High-velocity Trauma Research Articles

Functional Outcome of Hybrid Illizarov Technique in patients with Complex Tibial Plateau Fractures

Background:Tibial fractures are the most common long bone fracture, with approximately 25% being open. The majority of open tibial fractures result from a high velocity trauma, such as a motorcycle accident, or a low energy, torsional type injury, such as skiing. They are complex fractures to treat because of the lack of soft tissue coverage and blood supply of the tibial shaft. Aim: To determine the functional outcome of hybridillizarov technique in patients with complex tibial plateau fractures Study Design: Descriptive case series. Place of Study: Orthopedics Surgery Department, Jinnah Hospital, Lahore. Duration of Study: Study was carried out over a period of six months from 28-07-2021 to 28-01-2022 Methods: All the 73 patients fulfilling the selection with complex tibial plateau fractures of Schatzker's type V and VI were enrolled. Informed consent and demographic information were recorded. All the patients were evaluated for injuries, haemodynamically stabilized. Bone grafting and minimal internal fixation with cc screws was done in severely comminuted fractures. The functional results were measured by Rasmussen’s knee functional score (as per operational definition). Results: Distribution of the functional outcome of the patients was done, it showed that out of 73 patients 20(27.4%) were in excellent outcome, 41(56.2%) were in good outcome, 7(9.6%) were in fair outcome, 5(6.8%) were in poor. Conclusion: Based on our results, the use of hybrid illizarov fixation for the treatment of complex tibial plateau fractures is safe and effective in terms of low rates of complication and good functional results. Keywords: Functional outcome, Tibia plateau fracture, Hybrid ilizarov.

Successful single stage management of trifocal femoral fracture associated with distal medial condyle and Hoffa’s component by a novel technique

<p>Isolated fractures of the shaft of the femur are relatively common injuries. Ipsilateral multifocal fractures of the femur are less common with an additional proximal femoral fracture estimated to occur in up to 5% of diaphyseal fractures and additional distal femoral fracture occurring in 3-4%. Trifocal femoral fractures consisting of ipsilateral fractures of the proximal, diaphyseal, and distal femur are extremely rare. These fracture patterns are seen in the young adult population following high velocity trauma such as fall from height and road traffic accidents. The sequence of fracture type to be fixed first and the type of implant to be used are questions yet to be answered as one implant used for fixation of one fracture may not be amenable for fixation of the other fracture. These fractures are associated with significant complications and delayed rehabilitation. We describe a novel method in one such trifocal fracture pattern where the distal femoral intra-articular medial condyle with a hoffas element was stabilised by open reduction with a 4.5 proximal tibial ipsi-lateral anterolateral LCP and 2 inter-fragmentary compression screws which has not been reported in literature before. The advantages of such an implant is easy contour ability to the medial femoral condyle and adequate strength and achieving satisfactory absolute stability with options of using uni-cortical locking screws, all of which facilitates early knee ROM and rehabilitation.</p><p> </p>

Seat belt syndrome is caused by a different mechanism: A case report

Introduction and importanceSeat belt syndrome is associated with multiple visceral injuries and vertebral burst fractures. Small Intestinal perforations are seen in 5–15 % of blunt abdominal trauma. In our case, we will report a case that presented small intestinal perforation and thoracic vertebral fracture caused by a different mechanism.Case presentationPreviously healthy 48-year-old male presented to the emergency department following falling from 15 feats height. He was a paraplegic with a sensory level at T12. He did not have a clinical feature of spinal shock. He was complaining of epigastric and central abdominal pain and tenderness and was diagnosed to have a proximal Jejunal perforation associated with an unstable fracture of T12 causing spinal compression. Open intestinal repair followed by a posterior spinal exploration and pedicle screw fixation done.Clinical discussionViolent injury due to different mechanisms can have similar injuries to Seat belt syndrome. Ultrasonography is used to detect pneumoperitoneum, but the Contrast study is the gold standard to detect visceral injuries. The surgical approach to visceral injury depends on the patient's condition. But the laparoscopic approach has a more favorable postoperative outcome than open access.ConclusionIntestinal perforations associated with the neurological deficit are difficult to identify in an initial clinical assessment. Thoracolumbar fractures can associate with small bowel injuries during high-velocity trauma. Early identification and repair of the intestinal injury are important to prevent devastating complications and to improve neurological recovery after spinal surgery.

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.

Observation of role of orthofix limb reconstruction system in with non-union with bone loss shortening due to fresh fractures

The nonunion can develop after an open fracture, after 1oUs open reduction and internal fixation (ORIF), or as a sequela to chronic hematogenous osteomyelitis. The incidence also seems to be increasing especially in view of increasing high velocity trauma, which is usually treated by internal fixation. It is difficult to treat infected nonunion, because of the following reasons. Aim of the study is to observe the role of Orthofix limb reconstruction system as a treatment in non-union with bone loss with shortening due to fresh fractures. In the last twenty-five months we had the opportunity to treat thirteen cases of non-union and two cases of shortening With Limb reconstruction system. Out of thirteen patients eight patients had infected nonunion following open fracture and three patients had infected nonunion following previous surgeries with internal fixation for closed fractures and two patients had nonunion following treatment with traditional bone setters for closed fractures. Our follow up of cases varied from six to fifteen months. The results were divided into bony results and functional results, according to the classification of the ASAMI (Association for the study and application of the method of Ilizarov).

Subgaleal Hematoma with Bilateral Proptosis as a Manifestation of Fibrinogen and Factor X Deficiency - A Case Report

Subgaleal hematomas are usually seen after high-velocity head trauma; however, their presence following trivial injury should raise suspicion regarding an associated clotting disorder. Here we describe an interesting patient who presented to us with bilateral proptosis associated with a subgaleal hematoma due to fibrinogen and factor X deficiency. This condition can result in serious bleeding diathesis often necessitating multiple surgeries to control haemorrhage.
 Our patient, an 11-year-old male child presented to us 4 weeks after a minor head injury. He had a gradually progressive soft swelling on his forehead with proptosis of both eyes. Aspiration of the swelling at a nearby private hospital had revealed blood. The swelling recurred over a span of 2 weeks.
 On neurological examination, there were no positive findings. On local examination, he had a large, non-tender subgaleal hematoma over the bilateral fronto-temporo-parieto-occipital region of his head extending to both eyes. There was associated bilateral subconjunctival haemorrhage, periorbital ecchymosis and gross proptosis. The vision was affected on the right side, finger counting at 1 foot. Left side vision was intact. Extraocular movements were restricted in both eyes in all planes. CT scan of the brain showed subgaleal hematoma over the bilateral fronto-temporo-parieto-occipital region with an extension over the supraorbital ridge into the bilateral orbit beneath the orbital roof, there were bilateral relatively symmetrical areas of subperiosteal haemorrhages involving superior aspect of orbit causing proptosis and inferior displacement of the globes. On haematological examination, his haemoglobin was 5 gm/dl. Platelet count was 240,000/cumm. On coagulation profile, prothrombin time was 45 seconds (normal range 11.1–14.5 seconds) with an activated partial thromboplastin time of 39.5 seconds (normal range 28.1–39.7 seconds), and thrombin time was 58 seconds. The plasma fibrinogen levels were < 100 mg/dl (normal range- 200-400 mg/dl). D-dimer was strongly positive. The patient also had factor X deficiency. The peripheral blood smear had a normocytic normochromic picture.

Feline Femoral Fracture Fixation: What are the options?

The femur is the most commonly fractured bone in cats. Femoral fractures usually result from high-velocity trauma such as a road traffic accident or fall from a height and, as such, are associated with a wide variety of concurrent injuries. The initial focus of treatment should always be on assessment and stabilisation of the major body systems. Once any concurrent injuries have been addressed, all femoral fractures need surgical stabilisation, with the notable exception of greenstick fractures in very young cats, which can heal with cage rest alone. A number of different surgical options are available depending on the fracture type, location, equipment, surgeon experience and owner finances. Femoral fractures can vary hugely in complexity and the small size of feline bones can limit the choice of implants. Furthermore, cats can present unique challenges in the postoperative period due to their active nature and the limited means to control their exercise level. This review is aimed at general and feline-specific practitioners who have some experience of feline orthopaedics, as well as those simply wishing to expand their knowledge. The aim of this review is to help clinicians assess, plan and manage feline femoral fractures. It provides an overview of diagnostic imaging and a discussion of a range of suitable surgical options, including the principles of different types of fixation. It also highlights cat-specific issues, approaches and implants pertinent to the management of these cases. A number of original articles and textbook chapters covering many aspects of femoral fractures in cats and dogs have been published. Where possible, this review draws on information from key feline research and, where necessary, extrapolates from relevant canine literature. The authors also offer practical guidance based on their own clinical experience.

Blunt Traumatic Aortic Injury Management, a French TraumaBase Analytic Cohort

Blunt traumatic aortic injury (BTAI) in severe trauma patients is rare but potentially lethal. The aim of this work was to perform a current epidemiological analysis of the clinical and surgical management of these patients in a European country. This was a multicentre, retrospective study using prospectively collected data from the French National Trauma Registry and the National Uniform Hospital Discharge Database from 10 trauma centres in France. The primary endpoint was the prevalence of BTAI. The secondary endpoints focused chronologically on injury characteristics, management, and patient outcomes. 209 patients were included with a mean age of 43 ± 19 years and 168 (80%) were men. The calculated prevalence of BTAI at hospital admission was 1% (162/15 094) (BTAI admissions/all trauma). The time to diagnosis increased with the severity of aortic injury and the clinical severity of the patients (grade 1: 94 [74, 143] minutes to grade 4: 154 [112, 202] minutes, p = .020). This delay seemed to be associated with the intensity of the required resuscitation. Sixty seven patients (32%) received no surgical treatment. Among those treated, 130 (92%) received endovascular treatment, 14 (10%) open surgery (two were combined), and 123 (85%) were treated within the first 24 hours. Overall mortality was 20% and the attributed cause of death was haemorrhagic shock (69%). Mortality was increased according to aortic injury severity, from 6% for grade 1 to 65% for grade 4 (p < .001). Twenty-six (18.3%) patients treated by endovascular aortic repair had complications. BTAI prevalence at hospital admission was low but occurred in severe high velocity trauma patients and in those with a high clinical suspicion of severe haemorrhage. The association of shock with high grade aortic injury and increasing time to diagnosis suggests a need to optimise early resuscitation to minimise the time to treatment. Endovascular treatment has been established as the reference treatment, accounting for more than 90% of interventional treatment options for BTAI.

Popliteal Artery Injury After Fracture and/or Dislocation of the Knee: Risk Stratification for Revascularization Outcome.

Managing complex knee trauma involving both vascular and osseous injuries is challenging, yet the available guidelines for efficient popliteal artery injury management after high-velocity blunt knee trauma remain conflicting and inconsistent. In this study, the authors aim to identify the risk factors associated with delayed limb amputation and ischemic muscular sequela postrevascularization. Furthermore, we propose a treatment algorithm to improve the limb salvage rate. Patients who presented with traumatic popliteal artery injury resulting in vessel occlusion or rupture, followed by fracture and/or dislocation of the knee from January 2008 to December 2013, were included for retrospective review. Overall delayed amputation rate was 24% (7/29) and 16% (4/25) after successful revascularization. Mangled Extremity Severity Score is higher in the delayed amputation group than the limb-salvaged group (P = 0.02). Higher-impact force (P = 0.03), ischemic limb on presentation (P = 0.03), prolonged ischemia time (P = 0.04), unstable hemodynamics (P = 0.01), longer operation time (P = 0.04), and prolonged intensive care unit stay (P = 0.03) are risk factors of delayed amputation. Longer ischemia time (P = 0.04) and length of popliteal artery injury (P = 0.02) are associated with ischemic muscular sequela. Mangled Extremity Severity Score is a reliable predictor of limb salvage. An algorithmic approach may improve the outcome of popliteal artery injury after high-velocity blunt knee trauma.

Blunt Traumatic Aortic Injury Management, a French TraumaBase Analytic Cohort

Blunt traumatic aortic injury (BTAI) in severe trauma patients is rare but potentially lethal. The aim of this work was to perform a current epidemiological analysis of the clinical and surgical management of these patients in a European country. This was a multicentre, retrospective study using prospectively collected data from the French National Trauma Registry and the National Uniform Hospital Discharge Database from 10 trauma centres in France. The primary endpoint was the prevalence of BTAI. The secondary endpoints focused chronologically on injury characteristics, management, and patient outcomes. 209 patients were included with a mean age of 43 ± 19 years and 168 (80%) were men. The calculated prevalence of BTAI at hospital admission was 1% (162/15 094) (BTAI admissions/all trauma). The time to diagnosis increased with the severity of aortic injury and the clinical severity of the patients (grade 1: 94 [74, 143] minutes to grade 4: 154 [112, 202] minutes, p= .020). This delay seemed to be associated with the intensity of the required resuscitation. Sixty seven patients (32%) received no surgical treatment. Among those treated, 130 (92%) received endovascular treatment, 14 (10%) open surgery (two were combined), and 123 (85%) were treated within the first 24 hours. Overall mortality was 20% and the attributed cause of death was haemorrhagic shock (69%). Mortality was increased according to aortic injury severity, from 6% for grade 1 to 65% for grade 4 (p < .001). Twenty-six (18.3%) patients treated by endovascular aortic repair had complications. BTAI prevalence at hospital admission was low but occurred in severe high velocity trauma patients and in those with a high clinical suspicion of severe haemorrhage. The association of shock with high grade aortic injury and increasing time to diagnosis suggests a need to optimise early resuscitation to minimise the time to treatment. Endovascular treatment has been established as the reference treatment, accounting for more than 90% of interventional treatment options for BTAI.

Transoral digital reduction of complete anterior odontoid dislocation followed by fiducial-based navigated transcondylar screw fixation: illustrative case.

BACKGROUNDPosterior atlantoaxial dislocations (i.e., complete anterior odontoid dislocation) without C1 arch fractures are a rare hyperextension injury most often found in high-velocity trauma patients. Treatment options include either closed or open reduction and optional spinal fusion to address atlantoaxial instability due to ligamentous injury.OBSERVATIONSA 60-year-old male was struck while on his bicycle by a truck and sustained an odontoid dislocation without C1 arch fracture. Imaging findings additionally delineated a high suspicion for craniocervical instability. The patient had neurological issues due to both a head injury and ischemia secondary to an injured vertebral artery. He was stabilized and transferred to our facility for definitive neurosurgical care.LESSONSThe patient underwent a successful transoral digital closed reduction and posterior occipital spinal fusion via a fiducial-based transcondylar, C1 lateral mass, C2 pedicle, and C3 lateral mass construct. This unique reduction technique has not been recorded in the literature before and avoided potential complications of overdistraction and the need for odontoidectomy. Furthermore, the use of bone fiducials for navigated screw fixation at the craniocervical junction is a novel technique and recommended particularly for placement of technically demanding transcondylar screws and C2 pedicle screws where pars anatomy is potentially unfavorable.

ASSESSMENT OF OUTCOME IN CASES WITH EXTRAARTICULAR DISTAL THIRD TIBIA FIBULA FRACTURES TREATED WITH INTERLOCKING NAILING OF TIBIA WITH CONCOMITANT FIBULAR FIXATION BY ORIF WITH PLATE OR BY CLOSED NAILING

BACKGROUND- The present study aimed to assess and compare the radiological and functional outcome, union time and complications in cases of extraarticular distal third Tibia bula fractures treated with interlocking nailing of Tibia with concomitant Fibular xation either by ORIF with plate or by closed nailing. METHODOLOGY- This was observational prospective study which was carried out at Department of Orthopedics in Unique Super Speciality Centre, Indore (M.P.) for a period of 1 year on adults belonging to age group between 18 to 75 years of either gender. All the cases were randomly allocated in two groups. During surgery, fracture tibia was managed with the help of interlocking intramedullay nail in all the cases in both the groups whereas bular fracture in group A were managed using ORIF with semitubular plate or reconstruction plate and that in group B was managed using CRIF with rush nail/ square nail/ k wire. RESULTS-There was no statistically signicant association between the complications and the groups (p&gt;0.05), showing that the complications is independent of the groups. There was a signicant improvement in the score at 3 months and 6 months (p&lt;0.05) in both the groups; however, no statistically signicant difference in union time between the two groups (p&gt;0.05). Also no statistically signicant association between the outcome and the groups (p&gt;0.05) was observed. CONCLUSION- The choice of xation for adjunctive stabilization of bula has no effect on the fracture tibia union and the ultimate functional outcome. Closed nailing is better where the soft tissue morbidity is high (as in high velocity trauma and open fractures) and where bones are weak (elderly patients). Other immunocompromised states such as diabetes in which there are higher infection rates with traditional plating techniques.

Occult craniocervical dissociation on cervical CT: an under-appreciated presentation of craniocervical trauma requiring occipital cervical fusion.

Craniocervical dissociation is a rare and life-threatening injury that results from a significant hyperflexion-hyperextension force. Occult craniocervical dissociation is defined as an unstable craniocervical injury in the absence of atlanto-occipital joint space widening or other skull base line abnormality. The early and accurate diagnosis of craniocervical dissociation is crucial since the early diagnosis and subsequent stabilization with occipital-cervical fusion has been shown to reduce neurologic morbidity and mortality. Several normative skull base lines have been developed to predict craniocervical dissociation. The purpose of our study was to measure the atlanto-occipital joint space and four other common skull base lines in patients who underwent occipital-cervical fusion for post-traumatic craniocervical instability. Patients who underwent occipital-cervical fusion for craniocervical injury were identified retrospectively using a keyword search of radiology reports using Nuance mPower software. The cervical CT and MRI exams for these patients were reviewed and the atlanto-occipital joint space, Powers ratio, Wackenheim line, posterior axial line, and basion dens interval were measured. Detailed descriptions of craniocervical ligament injuries on MRI were recorded along with patient demographic information, clinical history, management, and outcome. Nine adult patients who underwent occipital-cervical fusion for an acute craniocervical injury were identified. Six patients demonstrated an atlanto-occipital joint space measuring 2mm or less on cervical spine CT with no additional abnormality in the Powers ratio, Wackenheim line, posterior axial line, or basion-dens interval. Three patients demonstrated widening of the atlanto-occipital joint space with two patients demonstrating an abnormality in at least two additional skull base lines. Clinical outcomes were variable with nearly half of the patients demonstrating persistent neurologic deficits, including one quadriplegic patient. A normal atlanto-occipital joint space and skull base line measurements on cervical CT demonstrated a low predictive value for detecting unstable craniocervical injuries. Occult craniocervical dissociation was present in two-thirds of patients who underwent occipital cervical fusion for acute, craniocervical trauma. A high clinical and radiologic index of suspicion for craniocervical trauma with subsequent follow-up cervical MRI to directly evaluate ligamentous integrity is necessary to accurately diagnose and triage patients with high velocity trauma.

An exception to every rule; high velocity impact not always required for bilateral 1st rib fractures

Introduction First rib fractures are commonly reported in high velocity trauma. The neuromuscular sequelae that can ensue, not the physical disruption of the rib, necessitate thorough evaluation for such injuries. Methods We describe a case of a patient who sustained bilateral rib fractures following low-energy trauma.

Short Term Analysis of the Functional and Radiological Outcome of Distal Femoral Fractures Fixed with Locking Compression Plate by Minimally Invasive Plate Osteosynthesis (MIPO) Technique

Background: Fractures of distal femur are very complex injuries and there is significant difficulty to manage. These injuries are severe and have a potential to produce long term disability. These fractures often are unstable and comminuted and tend to occur in elderly or multiply-injured patients. The fractures of distal femur account for 7% of all femoral fractures. If Hip fractures are excluded, 31% of fractures involve the distal femur. The fractures involving distal 15 cm of femur including distal femoral metaphysis (supracondylar) and articular surface (intercondylar) are classified as distal femur fractures [1]. Distal femur fractures exhibits bimodal age distribution. In young adults it occurs due to high velocity trauma like road traffic accidents. These patients often sustain multiple and compound injuries. Older patients sustain distal femur fractures mostly due to trivial fall occurring in elderly osteoporotic bone. In 1960’s most of these fractures were treated conservatively and documented better outcome than operative treatment. But with the advent of newer implants and modern techniques, these fractures are best treated with surgical stabilization. The newer modalities of treatment include minimally invasive plate osteosynthesis (MIPO) and Less invasive skeletal stabilization (LISS). Aim of this study: To evaluate twenty cases of distal femur fractures fixed with locking compression plate by minimally invasive plate osteosynthesis (MIPO) technique in the Department of Orthopaedic Surgery at SCB Medical College and Hospital, Odisha between July 2018 to November 2020. To prospectively analyse the clinical and radiological outcome of the above procedure. Keywords: Minimally Invasive Plate Osteosynthesis (MIPO), Distal Femoral Fractures, Radiological Outcome, Locking Compression Plate

Management of chronic palmar distal radio-ulnar joint (DRUJ) dislocation of wrist: A case report on young gymnast with one year follow up

Background: A palmar dislocation of distal radio-ulnar joint (DRUJ) is rare and causes gross functional restriction of pronation. It is certainly major cosmetic concern for the patient as keeps the forearm supinated because of dislocation. Usually, such injuries are caused due to high velocity trauma and fall on supinated hand. The literature is sparse on the management of palmar dislocation of DRUJ. Materials and Methods: We present a case report on the management of chronic palmar dislocation in a 27-year-old professional gymnast trainer with 1-year follow-up. We describe the surgical technique of open reduction by palmar approach and reconstruction of triangular fibrocartilage complex ligament by suture anchor. The post-operative rehabilitation protocol is also mentioned in detail. Results: The patient has 80° pronation and painless wrist range of movements at 1-year follow-up. She is able to perform all activities of daily living though not confident in weight bearing on affected wrist. Conclusion: As per our knowledge, this is described for the 1st time about the management of chronic palmar DRUJ case in young gymnast. The restricted pronation is important sign of palmar DRUJ dislocation. The return of pronation gives immense satisfaction to the patient.

Extramedullary Versus Intramedullary Bone Fixation Treatment of Peritrochanteric Fractures

<i>Background</i>: In the last few decades the rate of peritrochanteric fractures has increased because of increased rate of high velocity trauma accident and bone rarefaction due to osteoporosis in old age. DHS and PFN are the gold standard treatments used in treatment of these fractures. Nineteen studies were identified for analysis from 2007 to 2017 that meet our points of comparison. <i>Aim of the work</i>: Assessing of efficacy and complications of treatmeant of preitrochantric fracture by DHS versus PFN. <i>Materials and methods</i>: Outcomes from included trials will be combined using the systematic review manger software and manually screened for eligibility to be included. PRISMA flowchart will be produced based on the search results and the inclusion /exclusion criteria. After pooling of the collected data from the desired search studies, the relative risk of each of intended outcome measures of interest will be calculated and compared between each of the two main methods of peritrochanteric bone fixation treatment to reach a satisfactory conclusion. Evidence of publication bias will be sought using the funnel plot method. <i>Results</i>: PFN is better for treating unstable peritrochanteric fractures as it has less complications and better efficacy than DHS. <i>Conclusion</i>: The present study supports the treatment of peritrochanteric fractures with PFN, as it has less failure of fixation, decreased wound infection, less duration of surgery and less non-union complication than DHS.

Contiguous-Level Unilateral Cervical Spine Facet Dislocation-A Report of a Less Discussed Subtype.

Unilateral facet dislocation of subaxial cervical spine trauma is characterized by dislocation of inferior facet of superior vertebra over the superior facet of inferior vertebra. The injury is due to high-velocity trauma and associated with instability of spinal column. Such unilateral facet dislocations occurring at multiple adjacent levels for some reason are not reported or studied frequently. We have reported two cases of multiple-level dislocation of unilateral facets managed in our hospital with a review of available literature. The injury occurs as one side of the motion segment translates and rotates around an intact facet on the contralateral side. The major mechanism of injury is distractive flexion injury with axial rotation component. The injury is associated with instability secondary to loss of the discoligamentous complex. In cases with multiple-level dislocations of unilateral cervical facets, there are multiple mechanisms associated with significant neurological injury and most of them succumb at the site of injury. Only three other cases are available in English language literature. The neurological outcome is invariably poor. Multiple-level facet dislocations of subaxial cervical spine are reported sparsely in literature. We suspect that due to high-velocity nature of these injuries, most of them succumb soon after injury and not often reported. This article reports two cases of contiguous-level unilateral facet dislocation of subaxial cervical spine with associated injuries and the outcomes with review of literature.

Bilateral Floating Knee Injuries in an Infant: A Case Report and Literature Review

Background: Floating knee injury is defined as ipsilateral fractures of the femur and tibia. It was mostly seen among young men and is generally caused by high-velocity trauma such as motor vehicle accidents and falling from height. Although isolated fractures of the femur or tibia are relatively common in children, floating knee injuries are rare in adolescents and even less frequent in younger children.&#x0D; Case Report: In this study, we reported a case of bilateral floating knee injuries of a 10-month old girl infant. Radiographic examinations revealed diaphyseal fracture of the left femur and proximal metaphyseal fracture of tibia compatible with floating knee injury type B according to the classification proposed by Letts et al. To the best of our knowledge, there was not any previous report of bilateral infantile floating knee injury in the literature.&#x0D; Conclusion: Pediatric floating knee injuries are relatively uncommon and extremely rare among infants. The preferred method of treatment is a surgical fixation for all fractures of all ages.

TREATMENT OF PROXIMAL HUMERUS FRACTURES AND OUTCOME – A PROSPECTIVE STUDY

BACKGROUND: Proximal humerus fractures are commonest fractures account for about 4 – 5% of the fractures.Complicated fracture pattern in proximal humerus are increasing due to increase inincidence of high velocity trauma. Because of inconsistency in fracture classication, treatment and evaluation method,comparison of these fractures are impeded. This studydetermines and compare the results of different modalities of xations in proximal humerus fractures and outcome. MATERIALS AND METHODS: This study was done from August 2018 to February 2020 in king Georgehospital,Visakhapatnam. Total 32 patients with proximal humerus fractures were operatedwith different modalities depend on fracture pattern.The results were evaluated using the Neers Shoulder Scoring System. RESULTS:The results show that most Neer's two part fracture had excellent to satisfactory results (85%). Neer's three part fracture also had 73% excellent to satisfactory results. Neer's four part fracture which went into failure. This study results were compared with other studies by using chi square test. CONCLUSION: The management modality depended on the pattern of the fracture andthequality of the bone .The patient's goals with treatment options for these displaced fractures included closed reduction and percutaneous screws xation (13% cases), closed reduction and percutaneous k- wires xation (9% cases) ,open reduction and internal xation (78 % cases).