Extra articular arthroscopic release in post-traumatic stiff knees: a prospective study of endoscopic quadriceps and patellar release

Knee stiffness due to mismanaged trauma is still common in underdeveloped countries. Many patients with distal femoral fractures, patellar injuries or other local trauma present with intra-articular and extra-articular adhesions between the quadriceps and anterior femur. Nineteen knees with post trauma stiffness due to combined intra- and extra- articular aetiology were taken up for arthroscopic aided release after failing an aggressive physiotherapy protocol. Ultrasound was used to identify the extra-articular adhesions. The intra-articular part of the release was done by a standard protocol involving the release of all infrapatellar, suprapatellar and gutter adhesions, and then the extra-articular proximal adhesions were released by using special long periosteal elevators and arthroscopic scissors. We were able to release the adhesions as high as 9 inches above the patella, and in one case bony ankylosis between the patella and the femur was arthroscopically osteotomised (after 11 years of stiffness). Delay before surgery averaged 2.7 years (6 months-11.3 years). Mean active flexion at one year follow-up improved from 27.3 degrees to 119.3 degrees (average increase: 92 degrees). Mean preoperative extension lag reduced from 6 degrees to 1 degrees postoperatively. No CPM machine was available, and patients had to undergo daily manual and assisted therapy, with appropriate analgesia. Overall patient satisfaction was excellent; one patient developed a supracondylar fracture (infected old fracture with bone loss and severe contracture) and was retrospectively a wrong case selection. Arthroscopic aided quadriceps adhesion release is a good option in cases of neglected trauma; results are excellent even without sophisticated CPM machines, and the periosteal elevators needed are cheap and indigenous.     

Primary chondrosarcoma of the breast: a case report

Mammary sarcomas are uncommon tumors. Of these pure chondrosarcoma without any other area of epithelial or mesenchymal differentiation feature as even rarer. This excludes tumors like malignant cystosarcoma phyllodes and metaplastic carcinoma where malignant cartilaginous areas may be present. Further primary chondrosarcoma arises from breast stroma and not from underlying bone or cartilage. Only five cases of pure and primary chondrosarcoma have been reported so far. The sixth case is reported here.     

Transesophageal echocardiography-guided placement of internal jugular percutaneous venovenous bypass cannula in orthotopic liver transplantation

Venovenous bypass has improved patient survival and decreased morbidity and mortality in the field of orthotopic liver transplantation. The standard at many transplant centers is the use of the internal jugular percutaneous venovenous bypass cannulae (PVVBC) for venous return to the patient. Placement of these large (18F) PVVBC may lead to several complications and requires confirmation before use. Use of transesophageal echocardiography, an effective and rapid method to guide placement of the PVVBC and minimize potential complications associated with insertion of the device, is described.     

Isolated dorsal dislocation of the intermediate cunieform: a case report and review of the literature

We present one very rare case of patient with an isolated dorsal dislocation of the middle cuneiform (closed injury) sustained after a fall. He was treated surgically through a dorsal approach and fixation with K-wires after manual reduction was unsuccessful. A cast was applied for a total of 6 weeks followed by active range-of-motion exercises. At the 18-month follow-up, he was asymptomatic.     

Carbamazepine poisoning: treatment with haemodialysis.

Sir, A 32-year-old woman was brought to the emergency room 28 h afteringesting an unknown amount of carbamazepine (probably 150–200tablets containing 200 mg each). She had been taking cabamazepine400 mg twice daily for the past 10 years for symptomatic epilepsyrelated to cerebral arterio-venous malformation. She was unconsciousbut responding to noxious stimuli. She had shallow irregularrespiration     

Bjornstad syndrome

A 9-month-old boy presented with the complaints of loose motion, vomiting and difficulty in breathing. His scalp hairs were thin, brittle, and sparse and were of differing lengths with twisted appearance. Hair shaft microscopy revealed alternate light and dark segments and twisting of the hair shafts by 180 degrees along the axis. Serum copper levels were normal. The audiological testing revealed bilateral sensorineural hearing loss. Child was diagnosed as a case of Bjornstad Syndrome.     

Amnioinfusion in thick meconium

Objective : There are conflicting reports regarding the results of amnioinfusion in the management of meconium passagein utero. This study was done to evaluate transcervical amnioinfusion for meconium stained amniotic fluid during labour.Methods : 196 women at term in early labour with meconium were randomized to receive either transcervical intrapartum amnioinfusion with saline (96) or routine obstetrical care (100). Transcervical amnioinfusion of one liter saline infused over 30–45 minutes. End points were relief of decelerations, incidence of vaginal delivery, presence of meconium below the neonatal cords, and X-ray evidence of meconium aspiration.Results : Amnioinfusion resulted in relief of decelerations in 75% of cases as compared to 7% in the control group. Eighty-eight percent of patients delivered vaginally as compared to 58% in the control group (p<0.001). Neonatal outcome was significantly better in the infusion group. The incidence of meconium below the vocal cords was reduced from 48% to 17% (p<0.004) using amnioinfusion with positive X-rays for meconium aspiration in only 12.5% versus 26% (p<0.5).Conclusions : We concluded that transcervical intrapartum amnioinfusion is a safe, simple and inexpensive technique that reduces operative intervention and improves neonatal outcome, and is of tremendous relevance in developing countries.