Management of Appendiceal Masses in a Peripheral Hospital in Nigeria: Review of Thirty Cases

The objective of this work was to conduct a truly rural-based study to evaluate, from our own rural data devoid of influence from urban-based studies, the management of appendiceal masses in a typical peripheral hospital in Nigeria. The study aimed to highlight the results of neglected appendicitis in our community and the occasional difficulty of making a correct preoperative diagnosis. It also sought to draw the attention of the health care practitioner in our community to the importance of continued enlightenment of the people regarding the need to seek medical treatment early. This was a retrospective study, with the setting at St. Victoria Specialist Hospital, Ekwulobia, Anambra State, Nigeria, a rural hospital serving its community. A series of 30 patients who were managed for an appendiceal mass between January 1, 1992 and December 31, 2001, a 10-year period, were included in the study. We identified the cases by reviewing the surgical register. The relevant case notes were retrieved from the Records Department. The following data were extracted for each patient: age and sex; how early the patient presented; the history and presentation of the patient; whether the diagnosis was made before or during surgery; the treatment modality; length of hospital stay; and outcome. The results showed that 13 patients (43.3%) presented more than 1 week after the onset of symptoms. The age range was 15 to 60 years (average 27 years); 13 patients (43.3%) were in the age range of 40–49 years. Twenty men and ten women were treated, giving a male/female ratio of 2:1. The main clinical features were fever, anorexia, pain, tenderness, and a palpable mass in the right iliac fossa. The problem was diagnosed before surgery in 23 patients (76.7%) and during surgery in 7 (23.3%). Treatment modalities were conservative + interval appendectomy in 18 patients (60%); open and close + conservative + interval appendectomy in 3 patients (10%); immediate appendectomy without burying the stump in 2 cases (6.7%); right hemicolectomy (in one 40-year-old woman and one 55-year-old man); and incision and drainage of an appendiceal abscess in 5 patients (16.7%). No deaths were recorded. The study showed that appendical masses are most prevalent during the fifth decade of life and are rare before age 10 and after age 60. More men are affected than women, and most cases can be diagnosed before surgery, although some patients must await more sophisticated diagnostic tools or surgical exploration for diagnosis.     

Management of Physeal Fractures: A Review Article

BackgroundPhysis is the weakest structure in the skeleton of a child and a frequent site of an injury or fracture. A physeal fracture presents a unique challenge in the management as the sequalae of such an injury could lead to growth disturbances.MethodsIn this review, mainly focussing on traumatic physeal injuries, the authors discuss the applied anatomy, different fracture patterns, clinical assessment and management of physeal fractures in children.ResultsDiscussion on acute physeal injuries as well as physeal arrest and approach to its management is presented. Past attempts for treatment of physeal injuries and recent advances in their management is also discussed.ConclusionThe ideal approach to treat physeal injuries should take into account the location of injury, age of the patient, fracture type and growth potential of the involved physis. Prompt diagnosis and physeal-respecting treatment techniques are important.     

Surgical Management of Haemophilic Pseudotumors: Experience in a Developing Country

Aim: Hemophilic pseudotumors result from repeated episodes of bleeding into bone, subperiosteum, and soft tissue. Since clotting factors became available, uncontrolled perioperative bleeding is a less significant problem for surgeons in developed countries. However, they are more difficult to come by in China. Additionally, patients often have to undergo surgery for giant masses and suffer complications. We wanted to present our experience in the surgical management of hemophilic pseudotumors over a 40-year period. Methods: We retrospectively reviewed 429 hemorrhagic coagulopathy patients between 1983 and 2015. Diagnosis of hemophilic pseudotumor was confirmed following clinical, radiological, and pathological criteria. The data were recorded and analyzed: type and severity of hemophilia, presence of inhibitor, etiological antecedent, localization of pseudotumors, clinical signs, surgical management and outcomes. Results: Eighteen pseudotumor patients underwent surgical treatment. All of them were male, with mean age of 34.3 years. Fifteen patients had hemophilia A and three patients had hemophilia B. There were twelve proximal and two distal pseudotumor patients. The mean follow-up was 51.9 months. For pseudotumors in the extremities, complete surgical resection was achieved. For four patients with pelvic or abdominal pseudotumors, complete surgical resection was only achieved in two patients because of preventing potential vital organs injuries. Delayed healing of the incision, allergic reactions, and ureteral injury were the major complications. Conclusion: Surgery is an alternative method with safety and efficacy. Careful and individual treatment is required by the hematologist, orthopedic surgeon and other members of the team who collaborate and participate in hemophilic surgery.     

Management of Esophageal Foreign Bodies: Experience in a Developing Country

Background  

The outcome of esophagoscopy for removal of suspected esophageal foreign bodies (EFBs) is dependent on the FB characteristics and the surgeon’s experience. This study was conducted to review our experience and highlight challenges in the management of EFBs in a developing country. The value of radiologic signs in FB detection was also evaluated.     

Fractures Secondary to Nutritional Bone Disease in Dogs:A Review of 38 Cases

The pattern of bone fractures secondary to nutritional bone disease in 38 dogs was analysed using a radiographic survey. The majority of fractures were either caused by a fall (28.95 %) or showed no history of direct trauma (31.58 %). Mongrels were more commonly affected by pathological fractures, followed by Dobermanns and German Shepherds. Significantly more (P < 0.05) fractures were found in dogs aged less than 6 months (64.71 %). The incidence of such fractures was significantly higher in males than in females (M : F = 2.70 : 1.00). General radiological signs included a generalized decrease in cortical density, thinning of cortices and widening of metaphyses/epiphyses in most of the animals. Fractures were found significantly more frequently (P < 0.01) in the femur (81.58 %) than in any other bone. Of the different types of fracture, complete oblique and incomplete fractures were most common.     

Evidence-based Review: Management of Open Pediatric Fractures

Open fractures in the pediatric population are rare. As such, recommendations for care based on high-level studies are scarce. Furthermore, most level I and II recommendations come from studies involving open fractures in adults. Although it is generally accepted that open pediatric fractures have better outcomes than open fractures in adults, the lack of quality studies provide ample opportunities to answer questions regarding care of these injuries. This review explores the available literature and gives corresponding recommendations based on the level of evidence.     

A Retrospective Review of the Dall-Miles Plate for Periprosthetic Femoral Fractures: Twenty-seven Cases and a Review of the Literature

A retrospective review of the use of the Dall-Miles plate for periprothetic femoral fractures was performed at our institution. Twenty-seven fractures around a hip replacement were fixed using a Dall-Miles plate within 34 months. The mean age at operation was 74 (33-90) years. Twenty fractures were Vancouver B1, two B2, and five type C. Mean follow-up was 11 (2–41) months. Two fractured plates required revision and two fixations loosened, developing varus malunion. One malunion was related to deep infection. All four events occurred within six months of fixation. Two individuals were deceased within 3 months of surgery. Similar complications were evident in nine series published between 1990 and 2012. Increased incidence of periprosthetic femoral fractures is anticipated in a population with significant co-morbidities. Cortical strut allograft, iliac autograft and orthobiological supplementation remain options where non-union is anticipated.     

Management of Distal Fibular Fractures With Minimally Invasive Technique: A Systematic Review

Ankle fractures are extremely common, with isolated distal fibular fractures being the most common variant. The current gold standard in treating unstable distal fibular fractures is open reduction internal fixation. However, with potential risk of wound complications, minimally invasive techniques have been introduced. This systematic review was performed to evaluate the clinical and functional outcomes of varying minimally invasive techniques including minimally invasive plate osteosynthesis, intramedullary (IM) nailing, and IM screw fixation. A comprehensive English literature search on PubMed was performed yielding 543 studies. With specific study selection criteria, a total of 13 articles were selected. After studying the reference of each of the 13 studies, an additional 7 articles were included, resulting in a total of 20 studies reviewed. A total of 8 articles reviewed used IM nailing as the fixation of choice with a total of 211 patients. Of the 211 patients, 33 experienced complications. Six articles using minimally invasive plate osteosynthesis were reviewed with a total of 264 patients. Of the 264 patients, 39 experienced complications. IM screw fixation was used in 6 articles reviewed with a total of 219 patients. There were 30 cases of complications from the 132 patients. Additionally, mean American Orthopedic Foot and Ankle Society hindfoot-ankle scores among all fixation types was 88.4 ± 3.40 whereas the mean Olerud and Molander Score among all fixation types was 76.7 ± 16.58. The results of this study indicate that minimally invasive techniques for fixation of distal fibular fractures can provide excellent functional results with low complication rates compared with traditional open reduction internal fixation.     

Safety and Efficacy of Surgical Management of Hyperthyroidism: 15-year Experience from a Tertiary Care Center in a Developing Country

Background Ideal management of toxic goiter still remains elusive. Though surgical management of toxic multinodular goiter (MNG) is well accepted, surgical treatment of Graves’ disease (GD) is still controversial in view of the presumed increased incidence of complications. In this paper, we discuss the experience of the surgical management of hyperthyroidism at a specialized tertiary care endocrine center in a developing country, highlighting the minimal morbidity and satisfactory outcome in experienced hands. Materials and methods We retrospectively reviewed 325 consecutive patients with hyperthyroidism managed surgically from 1990 to 2005. The etiologic diagnoses were Graves’ disease (185), toxic MNG (105), and autonomously functioning thyroid nodules (AFTN) (n = 35). The indications for surgery in Graves’ patients were large goiter, relapse after antithyroid drug therapy (ATD), Graves’ ophthalmopathy, and presence of nodule. The indications for surgery in toxic MNG were retrosternal extension (n = 15), compressive symptoms (n = 20), and large size (grade II). Among the AFTN nodule size, those greater than 4 cm (85%) formed the major indication for surgery. Subjects with GD and toxic MNG were subjected to subtotal thyroidectomy (n = 93 prior to 1995) or total thyroidectomy (n = 205 post-1995). Hemithyroidectomy was the procedure of choice in patients with AFTN. Results Patients with Graves’ disease were younger in age, with shorter mean duration of goiter when compared with the other 2 groups. Eight percent of patients with Graves’ disease without a clinically palpable nodule and 25% of those with nodules had associated differentiated carcinoma, including papillary, follicular, and medullary thyroid cancer. Four percent of patients with toxic MNG had malignancy. Complications included temporary hypocalcemia (24%), permanent hypocalcemia (3%), and permanent vocal-cord palsy (1%). Conclusions Surgery for hyperthyroidism has negligible mortality and acceptable morbidity in experienced hands. It is a definite option in selected cases. Immediate and permanent cure of hyperthyroidism is achieved, with no recurrences, after total thyroidectomy. The cosmetic outcome is good, with excellent patient satisfaction and acceptance.     

眶下缘切口治疗颧骨复合体骨折64例临床总结

目的探讨应用眶下缘切口治疗颧骨复合体骨折的临床疗效、优势。方法64例颧骨复合体骨折,按Zingg分类:A3型32例,B型23例,C型9例;均选择眶下缘切口切开复位微型钛板内固定,必要时辅加口内前庭沟切口和其他眶周小切口;均不做冠状切口。结果疗效优44例(68.75%),良16例(25.00%),差4例(6.25%),骨折1级愈合率达68.75%(44/64),手术优良率达93.75%(60/64)。结论眶下缘切口具有创伤小、术野清晰、切口隐蔽、骨折复位良好、对位精确、微型钛板固定良好等优点,适宜于颧骨复合体骨折的治疗。     

Management and Outcomes of Bilateral Acetabular Fractures: A Critical Review of the Literature

BackgroundBilateral acetabular fractures constitute a rare entity, and their optimal management is unknown.Materials and MethodsA systematic literature search was conducted in PubMed, Embase and Cochrane Library between 1995 and 2020. Inclusion criteria were studies presenting cases of bilateral acetabular fractures and reporting outcomes. Extracted data included patient demographics, injury mechanism, fracture classification, associated injuries, management and outcomes.ResultsThirty-seven studies (47 cases; 35 males vs 12 females) were included. Mean age was 46 years old (range 13–84) and mean follow-up was 19.8 months (range 1.5–56). High-energy injuries (49%) and seizures (45%) were the most common injury mechanisms. Fracture type distribution differed according to injury mechanism. Treatment was surgical in 70% of cases (75% open reduction and internal fixation vs 25% acute total hip arthroplasty). Outcomes were excellent/good in 58% of patients. Complications included heterotopic ossification (11%), nerve injury (11%), degenerative arthritis (6%), DVT (6%), and infection (3%).ConclusionsBilateral acetabular fractures most commonly occur either after trauma or seizures and are commonly managed operatively. They are not devoid of complications, however, more than half (58%) achieve complete functional recovery.