Battered baby with multiple epiphyseal separations: case report and review of literature

Multiple epiphyseal separation in battered baby syndrome is a rare occurrence. We report epiphyseal separations of proximal tibia and distal humerus along with femoral shaft fracture in a child of two and half years of age. In the course of clinical, laboratory, and radiological examinations, the child was diagnosed to be a case of battered baby syndrome. The child was treated and isolated from the mother, who was the culprit for battering the child. We believe, in any epiphyseal injury below 3 years of age, particularly when the distal humerus physis is involved, diagnosis of child abuse should be considered as an etiology.     

Isolated cystic tuberculosis of scapula; case report and review of literature

Tubercular osteomylitis of scapula is extremely rare. The isolated involvement of this flat bone without any primary focus confuses the surgeon with other pathology and as a result there is always delay in diagnosis. This article discusses about an isolated multicystic tubercular lesion of scapula which remained untreated for about two years as the primary physician biased with the history of trauma and suspected it to be a post-traumatic hematoma. MRI picture was deceptive. Finally, diagnosis was established by fine needle aspiration which showed typical epitheloid granuloma on histology. Lack of awareness and nonspecific radiological picture may cause delay in diagnosis of scapular tuberculosis. Tuberculosis is an important consideration in isolated scapular swelling particularly in endemic regions and the histological diagnosis by fine needle aspiration may be helpful in cases of doubtful radiological pictures.     

Predictors of early outcome in unstable pelvic fractures

Objective:To define the preoperative and intraoperative variables which may affect the immediate postoperative outcome in surgically managed patients with unstable pelvic fractures.Methods:This study w...     

Posterior wall reconstruction using iliac crest strut graft in severely comminuted posterior acetabular wall fracture

Osteosynthesis of comminuted posterior acetabular wall fractures is a challenging task for surgeons. We report a series of eight cases of such fractures where the comminuted fragments were excised and the defect in the posterior acetabular wall was reconstructed with iliac crest strut graft. The graft was buttressed with a reconstruction plate on its posterior aspect. The patients were followed up every week until radiological signs of union were seen. Subsequent follow-up was after six months, one year and annually. Patients were evaluated clinically by Merle d’Aubigne and Postel score and radiologically by Matta score at their final follow-up. All fractures united radiologically after an average follow-up of 3.2 months. The clinical outcome after mean follow-up of 3.34 years (minimum two years and maximum five years) was as follows: two (25%) were excellent, two (25%) were very good, three (37.5%) were good and one (12.5%) was fair. Radiological grading at last follow-up showed excellent in one (12.5%), good in four (50%) and fair in three (37.5%) patients. No complication in the form of infection, heterotopic ossification, neurovascular injury or graft resorption was noticed. To conclude, excision of the small comminuted fragments and reconstruction of the wall using iliac crest strut graft is a viable alternative technique for reconstruction of the comminuted posterior acetabular wall fracture. The medium-term clinical and radiological results of this technique are satisfactory.     

Intragroup differences in risk factors for breastfeeding outcomes in a multicultural community.

A sample of 221 women who delivered at Al Qassimi Hospital, Sharjah, United Arab Emirates, were included in this prospective study to identify breastfeeding patterns at day 1, 1 month, and 6 months postpartum. The exclusive breastfeeding rate was 76.5% on day 1, 48.4% at 1 month, and 13.3% at 6 months. At 6 months, 16.1% had stopped breastfeeding. Simple and multivariable binary logistic regression analyses were used to identify factors associated with better breastfeeding outcomes. Nationality significantly affected exclusive breastfeeding at day 1 and 1 month. Pethidine use was associated with lower levels of exclusive breastfeeding at 1 month. Education was the most significant determinant of breastfeeding behavior at 6 months. Effects of the interrelationships between factors were examined and shown to influence breastfeeding outcomes in different population subgroups. The findings of this study suggest that strategies to improve breastfeeding should focus on risk factors specific to the population subgroup.     

Long term surgical treatment outcome of talar body fracture

Objective: Talar body fractures are rare and have poor treatment outcome. The purpose of this study is to report the long term surgical treatment outcome of closed talar dome fractures.Methods: Eight closed talar body fractures, treated by open reduction and internal fixation with small fragment cancellous screws and/or Herbert screws in our level Ⅰ trauma centre were retrospectively analyzed. Preoperative and postoperative radiographs of the foot (antero-posterior, lateral and oblique views) and ankle (antero-posterior, lateral and mortise views) were obtained. The patients were followed up both radiologically and functionally (foot function index, FFI) after 3 weeks, 6 weeks, 3 months, 6 months and then annually.Results: There were five crush fractures and three shear fractures (two sagittal shear and one coronal shear),with average follow-up of 5 years. No early complications were noticed in these patients. Late complications included osteoarthrosis of subtalar/ankle joints in six patients and osteonecrosis oftalar body in four patients. On functional assessment, mean FFI after 5 years was 104.63 points and worse outcome was noticed in crush injury and coronal shear fractures. Sagittal shear fractures had a good functional and radiological outcome.Conclusions: Late complications subsequent to surgically treated talar body fractures are inevitable, even though exact reduction and rigid fixation are achieved, thus patients are supposed to be counseled about the adverse outcome. Although crush and coronal shear fractures have poor outcome, sagittal injuries have good prognosis on long term evaluation.     

Pyruvate dehydrogenase deficiency caused by a new mutation of PDHX gene in two Moroccan patients

Pyruvate dehydrogenase deficiency is one of the genetic defects of mitochondrial energy metabolism. Clinical features are heterogeneous, ranging from fatal lactic acidosis in the newborn period to chronic neurodegenerative abnormalities. Most cases have mutations in the gene for the E1alpha subunit of the pyruvate dehydrogenase complex. Primary defects of the E3 binding protein component of the pyruvate dehydrogenase complex are rarier. We describe two unrelated Moroccan patients with the same new mutation c.1182 + 2T > C in the E3 binding protein gene PDHX and different clinical forms.