Internal Splint Research Articles

Combined distal tibial nerve transfer and tibialis posterior tendon transfer for foot drop correction: A surgical technique and case illustration

Tendon transfers have traditionally been the mainstay for treating foot drop and improving gait and mobility. Recently, distal nerve transfers from the tibial to the deep peroneal nerve have been explored, but with limited success in achieving ankle dorsiflexion. We present a novel surgical technique combining both distal tibial nerve transfers (to both deep and superficial peroneal nerves) and tibialis posterior tendon transfer to the tibialis anterior (internal splint). This dual approach aims to achieve comprehensive foot drop correction through the reinnervation of foot dorsiflexors and improved ankle function. A case illustration highlights this combined technique’s surgical steps and potential benefits.

Comparison of Polyvinyl Alcohol Sponge and Gauze Packing for Nasal Fracture Treatment: An Efficacy and Safety Analysis.

Nasal fractures are commonly treated using nasal packing as an internal splint after performing closed reduction. Although gauze and polyvinyl alcohol sponge (PVAS) are both commonly used for packing, few reports have compared their efficacy and safety in nasal fracture treatment. Therefore, in this study, the authors, aimed to retrospectively compare the efficacy and safety of gauze packing in 208 patients and PVAS packing in 225 patients who underwent closed reduction at our hospital. The proportions of patients requiring revision surgery did not differ significantly between the PVAS and gauze groups ( P =0.627). However, in comparison to the gauze group, the PVAS group displayed significantly fewer instances of uncontrolled epistaxis following packing removal, as well as fewer occurrences of dropout and loss of packing ( P =0.023, P =0.007, and P <0.001, respectively). The results of logistic regression analysis adjusted for confounding factors also showed that compared with the gauze group, the PVAS group was significantly less likely to experience packing dropout (odds ratio=0.13; 95% confidence interval, 0.06-0.29, P <0.001) for which younger and older age and allergic rhinitis were independent risk factors. In conclusion, both gauze and PVAS are effective packing materials as internal splints after closed reduction of nasal bone fractures. Specifically, PVAS utilization warrants consideration in pediatric and geriatric populations, individuals with allergic rhinitis, and those at elevated risk of bleeding.

Combined Wrist Extensor Tenodesis and Tendon Transfers for Severe Spastic Flexed Wrist Deformity: Surgical Technique and Case Series.

Spastic wrist flexion deformities both limit the functional use of the hand for grasp and pinch producing a stigmatizing appearance. Tendon transfers and total wrist arthrodesis are treatment options for this condition depending on the patient's characteristics, the latter the most commonly used in patients with severe wrist flexion deformities. Tendon transfers alone in this scenario have the tendency for recurrent deformity due to tenorrhaphy failure or soft tissue creep and resultant loss of tension. Total wrist arthrodesis is a more invasive procedure, which can have hardware or fusion problems and that is irreversible. We propose a novel technique that incorporates a distally based wrist extensor tendon slip and suture tape tenodesis to the distal radius. The rationale of this technique is to act as a protective, internal splint to prevent recurrent deformity after primary or revision tendon transfer for moderate to severe spastic flexed wrist deformities, avoiding the need to perform a total wrist arthrodesis.

BIOMECHANICS AND DESIGN OF INTRAMEDULLARY NAILS

Intramedullary nails (IMNs) are the current gold standard for treatment of long bone diaphyseal and selected metaphyseal fractures. Their design has undergone many revisions to improve fixation techniques, conform to the bone shape with appropriate anatomic fit, reduce operative time and radiation exposure, and extend the indication of the same implant for treatment of different fracture types with minimal soft tissue irritation.The IMNs are made or either titanium alloy or stainless steel and work as load-sharing internal splints along the long bone, usually accommodating locking elements – screws and blades, often featuring angular stability and offering different configurations for multiplanar fixation – to secure secondary fracture healing with callus formation in a relative-stability environment. Bone cement augmentation of the locking elements can modulate the construct stiffness, increase the surface area at the bone-implant interface, and prevent cut-through of the locking elements.The functional requirements of IMNs are related to maintaining fracture reduction in terms of length, alignment and rotation to enhance fracture healing. The load distribution during patient's activities is along the entire bone-nail interface, with nail length and anatomic fit being important factors to avoid stress risers.

Three-Dimensional Scaffolds for Bone Tissue Engineering.

Immobilization using external or internal splints is a standard and effective procedure to treat minor skeletal fractures. In the case of major skeletal defects caused by extreme trauma, infectious diseases or tumors, the surgical implantation of a bone graft from external sources is required for a complete cure. Practical disadvantages, such as the risk of immune rejection and infection at the implant site, are high in xenografts and allografts. Currently, an autograft from the iliac crest of a patient is considered the "gold standard" method for treating large-scale skeletal defects. However, this method is not an ideal solution due to its limited availability and significant reports of morbidity in the harvest site (30%) as well as the implanted site (5-35%). Tissue-engineered bone grafts aim to create a mechanically strong, biologically viable and degradable bone graft by combining a three-dimensional porous scaffold with osteoblast or progenitor cells. The materials used for such tissue-engineered bone grafts can be broadly divided into ceramic materials (calcium phosphates) and biocompatible/bioactive synthetic polymers. This review summarizes the types of materials used to make scaffolds for cryo-preservable tissue-engineered bone grafts as well as the distinct methods adopted to create the scaffolds, including traditional scaffold fabrication methods (solvent-casting, gas-foaming, electrospinning, thermally induced phase separation) and more recent fabrication methods (fused deposition molding, stereolithography, selective laser sintering, Inkjet 3D printing, laser-assisted bioprinting and 3D bioprinting). This is followed by a short summation of the current osteochondrogenic models along with the required scaffold mechanical properties for in vivo applications. We then present a few results of the effects of freezing and thawing on the structural and mechanical integrity of PLLA scaffolds prepared by the thermally induced phase separation method and conclude this review article by summarizing the current regulatory requirements for tissue-engineered products.

Radial Nerve Repair during Pregnancy with Internal Splinting for Radial Nerve Injury Following Humeral Plating.

Radial Nerve Repair during Pregnancy with Internal Splinting for Radial Nerve Injury Following Humeral Plating.

Abnormal Patterns of Biceps and Triceps Co-Contraction Following Elbow Surgery May Result in Elbow Stiffness.

This study examines the pattern of muscular contraction and the intensity of this contraction of the biceps and triceps following elbow surgery. We performed a prospective electromyographic study of 16 patients undergoing 19 surgical procedures on the elbow joint. We measured the resting EMG signal intensity of the biceps and triceps of the operated and the normal sides at 90 degrees. We then calculated the peak EMG signal intensity during passive elbow flexion and extension of the operated side. Seventeen of 19 elbows (89%) displayed a co-contraction pattern of the biceps and triceps near the end of flexion and extension during the passive range of motion. The co-contraction pattern was observed near the end of the range of motion in both flexion and extension. In addition to the observed co-contraction patterns, we detected higher contraction intensities for the biceps and triceps muscles in all patients in both flexion and extension for the elbows, which had been treated surgically. Further analysis suggests an inverse correlation between the biceps contraction intensity and the arc of motion measured at the latest follow-up. The co-contraction pattern and increased contraction intensity of periarticular muscle groups may result in internal splinting mechanisms, contributing to the development of elbow joint stiffness, which is frequently observed following elbow surgery.

Effectiveness of Absorbable Plates for the Treatment of Nasal Septal Cartilage Fractures.

Nasal bone fractures are the most common type of facial fracture. Nasal bone fractures often occur in combination with septal cartilage fractures, because the nasal septal cartilage acts as a vertical strut and provides structural support for the nose and bilateral nasal airway. However, the treatment for nasal septal cartilage fracture remains controversial, and if untreated, nasal septal cartilage fracture can lead to various complications, such as nasal obstruction and posttraumatic nasal and septal deformity. This study aimed to evaluate the effectiveness and safety of our procedure in which septal cartilage fractures were treated with septoplasty using an absorbable plate as an internal splint. Between January 2017 and November 2020, 21 patients with nasal septal cartilage fractures were treated with septoplasty using an absorbable plate as an internal splint. The severity of the septal cartilage fracture was graded from 0 to 3 according to the computed tomography septal grading system. The numeric graded scale of nasal septal cartilage fracture was evaluated preoperatively and 6 months postoperatively using a computed tomography scan. Of 21 patients with septal cartilage fractures, 12 were treated with a polycaprolactone (PCL) mesh plate, and 9 were treated with a polydioxanone (PDS) plate. In the PDS plate group, the preoperative numeric scale of nasal septal cartilage fracture was 2.50 (2.00-3.00), whereas the postoperative numeric scale was 1.00 (1.00-1.25, P = 0.023). In the PCL mesh plate group, the preoperative numeric scale of nasal septal cartilage fracture was 2.00 (2.00-3.00), whereas the postoperative numeric scale was 1.00 (1.00-1.50, P = 0.034). The effectiveness of the PCL mesh plate and that of the PDS plate group according to the septal grading scale were 1.45 (SD, 0.522) and 1.18 (SD, 0.603), respectively. However, these differences were not statistically significant. Our study shows that septoplasty using absorbable plates provides satisfactory and safe clinical outcomes in patients with nasal septal cartilage fractures.

Functional and Radiological Outcome in Atypical Subtrochanteric Femur Fracture After Surgical Fixation: A Retrospective Observational Study.

Background: Treatment for osteoporosis can have catastrophic side effects, including the uncommon fracture known as an atypical femur fracture (AFF), which is related to the long-term usage of antiresorptive agents. Bisphosphonate therapy may lead to significant and chronic suppression of bone turnover, impairing the bone's remodelling property and finally leading to incomplete or complete atypical femur fracture. AFF was defined by the American Society for Bone and Mineral Research (ASBMR) Task Force in 2010 and is far less prevalent than proximal femur (hip) fracture, with an incidence of 2 to 78 per 100,000 patients per year following two to eight years of bisphosphonate therapy, respectively. Due to the rarity of the fracture, it is still not clear what the functional and radiological outcome will be after surgery.Aim: To identify the functional and radiological outcomes of surgical fixation of atypical femur fractures.Methods: The study was conducted in a tertiary healthcare centre after scientific and ethical clearance from the competent authority. Between January 2018 and December 2021, individuals who were diagnosed with an atypical subtrochanteric femoral fracture associated with the use of bisphosphonates and treated surgically were retrospectively evaluated. The study's inclusion and exclusion criteria were used to include 20 patients. The features of an atypical subtrochanteric fracture were congruent with the radiographic findings. Most of the patients were treated with internal fixation with intramedullary osteosynthesis in standard with or without plate osteosynthesis. They were then followed up for a year to look at the functional and radiological outcomes.Results: All of the 20 patients who were included had an atypical subtrochanteric fracture, with 15 of them being female and 5 of them being male. The patients' mean age at surgery was 65.12 (range 49 to 82) years, and their average history of bisphosphonate use was 3 (range 2.5 to 5) years. All patients were treated surgically. We found that five months was the mean period for bone union (p = 0.990). Within six months, bone union was achieved in 11 patients (55 %) (p = 0.884). Five patients (about 25%) had implant failure and non-union, requiring two to three revision surgeries. At three, six, and nine months, the mean visual analogue score (VAS) was 4.14, 3.12, and 1.85, respectively. The modified Hip Harris Score had a mean of 72.66 and 15 patients (about 75% of them) could walk normally again after a fracture. The mean of the modified HHS was 72.66, and the VAS at three, six, and nine months was 4.14, 3.12, and 1.85, respectively.Conclusion: AFFs are rare fractures that must be treated effectively, and most of them require surgery. Successful treatment of AFF is possible by the use of intramedullary fixation, which enhances axial stability, serves as an internal splint, and lessens the likelihood of implant failure. A good functional and radiological prognosis can come from a stable fixation and a fracture that has been reduced anatomically.

Is it Necessary to Stabilize Every Fracture in Patients with Serial Rib Fractures in Blunt Force Trauma?

IntroductionManagement of traumatic rib fractures is subject of controversial discussions. Rib fractures are common, especially after traffic accidents and falls. There is no consensus on whether and how many rib fractures need reconstruction. Not every rib fracture needs to be stabilized, but conservative treatment by internal splinting and analgesia is not effective for all patients. Deformities of the chest wall with reduced thoracic volume and restrictive ventilation disorders must be avoided. Intraoperative assessment of fractures and chest stability plays a central role.Material and methodsFrom 07/2016 to 07/2021, a total of 121 chest wall stabilizations were performed (m:f = 2:1, age 65 ± 14.5 a). Indications for surgery were the following criteria: (1) palpatory instability of the chest wall, (2) dislocated fracture endings, (3) concomitant injuries, (4) uncontrollable pain symptoms. In all patients, a computed tomography scan of the thorax was performed before the osteosynthetic treatment to assess dislocation of the fracture endings and possible concomitant injuries of intrathoracic organs.ResultsVideo-assisted thoracoscopy was performed in all patients. Hemothorax and concomitant injuries of the lung, diaphragm and mediastinum could be assessed. This was followed by an intraoperative assessment of the rib fractures, in particular penetration of fracture endings and resulting instability and deformity. Relevant fractures could be identified and subsequent incisions for rib osteosynthesis precisely defined. 6.3 (±2.7) rib fractures were detected, but 2.4 (±1.2) ribs treated osteosynthetically. Bilateral rib fractures were present in 26 patients (21.5%). Post-operative bleeding occurred in seven patients (5.8%), a breakage of the osteosynthetic material in two patients (1.7%).DiscussionIntraoperative assessment of relevant fractures and dislocation is the decisive criterium for osteosynthesis. Thoracoscopy is mandatory for this purpose – also to identify accompanying injuries. Not every fracture has to be approached osteosynthetically. Even with serial rib fractures or multiple fractures in a single rib, the thoracic contour can be restored by stabilizing only relevant fractures. Intraoperative palpation can adequately assess the stability and thus the result of the osteosynthesis. Even after surgical treatment of thoracic trauma, adequate analgesia and respiratory therapy are important to the healing process.

Treatment of damage to the extensors of the fingers

The nature of operative and treatment methods depending on the terms of trauma and injury levels in 134 patients with injuries of hand finger extensors is established. The treatment method stereotype of injuries of hand finger extensors is developed. The internal splinting is typical and the most adequate treatment method for the 1st injury zone; the buried tendon sutures with temporal (to three weeks) fixation of the joint by the wire to accretion of the sutured ends of the injuried tendons are typical for the 2d zone; the primary and secondary tendon sutures with the palmar plaster bandage to accretion of tendons are typical for the 3d zone, the most favourable zone for recovery; the primary or secondary tendon sutures with the absence of defect butween tendon ends are typical for the 4th zone, and with defect more than 35 sm the free bridge-like plasty by autotransplant is typical. In chronic injuries of one two finger extensors when defect is more than 5 sm the transposition is advisable, that is switching the distal extensor end over to the new motor muscle.

A study on displaced mid-clavicular fractures treated by titanium elastic nailing system (Tens)

Introduction: The mid shaft clavicle fractures account for 70-80% of all clavicular fractures. Intramedullary devices behave as internal splints that maintain alignment without rigid fixation. TENS provide a three point fixation within S-shaped clavicle and effectively control rotation, angulation and shortening.Materials and Methods: study included 21 patients aged between 18 to 60 years who underwent CRIF/ORIF with TENS for mid clavicular fractures in Department of Orthopedics, SMCH. Percutaneous nails are placed from medial to lateral direction. Entry point is 1 cm lateral to sternoclavicular joint. 5 to 10 mm longitudinal skin incision made 2mm medial to entry point in clavicle. In open approach a small vertical incision made at level of fracture. Post operative follow up done at postoperative day 10, 3 weeks, 6 weeks, 4 months, 6 months.Results: Timing of operation was 2 to 15 days from date of injury. Close reduction was done in 6 cases and open reduction required in 15 cases. DASH score was 5 -10 at 24 weeks and constant shoulder score was 95-100 at 24 weeks. Time for clinical union was 6 to 12 weeks and for radiological union was 12 to 14 weeks.Discussion: TENS are only indicated for OTA type A and B mid clavicular fractures. Diameter of nail should not be less than half of that of medullary cavity.Conclusion: Fixation of displaced mid clavicular fracture with TENS is technically demanding and minimal invasive, early functional recovery and 100% rate of fracture union. Study gives sufficient evidence of excellence of this procedure in OTA type A midclavicular fractures, preferably transverse or short oblique fracture.

Technique to Fix the Stubborn Deviated Caudal Septum with an Internal Bone Graft Splint.

Background:Septoplasty, especially of the caudal portion, during cosmetic rhinoplasty is a crucial step in achieving satisfactory straight outcomes for the bony cartilaginous infrastructure and the skin envelope. Many methods are available, which range from septal mucosal resection to internal splinting by bone in a batten fashion; a power tool is usually used. This study describes a simple technique using a nonpower tool to correct the stubborn deviated caudal septum, with a thin available bone.Methods:Patients who underwent cosmetic open septorhinoplasty for crooked nose deformity and did not respond to the traditional septoplasty techniques were included. Bony splint was harvested from the bony septum and fixed to the caudal septum using an 18-gauge needle to create holes to fix the bony splint to the caudal septum through horizontal matrix sutures to correct septal deviation.Results:Six rhinoplasty patients who had significant caudal septal deviation and did not respond to the traditional techniques of septoplasty were included in this study. The patients were successfully treated by using an internal bony batten splint to correct the deviation. No postoperative complications were noted, and none of the patients required a revision surgery.Conclusions:Bony batten graft is not a new concept. It involves correcting the resistant caudal septum deviation by splinting it internally by using power tools and drills to create the holes to fix the bony splint graft. Using an 18-gauge needle to drill the hole is a simple, quick, and effective technique to correct and straighten the septum for resistant cases.

Does bidirectional splinting improve outcomes in cracked teeth with reversible pulpitis?

Aim To investigate the success rate of 'bidirectional' splinting - both internal and external - of teeth with longitudinal cracks and reversible pulpitis, as well as to identify any signs or symptoms that could give a prognostic indication of success.Design Cohort study.Cohort selection Thirty-four teeth from 33 patients visiting the Department of Conservative Dentistry at the Yonsei University Dental Hospital, Seoul, South Korea, between June 2016 and November 2017, diagnosed with longitudinal cracked teeth with reversible pulpitis. Teeth with signs of pulp necrosis, irreversible pulpitis or other types of longitudinal cracks were excluded.Data analysis These teeth were treated by a systematic protocol of initial external splinting with a metal band, crack removal and internal splinting with composite resin, placement of a temporary crown, before a final permanent crown. Symptoms and vitality were assessed at every stage and root canal treatment provided where deemed necessary. The teeth were then followed up for up to four years to assess tooth survival and pulp vitality.Results Accounting for five dropouts during the treatment protocol, 29 teeth reached at least a one-year recall. Of these, 21 (72%) had pulp survival, eight (28%) had required root canal treatment - six of those before final crown cementation - and zero teeth required extraction (100% survival rate). Cracked teeth without initial tenderness to percussion showed a 94% pulp survival rate, while those with tenderness had only a 46% pulp survival rate.Conclusions A systematic approach to treating cracked teeth with reversible pulpitis should be utilised to maintain tooth vitality and survival. Using a bidirectional splinting method provides good outcomes for these teeth. Tenderness to percussion is a significant prognostic indicator of pulp vitality and whether root canal treatment should be initiated.

Modified mini-incision "internal splinting" versus percutaneous repair technique of acute Achilles tendon rupture: fiveyear retrospective case-controlled study.

Several kinds of minimally invasive surgical techniques are applied to acute Achilles tendon rupture. The risks of sural never injury and re-ruptures are still major issues. The purpose of this study was to compare the middle-term results of two different minimally invasive repair techniques for acute Achille tendon rupture. Twenty-four cases underwent the modified mini-incision "internal splinting" repair technique in group A, and 29 cases underwent a percutaneous repair technique in group B and were evaluated. The intra-operative data, complications, the time of recovery, and the post-operative magnetic resonance imaging were analyzed. At the final follow-up, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Thermann score were evaluated. The mean follow-up time was 59.96 ± 4.16months (range 48-67). At the final follow-up, the AOFAS score and Thermann score in both groups had similar feedback. No nerve injury, infection, or re-rupture was encountered in group A, except two cases with anchor irritation. One case with sural nerve injury and one with a re-rupture were recorded in group B, respectively. The final MRI showed thicker regeneration of the tendon in both groups. The middle-term results indicated the modified mini-incision "internal splinting" technique for acute Achilles tendon rupture is similar to the percutaneous repair technique. A lower risk of sural nerve injury and re-rupture may be advantages.

Survival and prognostic factors of managing cracked teeth with reversible pulpitis: A 1- to 4-year prospective cohort study.

This prospective clinical study evaluated the clinical performance of managing cracked teeth with reversible pulpitis through a combination of internal and external splinting and investigated factors that can affect pulp survival after splinting. Thirty-four teeth diagnosed with cracks and reversible pulpitis were enrolled and treated with bidirectional crack splinting: 1) immediate splinting with a stainless-steel band, 2) internal splinting with crack line removal and resin filling and 3) external splinting with a temporary crown followed by final crown placement. If the symptoms remained/recurred, root canal treatment was performed. Patients were followed up at 3, 6 and 12months, then annually thereafter. Kaplan-Meier survival analysis to calculate the survival of the treated teeth and Cox univariate proportional hazards regression model to investigate prognostic factors were performed. Twenty-nine (97%) teeth were followed up for up to 4years. The pulp survival rate was 72% after banding and 91% after final crown cementation. No tooth was extracted (100% tooth survival rate). In the univariate Cox proportional hazard test, pain on percussion was the only statistically significant factor (hazard ratio=11.77). Teeth with pain on percussion at the first visit had a pulp survival rate of 46% during the follow-up period. In comparison, their counterparts without pain had a 94% pulp survival rate. Bidirectional splinting successfully managed cracked teeth with reversible pulpitis. Pain on percussion (mechanical allodynia) may be an important factor in deciding whether to attempt root canal treatment on symptomatic cracked teeth. A step-by-step approach with bidirectional crack splinting should be encouraged for a cracked tooth with a vital pulp without mechanical allodynia rather than pre-emptive root canal treatment.

Endoscopic “internal splinting” repair technique for acute Achilles tendon rupture

Recently, endoscopically assisted Achilles tendon repair techniques have improved to overcome the surgical complications. However, the risk of sural nerve injury and the strength of repair are still the most concerning aspects. Twenty three patients with acute Achilles tendon rupture were reviewed in the present study. We stitch the Achilles tendon above the ruptured site using the endoscopic locking loop suture technique, and the knotless anchor suture-bridge technique can be used to make the distal fixation of threads. The function was assessed using the muscle power (MRC0-5), ATRS scores, AOFAS ankle-hindfoot scores, and VAS scores at the final follow-up. The mean follow-up time was 15.74 ± 2.43months (12-18). At the final follow-up, the average of the muscle power (MRC0-5), ATRS score, AOFAS ankle-hindfoot score, and VAS score are 4.74 ± 0.45, 97.83 ± 2.77, 96.52 ± 4.87, and 0.35 ± 0.49, respectively. Every patient returned to previous sports activity at 6months postoperative. No wound infection and sural nerve injuries were encountered. Only one case suffers local irritation at the medial knotless anchor site. Endoscopic "internal splinting" repair for acute Achilles tendon rupture using locking loop stitch with suture-bridge technique leads to an expedited return to activity with a low risk of complications. Level IV, case series.

Shape memory alloy as an internal splint in a rat model of excisional wound healing

The purpose of an animal wound model is to replicate the wound healing process of humans as accurately as possible. Although rodents are attractive candidates for animal wound models, the drawback is that their major wound healing occurs by contraction, which is fundamentally different from that seen in humans, where healing is achieved mainly by re-epithelialization and granulation tissue growth. There has been an attempt to overcome such drawbacks by applying an external splint on wounded mice. This model, however, has a few problems concerning the assimilating ability of external splints with the dynamic soft tissue movements and robustness issues. The authors hereby describe a new animal wound model using an internal splint made of nitinol, one of the shape memory alloys (SMAs). SMA wire was inserted intradermally around the full-thickness excisional wound to act as the internal splint, and its ability to impede wound contraction was analyzed. In experiment 1, three different sizes of SMAs (0.18 mm, 0.24 mm, and 0.30 mm diameters of thickness) were inserted as the internal splint and their ability to impede the wound contraction was compared. The most effective size of SMA as the internal splint was selected among them. In experiment 2, contraction of the wound with the selected size of SMA inserted as the internal splint was compared with that of the unsplinted wound. SMA as an internal splint effectively impeded wound contraction without affecting the re-epithelialization rate, thereby successfully mimicking the human wound healing mechanism. In this study, the authors introduce a novel animal wound model that replicates the human wound healing mechanism. This model is robust, reliable, and easily reproducible.

Perioperative Management of Nasal Septal Perforation: A Case Series and Review.

Nasal septal perforation is a prevalent pathology, and its successful treatment remains a significant challenge. Surgical closure is complex, and there are a plethora of accounts of various surgical techniques within the existing literature. Much less has been written about perioperative considerations, which are arguably just as important. This article therefore focuses predominantly on the pre and postoperative management of patients with septal perforation. By drawing both on the existing literature and a series of 64 cases managed over several years by our department, this review aims to consolidate guidance on patient selection, timing of surgical intervention, postoperative splinting, use of antibiotics, and patient advice. It is clear that the size of the perforation (relative to the size of the septum), health of surrounding mucosa, and the systemic health and age of the patient remain essential considerations in patient selection and operative timing. Internal and external splints are widely used to good effect, but the role of nasal packing is less clear-cut. This article suggests packing, but with an increasing preference for NasoPore over BIPP (bismuth iodoform paraffin paste). Use of prophylactic antibiotics remains controversial. The complete closure rate for the series presented here was 81.3%, with an average perforation diameter of 15.1 mm (range: of 6-32 mm), and that for perforations with a diameter below 22 mm was 97.9%.

Operative fixation of type IV-VI acromioclavicular joint separation: an internal splint technique

&lt;p class="abstract"&gt;Treatment of acromioclavicular (AC) joint separation is controversial. Rockwood type I, II, III AC joint injuries generally treated conservatively. In the literature there is various treatment options described for treating type IV - VI injuries with good and poor outcome but no single gold standard method. Rockwood type IV - VI AC joint separation treated with internal splint technique by passing Merselene tape through drill hole at lateral end clavicle, passing it under coracoid process and tied it after reducing vertical displacement of AC joint. Simultaneously horizontal displacement corrected and Merselene tape passed through drill hole of acromian process and tied. Endobuttn supports Merselene tape at superior aspect of clavicle. This study was conducted between April 2015 to March 2019 in KPC Medical College and hospital, Kolkata after taking ethical committee permission. 20 patients undergo surgical fixation of type IV-VI AC joint separation within 3 weeks of injury. Outcome of clinical and radiological parameter assessment was at 6, 12, 24 weeks. Male female ratio was 7:3. Mean age 38.2 years, abduction was less than 100 degree in 2 patients at 6 months follow up due to inadequate compliance to physiotherapy. Other patients develop full Range of motion (ROM) and power of shoulder muscle 5/5. No cosmetic deformity except one painful scar. No postoperative displacement in alignment in Anteroposterior (AP) and axillary lateral view. This technique of interal spilint construct reduces need for rigid implant and biological procedure for acute AC joint dislocation though having excellent fixation strength, good reduction in both coronal and sagittal plane for proper healing of AC and Coracoclavicular (CC) ligaments.&lt;/p&gt;