Bilateral traumatic proximal humerus fractures managed by open reduction and internal fixation with locked plates

Fractures of the proximal humerus are uncommon in young patients.Although bilateral fracture of proximal humerus itself is rare,association with epilepsy and electrocution is frequent.Only one case of traumatic bilateral proximal humerus fracture has been reported in the literature.We report a rare case of bilateral traumatic displaced proximal humerus fractures in a 40 years old male patient,which was treated by means of open reduction and internal fixation with proximal humerus locked pates on both sides and obtained a good functional outcome.     

Retrospective comparative study of efficacy,safety and outcome of percutaneous intervention for Budd-Chiari syndrome patients with bilirubin less than 3 and 3–6 mg/dl

Objective:Comparing the efficacy, safety and outcome of percutaneous intrervention for Budd-Chiari Syndrome (BCS) patients with bilirubin less than 3 and 3–6 mg dl⁻¹.Methods and materials:188 BCS patients having serum bilirubin ≤6 mg dl⁻¹ and underwent percutaneous interventions were divided into two groups based on bilirubin level: 151 patients having bilirubin <3 mg dl⁻¹ were included in Group 1; and 37 patients having bilirubin 3–6 mg dl⁻¹ were included in Group 2. Both group were compare for technical success (successful recanalization of hepatic venous stenosis or creation of portocaval shunt with post-procedure gradient ≤5 mm of Hg), Safety (procedure-related mortality/morbidity or patient required transplantation) and outcome (resolution of clinical symptoms and survival).Results:Technical success was 94.7% in Group 1–89.1% in Group 2 with overall success rate was 93.6%. No significant differences observed between the two groups in regards to procedure related complication. Overall transplant-free survival at 1 and 5 years after intervention in both groups was 96.3 and 91.2% respectively. 1-year and 5-year survivals in Group 1 was 96.7%, and 93.1%, whereas Group 2 was 94.6 and 90.1% with no statically significantly difference between the two groups (p = 0.59). Percutaneous intervention results are good in patients having bilirubin up to 6 mg dl⁻¹, i.e. mild to moderate liver dysfunctions.Conclusion:Technical success, survival and outcome of percutaneous intervention in BCS patients having serum bilirubin 3–6 mg dl⁻¹ was comparable to patients having bilirubin level <3 mg dl⁻¹.Advances in knowledge:Percutaneous intervention treatment is suitable for treatment for symptomatic BCS patients having bilirubin up to 6 mg  dl⁻¹.     

Portal vein variations in 1000 patients: surgical and radiological importance

Objective:

The purpose of the study was to evaluate the spectrum and incidence of intrahepatic portal vein (PV) variations on triphasic abdomen multidetector CT (MDCT) and to discuss the surgical and radiological implications.

Methods:

A retrospective review of 1000 triphasic MDCT abdomen scans was performed in patients sent for various liver and other abdominal pathologies between January 2014 and August 2014. A total of 967 patients (N = 967) were included in the study. The variations in branching pattern of PV were classified according to classification used by Covey et al (Covey AM, Brody LA, Getrajdman GI, Sofocleous CT, Brown KT. Incidence, patterns, and clinical relevance of variant portal vein anatomy. AJR Am J Roentgenol 2004; 183: 1055–64) and Koç et al (Koç Z, Oğuzkurt L, Ulusan S. Portal vein variations: clinical implications and frequencies in routine abdominal CT. Diagn Interv Radiol 2007; 13: 75–80).

Results:

Normal anatomy (Type I) was seen in 773 patients (79.94%) out of 967 patients in our study. Trifurcation (Type II) anomaly was seen in 66 (6.83%) of cases. Right posterior vein as first branch of main PV (Type III) anomaly was seen in 48 (4.96%) of cases. Type IV anomaly and Type V anomaly was seen in 26 (2.69%) and 13 (1.34%) cases, respectively. 19 cases showed other types of variations.

Conclusion:

Variations in the hepatic PV branching patterns are commonly seen that are similar to variations in hepatic artery and biliary anatomy. Knowledge of these variations is extremely important for transplant surgeons and intervention radiologists.

Advances in knowledge:

Awareness of the variations in PV branching patterns is essential for intervention radiologists and vascular surgeons and avoids major catastrophic events.     

Tubercular arthritis of the elbow joint following olecranon fracture fixation and the role of TGF-beta in its pathogenesis

Tuberculosis （TB） occurring after a closed bone fracture in the patient with no history of TB and no evidence of TB infection at the time of initial fracture is a rare entity. We report one such case of a 48-year-old female, who presented in the emergency department with an olecranon fracture which was open reduced and inter- nally fixed with tension band wiring. Patient presented in the outpatient department with serosanguineous discharge at 3 weeks after surgery. The discharge was sent for culture and sensitivity tests, and the patient was managed by anti- biotics and daily dressings. There was wound dehiscence and the underlying implant was exposed, which was removed at 12 weeks after surgery. Repeat debridements and dressings continued for 6 months, but the discharge from the wound site continued. X-rays of the elbow performed at 6 months raised the suspicion of TB, which was confirmed by Ziel-Neelsen staining and histopathological examination of the debrided tissue. Following the confirmation, patient was put on antitubercular drugs. The patient responded to anti- tubercular drug therapy （ATT）, the purulent discharge from the wound ceased, and eventually the wound healed after 2 months of starting ATT.     

The effect of screw length on fracture load and abutment strain in dental implants with external abutment connections

Purpose: One of the most common types of failure in dental implants is fracture of the abutment screw, after which the remnant is usually not easily removed. The purpose of this study was to investigate the effect of abutment screw length on the amount of screw resistance load and strain after loading. Materials and Methods: Twenty-one implants and straight abutments were prepared. The implants were placed in acrylic resin blocks at an angle of 30 degrees relative to the long axis. The abutment screws were prepared and classified into seven groups based on length (n = 3 abutments per group). The implants and abutments were joined with a torque of 30 Ncm. Strain gauges were attached to the abutments, and the implant-abutment assemblies were compressed. Curves of strain over time, peak load, and load at fracture were measured. Linear models of the variables over the abutment screw length were analyzed. Results: The break and peak loads were significantly associated with abutment screw length. However, all measured break and peak loads were greater than the maximal occlusal force. There were no significant changes in peak or break strain values associated with screw length (P > .05). Conclusions: Clinically, fractured abutment screws may be replaced by shorter abutment screws without removal of the broken screw remnant.     

Scapulothoracic and scapholunate dissociation in the ipsilateral upper limb of a trauma victim

Scapulothoracic dissociation is a rare and complex injury pattern with varied presentation.Here we describe a case of a 32-year-old male who presented with scapulothoracic dissociation associated with brachial plexus injury,along with scapholunate dissociation.We also propose an injury mechanism that might link the two injury patterns,suggesting that the association might be more than by chance.The patient was managed according to established trauma care and resuscitation protocols followed by open reduction and internal fixation of the clavicle fracture,and fixation of scapholunate dissociation and had a successful outcome at follow-up.