Trivial Fall Research Articles

A prospective study to analyze the outcome of surgical stabilization of fractures of lower end of radius with Ellis plate

Introduction: The most common cause of distal radius fracture is a fall on an outstretched hand. Osteoporosis can make a relatively trivial fall result in a broken wrist. Many distal radius fractures in people older than 60 years of age are caused by a fall from a standing position Methodology: Total of 1336 bony injuries were reported to Hospital casualty and orthopedic opd during the study period. Out of which 382 are upper limb fractures. Total number of distal radius fractures are 60. After exclusion for detailed study 20 patients were selected Results: Using the Demerit score system of Gartland and Werley, we had 12 (60%) excellent results, 5 (25%) good results, 3 (15%) fair results and on poor results Conclusion: Thus open reduction and internal fixation by volar Ellis plating provides better functional results in fractures of distal end of radius. So this procedure can be used as alternative to other procedure in treating fractures of distal end radius

A prospective study to evaluate the radiological and functional outcome of unstable intertrochanteric fractures treated with proximal femoral nail

Background and Objectives: Intertrochanteric fracture is one of the most common fractures of the hip especially in the elderly. These fractures are three to four times more common in women and the mechanism of injury is usually due to low-energy trauma like a simple fall. More than 50% of intertrochanteric fractures are unstable. The surgical stabilization of unstable intertrochanteric fractures remains a persistent challenge. The purpose of this dissertation is to study the effectiveness and drawbacks of one such newer intramedullary device, the Proximal Femoral Nail in the management of unstable intertrochanteric fractures Methodology: This study is a prospective, time bound, hospital based study conducted at P.G.I of swasthiyog Pratishthan, Miraj, between March 2013 to Feb 2014. The study included 45 cases of unstable intertrochanteric fractures (AO classification 31A2 & 31A3) that were operated with the PFN which fitted into the inclusion criteria. All patients were informed about the study in all aspects and an informed consent was obtained. Follow up at 4, 8, 12, 18, 24 weeks for serial clinical and radiological evaluation was done and assessed clinically regarding pain, limp, hip movements, walking ability, deformity and shortening. Functional evaluation at end of 6 months was done by using Harris hip score. Results: The study included 45 cases of unstable intertrochanteric fractures (36 cases of 31A2 & 9 cases of 31A3) that were operated with the PFN. The average age was 64 years. The most common mode of injury was trivial fall in 30 cases. Good reduction was achieved in 39 patients (86.66%). Acceptable reduction was achieved in 6 patients. 3 intraoperative complications and 9 post-operative complications observed. The average time of union was 18.44 weeks. Maximum number of fractures united between 16-20 weeks. Good to excellent results were seen in 88.8% of the cases according to Harris hip score at end of 6 months.Conclusion: Hence we conclude that short Proximal Femoral Nail provides good fixation for unstable intertrochanteric fractures if proper preoperative planning, good reduction and surgical technique are followed, leading to high rate of bone union and minimal soft tissue damage especially for asian patients with relatively small femora.

Pathological fracture of proximal femur secondary to an aneurysmal bone cyst in a child

Aneurysmal bone cysts are enigmatic, locally destructive blood filled lesions of bone with unknown cause & unusual presentations. We report a case of an 8-year old male child who presented to us with a pathological fracture of right hip after a trivial fall. It was an aggressive aneurysmal bone cyst of the proximal femur complicated by a subtrochantric fracture. Treatment was done successfully with an intralesional curettage and implantation of a frozen cancellous cadaveric allograft of femoral head followed by internal fixation of the pathological fracture with plate and screw.

Role of endovascular embolization in treatment of acute bleeding complications in haemophilia patients.

Bleeding complications either spontaneously or post-operatively are very common in patients with haemophilia. Sometimes these bleeding complications remain unresponsive despite being on high dose of clotting factor replacement. The aim was to assess the role of endovascular embolization in patients with haemophilia in (a) treating haemorrhagic complications due to local causes refractory to clotting factors substitution and (b) reducing intraoperative blood loss in elective pseudotumour surgery. 10 patients seen between January 2000 and April 2015 with severe haemophilia A or B who had unexplained profuse persistent bleeding or required large pseudotumour excision and were taken up for digital subtraction angiography and embolization were included in the study. Data of all these patients were reviewed using the computerized hospital information system and picture archiving and communication system. Details including indications for the procedure, patient preparation for the procedure, imaging findings, details of angiography with intervention, if any, and outcome as well as follow-up data were analyzed. In 6 of these 10 cases, bleeding was spontaneous, in 2 cases due to trivial fall and in 2 cases due to post-operative bleeding. Angiography in these patients revealed vascular blush, abnormal hypervascularity or active extravasation. In all 10 patients, an embolization procedure was performed, with bleeding controlled in 8 patients. There were no procedure-related complications during the procedure, post-procedure bleeding or haematoma at the site of arterial access. One patient had recurrence of bleeding for whom surgical exploration was required, and one patient had significant bleeding intraoperatively which was controlled with high-dose clotting factors, blood transfusion and fresh frozen plasma intraoperatively. Endovascular embolization is a safe, effective and cost-saving procedure in arresting bleeding in selected patients with severe haemophilia who are unresponsive to adequate clotting factor replacement and where local vascular causes could be contributing to the bleeding. Pre-operative embolization is also a good procedure to reduce intraoperative blood loss in patients with large pseudotumours. Angiography and embolization in patients with haemophilia is technically challenging and should be performed by highly skilled interventional radiologists, which limits its wider use and familiarity among multidisciplinary teams managing haemophilia. By bringing the knowledge of this effective treatment to the specialist groups who care for patients with haemophilia, its wider application may be possible which can save life and/or reduce morbidity.

A comparative study of proximal femoral nailing and dynamic hip screw in the management of inter trochanteric fracture femur

Inter-trochanteric fractures of the femur are one of the most common fractures of the hip in the elderly. They occur usually due to low energy trauma like simple falls. The incidence is rising because of increased life expectancy. The prevalence of these fractures is related to numerous factors including osteoporosis, malnutrition, decreased physical activity, impaired vision, neurological impairment and altered muscle balance. The present study was a prospective randomized study consisting of 60 adult patients with fresh inter-trochanteric fractures of the femur who were treated with DHS or PFN at MediCiti institute of Medical Sciences Ghanpur, Rangareddy District, Andhra Pradesh between June 2010 and June 2012. This study was carried out to compare the results of inter-trochanteric fractures treated with DHS and PFN. All the 60 patients were followed up at regular intervals. Inter-trochanteric fractures were most common between the ages of 61-70 years in our series. A trivial fall at home was most common mechanism of injury (70%). Males outnumbered females. Type 1 and 2 (Boyd and Griffin) were most common. Blood loss was less for PFN (197 ml) as compared to DHS (304 ml). There were no significant differences in the intra-operative complications with both implants. The mean time for full weight bearing was 10.75 weeks for PFN and 14.42 weeks for DHS, for radiological union was 19.57 weeks for PFN and 22.04 Weeks for DHS. There were more excellent/good results with PFN (93%) as compared to DHS (78%). There was one poor result with DHS and none with PFN. Limb length discrepancy (>1cm) was equal in both groups (2 each).

Short stature Revealing a Pycnodysostosis: A Case Report.

Introduction:Pycnodysostosis is a rare genetic disease characterized by osteosclerosis and bone fragility. The clinical aspects are varied including short stature, acro-osteolysis of distal phalanges, and dysplasia of the clavicles. Oral and maxillofacial manifestations of this disease are very clear. The head is usually large, a beaked nose, obtuse mandibular angle, and both maxilla and mandible are hypoplastic. Dental abnormalities are common. We report a case with the typical clinical and radiological characteristics of the Pycnodysostosis associated with a conductive hearing loss, an association rarely reported.Case Presentation:A 12-year-female was admitted in our institute for short stature with a dysmorphic facies for evaluation. The patient reported a history of multiple fractures of the long bones after a trivial fall. On physical examination, she had the following features: short stature, limited mouth opening, short hands and feet with dysplastic nails; frontal and occipital bossing; and hypoplasia of the maxilla and mandible. Examination of the mouth: grooved palate, caries of the teeth, impacted and malposed teeth, persistent deciduous teeth and missing teeth. Laboratory investigations were normal. The radiographic examination showed a generalized increase in the bone density, slight condensation of the skull base and a very open mandibular angle. X-rays showed tapered phalanges with acro-osteolysis of the distal phalanges. A symptomatic treatment was proposed based on fracture prevention, oral hygiene, frequent dental visits and psychiatric support.Conclusion:The clinical and radiological features are the bases for the diagnosis of this disease. It is important to make the diagnosis as early as possible in order to plan the treatment and to provide a better life quality to the patients.

Generalized spastic dystonic cerebral palsy with regression of motor milestones due to congenital atlantoaxial dislocation: A diagnostic dilemma and rare association

In spastic cerebral palsy cervical dystonia with congenital AAD is a rare association. The combination of these and regression of milestones produces clinical dilemma. We present a case of generalized spastic dystonic cerebral palsy with AAD. The child had regression of the milestones following a trivial fall due to compression at the cervicomedullary junction. One has to differentiate the regression of milestones caused by untreatable herditary or treatable mechanical etiologies. This might make significant difference in management, prognosis and may have financial implications.

Cerebral Ischemia after Acute Epidural Hematoma in Child with Osteogenesis Imperfecta Type III

Osteogenesis imperfecta (OI) is a genetic disease characterized by reduced bone mass and increased risk of fractures. Among extra skeletal abnormalities, it presents coagulation disorders (vascular fragility, decreased platelet retention, decreased levels of factor VIII and deficient platelet aggregation induced by collagen), mainly hemorrhagic in varying degrees of manifestation We present a 6-years-old child with type 3 OI which after a trivial fall, developed extensive neurosurgical epidural hematoma with posterior complicating ischemia in the middle and posterior cerebral artery territories. Case reports of cerebral ischemia complications in brain hemorrhage after minor, trivial head traumas in normal children have been published, but none associated with OI patients since supposed they use present post traumatic hemorrhagic complications.

Peculiarities and Patterns of Cervical Spine Injuries in Children and Adolescents: A Retrospective Series of 84 Patients from a Single Institute

Cervical spine injuries occur infrequently in children but are associated with significant disability and mortality. A retrospective analysis was performed of 84 consecutive pediatric spine injuries treated at our institute from January 2002 to December 2011. The mean age was 14.7 years. There were 18 patients (21%) in group A (0-12 years) and 66 patients (79%) in group B (13-18 years). Overall, injury was more common in boys (ratio of 6:1). Trivial fall was the predominant cause in group A and fall from height in group B. There were 30 children (36%) with injuries of the upper cervical spine, 53 (63%) with injuries of the lower cervical spine and 1 patient (1%) with a combined injury of upper cervical spine and thoracic spine. Overall, 22% of the group A children and 67% of the group B patients had more severe injuries (Frankel grades A, B and C); 21% (18/84) were treated by surgical fusion. Where follow-up was available, 17 out of 22 children (77%) had good outcome (Frankel grade >C). In conclusion, mechanisms and patterns of injury in children are age related and the majority of the children had good outcome.

Skull-base Osteomyelitis: a Dreaded Complication after Trivial Fall and Inadequate Management

Introduction: Skull-based osteomyelitis is bony infection which generally originates from inadequately treated chronic infection, adjoining tissue infection or after trauma.Case: 11 month female child had a trivial fall while standing near a bucket. The child developed fracture of right clavicle and left orbital swelling which was inadequately treated. This resulted in in spread of infection to adjoining tissues, skull bones, sinuses and brain.Conclusion: Cranial base osteomyelitis is rare but dreaded condition which requires early diagnosis and prompt treatment to avoid mortality and morbidity in form of neurological deficits and permanent disability

Appearance of isolated thrombocytopenia in a patient of acute subdural hematoma

Abstract Thrombocytopenia in critically ill patients probably reflects the severity of the underlying illness and these patients have a higher mortality due to the severity of overall clinical status. In present article we report a case of acute subdural hematoma who developed progressive thrombocytopenia resulting in fatal outcome. A 75 year gentleman presented with history of sudden onset headache and lapsed into altered sensorium. There was history of trivial fall before he developed headache. The patient was deeply comatose with pupils bilateral 2 mm and reacting to light. Computerized tomography (CT) scan brain showed large right fronto-temporo-parietal acute subdural hematoma with mass effect and midline shift. Post-operatively he was kept on elective ventilation. On following days the patient continues to develop thrombocytopenia (Day- 3 Platelet count 75,000, day-4 60,000, day-5 25,000). Thrombocytopenia is a common but a potentially life-threatening condition problem and has been considered to play a role in worsening the prognosis of critically ill patients in intensive care unit. Few studies statistically examine the strength of the association between risk factors and outcomes related to thrombocytopenia, additional research is recommended to identify putative molecular determinants.

Mineralizing angiopathy with basal ganglia stroke in an infant.

Basal ganglia stroke is known following trivial head trauma. Recently a distinct clinic-radiological entity termed ‘mineralizing angiopathy’ was described. We report an infant who developed basal ganglia stroke following trivial fall. His clinic-radiological features are described.

Bipolar hemiarthroplasty for primary abductor deficiency with femoral neck fracture.

Bipolar hemiarthroplasty for primary abductor deficiency with femoral neck fracture.

Bilateral Femoral Neck Fractures in A Young Patient Suffering from Hypophosphatasia, Due to A First Time Epileptic Seizure.

Introduction:We report a case of an adolescent sustaining bilateral femoral neck fractures due to a first time epileptic seizure, as a result of expansion of his known syrinx.Case Report:A 19-year-old patient suffering from hypophosphatasia (HPP), Arnold-Chiari malformation, and a ventriculoperitoneal shunt sustained a trivial fall with profound pain and an inability to mobilize. Radiographs demonstrated a right-sided Garden-4 femoral neck and left-sided multi-fragmentary intracapsular/extracapsular fractures. The patient had previously suffered bilateral proximal femoral shaft fractures, treated with intramedullary unlocked nail fixation that was still in situ. Operative treatment with an exchange to Synthes Adolescent Lateral Recon nail was performed on the right with two Recon screws inserted into the femoral head. On the left, the existing Pedinail was preserved with an additional single screw inserted into the femoral head. In addition, 3 months of non-mobilization was required for adequate bone healing. After 1-year from time of injury, there is no avascular necrosis on radiographs and the patient is mobilizing pain-free.Conclusion:Patients with hypophosphatasia have delayed bone healing. We recommend surgical fixation with an intramedullary device and periods of non-mobilization until there is radiographical evidence of adequate bone healing.

Ultra Long Construct Minimally Invasive Spinal Stabilization Using Percutaneous Pedicle Screws in the Treatment of Symptomatic Multicentric Spinal Metastasis.

Managing multiple level spinal metastases is challenging. We report the case of a 58-year-old female with advanced lung cancer who presented with multiple pathological fractures of the thoracic spine (T5, T6, T7, and T8 vertebrae). She was treated with palliative radiotherapy. Her resting pain improved, but the instability pain persisted. One month later, she had a trivial fall leading to a pathological fracture of the L2 vertebra with cauda equine syndrome. The patient was treated surgically with minimally invasive decompression of the L2 and with percutaneous instrumented stabilization using an ultra-long construct from T3 to L5 (15 spinal levels), spanning the previously radiated zone and the decompression site. Postoperatively, she had significant improvements in pain and neurology. There were no surgical complications. Ultra long construct minimally invasive spinal stabilization is the ideal approach for symptomatic multicentric spinal metastasis with poor prognostic scores. Using this technique, the goals of spinal stabilization and direct neural decompression can be achieved with minimal morbidity.

Anterior dislocation of hip following DHS fixation of intertrochanteric fracture: A case report.

Intertrochanteric fractures are commonly seen in elderly population. 90% of these occur following a trivial fall. Dynamic hip screw fixation is one of the most common modality of treatment, although intramedullary fixation devices are gaining popularity in recent times, especially in unstable fractures. Dislocation of hip following a DHS fixation of hip is a very rare complication. There are only two case reports which describes dislocation of hip following DHS fixation of an intertrochanteric fracture. Here we present a case of anterior dislocation of hip following DHS fixation of an intertrochanteric fracture. We also discuss about the possible causes of this rare complication, its management and follow up.

Intraoperative Life Threatening Acute Lung Injury Due to Multiple Septic Pulmonary Emboli during Transpedicular Biopsy and Kyphoplasty.

A 55-year-old gentleman was presented to our clinic two months after a trivial fall with persistent pain, gibbus at the thoraco-lumbar junction and intact neurology. Radiological and laboratory investigations suggested osteoporotic fracture or metastasis. Due to unremitting pain, a plan was made to do transpedicular biopsy and kyphoplasty. Biopsy needles were inserted into both pedicles and an attempt at aspiration was made. Since the aspirate was dry, 5 to 6 mL of saline was injected through one needle and an attempt at aspiration was made through the other. Three-millilitres of sero-sanguineous material mixed with pus came out and kyphoplasty was deferred. After extubation, the patient developed severe bronchospasm and was transferred to the intensive care unit. Investigations confirmed multiple septic pulmonary emboli and the patient recovered completely after treatment. This report highlights that confirmation of the diagnosis is essential before performing any procedure that increases the intravertebral pressure and the place should have appropriate facilities to manage complications.

Bilateral spontaneous rupture of quadriceps tendon in a case of gout

Introduction: Bilateral and spontaneous quadriceps tendon rupture is a very rare phenomenon in clinical scenario. It is usually associated with trivial trauma superimposed on pathological and weakened quadriceps tendon due to various conditions. Because of its uncommon nature it is frequently misdiagnosed and mistreated. Case Report : A 57-year-old gentleman developed bilateral spontaneous quadriceps tendon rupture following a trivial fall. Further evaluation revealed that he was suffering from gout. Bilateral quadriceps tendon tears were surgically repaired with Krackow technique. He was started on treatment for hyperuricemia. He achieved good functional results at 20-week follow-up. Conclusion : Bilateral spontaneous quadriceps tendon rupture occurs in pathologically weakened tendon due to various disease processes. Correct diagnosis and early treatment provides best functional results.

Pre-injury demographic patterns of patients sustaining hip fractures in malaysia.

Hip fractures entail a growing economic burden on the health care system. Study is warranted to further our understanding of its patterns and to create increased awareness in health care providers and the public. Data was extracted from the ongoing National Orthopaedic Registry of Malaysia (NORM), for the period June 2008 till December 2009. Patients aged 50 years and above without previous pathological fracture hip fractures were included in the study. Most hip fracture patients were 70 years and above (69.5%) with a mean (SD) age of 73.8 (10.3) years. Females represented the majority of the patients in this study (68.4%). Low energy trauma (i.e. trivial fall) was to the main mechanism of hip fractures in this study (81.3%). Aging adults should be made aware of timely preventive strategies (including osteoporosis prevention) fall prevention measures, and encouraged to maintain physically active lifestyles. Hip fracture, pre-fracture status.

Bilateral Anterior Dislocation of the Shoulder: Review of Seventy Cases and Proposal of a New Etiological-mechanical Classification

BackgroundAlthough anterior shoulder dislocation is common in everyday practice in Emergency Departments, bilateral presentation is a rare entity. ObjectivesThe aim of this article is to report two additional cases of this rare injury and to introduce a new mechanism that can produce it. We made an exhaustive review of the literature and found 68 cases in printed publications. Also, we analyzed the mechanism of injury and the presence of predisposing factors, and propose a new etiological-mechanical classification. Case ReportOne case occurred after a trivial fall, and the other was produced by a mechanism not previously reported: the patient pushed strongly forward, expecting a resistance and finding none, his arms kept the forward movement and the shoulders dislocated. DiscussionThis lesion has a bimodal distribution, affecting mainly men (70%) with a mean age of 33.5 years, whereas in women, the average age is 57 years. The most common cause is trauma (50%), followed by muscle contractions (37%) due to seizures of different causes (epileptic, hypoglycemia, toxic, or hypoxic) or electrocution. In 15.7% of the cases, the diagnosis of bilateral anterior dislocation was not acute (<3 weeks), and in virtually all of these cases it was not traumatic. ConclusionThe bilateral anterior shoulder dislocation may not be as rare as previously thought and must be taken into account in emergency services. The authors propose a new etiological-mechanical classification. Also, the importance of radiologic diagnosis must be highlighted.