Successful Manual Reduction Research Articles

Manual reduction in testicular torsion and subsequent treatment after successful reduction: a series of reports in a single institution.

To explore the factors affecting the success of testicular torsion manual reduction and the safety of subsequent conservative treatment after successful reduction. Clinical data of 66 patients with testicular torsion treated in our emergency department from February 2017 to February 2022 were retrospectively collected. Manual reduction without anesthesia was performed in 19 patients. Patients with successful manual reduction chose different subsequent treatments according to the wishes of themselves and their guardians, including continuing conservative treatment and surgical exploration. Relevant clinical data were collected and analyzed. Manual reduction was successful in 11 patients (11/19). Seven of them chose to continue conservative treatment, and four underwent surgical exploration immediately. Among the 7 patients who were treated conservatively, 3 underwent surgical treatment due to scrotal discomfort or testicular torsion at different stages, and the remaining 4 patients showed no recurrence of torsion during follow-up. Compared with other patients, patients with successful manual reduction had the shorter duration of pain (p < 0.05). The time from visiting our hospital to surgery in patients who attempted manual reduction was slightly shorter than those who underwent surgery directly (p > 0.05). The testes of these 11 patients were all successfully preserved. The short duration of pain may contribute to the success of manual reduction, and manual reduction did not increase the preparation time before surgery. Due to the unpredictable risk of recurrence, immediate surgical treatment is still recommended, or postponed elective surgical treatment should be offered in the next days or weeks.

Successful laparoscopic repair for reduction en masse of infantile inguinal hernia: a case report of this rare condition.

BackgroundReduction en masse (REM) is a rare condition following manual inguinal hernia (IH) reduction in which a hernia sac is reduced back into the preperitoneal space with a loop of the bowel incarcerated at the neck of the sac. It resembles successful manual reduction and may thus be overlooked easily. We herein report an infantile case of REM of an IH that was successfully treated laparoscopically.Case presentationA 10-month-old boy with a surgical history of bilateral open IH repair at 4 months old presented with a bulge in his left groin and vomiting. A left incarcerated recurrent IH was suspected, and manual reduction was performed. The hernia was apparently reduced successfully, but abdominal distention and vomiting persisted. He was admitted for further observation due to the symptoms. On day 2 after admission, abdominal X-ray showed extensive small bowel obstruction (SBO). Enhanced computed tomography (CT) revealed protrusion of the small bowel with a closed-loop in the left groin. A closed-loop SBO due to postoperative adhesion or an internal hernia was suspected. To assess the etiology of SBO, emergent laparoscopic exploration with hernia repair was planned. Laparoscopy revealed REM of the left incarcerated IH with a thickened peritoneum at the neck of the sac. Laparoscopic reduction was performed, and the incarcerated small bowel showed no signs of ischemia. The hernia sac was not associated with the previously ligated processes vaginalis, which had been closed by a previous Potts’ procedure. It was located at the inside of the processes vaginalis. The sac was successfully closed by laparoscopic percutaneous extraperitoneal closure procedures, and iliopubic tract repair was also performed via the previous inguinal incision. The postoperative course was uneventful.ConclusionPediatric IH is due to the patent processes vaginalis, and REM is extremely rare. Laparoscopic surgery for REM is a relatively common and useful approach for the diagnosis and treatment of adults. In our infantile case, the laparoscopic approach was similarly effective for both investigating the cause of SBO and performing high ligation of the sac for this rare condition with IH.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40792-022-01535-1.

Man With Groin Pain

A 19-year-old male patient was transferred to the emergency department after a motorcycle accident. His main complaint was pain in the left groin and scrotum. He was hemodynamically stable and had a firm, movable, and tender mass over the left groin (Video E1 [available at http://www.annemergmed.com]). The testis in the left scrotum could not be palpated (Figure 1). The emergency physician performed ultrasonography that revealed normal echotexture of testis without hematoma or focal lesions (Figure 2) and confirmed the diagnosis by computed tomography (Figure 3).Figure 2Sonography of the left groin mass in the sagittal plane showed ovoid and homogeneous echogenicity, which favor a normal testis image.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Computed tomography image of the abdomen and pelvis in the axial view with intravenous contrast demonstrating dislocation of the testis over the left inguinal region.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Traumatic testicular dislocation. The patient underwent a successful manual testicular reduction in the emergency department. Unfortunately, the testicle redislocated easily, and a urologist performed successful surgical exploration and orchiopexy. Traumatic testicular dislocation is a rare complication of scrotal trauma, typically resulting from straddle injury sustained in a motorcycle collision. The most common dislocation site is the superficial inguinal region, accounting for >50% of cases. Successful manual reduction includes normal scrotal anatomic positioning and immediate pain relief. However, this may only be possible in 15% of cases given the small size of the defect in spermatic cord layers, edema of the scrotal wall, and the possibility of further testicular damage.1Tai Y.S. Chen Y. Tsai P. et al.Traumatic testicular dislocation: a rare occurrence of blunt scrotal injury.Urol Sci. 2014; 25: 158-160Abstract Full Text Full Text PDF Scopus (4) Google Scholar Surgical repair is required if manual reduction fails or there are coexisting injuries.2Subramaniam S. Ab Khalil M.K. Zakaria J. et al.Managing traumatic testicular dislocations: what we know after two centuries.BMJ Case Rep. 2020; 13e236801Crossref Scopus (3) Google Scholar,3Riaza Montes M. Palacios Ramos J. Gallego Sánchez J.A. Testicular dislocation: an atypical case and review of the literature.Urol Case Rep. 2020; 33: 101405Crossref PubMed Scopus (2) Google Scholar https://www.annemergmed.com/cms/asset/bd128463-f101-4c82-8a09-caa0deea2109/mmc1.mp4Loading ... Download .mp4 (2.74 MB) Help with .mp4 files Video E1

Case Report: Rectal Prolapse with Incarcerated Retroverted Gravid Uterus

Abstract Background: The prevalence of combined incarcerated gravid uterus with rectal prolapse is extremely rare condition and only two case have been reported before. Aim of Study: This study aimed to report a third case report of incarcerated gravid uterus within rectal prolapse to raise awareness of its diagnosis and management. Patient and Methods: Case: A case of 33 year old lady with prolapsed incarcerated gravid uterus (gestational age about 12 weeks) in a rectal prolapse and managed by successful manual reduction under anesthesia followed by rectal cerclage. The pregnancy passed without complications and ended by giving a healthy girl. Conclusion: Incarcerated retrovertd gravid uterus within rectal prolapse is a very rare case, so the obstetricians should be aware of its risk. Gentle manual reduction under anesthesia is an effective procedure with limited complications.

Recommendations for patient management after manual reduction of incarcerated inguinal hernia: a literature review

Introduction: Topic of this review is to provide a systematic overview of the current evidence on the management of patients after manual reduction of an incarcerated inguinal hernia. Methods: Available literature regarding incarcerated or strangulated inguinal hernias published until March 2019 was obtained and reviewed. 32,021 papers were identified, of which only 20 were of a sufficient value to be used in this review. Results: The terms ‘incarcerated’ and ’strangulated’ are used interchangeably in the literature making separate analysis of these two entities almost impossible, although manual reduction is very unlikely to be successful when the hernia has strangulated contents. Following successful manual reduction, mesh repair is generally superior compared to pure tissue repair with regard to recurrence rates. Nevertheless, mesh repair is associated with a significant increase in the surgical site infection (SSI) rate, especially when bowel necrosis is present. The laparoscopic approach provides the benefits of avoiding an unnecessary laparotomy and reducing associated morbidity, but it does require the availability of appropriate equipment and an appropriately skilled surgical team. Conclusion: A mesh repair is generally superior to a pure tissue repair in the surgical management of emergency inguinal hernias, reducing the recurrence rate, but can be associated with an increased risk of SSI depending on the level of contamination. The laparoscopic approach is recommended if an experienced surgical team and necessary equipment are available.

Clinical effect of manual reduction of humeroradial joint in the treatment of type Ⅰ–Ⅲ fresh Monteggia fracture in children

PurposeTo evaluate the efficacy of closed reduction on the humeroradial joint in the treatment of Bado type Ⅰ, Ⅱ and Ⅲ fresh Monteggia fractures in children and investigate the effect of clinical factors, including Bado classification, age and time of treatment on the success rate of closed reduction. MethodsWe retrospectively studied the data of children ≤10 years old with fresh Monteggia fractures (injury within two weeks) treated by manual reduction with plaster immobilization from January 2014 to April 2019. All patients were followed up in the outpatient department every two weeks for 4–6 weeks until plaster removal and then 3, 6 and 12 months. Online or telephone interview was provided for some inconvenient patients after 6 months. Mackay criteria were used to evaluate the clinical effect. Radiographic data were collected and reviewed to assess the reduction of the humeroradial joint. Function of the elbow joint and forearm was evaluated and risk factors related to the failure of reduction were assessed. The successful manual reduction was analyzed from three aspects, respectively Bado fracture type (Ⅰ, Ⅱ, Ⅲ), patient age (<3 year, 3–6 years, >6 years) and time interval from injury to treatment (group A, <1 day; group B, 1–3 days; group C, >3 days). ResultsAltogether 88 patients were employed in this study, including 58 males (65.9%) and 30 females (34.1%) aged from 1 to 10 years. There were 29 cases (33.0%) of Bado type Ⅰ Monteggia fractures, 16 (18.2%) type Ⅱ and 43 (48.7%) type Ⅲ. Successful manual reduction was achieved in 79 children (89.8%) at the last follow-up. The failed 9 patients received open surgery. Mackay criteria showed 100% good-excellent rate for all the patients. The success rate of manual reduction was 89.7%, 87.5% and 90.7% in Bado type Ⅰ, Ⅱ and Ⅲ cases, respectively, revealing no significant differences among different Bado types (χ2 = 0.131, p = 0.937). Successful closed reduction was achieved in 13 toddlers (13/13, 100%), 38 preschool children (28/42, 90.5%) and 28 school-age children (28/33, 84.8%), suggesting no significant difference either (χ2 = 2.375, p = 0.305). However time interval from injury to treatment showed that patients treated within 3 days had a much higher rate of successful manual reduction: 67 cases (67/71, 94.4%) in group A, 10 cases (10/11, 90.9%) in group B, and 2 cases (2/6, 33.3%) in group C (χ2 = 22.464, p < 0.001). Fisher's test further showed significant differences between groups A and C (p = 0.001) and groups B and C (p = 0.028). ConclusionClosed reduction is a safe and effective method for treating fresh Monteggia fractures in children. The reduction should be conducted as soon as possible once the diagnosis has been made.

Incarcerated and strangulated inguinal hernias in children: A 10-year retrospective analysis

Abstract Background: In pediatric inguinal hernia, the most feared complication is incarceration, which can lead to catastrophic consequences if not resolved expeditiously. Aims: This study assessed the usefulness of manual reduction of complicated inguinal hernia in children. Settings and Design: This study was designed to study the age at presentation, gestation age at birth, duration of symptoms, success rate of manual reduction of incarcerated inguinal hernia, subsequent treatment, operative findings, and outcome of strangulated cases in pediatric patients. Materials and Methods: This is a retrospective study involving 56 children under 15 years of age with a diagnosis of complicated inguinal hernia managed between January 2009 and December 2018 at a tertiary care hospital in Nigeria. Demographic characteristics, clinical presentations, management, and outcome were retrieved. Data were analyzed using SPSS software version 22 (IBM Corp., NY, USA). The results were presented as frequencies and percentages. Categorical variables were analyzed using Chi-square test. P &lt; 0.05 was deemed statistically significant. Results: The age of patients ranged between 8 days and 14 years, with a median of 2 months; 79% were infants. Males outnumbered females by a ratio of 27:1, and the rate of incarceration was 5.0%. Majority (89.3%) had no previous hospital visits. Those who had successful manual reduction was 80%. Time of presentation was a statistically significant factor for successful reduction, P &lt; 0.05. One patient experienced en masse reduction, and there was no mortality. Conclusion: Majority of those with incarcerated inguinal hernias were infants, and manual reduction was associated with early presentation.

Treatment of Locking of the Metacarpophalangeal Joint of the Thumb

Locking of the thumb metacarpophalangeal joint is a relatively rare condition. We report successful treatment in 11 cases of locking of the thumb. Ten patients were diagnosed at an average of 3.2 days (range: 0–21 days) from the injury onset, whereas one patient was diagnosed at 4 months from the injury. Seven of 11 cases underwent successful manual reduction, whereas the other four cases required surgical treatment. Among the surgically treated cases, all cases had a sharp prominent of the radial condyle of the metacarpal head. Therefore, this case series showed 1 chronic case and 4 of 10 cases with a nonround shape of metacarpal heads requiring open reduction.

Incarcerated rectal prolapse due to a giant villous adenoma

Villous adenomas may present with bleeding, diarrhea, electrolyte imbalance (Mackittrick-Weelock syndrome), obstruction, being a very rare cause of rectal prolapse. Rectal prolapse is a full thickness protrusion of the rectum through the anal canal and its presentation as an incarcerated rectal prolapse is very infrequent. If manual reduction is deemed impossible, perineal recto-sigmoidectomy, or Altemeier’s procedure, is one of the best surgical options, as an alternative transanal excision of the polyp could be performed with subsequent manual reduction of the rectal prolapse. We report the case of a female patient, admitted to the emergency room presenting an incarcerated rectal prolapse with a friable ulcerated mass of 10 × 8 × 5 cm, compatible with a villous polyp in the back side of the rectum. Since manual reduction was considered not feasible, surgery was decided and a transanal excision of the polyp was performed, following a successful manual reduction of the rectal prolapse. This case is of particular interest for its unusual association of incarcerated rectal prolapse due to a giant villous adenoma, having only 4 cases been reported in the literature.

Observation of dizziness in patients with otolith disease after successful manual reduction

Objective:To observe the incidence and duration of dizziness after the successful manipulation of the posterior semicircular canals in otolith patients.Method:Our department of 2008-2012 outpatient manipulative reduction successful 80 cases of otolith disorders were divided into two groups: the young group (<55 years old) in 45 cases, the elderly group (over 55 years) in 35 cases, observe the incidence and duration of two groups of patients with dizziness. Result: The young group dizziness occurred in 12 cases(26.7%), dizziness duration (7.8±2.2) days; The incidence of dizziness in the elderly group was 45.7% (16/35), dizziness duration (12.6±2.4) days; the difference between the two groups in the incidence and duration of dizziness were statistically significant (P<0.05). Conclusion: The incidence of dizziness in the patients with otolith disease in the young group was significantly lower than that in the elderly group. The duration of dizziness was significantly lower than that of the elderly group.

Clinical study of aged patients with secondary benign paroxysmal positional vertigo

Objective: To investigate the clinical features and evaluate the efficacy of manual reduction in treatment of age patients with secondary benign paroxysmal positional vertigo (s-BPPV). Methods: Thirty-two cases of aged patients ( the s-BPPV group: including 19 cases of female and 13 males, age from 60 to 86 years old)with secondary benign paroxysmal positional vertigo from Jul. 2013 to Sep. 2015 in our hospital were retrospectively analyzed. The results were compared with 121 patients( the primary group: including 82 cases of female and 39males, aged from 60 to 86 years old)with aged primary benign paroxysmal positional vertigo(p -BPPV). All the patients were followed up for 12 months. Statistical data analysis was carried out with SPSS 19.0. Results: 20.92%(32/153)of all the observed elderly patients with BPPV was the aged s-BPPV. The sex ratio and onset age had no significant difference between the two groups(χ(2)=0.79, P>0.05; t=0.37, P>0.05). The rate of two or more semicircular canal involvement in the secondary group(21.88%) was higher than that in primary group(6.61%)(χ(2)=6.67, P<0.05). Bilateral semicircular canals were involved in 5 of the 32 cases in secondary group(15.63%) and 4 of the 121 cases in aged primary group(3.31%), The difference was significant(χ(2)=6.94, P<0.05). The effective rate after first manual reduction was 57.50%(23/40)in secondary group and 82.31%(107/130)in primary group, the difference was significant(χ(2)=10.46, P<0.05). The total effective rate were 87.50%(35/40) after more than once manual reduction in secondary group and 91.54%(119/130) in primary group, the difference was not significant(χ(2)= 0.59, P>0.05). The numbers of circulation of the first successful manual reduction management were (3.9±1.3)times in secondary group and (2.1±1.1)times in primary group, the difference was significant(t=3.15, P<0.05). The recurrence rate was 37.50%(15/40) in the secondary group and 16.15%(21/130)in primary group after during follow-up for 12 months, the difference was statistically significant(χ(2)=8.35, P<0.05). Conclusions: It's shown that the aged patients with secondary BPPV is not rare in clinical practice, sudden deafness and head trauma are frequent more than other reasons. The aged patients with secondary BPPV are prone to injury in multi-semicircular and bilateral canal compared with the primary BPPV. The effective rate after first manual reduction of secondary BPPV is lower than primary BPPV, it's needed more circulation of first success in manual reduction management. The total effective rates are not significant in two groups and recurrence rate is relatively high in secondary group.

Factors Associated With Manual Reduction of Incarcerated Inguinal Hernia in Children

Background: In patients with incarcerated inguinal hernia, initial manual reduction, which is not always feasible, rather than immediate surgery, is associated with fewer complications. The aim of the study was to evaluate factors associated with successful manual reduction of incarcerated inguinal hernia in children. Methods: A prospective cohort study between January 2010 and December 2014 of children admitted with incarcerated inguinal hernia to a single surgical unit. Results: A total of 34 patients with a median age of 4.2 months (range: 2 weeks to 14 years) were recruited. Manual reduction was attempted in 23 (67.6%) patients and successful in 13 (56.5%). A total of 9 (26.5%) patients had bowel strangulation. Shorter incarceration (median of 18.2 vs. 48.4 hours, p = 0.004) and longer duration of previous swelling (median of 20 vs. 3.5 weeks, p = 0.029) were associated with successful manual reduction. Bowel strangulation rate was higher amongst patients excluded from manual reduction, using the set criteria, compared to those who had failed reduction (77.8% vs. 22.2%, p = 0.044). Conclusions: Manual reduction is more likely to be successful in patients who present early after incarceration as well as those with wider internal rings. Keywords : children, incarceration, inguinal hernia, manual reduction, strangulation

Efficacy of eminectomy in the treatment of prolonged mandibular dislocation

Surgery of the temporomandibular joint is indicated for different clinical situations, including internal derangements, hypomobility, hypermobility, pathology and trauma. Mandibular dislocation is an acute painful condition that causes severe functional limitation. Manual reduction, with or without pharmacological assistance, is the treatment of choice and should be performed as early as possible. On rare situations mandibular dislocation may not be perceived by the patient and remain undiagnosed or misdiagnosed for a long period. This may include severe illness, neurological diseases and prolonged intensive care hospitalization with oral intubation and sedation. Treatment of prolonged mandibular dislocation is different. Morphological changes of the joint and associated structures will prevent successful manual reduction even with the patient under general anesthesia. Basically, two types of surgery may be indicated: elimination of the articular eminence (eminectomy) or reestablishment of a new condyle-ramus relationship, that can be achieved by condilotomy. This article reports a case of prolonged mandibular dislocation that was treated surgically with success. A review of the literature is performed by authors and advantages and disadvantages of each type of treatment are discussed.

Hip Injury–Football

HISTORY: A 13-year-old male running back was injured in a freshman high school football game. The tackeler legally lifted the running back into the air and came down on top of him. The running back landed on his right hip (on grass) and felt an immediate severe pain in the medial anterior and posterior right hip which radiated down the medial thigh. The patient was immobilized on a spine board with C-spine precautions and transported to the nearest emergency department. Paramedics noted that even the smallest passive movements of the right lower extremity (RLE) ellicited extreme pain. PHYSICAL EXAMINATION: Diffuse tenderness of the medial right hip (sparing the greater trochanter). RLE internally rotated and shortened. Small passive movements of right hip exacerbated pain. Skin and soft touch sensation intact. Dorsal Pedal and Femoral Pulses: 2+/4 bilaterally. Patient could move right ankle and toes on command. (Neck Exam: Unremarkable.) DIFFERENTIAL DIAGNOSIS: Hip fracture Hip dislocation Femoral fracture Labral tear hip Pelvic fracture Pubic ramus Ischial tuberosity Acetabulum TEST AND RESULTS: Radiograph Right Hip Anterior-Posterior View: Superior/posterior dislocation femoral head. Post-Reduction Radiograph Right Hip Anterior-Posterior View: Successful reduction with questionable posterior right acetabular fracture. (C-spine series: WNL.) FINAL WORKING DIAGNOSIS: Right hip dislocation with right acetabular fracture TREATMENT AND OUTCOMES: ED Treatment: IV hydromorphone and promethazine for pain. Etomidate for conscious sedation. Successful manual reduction right hip under sedation. While sedated, post reduction right hip passive range-of-motion ellicited a second posterior dislocation with abduction. Right hip manually reduced a second time. Temporarily splinted by taping legs together. Foley catheter placed. Hospital Course: CT pelvis revealed right femoral head well-positioned with fracture posterior/ superior right acetabulum. Open reduction internal fixation of right posterior wall acetabular fracture. After discharge: Initially non-weightbearing. PT initiated upon discharge. Walking with slight limp after seven weeks. Plan to resume sports activities within 4 to 12 months.

Successful manual reduction of locked metacarpophalangeal joints in fingers.

Many studies on the etiology and operative treatment of locked metacarpophalangeal joints in fingers have been reported, but there have been few investigations on manual reduction. The rate of success of manual reduction in previous reports has been low, and no consensus has been reached with regard to the best method of manual reduction. On the basis of our experience with operative treatment, we devised a safe method of manual reduction. Between January 1987 and December 1995, we reduced a locked metacarpophalangeal joint in twelve female patients; every locked finger was successfully reduced, and complications such as fracture did not occur during manual reduction. The average duration of follow-up was five years and nine months (range, three years and two months to nine years and three months). Six patients had no recurrence of the locking. Four of the six remaining patients had one or two incidents of locking, had no alteration in the activities of daily living, and did not want operative treatment. The two remaining patients reported that they had incidents of locking several times a day, and they requested operative treatment as they were afraid of additional recurrences. One patient had an open reduction fifteen months after the initial episode of locking, and the other patient elected not to have an operation for personal reasons. We believe that our method of manual reduction should be used to treat a locked metacarpophalangeal joint in a finger and that operative treatment should be limited to patients in whom manual reduction is unsuccessful or the reduction is unstable.

Incarceration of inguinal hernia in infants prior to elective repair

The low morbidity and good results of elective herniorrhaphy in children are adversely affected by incarceration. Since incarceration is a potentially avoidable complication, we reviewed 908 consecutive cases to determine its incidence and consequences in children awaiting elective operation for an inguinal hernia. Eighty-five of the 908 children presented with an incarcerated hernia. Thirty of these 85 patients (35%) were known to have an inguinal hernia prior to incarceration, and 25 of the 30 were awaiting elective hernia repair. The median time from surgical office visit to planned operation was 22 days, but the mean interval from office visit to incarceration was 8 days. Eighty-five percent of the children with incarcerated hernias were infants under 1 year of age. Seventy-one of the 85 patients with an incarcerated hernia (84%) had successful manual reduction. They were all admitted and had a mean hospital stay of 2.5 days. Emergency operation after unsuccessful attempts at reduction was required in the other 14 children, increasing the average length of stay to a mean of 4.0 days. Significant complications, including infarction of the testis or ovary, bowel obstruction, intestinal necrosis, wound infection, and recurrent hernia, occurred in 26 of the 85 children (31%). We conclude that incarceration is a preventable problem. Even patients scheduled for hernia repair are at risk and the operation should be performed soon after the diagnosis is made. Infants are the highest priority group, since 35% of children less than 12 months of age experienced incarceration while awaiting elective surgery. Timely operation can be expected to avoid the complications and prolonged hospitalization associated with incarcerated inguinal hernia in infants and children.

Acetabular posterior wall fracture. 38 cases followed for 5 years.

Thirty-eight patients with a fracture of the posterior wall of the acetabulum were reviewed after 5 (2-12) years. Of 18 patients with successful manual reduction of a femoral head dislocation, a small fracture fragment, no sciatic nerve injury and who were not operated on, 17 had a good result. Of 20 patients who were operated on either because of the large size of the fracture fragment or because of a persistent dislocation of the femoral head, 6 had a poor result due to femoral head necrosis. In these 6 patients the reduction had been delayed and the acetabular osteochondral lesion was more severe than in the other patients. Skeletal traction seems unnecessary in the treatment of acetabular posterior wall fracture.