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   Table of Contents - Current issue
Coverpage
January-June 2017
Volume 6 | Issue 1
Page Nos. 1-25

Online since Friday, February 2, 2018

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ORIGINAL ARTICLES  

Flexible intramedullary nail is still a cost-effective, minimally invasive treatment for stable tibial diaphyseal fracture - A large scale study p. 1
KR Gowtham, MR Nambiar
DOI:10.4103/ajt.ajt_4_17  
Background: Many times, we come across patients who ask for conservative line of treatment either because of lower socioeconomic status or many people are unable to stay in the hospital for various reasons. Being orthopedicians, mere treatment of fracture should not be our only aim. Our aim also should be to treat patient as a whole. In country like India, especially in rural set-up, economy plays a major role. Hence, we conducted a study to evaluate the cost-effectiveness of flexible unreamed nailing, using Ender nails for the most common long bone fracture, i.e., tibia. Materials and Methods: Nearly 590 patients with diaphyseal fractures were fixed with Ender nails from September 2002 to September 2016. The mean age of the patients was 39 years (range 18–65 years). Inclusion criteria were closed fractures and type 1 compound fractures with relative stable configuration. Exclusion criteria were long oblique and spiral fractures; type 2 and type 3 open fractures. Two Ender nails of 4.5 mm each were passed across the fracture site into the distal fragment. The mean follow-up was 16 months. Results: Average time to fracture union was 11 weeks (range 8–14 weeks). Average peri-operative blood loss was <10 ml and operative time was about 20 min. Average radiation exposure was six shoots. Range of knee movement achieved in most of the cases was >120°. Conclusions: Ender nailing in cases of tibial diaphyseal fractures could achieve reliable fracture stability, better union with least complications. Advantage of low-cost intramedullary device, its easy removal, and less hospital stay makes this even more attractive for the poor patients.
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Motorcycle spokes entrapment foot injuries: Prevalence, and pattern of presentation in a private orthopedic and trauma center, Southeast Nigeria – A 10-year retrospective analysis p. 6
Thaddeus Chika Agu
DOI:10.4103/ajt.ajt_8_17  
Background: Pupils commuting on the backseats of motorcycles to and from schools is commonplace in cities where motorcycles are used for intracity transportation. Often times, the feet of these children get entrapped between the spokes as the motorcycles are in motion and this could cause severe injuries. This is a major health concern in Nigeria because of the increasing use of motorcycle as a transport system. Study Design and Setting: This is a 10-year retrospective analysis of all the motorcycle spokes injured patients admitted in a private orthopedic and trauma center in the southeast region of Nigeria between January 2007 and December 2016. Results: A total of 690 patients seen during the period under review were victims of motorcycle accidents. Seventy-one patients (10.3%) had spokes entrapment foot injuries. They were mostly between the ages of 5–<10 years, n = 50 (70.4%) with the mean of 6.2 years, standard deviation = 1.093. Majority of the injuries were Grade III and the worrisome patterns were degloved heels n = 26 (15.4%) and Achilles tendon tear n = 20 (11.8%). The most significant complication was marginal necrosis of the heel pad n = 8 (30.8%). The patients except one had full recovery and without morbidity. Discussion: Motorcycle spokes entrapment foot injuries occur commonly in children passengers with variation in pattern and severity. Early presentation and prompt treatment made the outcome of these injuries favorable. Conclusion: The dangling feet of a child passenger sitting on a motorcycle could get entrapped in the spoke wheel causing injuries. Strong and enforceable legislation on the use of commercial motorcycles and public enlightenment on these injury patterns are advocated.
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Blunt abdominal trauma in child: Epidemiological, diagnostic, and therapeutic analysis of 55 cases p. 11
Oumar Ndour, Souleymane Camara, Vianel Tendart, Aimee Lakh Faye Fall, Fatou Gassama, Pape Alassane Mbaye, Ndeye Aby Ndoye, Cheikh Diouf, Mbaye Fall, Gabriel Ngom
DOI:10.4103/ajt.ajt_12_17  
Objective: The objective of this study was to report the epidemiological, diagnostic, therapeutic, and evolutionary aspects of blunt abdominal trauma in children. Patients and Methods: We carried out a descriptive retrospective study which collected between 55 children of victims of abdominal bruises and the children's surgery department of the Aristide Le Dantec hospital in Dakar between January 1, 2009, and December 31, 2015. The parameters studied were as follows: age, sex, circumstances and mechanisms, hemodynamic status, abdominal table, imaging, associated lesions, and treatment. Results: The mean age was 7.2 years. Boys were more affected with a sex ratio of 3.58. Road accidents were the most frequent cause of accidents with 50.9%. Thirty-six lesions of solid and hollow organs were recorded. The liver was the most affected organ (23.63% of patients), followed by spleen (9.1%) and kidney (7.3%). Multiple trauma was observed in 30.9% of patients with extra-abdominal lesions involving the thorax (64.7%), the skull (35.3%), and the pelvis (35.3%). Forty-seven patients (85.45%) received conservative treatment with a success rate of 93.62%; 11 patients (20%) underwent surgery. The overall morbidity rate was 14.54%, and mortality was 1.81%. Conclusion: Abdominal bruising in children is more common than wounds in the abdomen. Road accidents are the main etiology. Conservative treatment is in vogue in the service and gives very good results.
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CASE REPORTS Top

Unusual intraorbital foreign bodies: A report of two cases and review of literature p. 19
Oluyemi Fasina, Mary O Ugalahi, Olufunmbi T Oluwaseyi, Charles O Bekibele
DOI:10.4103/ajt.ajt_11_17  
Orbital trauma with retained foreign bodies (FBs) is uncommon but potentially blinding injuries. We report two patients with unusual, large, intraorbital wooden and metallic FBs managed at a tertiary health facility. They had orbital exploration and successful removal of the FBs with satisfactory postoperative outcome. It is advised that large intraorbital FBs (IOrbFBs) be removed promptly. Orbital complications following injury with a wooden IOrbFB could be prevented by prompt surgical removal.
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Airway management in maxillofacial gunshot injury: A case report and literature review p. 23
K. N. J. Prakash Raju, D Anandhi, Joseph Alexis, K Aswin, Vinay R Pandit
DOI:10.4103/ajt.ajt_13_17  
Airway management of patients with maxillofacial trauma is complex and crucial because it can dictate a patient's survival. Often, the status of the cervical spine is unknown in the acute setting, and care must be taken to prevent inadvertent neurological injury. Airway management is a unique and a defining element to the specialty of Emergency Medicine. Failure to secure the airway can drastically increase the morbidity and mortality of the patient within few minutes. Here, we report a case of a young man with shattered mandible following gunshot injury, presenting with airway compromise. Our emergency team successfully managed his airway, and he got operated and successfully discharged without any morbidity.
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