Journal of Orthopedic and Spine Trauma
Volume:5 Issue: 2, Jun 2019

Intramedullary nailing (IM nailing) is the standard of care for the treatment of most diaphyseal lower extremity fractures. A few studies have assessed and compared the infection rate following reamed and unreamedIM nailing in open long bone fractures. In the present study, we attempted to compare the infection rate between two procedures in open fractures of tibia.

In this prospective study, we included consecutive patients suffering from open fractures of tibia (Gustilo subtypes II or IIIA) who required IM nailing. Patients younger than 16 years old, other Gustilo types (I, IIIB, and IIIC), fractures reaching to the tibial plateau articular surface, and simultaneous fractures of other bones in the extremity were excluded. All patients were followed up for one year to assess the postoperative infection rate.

Of 59 patients, 37 underwent reamed IM nailing and 22 underwent unreamed IM nailing. In reamed group, 4 cases (10.8%) experienced an infection requiring reoperation and antibiotic therapy, while in the unreamed group, it was 5 cases (22.7%). The difference between the groups was not statistically significant.

Reamed and unreamed IM nailing procedures for fractures of tibia have similar outcome regarding long-term postoperative infections that require reoperation and antibiotic therapy.

Decreased bone mass, often measured using bone mineral density (BMD) is frequently seen in patients with end-stage renal disease (ESRD) undergoing hemodialysis. It may cause serious bone health problems such as fractures. Several risk factors of low bone mass in the patients on hemodialysis have been proposed including age and body mass index (BMI). Our current study explored the relationship between BMI, age, sociodemographic status, and BMD among postmenopausal women on hemodialysis.

This study enrolled postmenopausal women on hemodialysis whose bone densitometry was checked and assessed with the age, BMI, and social status. Statistical analysis was performed in SPSS software.

Sixty participants with a mean ± standard deviation (SD) of age of 57.00 ± 10.63 years were enrolled. After adjustment of sexand age, normal-weight women had 2 times the prevalence of low bone density compared to the obese women [prevalence ratio (PR) = 2, 95% confidence interval (CI): 1.4–2.8]. For osteoporosis, the PR was also twice higher for the women with normal BMI (PR = 2, 95% CI: 1.3-2.8) and 1.6 times higher for the overweight group than the women in the obese group (PR = 1.6, 95% CI: 1.3-2.4).

Among the women on hemodialysis, obese women have lower prevalence of osteoporosis than normal-weight cases

Congenital dislocation of the patella (CDP) is an uncommon disorder, which presents with hypoplastic, irreducible patellae. It is accompanied by knee flexion contracture, external rotation of the tibia, and genu valgus. We present the case of a seven-year-old girl with CDP, who was misdiagnosed as having cerebral palsy crouch gait and underwent distal femoral extension osteotomy, without paying attention to the dislocated patellae. Recurrence ensued, and the patient was referred for further evaluation. After a second surgery to address the dislocated patellae, the flexion contracture and gait pattern improved significantly. This case underscores the importance of a systematic, thorough physical examination, without which uncommon diagnoses will be overlooked, exposing the patient to further morbidity and complications.

Asymmetric bilateral hip dislocation is a rare condition and the association with bilateral femoral head fracture makes it even more rare. We report a patient with asymmetric bilateral hip fracture – dislocation and our management and therapeutic approach.

A 28-year-old male sustained motor vehicle accident and presented asymmetric bilateral hip fracture-dislocation. In the initial step close reduction was performed and in the following step the patient underwent bilateral open reduction and fixation of femoral head fragment by screws. The results were satisfactory after 5 year follow-up.

Although rare, paradoxical femoral head fracture should be considered in patients with hip dislocation. Our management and therapeutic approach seems to be appropriate for this case and is suggested in similar cases.