Ingrown toe-nail: A clinical study

Extensive review of the literature and considerable clinical experience with the handling of ingrown toe-nails have prompted the writer to summarize the present status of the subject, and to outline a simplified mode of management that will be applicable to any stage of the lesion, and that will incur a minimum loss of time to the patient.     

Meckel's diverticulum: A review of thirty-nine cases

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1. Some historical aspects are discussed.     

A comprehensive update on current fixation options for two-part proximal humerus fractures: A biomechanical investigation

Background

Recent advancements in implant technology offer updated options for surgical management that have been rapidly adopted into clinical practice. The objective of this study is to biomechanically test and compare the current fixation options available for surgical fixation of two-part proximal humerus fractures and establish load to failure and stiffness values.

Methods

Sixteen match-paired (32 total) fresh-frozen, cadaveric specimens were randomized to receive 1 of 4 fixation constructs following creation of an AO/OTA Type 11A3 (two-part) proximal humerus fractures. Fixation constructs tested consisted of 3.5 mm fixed angle plate (3.5-FAP), 4.5 mm fixed angle plate (4.5-FAP), humeral intramedullary nail (IMN), and a humeral intramedullary nail with a fixed angle blade (IMN-FAB). Specimen bone density was measured to ensure no adequate, non-osteoporotic bone. Constructs were tested for stiffness and ultimate load to failure and compared via one-way ANOVA analysis with subsequent post hoc Tukey HSD multiple group comparison statistical analysis.

Results

The IMN-FAB construct was significantly stiffer than the 3.5-FAP construct (123.8 vs. 23.9, p < 0.0001), the 4.5-FAP construct (123.8 vs. 33.3, p < 0.0001) and the IMN construct (123.8 vs. 60.1, p = 0.005). The IMN-FAB construct reported a significantly higher load to failure than the 3.5-FAB construct (4667.3 N vs. 1756.9 N, p < 0.0001), and the 4.5-FAP construct (4667.3 N vs. 2829.4 N, p = 0.019, Table 2). The IMN construct had a significantly higher load to failure than the 3.5-FAP construct (3946.8 vs. 1756.9, p = 0.001, Table 2).

Conclusion

Biomechanical testing of modern fixation options for two-part proximal humerus fracture exhibited that the stiffest and highest load to failure construct was the IMN-FAB followed by the IMN, 3.5-FAP and then the 4.5-FAP constructs. However, prospective clinical trials with longer-term follow-up are required for definitive assessment of the ideal fixation construct for surgical management of two-part proximal humerus fractures.     

Complications related to fracture treatment in HIV patients: A case report

We present the case report of a 40-year-old woman who was HIV-positive in Highly Active Anti-Retroviral Therapy (HAART) and affected by femural pertrochanteric fracture, which was treated by endomedullary nailing. Two years after the surgical operation, the woman developed an aseptic symptomatic osteolysis around the implant. Hardware removal was resolutive. Aseptic and septic hardware mobilization, hardware removal, and implant decision in HIV patients with pertrochanteric fractures is discussed. The authors suggest close follow-up and prompt hardware removal, as soon as X-rays demonstrate healing signs, in HIV patients with fracture fixation, if general condition allows.     

Safety and efficacy of surgical hip dislocation in managing femoral head fractures: A systematic review and meta-analysis

BACKGROUNDFemoral head fractures (FHFs) are considered relatively uncommon injuries; however, open reduction and internal fixation is preferred for most displaced fractures. Several surgical approaches had been utilized with controversial results; surgical hip dislocation (SHD) is among these approaches, with the reputation of being demanding and leading to higher complication rates.AIMTo determine the efficacy and safety of SHD in managing FHFs by reviewing the results reported in the literature.METHODSMajor databases including PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched to identify studies reporting on outcomes of SHD utilized as an approach in treating FHFs. We extracted basic studies data, surgery-related data, functional outcomes, radiological outcomes, and postoperative complications. We calculated the mean differences for continuous data with 95% confidence intervals for each outcome and the odds ratio with 95% confidence intervals for binary outcomes. P < 0.05 was considered significant.RESULTSOur search retrieved nine studies meeting our inclusion criteria, with a total of 129 FHFs. The results of our analysis revealed that the average operation time was 123.74 min, while the average blood loss was 491.89 mL. After an average follow-up of 38.4 mo, a satisfactory clinical outcome was achieved in 85% of patients, with 74% obtained anatomical fracture reduction. Overall complication rate ranged from 30% to 86%, with avascular necrosis, heterotopic ossification, and osteoarthritis being the most common complications occurring at an incidence of 12%, 25%, and 16%, respectively. Trochanteric flip osteotomy nonunion and trochanteric bursitis as a unique complication of SHD occurred at an incidence of 3.4% and 3.8%, respectively.CONCLUSIONThe integration of SHD approach for dealing with FHFs offered acceptable functional and radiological outcomes with a wide range of safety in regards to the hip joint vascularity and the development of avascular necrosis, the formation of heterotopic ossification, and the development of posttraumatic osteoarthritis; however, it still carries its unique risk of trochanteric flip osteotomy nonunion and persistent lateral thigh pain.     

Total Hip Arthroplasty For Femoral Neck Fracture : Comparing In-Hospital Mortality,Complications, and Disposition to an Elective Patient Population

Patients treated with total hip arthroplasty (THA) for osteoarthritis (OA) and femoral neck fracture (FNF) between 1990–2007 were compared using the National Hospital Discharge Survey (NHDS). In-hospital, post-operative complications and disposition were compared at six-year intervals to establish trends over time. A total of 2,160,061 THAs were performed for OA, while 174,641 were performed for FNF. Peri-operative mortality and pulmonary embolism rates following elective THA were lower at each interval when compared to THA performed for FNF (P < 0.001). Hematomas, infections, and dislocations were also higher in the traumatic group. The FNF group showed improvements with respect to mortality and rates of pulmonary embolism, infection, and dislocation over time. During the most recent interval, there was no difference in dislocation rates between the two groups. The length of stay and the percentage of patients discharging to a rehab facility were significantly higher in the FNF group at each time interval.     

Trends of Surgical Treatment in Femoral Neck Fracture : A Nationwide Study Based on Claim Registry

We evaluated current trends of surgical treatment, such as internal fixation and hip arthroplasty, in femoral neck fracture. We assessed annual proportion of the each procedure in patients aged 50 years or more from 2006 to 2011, using the data of Health Insurance Review and Assessment Service (HIRA), which is a national claim registry. The proportion of hip arthroplasty increased while that of internal fixation decreased annually during the 5 years. The proportion of total hip arthroplasty increased in patients aged ≤ 65 years, and that of hemiarthroplasty increased in patients aged ≥ 65 years. The proportional increase of hip arthroplasty seemed to conform to the recent evidence regarding the outcomes of surgical treatments for the femoral neck fracture.     

Low rectovaginal fistulas : Approach and treatment

Experience with thirty-two patients with a low rectovaginal fistula with or without attendant sphincter damage is reported. The technic used is advancement of the anterior rectal wall with excision of the infected anal glandular tissue and repair of muscle tissue when indicated. Anorectal infection and childbirth injuries were the common causes. An acceptable recurrence rate was achieved. Colostomy was not used in this series.     

Construction of a pseudolarynx after laryngectomy and radical neck dissection : A preliminary report

Voice rehabilitation is a major problem after laryngectomy. A new method to construct a pseudolarynx after total laryngectomy by suturing the trachea to the hyoid bone is described. The surgical technic is relatively simple. Patients are able to speak in the immediate postoperative period without intensive therapy. The quality of speech is good. Aspiration of liquids is a common problem, but in time patients learn to swallow with minimal or no aspiration. This procedure could be utilized in selected cases for good voice rehabilitation after total laryngectomy.     

Total thyroidectomy in the treatment of angina pectoris: Late results in fourteen cases

A series of fourteen patients, who had had total thyroidectomies at least two years previously, is reported. All of these patients were suffering from angina pectoris of the most severe form. All showed some degree of coronary sclerosis and several presented definite evidence of cardiac infarction.