shaya alimoghadam

The management of proximal femoral fractures, especially comminuted subtrochanteric ones, poses a surgical challenge. It is relatively easier to perform the open reduction of these fractures in the lateral position on a standard radiolucent table, but obtaining an accurate lateral view of the femoral head and neck remains difficult. This study presents a method that overcomes the limitations of fluoroscopy in the lateral decubitus position and improves the accuracy of obtaining a true lateral view. The technique involves positioning the patient in the lateral decubitus position with the u naffected hip flexed at a 45°angle. Additionally, the C-arm is tilted 30-35° cephalad, eliminating the need for position changes or leg manipulation. This method reduces the risk of losing reduction, particularly in cases involving obese patients or complex fractures. By simplifying proximal femur fixation in the lateral decubitus position, this technique can potentially improve patient outcomes. Level of evidence: V

We report a case of a 32-year-old pregnant woman who suffered a combined type pelvic fracture and medial malleolus fracture due to a car accident at 24 weeks and 2 days of gestation. She underwent external fixation of the pelvic ring and percutaneous screw fixation of the ankle fracture. She recovered well and delivered a healthy baby by cesarean section at 37 weeks and 1-day gestation. External fixation can be a definitive treatment option for some pelvic fractures with anterior instability in pregnant patients, as it reduces the risk of fetal harm. Level of evidence: IV

Constipation is one of the most common complaints in children. Guidelines on functional constipation recommend digital rectal examination (DRE) when constipation is suspected. However, diagnosis of megarectum by ultrasonography would differentiate children with constipation from those with dysfunctional defecation.

In this research, we evaluated the utilization of ultrasonography to measure the diameter of rectal ampulla for the diagnosis of functional constipation.

In this study, 94 patients < 14 years old diagnosed with functional constipation were included. Patients were examined by both DRE and ultrasonography before and after a conventional stool softener treatment.

The diameter of the rectal ampulla was significantly wider in patients with large stool mass in DRE than in patients with normal digital rectal exams. There was a significant relationship between fecal incontinence and pre-treatment DRA. By increasing the severity of fecal incontinence, the average DRA in patients increased significantly. Additionally, there was a significant statistical difference between the patient’s DRA before and after treatment. Finally, the relationship between constipation and DRA adjusted model showed that the risk of abnormal DRA was 3.1 times larger in patients with three and four symptoms than in patients with two symptoms and this relationship was statistically significant.

Ultrasonography can be a suitable replacement for DRE; however, further investigations are required.

We report a 22-month-old boy who referred due to nausea, vomiting, abdominal pain and watery non-bloody diarrhea and after thorough evaluation, a large defect in the left postero-lateral side of diaphragm and presence of bowel loops, spleen, stomach and left lobe of liver in the left hemi-thorax were detected. So, he was operated and managed with the impression of Bochdalek hernia. We have also reviewed the similar case reports in the past 10 years, briefly, in order to map the presentations and clinical course of cases with Bochdalek hernia which were diagnosed late, for giving physi-cians a better insight on this issue.