of the Method of Ilizarov Group score. Results: In 81.8% cases the mechanism of injury was road traffic accident. Mean time for complete weight bearing was 19.33 weeks, mean time for union was 26.18 months. ASAMI Radiological outcome was Excellent in 45.5%, Good in 30.3%, Fair in 9.1% and Poor in 15.2% cases. ASAMI Functional outcome was Excellent in 33.3%, Good in 51.5%, Poor in 15.2% cases. Pin tract infection was found in 39.4% and malunion in 24.2%. The mean time for union (p=0.0004), incidence of non-union (p=0.014) was found to be statistically significant to the severity of initial injury. Conclusion: Thus by this study it can be expressed that external fixator is a feasible implant in the definitive management of open tibia fractures.

Patebond technique of open patella fracture

We report a case of 29 yr old male patient with right sided transverse patella fracture in a grade Iamb open wound as per Gustillo Anderson classification due to road traffic accident. As it was an open wound we wanted an early intervention for better recovery of patients ROM around knee without any morbidity. We utilized a novel technique in which we reinforced the patellar tendons by tying it with Krakow technique and the distal pole of transverse fracture patella was tied with superior pole in a crises cross fashion by passing no 5 ethibond sutures through transosseous route in the patella. A good articular congruity with maintained reduction, a sound union without any implantation, improved ROM with rehabilitation and most importantly without any evidence of infection were the positive outcomes.

VARIOUS MODALITIES OF TREATMENT OF PROXIMAL TIBIAL FRACTURES : A PROSPECTIVE LONGITUDINAL STUDY

Background: Tibial plateau fractures are one of the commonest intra-articular fractures. They result from indirect coronal or direct axial compressive forces. This makes about 1% of all fractures and 8% of the fractures in elderly. Nevertheless, tibial plateau fractures challenging remain because of their number, variety and complexity. With advancements the treatment of each fracture type is still not defined hence we have taken up this study to analyze various fracture patterns and its outcome. : The study includes 40 patients having the fractures of the proximal tibialMethods metaphyseal; metaphyseodiaphyseal with or without intra-articular extension (including upper third fractures of tibia), closed fractures, fractures with Open grade-I wounds (Gustillo Anderson Classification).The study excludes compound fractures having grade II and III (Gustillo Anderson) and Paediatric patients. The treatment method was based on the type of fracture, the amount of displacement , the amount of depression and surrounding skin condition of the tibial plateau.We used the Schatzker classification because it is closest to describing the specific fracture type and it is easy to apply. In this study there were 40 patients with mean age of 39.18 (median 38.5 and min – max 25 to 55) with 25Results: male (62.5%) and 15 (37.5%) female with significant male preponderance. In this study road traffic accident was the commonest mode of injury (65%) and produced different types of fractures, followed by fall from height (22.5%), injury while playing sports (12.5%). The correct method of management of tibial condylar fractures depends onConclusions: good clinical judgment. If rational treatment is to be instituted the surgeon must have sound knowledge of the personality of the injury and a clear understanding of the knee examination, imaging studies and must be familiar with variety of techniques available at present for treating tibial condyle fractures.

Evaluation of seasonal ecological vulnerability using LULC and thermal state dynamics using Landsat and MODIS data: a case study of Prayagraj City, India (1987-2018).

Prayagraj city (India) has been selected as a smart city by the Ministry of Housing and Urban Affairs,Government of India in 2015. However, long-term spatiotemporal seasonal Land Use/Land Cover (LULC) dynamics and Land Surface Temperature (LST) interactions with ecological vulnerability for different seasons are lacking. Accordingly, this research has been carried out to study the seasonal (summer and winter) LULC and its change pattern, thermal dynamics, and their role in exploring the ecological state over Prayagraj city and its surroundings using multi-temporal Landsat (1987-2018) and MODIS Terra data (2007-2018) at both diurnal and nocturnal scenarios. The LULC classification was carried out using Maximum Likelihood Classifier (MLC) by adopting the Anderson classification scheme with more than 85% of overall accuracy. The Landsat data-based LST has been estimated using Mono-Window Algorithm (MWA) for diurnal scenario whereas MODIS-based LST was calculated for nocturnal scenario. Ecological vulnerabilitystate has been evaluated both in day-time and night-time using Urban Thermal Field Variance Index (UTFVI) in summer and winter during 1987-2018 and 2007-2018, respectively. Overall, built-up land increased the most by 18.25% which was responsible for massive urbanization during 1987-2018. In contrast, forest land decreased by 2.22% during 1987-2018. The most vulnerable class was agriculture land followed by forest land irrespective of seasons. Thermal state was intensified by mean LST by 1.25 ℃ in summer and 0.58 ℃ in winter in day-time. However, in night-time, the mean LST intensified by 6.64 ℃ in summer and 1.86 ℃ in winter. The excellent ecological class having no SUHI effects declined in summer during 1988-2018 by 1.59% but surged in winter by 12.33% during 1987-2018 in north-west regions at day-time, whereas in night-time the excellent ecological class having no SUHI effects severely declined in summer as well as in winter during 2007-2018 by 11.1% and 1.32%, respectively. However, the worst ecological class having strongest SUHI effects severely spread in night-times compared to day-time which mainly concentrated in central core part of the city during 2007-2018 by 5.33%. The present study has generated a comprehensive long-term geospatial database which can be used for urban planning to achieve sustainable development to make Prayagraj city a truly smart city in future.

To evaluate the outcome of vacuum assisted closure in open fractures of tibia

Despite numerous advances, compound fractures of long bones continues to be a challenge for the treating surgeon. Standard wound dressing required prolonged period, repeated debridement, trauma to granulation tissue and had poor patient compliance. Vacuum-assisted closure provides an extremely efficacious method for treating difficult wounds. This research aimed to study whether VAC gives better outcome in open fractures after primary intervention, whether it leads to faster and more effective wound healing and whether it leads to shorter length of stay in hospital. An interventional study was conducted, studying 30 cases of open tibia fractures who were fitting in the inclusion criteria. It followed Gustillo- Anderson classification to classify cases and then mapped out various conclusions on the aim of study whilst also charting the effect of the treatment in different circumstances, demographics and like. Amongst the 30 cases studied,all patients were evaluated clinically after the primary fixation and following VAC application, for an average period of follow up of 12 months. Majority of patients required 4-5 VAC dressings. The mean decrease in wound size was 9.97 cm [21.22%]. Out of 30 patients, 4 patients had excellent, 16 patients had good, 8 patients had fair and 2 patients had poor result.In this study, 30 patients were included with open fractures of tibia after primary internal fixation with VAC application. The greatest advantage of VAC was found to facilitate rapid formation of granulation tissue on wounds with exposed tissue and implants hence shorten healing time and minimize secondary soft tissue defect coverage procedures. This technique has indeed resulted in the effective decrease in wound size, and decrease in hospital stay and given a better functional outcome.

Treatment of open fracture of lower limb in high altitude area

To explore the treatment methods and experience of open fracture of lower limb in high altitude area. From January 2016 to January 2021, 62 patients with open fractures of lower limbs were treated by staged surgery with the concept of injury control orthopedics, emphasizing wound treatment and combining various fracture fixation methods. There were 51 males and 11 females, ranging in age from 14 to 59 years old, with a mean of (37.2±12.3) years old; and the course of disease ranged from 7 to 59 days, with a mean of (23.7±15.5) days. According to Gustilo Anderson classification, there were 14 cases of typeⅠ, 24 cases of typeⅡ, 14 cases of typeⅢA, 8 cases of typeⅢB and 2 cases of typeⅢC. The fracture repair and wound healing were observed, and the clinical efficacy was evaluated by Johner-Wruhs evaluation standard. Fifty-five patients were followed up, and the duration ranged from 4 to 36 months, with a mean of (14.7±8.5) months, and 7 cases were lost to follow-up. According to Johner-Wruhs evaluation criteria, 33 cases got an excellent result, 16 good, 4 poor and 2 bad. The wound healing was poor in 2 cases, partial necrosis of Achilles tendon in 1 case, nonunion of fracture in 1 case and delayed healing of fracture in 2 cases. It is an effective method to treat the open fracture of lower extremity in high altitude area to pay attention to the management of soft tissue injury, the management of wound moisturizing, staged operation of fracture and full protection of blood supply at the fracture end. Paying attention to the treatment of soft tissue injury and the management of wound moisturizing, staged operation of fracture and full protection of blood supply at the fracture end are effective methods for the treatment of open fracture of lower limbs in high altitude areas.

Validity of vetrivel trauma score in predicting salvage of limb in gustilo anderson grade III B and grade III C open fractures

There have been many classification systems developed for open fractures like Gustilo Anderson grading system, Mangled extremity severity score, Ganga hospital open injury severity score. But the gray zone still exists in many open fractures whether the limb has to be salvaged or amputated. The above-mentioned scores have poor sensitivity and specificity in evaluating open fractures. This led to the development of a novel scoring system known as Vetrivel trauma score.This study aims to assess the validity of this novel scoring system in predicting the outcome of limbs in Gustilo Anderson Grade IIIB and Grade IIIC open fractures.One hundred and forty-four open fracture cases were taken for this study. 82 patients sustained Grade III injuries according to the Gustilo Anderson classification. Of these, 35 patients were of Grade IIIB and above. These 35 patients were scored using Vetrivel Trauma score, Ganga hospital open injury severity score, and Mangled extremity severity score.Vetrivel trauma score was compared with Ganga hospital open injury severity score, and Mangled extremity severity score. Analysis indicated Vetrivel trauma scoring system is more accurate than others. The area under the curve of the receiver operating characteristic curve for Vetrivel Trauma score (0.983) is found to be significantly higher than other scoring systems compared.Vetrivel trauma score is a better predictor of injury severity in Grade IIIB and Grade IIIC open fractures with the highest sensitivity and specificity in deciding amputation versus salvage. A score of 39 or more has the highest predictability for amputation.

Epidemiologic characteristics and pre-hospital care of traumatic injuries during the COVID-19 pandemic in an emerging and developing country: A single tertiary centre experience

BackgroundPre-hospital care has been shown to reduce the mortality in trauma patients. The present study is an attempt to identify the status of pre-hospital orthopaedic trauma care in developing countries during COVID-19 pandemic. MethodsThis was a prospective observational study carried out in a tertiary care setup from March 25th, 2020 to January 31st, 2021. All the data pertaining to the traumatic injuries including demographic details and epidemiologic characteristics were recorded in an electronic database. ResultsA total of 1044 patients were included in the study for evaluation. The mean age was 35.24 ± 19.84 years. There were 873 males and 171 females. A total of 748 presented from nearby states, with 401 being the referrals and 347 cases coming directly to hospital. A total of 141 open fractures presented directly and 269 were referred from nearby states. Out of 269 cases of open fractures, only 67 and 139 were given intravenous antibiotics and had wound dressing done respectively at the periphery site. A total of 125, 112, 92 and 84 patients were received without traction/splintage, intravenous fluids, dose of analgesics and recording of vitals respectively. Delay from injury to presentation in emergency/administration of antibiotic (Hours) was 7.06. Road side accidents were main cause comprising of 52.58% cases. Gustilo Anderson classification grade-2 comprised of majority of the open fractures (51.63%). Lower limb fractures comprised of majority of the injuries (70.59%). Majority were adults and conservative management was the most common mode of treatment. A total of 197 and 265 patients had associated head injuries and blunt trauma chest/blunt trauma abdomen respectively. ConclusionEmphasizing on pre-hospital care measures, with special focus on co-ordination between primary, secondary and tertiary health care facilities is the need of the hour and can prevent additional morbidities, avoiding overburden of the already compromised healthcare centres.

Occipital condylar avulsion fractures in the acute trauma setting: Stable or unstable injury?

Occipital condylar avulsion fractures are considered potentially unstable, associated with craniocervical dissociation spectrum injuries, and thought to carry a relatively high mortality rate based on the current literature. The purpose of this study was to identify patient with acute, occipital condylar avulsion fractures and evaluate for the incidence of concomitant cervical osteoligamentous trauma and craniocervical dissociation spectrum injury on cervical spine CT and MRI. Patients who suffered an inferomedial occipital condylar avulsion fracture were identified retrospectively using Nuance mPower software. Cervical spine CT and MRI reports performed within 48h for this patient cohort were then reviewed by two CAQ certified neuroradiologists. Confirmation of an occipital condylar avulsion fracture was recorded along with any concomitant craniocervical junction injury. Relevant clinical history, including management and outcomes, was recorded for each patient. Thirty-four patients were identified with an inferomedial fracture of the occipital condyle. Of the 85% of patients who underwent cervical MRI, all but one patient demonstrated a 'negative' MRI without major craniocervical junction ligamentous injury. These patients were treated conservatively with external bracing without persistent neurologic deficits upon 4-month follow-up. Inferomedial fractures of the occipital condyle are currently classified as potentially unstable fractures based on the Anderson classification system. Our data suggest that an isolated occipital condylar avulsion fracture without an additional C1-C2 fracture or widening of the atlanto-occipital joint space is likely a stable injury that can be treated conservatively with excellent clinical outcomes.

Les pseudarthroses infectées du tibia: évaluation de la méthode d’Ilizarov avec compression distraction sans geste de débridement local

BackgroundThe treatment of infected nonunion requires radical debridement with stable fixation. Sever soft tissue compromise of the nonunion site might interfere with radical debridement. This study discussed the outcome of treatment of infected tibial nonunion with sever soft tissue compromise by a cyclic compression distraction technique using Ilizarov without radical debridement. MethodsThis study comprised 17 patients with unilateral infected tibial nonunion; 10 with diaphyseal and 7 with metaphysial locations. Their mean age was 21.9 years. There were 12 males and 5 females. The right side was affected in 11 patients and the left side in 6 patients. According toGustilo and Anderson classification, all patients were grade III. The mean limb shortening was 1.3cm. All patients were treated initially in another institute by uniplanner external fixator with rotational skin flap done in 11 patients and thiersch graft in 6 patients. One patient had common peroneal nerve affection. Distal circulation was sufficient in all patients. None of our patients had chronic diseases. Two to three cycles of gradual distraction compression were done. Each cycle consisted of distraction, followed by compression, then distraction, and lastly compression. The mean follow up period was 29.35 months. ResultsUnion was achieved in all patients at a mean time of 23.9 weeks. According to Hammer et al.; there were 8 patients with grade 1, and 9 patients with grade 2. According to Johner and Wruhs’ criteria; the outcome was excellent in 6 patients, goodin 3 patients, poor in 4 patients, and fair in 4 patients. Complications had occurred as pin tract infection(47.1%), persistent discharging sinus (5.9%), and valgus ankle deformity (11.8%). Refracture did not occur in any case till the final follow up. ConclusionAlthough debridement is essential in the treatment of infected tibial nonunion, it could harm the limb in severe soft tissue compromise. Cyclic compression distraction by Ilizarov had a satisfactory outcome in the treatment of such cases through enhancement of a biological environment to achieve union. Level of evidenceIV; prospective case series.

The Effect of Delayed Surgical Debridement in the Management of Open Tibial Fractures: A Systematic Review and Meta-Analysis.

Introduction: Open tibial fractures are complex injuries with variable outcomes that significantly impact patients’ lives. Surgical debridement is paramount in preventing detrimental complications such as infection and non-union; however, the exact timing of debridement remains a topic of great controversy. The aim of this study is to evaluate the association between timing of surgical debridement and outcomes such as infection and non-union in open tibial fractures. Materials and Methods: We performed a systematic review and meta-analysis of the literature to capture studies evaluating the association between timing of initial surgical debridement and infection or non-union, or other reported outcomes. We searched the MEDLINE, PubMed Central, EMBASE, SCOPUS, Cochrane Central and Web of Science electronic databases. Our methodology was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane handbook for systematic reviews of interventions. Results: The systematic review included 20 studies with 10,032 open tibial fractures. The overall infection rate was 14.3% (314 out of 2193) and the overall non-union rate 14.2% (116 out of 817). We did not find any statistically significant association between delayed debridement and infection rate (OR = 0.87; 95% CI, 0.68 to 1.11; p = 0.23) or non-union rate (OR = 0.70; 95% CI, 0.42 to 1.15; p = 0.13). These findings did not change when we accounted for the effect of different time thresholds used for defining early and late debridement, nor with the Gustilo–Anderson classification or varying study characteristics. Conclusion: The findings of this meta-analysis support that delayed surgical debridement does not increase the infection or non-union rates in open tibial fracture injuries. Consequently, we propose that a reasonable delay in the initial debridement is acceptable to ensure that optimal management conditions are in place, such that the availability of surgical expertise, skilled staff and equipment are prioritised over getting to surgery rapidly. We recommend changing the standard guidance around timing for performing surgical debridement to ‘as soon as reasonably possible, once appropriate personnel and equipment are available; ideally within 24-h’.

Synergic effect of corneal hysteresis and central corneal thickness in the risk of early-stage primary open-angle glaucoma progression.

To evaluate corneal hysteresis (CH), acquired with ocular response analyzer (ORA), as a risk factor for glaucoma progression in early-stage primary open-angle glaucoma (POAG). In a historical cohort study, patients diagnosed in 2011 with early-stage POAG according to the Hodapp, Parrish and Anderson classification modified for Octopus perimetry and followed up until glaucomatous progression development; otherwise, observations were censored in October 2018. Cox regression was used to obtain hazard ratios (HR) to evaluate baseline variables (CH, central corneal thickness, gender, age IOP and glaucoma family history) as risk factors for perimetric glaucoma progression. A likelihood ratio test for interaction was performed in order to assess the effect of the combination of CH and CCT on the risk of progression. Of the cohort of 1573 patients, 11.38% developed early-stage POAG progression during the follow-up. The mean follow-up time was 3.28 ± 1.92years. Patients without progression had a higher CH (11.35 ± 1.43 vs 9.07 ± 1.69mmHg; p < 0.001) and CCT (570.75 ± 17.71 vs 554.51 ± 23.20; p < 0.001). In the multivariate analysis, each 1mmHg of lower CH was associated with an increase of 2.13 times in the HR of progression (95% CI: 1.92-2.32; p < 0.001). CH hazard ratio was modified by CCT, with higher values of CCT and CH resulting in a higher HR of early glaucoma progression (p < 0.001). CH can be considered as a risk factor of progression in early-stage POAG. The risk associated with CH changed depending on CCT values, acting synergistically slowing the risk of glaucoma progression with higher values.