Common Mode Of Injury Research Articles

A Study of Functional Outcome of Retrograde Intramedullary Interlocking Nailing in Treatment of Supracondylar Femoral Fracture

INTRODUCTIONFractures of the distal femur are usually sustained from high velocity trauma in adults and trivial fall in elderly. These fractures are usually associated with severe degree of comminution and intra-articular involvement. Therefore, anatomical reduction of fracture fragments, restoration of limb length, and early mobilization are key factors for optimal outcomes of involved limb. This longitudinal study was intended to evaluate the functional outcome of distal femoral fracture in adults managed surgically by Retrograde Nail. MATERIAL AND METHODSThis prospective and observational hospital based study was carried out in Orthopedics Department, Universal College of medical Sciences-Teaching Hospital (UCMS-TH) from July 2020 to June 2021. All patients with traumatic distal femoral fractures (AO/OTA type A) who fulfilled the inclusion criteria were enrolled in the study and were treated surgically by Retrograde Nail. Fracture was classified according to AO/OTA classification and functional outcome was assessed according to Neer’s scoring system. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months. RESULTSIn this study of 30 cases, male to female ratio was 3:2 with mean age of 39.47 years. Road Traffic Accident (RTA) was most common mode of injury. The functional outcome evaluated according to Neer’s scoring system was found good result in 43.3%, excellent in 36.7%, fair in 16.7% and poor in 3.3%. The mean Neer’s score was 78.9. CONCLUSIONDistal femoral fractures (AO/OTA type A) when treated with retrograde nailing has good to excellent functional outcome in majority of cases with minimal manageable complication.

The Outcome of Trauma Patients in the Mixed Semi-closed Intensive Care Unit

INTRODUCTIONNepal due to its geographical condition, inadequate resuscitation on time, and lack of full-time intensivist in a trauma team is a cause of trauma-related morbidity and mortality. MATERIAL AND METHODSIt was a prospective, descriptive observational cross-sectional study in a level three intensive care unit of National Medical College for six month. All patients >18 years with a history of road traffic accidents, falls, drowning, physical assaults, and self-inflicted violence admitted to the mixed intensive care unit of a tertiary care hospital were included in this study. RESULTSOne hundred and ninety-one patients were included in this study. 152(79.5%) were males and 39(20.4%) were females. A road traffic accident was the most common mode of injury in 166(86.9%) patients. 178(93.1%) patients survived and went home, 10(5.3%) expired, 2(1%) left the hospital against medical advice (LAMA) and 1(0.5%) gave do not resuscitate orders (DNR). The mean days on the mechanical ventilator was 3.39±2.57 days. Mortality in an intubated patient was 8.6%. Mean LOS in the ICU was 4.28±4.12 days. SOFA and APACHE II scores were a good predictor of outcome, with the SOFA score being the most effective Injury severity score predicted mortality with a sensitivity of 88.9%, a specificity of 22%, with an AUROC curve of 0.543±0.092 with cut off score of 5.5. CONCLUSIONRaising public awareness, and strictly following the traffic rules can help in reducing the incidence of trauma. Trauma team consisting of full-time intensivists should be established to decrease the mortality in the intensive care unit.

Etiological Characteristics and Treatment Outcomes of Eye Lid Laceration: A Hospital Based Prospective Study

Introduction: Lid laceration is a very common peri-ocular trauma. Regarding the etiology and treatment, it lacks studies in developing nations including Nepal.
 Aims: To assess the etiological characteristics and treatment outcomes of eyelid laceration.
 Methods: In this study, 47 cases of traumatic eyelid laceration were consecutively studied and its epidemiology, etiology and treatment outcome were evaluated.
 Results: The 47 patients were included in the study. The mean age of study population was 26.14 ± 18.02 years. Male: female ratio was 1.6:1. The trauma occurred on road in 34 (72.3%) cases, followed by at home (14.9%), at work place (8.5%) and at entertainment areas (4.2%). The most common mode of injury was road traffic accident (72.3%) followed by fall injury (17%), Physical assault (6.4%) and animal bite (4.3%). The 68.1% of had isolated lid laceration, 12.7% had other adnexal injuries and 10.6% had globe injuries, 8.5% had other facial injuries and only 4.1% had systemic trauma. The partial thickness laceration was observed on 42(89.4%) cases and full thickness laceration on 5 (10.6%) cases. The length of lid laceration ranged from 4- 45 mm (mean ±SD was 14.7±8.3 mm). The 14.9% cases had canalicular laceration. The 85% of the laceration healed without visible scar. Only 4 patients (8.5%) had thick hypertrophic scar. The visual function was intact in 44 patients whereas impaired in 3 patients with accompanying open globe injury. The complications noted were hypertrophic scar (8.6%), wound infection (2.1%), ectropion (2.1%), corneal opacity (2.1%) and phthisis bulbi (2.1%).
 Conclusion: This study highlights the high-risk people and work place for eyelid laceration and the safety precautions in dangerous settings, including daily and routine work places. Only accompanying open globe injury can damage visual function.

Clinical Characteristics of Pediatric Thoracolumbar Spinal Injuries: A Retrospective Study

Aim: To determine the clinical characteristics of pediatric thoracolumbar spinal injuries Study design: A retrospective study Place and Duration:This study was conducted at Pakistan Institute of Medical Sciences Islamabad from Jan 2021 to Jan 2022 Methodology:An analysis of pediatric thoracolumbar (TL) injuries was conducted to determine the epidemiology, risk factors, mechanisms, patterns, and management of pediatric TL injuries. A plain radiograph (anteroposterior and lateral view) was taken on all patients for diagnosis. In the case of surgical intervention or doubtful skeletal abnormalities observed on plain radiographs, thin-slice computerized tomography (CT) scans were obtained. In patients with neurological deficits or those who were scheduled for surgical intervention, magnetic resonance imaging (MRI) was performed. Results:A total of 90 children were treated at our institute for TL spine injuries, representing 2% of all spine injuries. Males predominate (3:1) with a mean age of 15.9 plus 3.2 years (range: 2–18 years). Falling from a height was the most common mode of injury. Most children (71.1%) sustained injuries after falling from height, 18/90 (20%) after a motor vehicle accident, and the rest after a heavy object fell over their neck. A total of 27.8% of the patients (the majority) had Grade A injuries. The most common spinal level injured was the lumbar spine (53.3%), and fractures accounted for 93.3% of all injuries. A total of 18/90 (20%) children underwent surgical fixation. There were 21 children available for follow-up, of which 13 (62%) were ambulant. Conclusion:The lumbar area is most affected by TL injuries, which are uncommon and most often occur in youth older than 10 years. When necessary, a surgical fusion of the affected vertebrae is a secure and reliable procedure. Keywords: Pediatrics, epidemiology, spine, thoracolumbar, injury

Medial Malleolar Fracture Management—A Comparative Study of Radiological Outcome between Open Reduction Internal Fixation and Closed Reduction Percutaneous Fixation

Background Medial malleolus fracture is commonly seen nowadays in orthopaedic practice. There are different modalities of treatment based on fracture pattern and socioeconomic status. Undisplaced fracture can be managed by cast application. Various surgical modalities of treatment are available in treating medial malleolus fracture like tension band wiring, cancellous screw or cortical screw fixation, plate fixation, Kirschner wire, and suture anchors. The purpose of our study was to evaluate radiological outcome of medial malleolus fracture managed with open reduction internal fixation and closed reduction percutaneous fixation. Materials and Methods Our study included 67 patients who met inclusion criteria and were divided into two groups. Group 1 included 52 patients with medial malleolar fractures cases and were treated with open reduction and internal fixation either by cancellous screw fixation or tension band wiring. Other 15 patients in group 2 were treated by closed reduction and internal fixation with cannulated cancellous screw. All postoperative patients were evaluated at 1st month, 2nd month, 3rd month, 6th month, and 1 year. We evaluated patient clinically and radiological union of fractures. Results In our study out of 67 patients there was male preponderance and average age was 46.55 years. Right-side fractures were more compared with left-side fractures. Most common mode of injury was road traffic accident. Transverse fracture pattern was more in number in our study. Average union time in group 1 was 13.46 weeks and group 2 is 15.14 weeks. Fracture union was 96.15% in group 1 and in group 2 was 93.33%. Conclusion In our study, average radiological union time in patients treated with open reduction internal fixation was early compared with percutaneous fixation. This could be due to direct visualization of fracture site and good approximation of fracture fragments in open reduction internal fixation technique.

Epidemiology of Distal Forearm Fracture: A Population-Based Study of 5426 Fractures.

Despite intensive research into the epidemiology of adult distal forearm fractures, the literature is limited. This study aimed to provide a full overview of adult distal forearm fracture epidemiology, including incidence, fracture classification, mode of injury, and trauma mechanism in patients sustaining a distal forearm fracture, based on an accurate at-risk population with manually validated data leading to a high quality in data. This was a population-based cohort study with a manual review of X-rays and charts. The primary outcome measure was the incidence of adult distal forearm fractures. The study was based on an average at-risk population of 522 607 citizens. A total of 5426 adult distal forearm fractures were included during the study period. Females accounted for 4199 (77%) and males accounted for 1227 (23%) of fractures. The overall incidence of adult distal forearm fractures was 207.7/100 000/year. Female incidence was 323.4/100 000/year, and male incidence was 93.3/100 000/year. A marked increase in incidence with increasing age was observed for females after 50 years of age. The incidence of distal radius fractures was 203.0/100 000/year, and the incidence of isolated ulna fractures was 3.8/100 000/year. The most common fracture type was an extra-articular AO type 2R3A (69%), and the most common mode of injury was a fall from own height (76%). A small non-trending year-to-year variation was observed during the 5-year study period. Results show that adult distal forearm fractures are very common in women after the postmenopausal period. The overall incidence of adult distal forearm fractures was 207.8/100 000/year. Female incidence was 323.4/100 000/year.

Incidence of Fracture and Dislocation Patterns in Patients with Extremity Injuries Reporting to a Tertiary Care Hospital

Background: Trauma is globally associated with significant mortality with developing countries bearing a disproportionately high burden. It represents a major epidemic of non – communicable disease. The aim of this study is to evaluate the incidence of various fracture and dislocation patterns in patients with extremity injuries and their 1- year mortality rate. Materials and Methods: An observational, prospective study was undertaken to analyse the incidence of fracture and dislocation patterns in patients coming to the Orthopaedics OPD and emergency medicine department in a tertiary hospital during a period of two years from 1st, October 2017 to 30th, September 2019. Overall, 1182 patients were enrolled for the study with a mean age of 43 yrs. Results: Age group 21 – 30 years was most common (17.1%) age to suffer injuries with a male preponderance (67.5%). The most common mode of injury was by road traffic accident (43%). 97.9% of the injuries had unilateral involvement with the lower extremity (57.2%) and the femur (21.2%) being most frequently fractured. Dislocations/fracture-dislocations constituted only 5.5% cases with shoulder dislocation being the most frequently involved joint. Plain radiographs were used in 96.9% cases for final diagnosis. Forty cases (3.4%) were found to not survive in the 1-year follow up after fracture. Conclusion: The present study shows that most of the causes of trauma are preventable. This study could assist in raising the profile of RTI as a public health problem which needs to be addressed as a preventable cause of mortality and morbidity, and planning appropriate interventions for this major challenge.

Functional outcome of anatomical reconstruction of anterior cruciate ligament with hamstring graft: A one year hospital based - observational study

Background: Knee injuries are more common in the modern era due to increase in the road traffic accidents and more involvement in sports related activities by young people. Anterior cruciate ligament is the often injured ligament around knee joint. Anterior cruciate ligament has a pivot role in function and stability of the knee joint, being the primary stabilizer preventing the anterior translation of tibia over femur. Arthroscopic anterior cruciate ligament reconstruction has become the gold standard in the management of these injuries.Objective of the study: To assess the functional outcome of anatomical reconstruction of ACL with quadrupled hamstring graft.Materials and Methods: Patients with post traumatic anterior cruciate ligament injury admitted to the Department of Orthopaedics at the Kle's Dr. Prabhakar Kore Hospital and Medical Research Centre and Charitable Hospital, Belagavi in between 1st January 2019 to 31st December 2019, over a period of one year – hospital based observational study.Results: The study group comprised of 30 patients. In our study the most common mode of injury was found to be Road traffic accident followed by sports. Abundant of the patients were in the age group of 18-25yrs. In our study 13 patients had isolated ACL injury, 11 pts had medial meniscus injury, 4 patients had lateral meniscus injury and 2 patients had both the meniscus injured. It is found that 57% of them associated meniscal injury. Functional outcome was assessed using LYSHOLM and GILLQUIST SCORE. At the end of 9th month follow up 80% of the patient had excellent score which were 57% at the 3rd month. 13% of patient had good score at the end of 9th month and 7% of patient had fair score. None of the patient had poor score.Conclusion: Anatomical reconstruction of ACL with quadrupled hamstring graft gives better clinical outcomes. The advantage of using hamstring graft are reduced donor site morbidity and less anterior knee pain in long term follow up. It has better subjective and objective functional outcome with low graft rejection or failure rate.

Presentation of trauma patients in a tertiary care hospital in Pakistan.

Objective: To observe the presentation, nature of injury and outcome of patients presenting with trauma in the leading emergency setting of Pakistan. Study Design: Cross Sectional. Setting: Jinnah Sindh Medical University/Jinnah Postgraduate Medical Center. Period: July 2019 to December 2019. Material & Methods: Patient’s age, location and mode of injury, duration from injury to emergency department, Glasgow coma scale (GCS), full outline of unresponsiveness (FOUR) score and outcome of patients were measured. Results: The most common age group presenting to the emergency department in tertiary care hospital in Karachi was between 18 to 40 (61.4%). The most common head injury was laceration (16.9%) and the most common chest injury was pneumothorax (2.6%). The most common mode of injury was road traffic accidents (76.8%). 73.3% had mild Glasgow coma scale (GCS) and the most common full outline of unresponsiveness (FOUR) score was between 13-16 (79.6%). Conclusion: Road traffic accidents are contributing to a significant number of patients coming to the emergency department with trauma. Head injury is very frequent in patients presenting to patients in ER.

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.

Children's distal forearm fractures: a population-based epidemiology study of 4,316 fractures.

AimsThe aim of this study was to report a complete overview of both incidence, fracture distribution, mode of injury, and patient baseline demographics of paediatric distal forearm fractures to identify age of risk and types of activities leading to injury.MethodsPopulation-based cohort study with manual review of radiographs and charts. The primary outcome measure was incidence of paediatric distal forearm fractures. The study was based on an average at-risk population of 116,950. A total number of 4,316 patients sustained a distal forearm fracture in the study period. Females accounted for 1,910 of the fractures (44%) and males accounted for 2,406 (56%).ResultsThe overall incidence of paediatric distal forearm fractures was 738.1/100,000 persons/year (95% confidence interval (CI) 706/100,000 to 770/100,000). Female incidences peaked with an incidence of 1,578.3/100,000 persons/year at age ten years. Male incidence peaked at age 13 years, with an incidence of 1,704.3/100,000 persons/year. The most common fracture type was a greenstick fracture to the radius (48%), and the most common modes of injury were sports and falls from ≤ 1 m. A small year-to-year variation was reported during the five-year study period, but without any trends.ConclusionResults show that paediatric distal forearm fractures are very common throughout childhood in both sexes, with almost 2% of males aged 13 years sustaining a forearm fracture each year.Cite this article: Bone Jt Open 2022;3(6):448–454.

A PROSPECTIVE STUDY FOR EVALUATION OF FUNCTIONAL OUTCOMES OF PLATE OSTEOSYNTHESIS FOR CLOSED INTRAARTICULAR CALCANEAL FRACTURES

Background: Calcaneal fractures account for 65% of tarsal injuries most (70%) of them are intra articular. It is the most repeatedly fractured tarsal bone. Axial loading is the most common mode of injury,falls from height, especially in male construction workers are the most frequent cause. Other fractures associated with falls from height have to be excluded such as pelvic and spinal fractures. Aims and Objective: To analyze the functional outcome of closed displaced intraarticular calcaneal fractures treated by plating. Materials and methods:This is a prospective study of 16 patients with displaced intraarticular fractures (Type–II Sanders and above) of calcaneum, which were admitted to the hospital and operated on with platingthrough extensile lateral approach, between November 2019to October 2021. Result: In our study functional outcome according to the AOFAS(American Orthopaedic Foot And Ankle Society) score was Good(>75) in 14 cases(87.5%) and Fair(50-74) in 2(12.5%) and mean AOFAS score is 87.123. Conclusion: Open reduction and internal fixation of displaced intra-articular calcaneal fractures by locking calcaneal plate maintain the joint congruity and decrease the incidence of subtalar arthritis. Althoughconservative treatment was considered the gold standard previously, there is an increased tendency toward internal fixation with excellent results.This study concludes that displaced intra-articular fractures of calcaneum give good results by open reduction and internal fixation with locking plates.

Clinical Profile of Patients Presenting with Corneal Foreign Bodies: A Cross-Sectional Study Conducted in a Tertiary Hospital in Nepal.

Corneal foreign bodies are one of the commonest forms of ocular trauma, the majority of which occur due to occupational exposure. The aim of this study was to study the profile of patients with corneal foreign bodies. A hospital based prospective study was conducted among 60 patients presenting to the ophthalmology outpatient department in Dhulikhel Hospital-Kathmandu University Hospital (DH-KUH) over a time span of 6 months. Demographic data of patients, clinical characteristics of foreign bodies and associated complications were noted. Most of the patients were males (n=55) belonging to the 21-30 age group (n=24). Majority of them were workers in metal industries (n=26). Welding and cutting metal were implicated as the most common mode of injury (n=53). By virtue of this study, we identified the high risks associated with sustaining this form of ocular trauma. The incidence and hence the prevalence of corneal foreign body can be gradually levelled down if we aware the people about the associated complications and advise them to use protective eye wears (PEW).

The clinical profile and causative factors for eyelid lacerations at a tertiary eye care centre in South India

The aim of this study was to identify the clinical profile and the likely causative factors for eyelid lacerations at a tertiary eye care centre in South India. This was done so that the data can be used to identify the most common patterns of injuries, using which effective safety measures can be developed. A retrospective study was done through a review of hospital records of 57 cases of traumatic eyelid lacerations who presented to our centre in the period between Jan 2017 to Jan 2018. The data collected were related to epidemiological factors, causative factors, site of injury, structures involved and association with visual outcome. Of the 57 patients included in our study, 39 were men & 18 were women. The mean age of patients was 17+_ 2.8 years. As far as the location of injury was concerned, 67.32% patients sustained them while outdoors, 10.52% at home, 23.16% at their workplace. The most common mode of injury was by trauma caused accidentally in 36 patients (63.15%), assault in 11 patients (19.29%), falls in 10 patients (17.54%), laceration involving either the punctum or canalicular drainage system were seen in 33.26% patients. Based on the Snellen chart visual acuity of the injured eye/s was as follows: in 54 patients (90.6%), the visual acuity was better than 6/60; while in 3 patients (9.4%), the visual acuity was worse than 6/60.

ANALYSIS OF INJURY PATTERNS AND OUTCOMES OF PATIENTS WITH BLUNT ABDOMINAL TRAUMA – A TERTIARY CARE CENTRE EXPERIENCE

OBJECTIVE:Blunt abdominal trauma is one of the leading causes of morbidity and mortality in all age groups. Hemodynamic status of the patients and abdominal imaging play a major role in deciding the mode of management. The aim of this study is to analyse the clinical presentations, management and factors predicting outcome in patients with blunt injury abdomen presenting to a tertiary care centre in South India. METHODS:Combined retrospective and prospective analysis of prospectively maintained institutional database was performed. Data of all patients admitted with blunt abdominal trauma was analysed with regards to baseline characteristics, management and outcomes. RESULTS: One hundred and ten patients were admitted with blunt abdominal trauma in our institution from July 2014 to June 2015. Ninety-eight patients (89.1%) were male. The most common mode of injury was road trafc accidents (75.5%). Most common organs injured were spleen (28.2%), liver (22.7%) and small bowel (18.2%). Majority of the patients (73.6%) underwent operative management. Success rate of non-operative management was 89.7%. Overall mortality rate was 20.9%. CONCLUSION: Blunt abdominal trauma is associated with signicant morbidity and mortality. Computed tomography is the imaging modality of choice in hemodynamically stable patients to decide management. Non-operative management is successful in carefully selected cases. Old age, delayed presentation, presence of peritonitis, hemodynamic instability, and need for postoperative mechanical ventilation are associated with increased mortality.

Study on clinical characteristics and outcome evaluation of cross finger flap in soft tissue defect of finger at Can Tho Central General Hospital

Background: Fingers and hand are important parts of human body and soft tissue defect of fingers are the most common form of hand injuries. There are various techniques used for reconstruction of finger defect but cross finger flap is effective and very simple procedure without significant complication or require special techniques. Objectives: To examine characteristics of clinical and to evaluate the outcomes of cross finger flap for reconstruction of soft tissue defect of fingers. Materials and methods: 22 patients who had soft tissue defect of fingers who had undergone the cross finger flap cover. We noted mechanism of injury, size of defect, size of the flap, type of cross finger flap was used. Outcome measures recorded were flap viability, flap sensibility using two -point discrimination (TPD), total active motion of fingers (TAM) and patient satisfaction.
 Results: Among 22 patients treated with cross finger flap, there were 18 men and 4 women with the average age 38.6±11.4. The most common mode of injury was industrial accident (59.1%). The mean size of the defect was 205.5±86.6mm2 (range: 110mm2-500mm2). The average TPD test measured was 7.6±1.5mm. Full range of motion was obtained in 81.8% of patients. The functional and aesthetic results were satisfactory in 95.5% patients. Conclusion: The cross finger flap is safe and effective method for reconstruction of soft tissue defect of finger. This procedure is simple to perform under local anesthesia and is able to provide both mechanical stability & sensory recovery.

Prevalence of Abnormal Bone-Specific Alkaline Phosphatase in Orthopaedic Trauma Patients: A Cross-Sectional Study From a Tertiary Trauma Centre.

Introduction: Bone-specific alkaline phosphatase (BALP) has been a sensitive and reliable marker of bone metabolic activity. The study aimed to study the epidemiology of orthopaedic trauma patients and estimate the level of BALP in these patients.Material and methods: This hospital-based observational cross-sectional study was conducted on over 300 patients admitted to the orthopaedic trauma unit in the level I trauma centre of North India during the study period from January 2020 to January 2021. The level of BALP was assessed in serum samples of 258 patients.Result: A total of 300 patients were included in this study, with an average age of 33.52±17.16 years. Road traffic accidents were the most common mode of injury among admitted patients. We found a significant linear correlation between age and mean BALP levels (P-value < 0.005). The mean age of patients having abnormal BALP is 63.0±16.61 years. Females (22.61±16.23) had greater mean BALP levels than males (13.15±5.86). Among different fractures, fractures around the hip had a higher mean BALP level (23.17±15.07). Patients with diabetes mellitus have higher mean BALP levels.Conclusion: BALP is a cost-effective, readily available bone marker to assess the metabolic activity of orthopaedic trauma patients. Old age patients should undergo routine BALP estimation at admission to rule out metabolic disorders, and timely intervention will prevent complications associated with metabolic disorders.

Chronic Osteochondral Fractures of the Patella Managed with Open Reduction and Internal Fixation Yields Excellent Knee Function.

Currently, the management of acute osteochondral fractures (OCFs) of the patella is well established. However, the management of chronic OCFs remains debatable, as it is not clear whether such lesions can be accurately reduced or whether they will reliably heal. With well proven results of open reduction and internal fixation (ORIF) with headless compression screws (HCS) for acute OCFs, the application of this technique in late presenting cases is inconclusive. Thus, we present the clinicoradiological outcome of patients with chronic osteochondral injuries managed with ORIF. Fifteen patients who underwent surgical fixation by ORIF with HCS for chronic OCFs of the patella, between February 2013 and June 2018, were retrospectively analyzed after a mean follow-up of 3.8 years (range: 2-7 years). The mode of injury, size of the osteochondral fragment, and knee range of motion along with Kujala's scoring were examined clinically and radiological assessment was done by X-rays and magnetic resonance imaging (MRI) scans. Fifteen patients (11 males and 4 females), with a mean age of 17 years with chronic OCF of patella were enrolled. Noncontact twisting injuries were the most common mode of injury seen in 86.66% of patients and postcontact injuries in two patients (13.33%). The mean time from trauma to presentation was 7 weeks (range: 6-14 weeks). The mean preoperative Kujala's score improved from 44 to 84.8 at 6 months and 92.6 at 2 years, postoperatively. Intraoperatively, the lesion was found in medial patellar facet in 12 patients and 3 had lesions in the central facet. The mean size of the lesion was 20 mm × 18 mm. Radiological union was observed in all patients, at a mean duration of 16 weeks (range: 12-20 weeks). One patient underwent implant removal 1 year after initial surgery for mechanical symptoms. ORIF of OCFs of the patella using headless cannulated screws is simple, reliable, reproducible, and provides satisfactory outcomes. This technique can be considered for fixation of fragments with adequate subchondral bone.

Traumatic Perforation of Tympanic Membrane

Introduction: Traumatic perforation of tympanic membrane (TM) is caused by increase in air pressure due to slapping, road traffic accident, blast injury, syringing, trauma by ear buds, etc., The incidence has been increased in recent times due to increased domestic violence and road traffic accidents. Hence, there is a need for early identification, evaluation, and management to reduce the morbidity. Objectives: The objective of the study was to describe etiologies of traumatic perforation of TM, to assess the findings of pure tone audiometry (PTA) among patients with traumatic perforation of TM, and to determine the outcome. Materials and Methods: This study was done between November 2017 and May 2019 in the department of ENT at Bangalore Medical College and Research Institute on 88 patients with traumatic perforation of TM who were subjected to otoscopic examination, tuning fork tests, and PTA. Patients were followed up on weekly basis. Results: Out of 88 patients, 33 patients (37.5%) were in the age group of 21–30 years. Fifty-four were males (61.36%) and 34 were females (38.63%). Slapping is the most common mode of injury with 50 (56.8%) patients. Left ear 55 (62.5%) was more commonly involved than right ear 33 (37.5%). Small perforation 55 (62.5%) was more common followed by medium-sized perforation 25 (28.4%) and large perforations were the least 8 (9.1%). Multiple quadrants were involved in 33 patients (37.5%). Posteroinferior quadrant was most commonly involved. Deafness (75%) was the most common symptom involving 66 patients. Average time taken for spontaneous healing was 37 days. Mean hearing improvement compared between hearing loss at the time of trauma and after 3 months was 13.18 ± 7.05 dB, which is statistically significant (P = 0.0001). Conclusion: Traumatic perforation of TM spontaneously healed in 80 participants (90.90%), whereas eight participants (9.09%) underwent surgery, i.e., tympanoplasty.

Functional Outcome and Quality of Life After Surgical Fixation of Tibial Plateau Fracture in a Tertiary Care Center of Nepal

IntroductionFunctional outcome and quality of life (QoL) of patients will change following tibial plateau fracture fixation. There are limited studies evaluating functional and radiological outcomes following tibial plateau fixation in Nepal, and none has evaluated QoL. We aim to evaluate functional outcome and QoL in patients with tibial plateau fracture with a follow up period of more than two years. MethodsThis was a cross sectional, observational study done at Dhulikhel Hospital, from August 2021 to January 2022. Western Ontario and McMaster Universities Arthritis Index (WOMAC) functional outcome and World Health Organization QoL-8 (WHOQoL-8) questionnaire were filled by patients operated for tibial plateau fracture from 2011 to 2019. Compound fractures, untraceable patients, and those managed with casts were excluded from the study. ResultsThere were 121 patients (male: female = 2.3:1) with a mean age of 37.1 years. Road traffic accidents (44.6%) were the most common mode of injury, and Schatzker type IV (30.6%) was the most common type of fracture. The average WOMAC score was 13.05±12.1 and the average WHOQoL-8 score was 30.24±4.1. The average WOMAC score in high-energy and low energy trauma patients were 17.07±12.29 and 8.21±10 respectively. The average WHOQoL-8 in high energy and low energytrauma patients were 29.28±3.59 and 31.38±4.38 respectively. ConclusionsSurgical reduction and stable internal fixation of tibial plateau fractures with long term follow up has a good functional outcome and quality of life. High energy trauma is associated with poor functional outcome and quality of life.