bluuebunny/crossref_metadata_2025 huggingface dataset:
Buried bumper syndrome: prevention and management in the community
Authors: Carter-Stephens Ruth
Published: September 2021

Percutaneous endoscopic gastrostomy (PEG) is a well-established form of artificial nutrition. Buried bumper syndrome (BBS) is a rare but severe complication related to this type of feeding tube. BBS is described as when the internal bumper migrates into the stoma tract and/or the mucosa, and the inner lining of the stomach starts to grow around and over the internal bumper. It can result in pain, infection and the loss of the feeding tube as a port of entry for delivery of nutrition, hydration and medication into the stomach. When suspected, BBS requires urgent referral into specialist hospital services. It is somewhat preventable with appropriate aftercare; however, incidents do occur. The evidence and guidance on care of PEGs differs, and more data and research are needed into the incidence of BBS and what influences it. Access to appropriate nutrition support teams is essential to support patients and their caregivers with all aspects of enteral feeding.
Barriers affecting patient adherence to intermittent self-catheterisation
Authors: Balhi Salma , Arfaoui Rym Baati
Published: September 2021

Intermittent self-catheterisation (ISC) is now considered the standard of care for most patients with neurological conditions and associated lower urinary tract disorders. Numerous societies, led by the International Continence Society, are in agreement on the effectiveness of ISC. Use of intermittent catheters is reported to reduce the risk of catheter-associated urinary tract infection compared with indwelling urinary catheters while improving patient comfort and quality of life. However, previous studies have shown that, despite the benefits of ISC, it will not guarantee behavior change and the integration of this procedure into the daily life of patients. Patients may encounter internal (related to the patient themselves) and external (related to their environment) difficulties. Identifying these obstacles early will help promoting ISC success. This review aims to identify internal and external barriers related to ISC and to propose adequate solutions to avoid them.
A renewed look at silver dressings for wound infections: Ag Oxysalts technology
Authors: Dhoonmoon Luxmi , Turner-Dobbin Hayley , Staines Karen
Published: September 2021

Wound infection is an important complicating factor in the wound healing process, and infections can be even more complex and difficult to manage in the case of wounds with biofilms. Silver has been used to treat infected wounds for a long time now, and the strength of the product depends on the number of Ag ions, where the greater the number of ions, the higher and faster the reactivity is. Ag Oxysalts technology—used in 3M Kerracontact Ag dressing—has three times more ions than standard silver dressings. The technology also does not show the typical disadvantages of silver, such as cytotoxicity and systemic toxicity. This article discusses the use of Ag Oxysalts technology for infected wounds and presents case studies to support the efficacy of this product in promoting wound healing.
Charge Transfer Resistance and Adsorption performance of a New Pyrrole Derivative on Mild steel in Acidic media: Antibacterial studies
Authors: Pandimuthu G. , Muthukrishnan P. , Rameshkumar S. , Paramasivaganesh K. , Sankar A.
Published: September 2021

In the present work, Pyrrole derivatives containing oxygen, nitrogenand aromatic rings namely,N-(1H-Pyrrol-2-ylmethylidene)-2,3-dihydro-1,4-benzodioxin-6-amine (BPS) was synthesized and its anticorrosion potential was studied applying the gravimetric, polarization and AC impedance methods on the mild steel (MS) corrosion in corrodent (0.5M H2SO4 and 1 M HCl). It is observed that in the acidic environments, the inhibition efficiency (IE) of the BPS raised with the enhance in the concentration and it resulted in greater inhibition efficiency in1 M HCl solution than in 0.5M H2SO4 solution. The inhibition efficiency assessed by Electrochemical Impedance Spectroscopy reaches about 81.6% in 0.5 M H2SO4 and 84.2% in 1.0 M HCl solutions at 600 ppm of BPS.The studied BPS being mixed type inhibitor was shown by the Tafel polarization curves. And it was noticed that over the MS surface, the adsorption of the BPS obeyed Langmuirisotherm. In order to ascertain the inhibitor mechanism, the potential of zero charge (PZC) was measured. Electrochemical Impedance spectroscopy was applied to assess the influence of temperature on corrosion inhibition.The surface morphology of MS surface was analyzed using SEM and AFM techniques. The anti-bacterial activity for the BPS was studied as a divergent analysis.
Preparation, Characterization and Analytical Application of Tin (IV) Tungstoselenate - 1, 10 Phenanthroline
Authors: Laiq Esmat , Nabi Syed Ashfaq
Published: September 2021

Synthesis of a composite ion exchange material Tin (IV) tungstoselenate - 1, 10 phenanthroline has been achieved by mixing differentvolume ratios of the organic counterpart with the inorganic ion exchangertin (IV) tungstoselenate. Final sample, having 0.88mmoles of 1, 10 phenanthroline per gram of inorganic ion exchanger, was chosen for characterization, including ion exchange capacity, thermogravimetric analysis, and Fourier transform infrared spectroscopy. The ion exchange capacity of Li+, Na+, Ca2+, Sr2+ metals was determined by using the synthesized material. The adsorption behavior of Al3+,Co2+,Ni2+,Cu2+,Cd2+,Pb2+ in various solvent systems have been studied. Based on distribution Coefficient (Kd) values, few analytically necessary separations of metal ions from the synthetic mixture have been achieved on the column of the composite ion exchanger.
Bilateral Tibial Proximal Fractures Caused by Secondary Osteomalacia due to Autoimmune Polyendocrine Syndrome Type 2: A Case Report
Authors: Nakagawa Daisuke , Oe Keisuke , Fukui Tomoaki , Kuroda Ryosuke , Niikura Takahiro
Published: August 2021

Introduction: Hypophosphatemic osteomalacia can be overlooked or confused with other musculoskeletal disorders due to the variety of associated clinical, laboratory, and radiographic findings. If osteomalacia is diagnosed early and the fractures are not displaced, they often heal with nutritional supplements, but, if they progress to displaced fractures, they may require surgical intervention.
Case Report: We present a case of secondary osteomalacia due to autoimmune polyendocrine syndrome Type 2 due to this condition, the patient developed bilateral tibial proximal fractures and her varus deformity had progressed. No clear indication of the timing for surgery for adults with osteomalacia has been reported. However, medical treatment improves the symptoms of osteomalacia and it is reported that in children, appropriate level of the serum phosphate (P) should be attained and maintained for the successful bone healing after osteotomy. Therefore, we prioritized pharmacological treatment and prescribed surgery after confirming that the value of serum phosphate P had been improved to recommended levels (2.5-3.5 mg/dl). We performed high tibial osteotomy for the right side and gradual correction by an external fixation for the left tibia, because of more severe deformation, and converted to an internal fixation to shorten the treatment period. During conversion, we performed the operation with a locking plate by the minimal invasive plate osteosynthesis method (MIPO).
Conclusion: We conclude that the use of different deformity correction methods, depending on the degree of deformity, and the pharmacological treatment of osteomalacia may lead to favorable results.
Keywords: Osteomalacia, autoimmune polyendocrine syndrome type 2, deformity correction method.
Pubic Osteolysis in an Elderly Masquerading as Malignancy: A Case Report and Review of Literature
Authors: Vaishya Raju , Mittal Parv , Vaish Abhishek , Khosa Robin
Published: August 2021

Introduction: A rapidly progressive destructive lesion characterizes pubic osteolysis (PO) in the pubic bone due to an inadequate fracture healing response. It may be seen in pelvic insufficiency fractures (IF) secondary to radiation therapy (RT) of pelvic malignancies, occurring even in the absence of significant trauma. Such a radiological picture may distract the clinician towards a malignant etiology and may affect the management.
Case Report: A 79- year- old female, known case of carcinoma of the urinary bladder, underwent contrast-enhanced computed tomography (CT) (CECT) of the abdomen and pelvis as a routine follow- up and was found to have an osteolytic lesion in the right pubic bone, suggesting a malignant pathology. CT- guided biopsy did not reveal any malignant or infective etiology. The patient showed recovery with conservative management.
Conclusion: Osteolytic lesions of the pubic bone can often occur following radiation for pelvic malignancies. It occurs due to impaired fracture reparative response by a bone afflicted by radiation therapy RT. It can be managed effectively with conservative analgesics, bisphosphonates, calcium, and Vitamin D supplementation. The radiographic picture can imitate malignant or infective lesions and provoke invasive testing for confirmation. The clinicians need to be conscious of this clinical entity to initiate proper treatment and avoid unnecessary investigations.
Keywords: Pubic Osteolysis; Insufficiency Fracture; Radiation; Pelvis.
Delay in Treatment of a Bimalleolar Ankle Fracture during Coronavirus Disease-19 COVID-19 Pandemic Leading to Amputation
Authors: Regala Peter , White Peter B , Bitterman Adam D , Katsigiorgis Gus , Dicpinigaitis Paul A
Published: August 2021

Introduction: Severe acute respiratory syndrome coronavirus-2 (SARs-CoV-2), also known as coronavirus disease-19 (COVID-19), is a novel respiratory disease which has fundamentally disrupted societal norms. Common responses to the pandemic have called for “social distancing” and national lockdowns. There is little evidence as to how public perception surrounding exposure to the virus may impact patient care. Here, we present a case of a patient who deferred medical treatment due to concerns regarding exposure to the virus.
Case Report: A 99-year-old female who presented to an emergency department of a community hospital on Long Island, New York, during the COVID-19 pandemic complaining of right ankle pain after a fall three 3 weeks ago. Fear of contracting COVID-19, led to initial avoidance of medical evaluation. On presentation, the patient presented with a Gustillo-Anderson Grade III A, bimalleolar ankle fracture with associated gangrene. After evaluation and a thorough discussion with the patient and her family, the patient underwent guillotine amputation.
Conclusion: Public perception surrounding COVID-19 has created a sense of fear that can impact patient behaviors, such as prevent them from seeking medical care when necessary. As physicians, we need to make patients feel safe and increase availability to patient care during this time to prevent similar issues as demonstrated in this case.
Keywords: Coronavirus disease-19, bimalleolar ankle fracture, amputation.COVID-19, Bimalleolar Ankle Fracture, Amputation
Isolated Septic Arthritis of the Hip Due to Fusobacterium nucleatum in An Immunocompetent Adult: A Case Report and Review of the Literature
Authors: Nishi Masanori , Yoshikawa Yasushi , Kaji Yasutaka , Okamoto Satoshi , Inagaki Katsunori
Published: August 2021

Introduction: Hip septic arthritis is more common in children than in adults. Staphylococcus aureus and Streptococcus spp. are commonly found in association with septic joints. In contrast, Fusobacterium nucleatum septic arthritis in adults is extremely rare. To the best of our knowledge, only five cases have been reported in the literature in English, and three of them were cases of periprosthetic joint infection. We report a rare case of hip septic arthritis due to F. nucleatum in an immunocompetent adult.
Case Presentation: A 56-year-old Asian man with a history of bilateral Perthes’ disease and mild alcoholic liver disease presented to our hospital complaining of worsening right hip pain and difficulty in walking for the previous 3 weeks. On presentation, his temperature was 38.7°C, and laboratory results showed a white blood cell count of 19 200 cells/µL and a C-reactive protein level of 43.56 mg/dL. Hip movements were limited due to pain. Contrast-enhanced computed tomography and magnetic resonance imaging showed fluid retention, suggesting infection. F. nucleatum was detected in the culture test from joint aspirate. Surgical drainage was performed 3 times in combination with antibiotherapy. Finally, we performed two-stage total hip arthroplasty, and the post-operative course was uneventful without implant loosening or infection relapse.
Conclusion: The patient had a history of Perthes’ disease and had hip osteoarthritis, which may have contributed to the development of hip septic arthritis. We treated this rare case of hip septic arthritis due to F. nucleatum with two-stage revision surgery and antibiotherapy. Clinicians should be aware that F. nucleatum could be the etiologic agent of hip septic arthritis in an immunocompetent patient.
Keywords: Septic Arthritis, Hip joint, Fusobacterium nucleatum, Adult
Outcome of neglected talus neck fracture and it’s management: A Case Report
Authors: Moger Nagaraj Manju , Pragadeeshwaran J. , Verma Aman , K.V Ankith , Aditya K. S. , Meena Pradeep Kumar
Published: August 2021

Introduction: Talus fracture is an uncommon fracture that can be encountered on day- to- day basis. However, it is the 2nd most common tarsal bone to get fractured after calcaneum and accounts for approximately 1% of all fractures around foot and ankle. The anastomotic ring around the talar neck is highly likely to get damaged at the time of the fracture, which, in turn, hampers the blood supply to the body of talus. As a result, the bone healing is delayed and the integrity of the healed fracture is poor which leads to poor functional outcome. Almost 39% cases are missed during the initial evaluation, and talus fracture accounts for almost 50% of all the missed injuries (6–8). A high level of clinical suspicion is required to avoid missing such injuries.
Case Report: A 26-year-old male presented to the outpatient department with chief complaint of pain over the left foot while walking for past 6 months. There was a history of significant trauma to the foot 6 months back (fall from 12 feet) for which he sought medical advice and was managed with analgesics and rest for a couple of weeks. He presented to us 6 months later with chronic, dull aching, and continuous pain which aggravates while walking and standing. The diagnosis of the non-union fracture neck of talus was made after radiology and was managed by open reduction and internal fixation with cannulated cancellous screws along with contralateral iliac crest cancellous bone grafting.
Conclusion: Delay in diagnosing such injuries accelerates the vascular compromise, delays timely intervention, and ultimately leads to increased morbidity.
Keywords: Talar neck fracture, non-union talus fracture, delayed union talus.
Melorheostosis of the Fossa Intercondylaris Femoris – A Case Report and Review of the Literature
Authors: Ahrens Helmut , Theil Christoph , Gosheger Georg , Mühl Sebastian , Deventer Niklas , Schneider Kristian Nikolaus
Published: August 2021

Introduction: Melorheostosis is a rare benign bone condition characterized by excessive segmental sclerosis of cortical bone being reminiscent of dripping candle wax. It typically affects the long bones and can cause impingement and nerve compression syndromes that may require surgical treatment.
Case Report: We report the case of a 49-year-old male patient with a 12-month history of the left-sided knee pain and a concomitant limitation of his left knee flexion to 90 degree. Radiographic and magnetic resonance imaging revealed the typical radiographic appearance of melorheostosis with an extraosseous lesion in the fossa intercondylaris femoris being causative for the limited knee range of motion. Following the resection of the extraosseous part of the lesion through a direct open approach, the patient is pain free with a maximum of 110 degree knee flexion at 12-month follow-up.
Conclusion: Melorheostosis can present with manifold clinical manifestations that potentially require surgical treatment. Even in patients with a challenging localization of extraosseous lesions, a good to excellent functional outcome is possible.
Keywords: Melorheostosis, Léri disease, Candle wax disease, Surgery, Fossa intercondylaris femoris, Notch.
Primary Total Hip Replacement in a Case of Unilateral Hypo Plastic Proximal Femur – A Case Report
Authors: Mahajan Neetin P , Gadod Lalkar Laxman , Chandanwale Ajay S , Kumar G S Prasanna , Narvekar Mrugank , Gajbe Ishan
Published: August 2021

Introduction: Primary total hip replacement in hypo plastic proximal femur is difficult due to the presence of a small canal, soft- tissue contracture, fragility of bone, and poor femoral cement mantle when used. Intraoperatively, there could be occurrence of fracture of the femur, inadequate fit, and fill with cement less femoral component. It is found unilaterally in cases of osteonecrosis of femoral head, post- traumatic, and in sequelae of childhood septic arthritis.
Case Report: A 45-year- old male patient presented to the OPD with complaints of pain in the left hip and difficulty in walking since for 4 years. The patient had a history of fever and swelling over the left hip in childhood with no treatment taken for the same. X-ray of pelvis with both hips showed deformed femoral head, short neck, narrow femoral canal (Grade 1 Dorr), and arthritic changes in acetabulum. We managed with total hip replacement using Wagner cone stem. Postoperatively, the patient is having good range of motion and having no difficulty in walking and weight- bearing. Functional outcome is good as per Harris hip score.
Conclusion: Total hip replacement in hypo plastic femur with arthritis is always a challenging problem. It requires surgical expertise and proper implant selection and pre-operative planning, which prevents intraoperative and post-operative complications. Wagner cone stem is a very good option in managing this type of patients.
Keywords: Unilateral hypo plastic proximal femur, childhood septic arthritis, narrow femoral canal (Grade 1 Dorr), total hip replacement, Wagner cone stem.
A Soft- Tissue Injury Diagnosis in Knee Replacement Patients cannot be made without a Plain Radiograph
Authors: Castelhano Rute , Deo Sunny
Published: August 2021

Introduction: The design of some knee replacements includes the use of a mobile polyethylene bearing which can potentially dislocate away from the main bearing surfaces. This is particularly the case in unicompartmental or partial knee replacements (UKRs), and the most widely used UKR currently has this feature. Bearing dislocations are typically very painful and disabling, but not always, as in the case we present.
Case Report: We report the case of a patient presenting at a 1 -year follow- up following a mobile bearing UKR. At this consultation, the patient reported a smooth initial recovery but with on-going pain and swelling in the posterior aspect of his knee for 3 months, diagnosed as a soft- tissue strain.
Results: Radiographs at 1 year follow-up appointment showed that the polyethylene insert was dislocated posteriorly towards the popliteal fossa with metal components in direct contact. At revision surgery, this was confirmed as a chronic dislocation with severe metallosis requiring revision to a total knee replacement.
Conclusion: We report a case of a posterior dislocation of a mobile polyethylene bearing of a partial / unicompartmental knee replacement UKR with delayed definitive treatment due to mis-diagnosis at the time of onset of symptoms and signs. The key lesson is that plain radiographs should be obtained promptly for any local issue in knee replacement patients.
Keywords: Unicompartmental knee replacement, metallosis, mobile bearing dislocation, soft tissue injuries.
Congenital Dislocation of the Patella – Surgical Treatment Rationale and Literature Review
Authors: Pedrotti Luisella , Bertani Barbara , Rosa Federica De , Fossati Federica , Ghilotti Margherita , Mora Redento , Tuvo Gabriella , Mosconi Mario
Published: August 2021

Introduction: Congenital dislocation of the patella (CDP) is a rare condition and its treatment is not well defined. In CDP, patella is dislocated on the lateral aspect of the distal femur, laterally from the trochlear groove, it cannot be reduced manually and it is almost always associated with genu valgum, lateral torsion of the proximal tibia, and flexion contracture of the knee. This condition is present at birth, but the clinical findings can be subtle at birth due to the size and character of the structures being examined; early diagnosis is essential, but it may be delayed to late childhood or adulthood. If CDP is not promptly treated, the disability increases during growth, so surgical correction should be planned as soon as the diagnosis is confirmed.
Case Report: We report a case of bilateral CDP associated with bilateral proximal radioulnar joint stiffness; the patient at the age of diagnosis was 11 years old and underwent a bilateral delayed surgical procedure; the 4-year follow-up results are satisfactory. Surgical treatment rationale and literature are reviewed.
Conclusion: Surgical correction for CDP is generally recommended, but there is no agreement in literature on the ideal treatment and in some cases, with mild impairment of the knee function, observation alone has been suggested. The decision about a surgical treatment can be difficult and depends on the degree of disability of the patient.
Keywords: Congenital dislocation of the patella, bilateral congenital dislocation, patella, Z-plasty quadriceps muscle, lateral retinaculum release, lack of active knee extension.
A Rare Case of Sphingomonas paucimobilis Spondylodiscitis Managed Surgically
Authors: Dsouza Areena , Mallepally Abhinandan Reddy , Marathe Nandan Amrit , Das Kalidutta , Mohaptra Bibhudendu
Published: August 2021

Introduction: Sphingomonas paucimobilis is an opportunistic pathogen and a rare cause of human infection. This case report shows bacteremia with pyogenic spondylodiscitis in lumbosacral spine caused by Sphingomonas and discusses its clinical diagnosis, treatment, and literature reviews.
Case Report: Patient presented with severe low back pain, inability to walk and fever following a L5-S1 decompression elsewhere, which corresponded clinico-radiologically with a picture of a spondylodiscitis on radiographs, magnetic resonance imaging, and computed tomography. His blood culture was positive for S. paucimobilis. He was treated successfully by surgical debridement, stabilization, and fusion along with intravenous Linezolid followed by oral therapy, based on the antibiotic susceptibility profile. Repeat blood culture was negative after 7 weeks of antibiotic therapy. Patient improved symptomatically with radiographs showing good fusion at 1 year follow-up. S. paucimobilis, though a low virulence organism, is an emerging pathogen and should be dealt with cautiously.
Conclusion: This reiterates the importance of culture as unusual organisms may be isolated and appropriate antibiotics form the mainstay of treatment.
Keywords: Sphingomonas paucimobilis, spondylodiscitis, spinal fusion, linezolid.
Total Hip Arthroplasty after McMurray’s Osteotomy – A Case Report and Review of Literature
Authors: Gawhale Sangeet , Bansal Sagar , Yadav Amit , Mishra Shaswat , Akshay K S , Chikodi Angad
Published: August 2021

Introduction: Total hip arthroplasty after McMurray’s osteotomy increases the operative difficulties and decreases the chances of better outcome. With the advent of modular femoral stems, minute changes can be done to individual joints, which allow intraoperative flexibility and better post-operative outcome. Thus, it should be considered as an option for complicated cases.
Case Report: We report a case of a 35-year-old female with chief complain of pain in the left hip while walking for the past 2 years. The patient also had difficulty in squatting and sitting cross legged. History of fracture in the left hip at 4 years of age for which McMurray’s osteotomy was done. The patient was operated with total hip arthroplasty using modular Sivash range of motion (S-ROM) stem.
Conclusion: Modular S-ROM total hip arthroplasty is a good option for treatment in cases with previous osteotomy in femur.
Keywords: McMurray’s osteotomy, total hip arthroplasty, Sivash range of motion.
Acute Septic Carpal Tunnel Syndrome in a Rock Climber
Authors: Zbeda Robert M , Rabinovich Remy V , Vialonga Mason , Seigerman Daniel A
Published: August 2021

Introduction: Rock climbing is an increasingly popular sport in the United States. Acute and chronic upper extremity injuries related to rock climbing are frequently reported and include flexor pulley ruptures and hamate stress fractures. Deep space hand infections after indoor rock climbing are a sport-related pathology that has yet to be reported. Our purpose is to describe an acute septic carpal tunnel syndrome following rock climbing at an indoor climbing gym in a patient who required urgent irrigation and debridement.
Case Report: A 33-year-old Caucasian male presented with an acute septic carpal tunnel syndrome 4 days after rock climbing at an indoor gym. On physical examination, he exhibited numbness over the fingers, significant tenderness to palpation, and pain with passive range of motion. His inflammatory markers were markedly elevated and deep space hand infection was confirmed with computed tomography scans. The patient was taken for urgent exploration, irrigation and debridement, and carpal tunnel release.
Conclusion: We theorize that the patient had an abrasion on the finger or palm that created an entryway for a pathogen. We are unaware of another report of a deep space hand infection associated with rock climbing activities. This case report will hopefully spread awareness of this clinical entity to improve evaluation and prevention of hand infections in rock climbers, as well as providing guidelines for appropriate and timely treatment of the condition.
Keywords: Hand surgery, infection, rock climbing.
Telangiectatic Osteosarcoma in a Young Child – A Case Report and Review of the Literature
Authors: Jeyarani Gracelin , Jayaraman Dhaarani , Menon Gopinath , Harshavardhaan JK Giriraj , Rajendiran S , Murali Arunan
Published: August 2021

Introduction: Osteosarcoma (OS) is one of the most common primary malignant bone tumors in children and adolescents. OS incidence varies significantly with age and peak incidence is in adolescent age group. Telangiectatic osteosarcoma (TOS) is an unusual variant of OS, forming 3–10% of all OSs. Only few case reports of this rare variant of OS are described in the literature.
Case Report: We report a 6-year-girl who presented with fracture of the left proximal humerus after a trivial trauma. X-ray left shoulder showed osteolytic lesions in the left proximal humerus with fracture of proximal humerus. Open biopsy from the left proximal humerus osteolytic lesion suggested clusters of highly atypical cells like osteoid material and focal areas of hemorrhage and necrosis suggestive of TOS. The child was started on chemotherapy followed by limb-salvage surgery with wide resection of the tumor in the left proximal humerus. She completed her adjuvant chemotherapy and is currently doing well for the past 4 years.
Conclusion: OS occurs more frequently in adolescents around the knee in the metaphyses. The most common histologic type is osteoblastic/fibroblastic or chondroblastic type. Very few cases have been reported in <5 years age group and it’s relatively rare in 5–10-year-old children. Rare histologic variants, especially telangiectatic variant, are more common in younger children and occur more in upper limbs. Imaging reveals mainly osteolytic lesions, unlike in conventional OS. This case highlights the utmost role of histopathology in the diagnosis of the bone tumors which would guide the management appropriately.
Keywords: Osteosarcoma, pathological fracture, expansile lytic lesion, telangiectatic osteosarcoma.
Foreign Body Induced Osteomyelitis in the Hand – Commonly Missed Clinical and Radiological Diagnosis
Authors: Regmi Meghna , Desai Sanjay , Patwardhan Sandeep , Deshmukh Wipula , Kapoor Tushar , Patil Nandakishore
Published: August 2021

Introduction: Thorn prick is commonly seen in people that are involved in gardening. In some cases, they are unaware of the precedent thorn prick or present for medical attention quite late and forget about the history of thorn prick. In such cases, it is challenging for the clinicians and the radiologist to rule out the cause of the osteomyelitis caused by an unrecognized foreign body.
Case Report: A 14-year-old girl presented with a swelling of the hand and discharging sinuses with a radiographic picture of osteomyelitis of the 5th metacarpal. The CT and MRI showed features consistent with osteomyelitis as well, possibly tuberculous in etiology. Even after the completion of AKT (anti-tubercular treatment), the patient continued to have discharging sinuses out of which a plant thorn spontaneously egressed, and subsequently, the patient was completely relieved of her symptoms. Retrospective evaluation of the MRI showed the presence of a foreign body that was hyperdense on CT and was initially thought to be a sequestrum.
Conclusion: Hence, even though a definite history of trauma/thorn prick is not given (although highly unusual in the case of hand), an organic foreign body should be considered in the etiologic differential diagnosis of non-responding chronic osteomyelitis and discharging sinuses.
Keywords: Thorn, osteomyelitis, hand.
Neglected Posterior Hip Dislocation in Adults presenting after One Year Managed Successfully with Single Stage Total Hip Arthroplasty: A Case Series
Authors: Jain Mantu , Swaroop Shakti , Kumar Doki Sunil
Published: August 2021

Neglected Posterior Hip Dislocation in Adults presenting after One Year Managed Successfully with Single Stage Total Hip Arthroplasty: A Case Series
A Rare and Unique Complication of Pins and Rubbers Traction System (Suzuki frame) while Managing Simple PIPJ Fracture-dislocation
Authors: Lad Parag B. , Ahire Pankaj
Published: August 2021

Introduction: The management of acute proximal interphalangeal (PIP) joint fracture-dislocation by dynamic external fixator is widely practiced method. The complications such as pin loosening or non-union or stiffness are known and can be treated well. The over distraction causing vascular compromise and calcification of volar plate jeopardizing the function and viability of the affected digit is not reported so far.
Case Report: We report a case of 2 weeks post-traumatic ring finger PIP joint fracture-dislocation in a 21-year-old male which was treated by pins and rubber dynamic traction method. The affected digit was found cold and lengthened at 3 weeks of distraction causing vascular compromise. The X-ray showed over distraction by 1.5 cm at PIP joint. The digit was salvaged by removing distractor and applying splintage. Later, at 6 weeks, X-ray showed volar plate calcification causing joint stiffness. This was tackled by volar plate arthroplasty. At 2 months, the patient got 20–80° movement without pain.
Conclusion: The dynamic pins and rubber traction system for acute PIP joint injury can result in complication like over distraction leading vascular compromise. The clinical and radiological assessment with such technique is mandatory once a week to avoid missing such disasters. Even if such complication occurs, immediate fixator removal and splintage can save the digit. Once it survives, secondary procedure for gaining movement or stabilizing the joint like volar plate arthroplasty can be considered.
Keywords: Pins and Rubbers traction system, Over distraction, Vascular compromise
Unusual Combination of Hip Dislocation with Ipsilateral Femoral Neck and Acetabulum Fracture: A Rare Case Report
Authors: Gupta Ravi , Singhal Akash , Sharma Atul Rai , Patil Anurag , Masih Gladson David
Published: August 2021

Introduction: Traumatic dislocation of hip associated with ipsilateral femur neck and acetabulum fracture is a rare and devastating injury as a result of high-energy trauma, with potential complications of femur head aseptic necrosis and hip joint degenerative arthritis. Patients, postoperatively, may encounter decreased functional outcomes and serious challenge, during activities of daily living. Management guidelines lack clarity, with possible options including fracture fragments fixation or hip joint replacement.
Case Report: A 45-year-old patient was diagnosed with posterior dislocation of hip with ipsilateral femur neck and acetabulum fracture. Plan for emergent hip reduction and primary surgical fixation of fracture fragments was made. Intraoperatively, posterior wall acetabulum fracture was found to be excessively comminuted and non-amenable for fixation and femoral head was found to be avascularized. Subsequently, plan was changed to total hip replacement with acetabular defect reconstruction. At 1-year follow-up, no aseptic loosening was observed on radiographic views of pelvis, with total Harris Hip Score of 91.
Conclusion: Early operative management for such complex injuries is a necessity. Definitive management in the form of primary fracture fixation/arthroplasty should be decided intraoperatively.
Keywords: Femur neck, hip dislocation, acetabulum fracture, ipsilateral, case report.
Neurogenic Heterotopic Ossification of the Hip after Brain Injury. Function Recovery Preserving Hip Joint: A Case Report
Authors: Viglietta Raffaele Iorio Edoardo , Massafra Carlo , Ferretti Andrea
Published: August 2021

Introduction: Up to 30% of patients with spinal cord injury and to 20% of patients with traumatic brain injury develop neurogenic heterotopic ossification (NHO). Patients develop restriction in joint range of motion (ROM) and impairment in activities of daily life. When neurological recovery occurs, joints dysfunction represents the cause for patients’ autonomy loss.
Case Report: We present the case of a 39-year-old Caucasian male involved in a car accident and experienced 14 days of post-traumatic coma. After rehabilitation, no residual motor or sensory neurological deficit was present, but bilateral NHOs surrounding hip joints developed. Seventeen months after trauma, the patient was admitted to our institute. He was confined to bed, absolutely unable to walk, stand or sit. Radiological evaluation consisted in Antero-Posterior X-ray view only, due to the inability to open up his hips for lateral views, and 3D computed tomography scan. “Functional resection” of the ossifications was performed and rehabilitation started from day 1 after surgery. At the final follow-up 24 months from the second operation high grade of clinical satisfaction was reported. The patients were able to walk independently, to put on his socks, and to drive a car and bike. Painless right and left hip ROM was, respectively, 100° and 90° for flexion, 10° for extension, 35° and 30° for abduction, and near normal internal and external rotation. The patient referred that further improvement in mobility and fluency was still present day by day.
Conclusion: The rarity of the condition frequently bring to a delay in treatment and the absence of specific guidelines made treatment still dependent on surgeon experiences. A multidisciplinary approach is essential for success. Surgeons should be aware that it is important to refer patients to specialized center, because early resection could provide excellent results, preserving hip, and restoring function and patient independency.
Keywords: hip, ossifica
Closed Humerus Shaft and Distal Humerus Fractures with associated Brachial Artery Thrombosis in Adult Patients and its Management – A Case Series
Authors: Mahajan Neetin P , Kumar G S Prasanna , Sakhare Vaibhav
Published: August 2021

Introduction: The humerus fractures can present as isolated or associated with other injuries and these fractures can be associated with both primary and secondary iatrogenic or traumatic neurovascular injuries. The timely management of these injuries helps in preventing catastrophic consequences.
Case Presentation: Two cases of humerus fractures were presented with brachial artery thrombosis. First case is 56-year-old female with distal humerus fracture and second is 32-year-old female with humerus shaft fracture. Both the patients had feeble pulse at the time of presentation. Urgent CT angiography of the upper limb was performed and vascular surgeon intervention was taken. First case showed complete non opacification of distal brachial artery due to thrombosis, which was managed with bicolumnar plating with embolectomy. The second case of humerus shaft fracture showed non contrast opacification at the fracture, which was managed with intramedullary nailing with removal of the bony fragment impinging on the artery and embolectomy. Postoperatively, both the patients are having good functional and radiological outcome without any complications.
Conclusion: Proper early clinical evaluation for vascular deficits helps to prevent the delayed diagnosis and radiological investigations helps to identify the cause and location of the vascular insults. Early surgical intervention in association with vascular surgeons helps in getting better outcome and prevents complications related to vascular injuries.
Keywords: Distal humeral fracture, brachial artery thrombosis, humerus shaft fracture, embolectomy.
A Novel “Shark-Fin” Pyramidal Achilles Bone-Tendon Allograft Surgical Technique for Delayed Reconstruction of Triceps Tendon Rupture and Review of the Literature
Authors: Holmes Natalie , Al-Janabi Mina , Virani Siddharth , Relwani Jaikumar
Published: August 2021

Introduction: Triceps tendon injuries are rare and often caused by direct trauma to the arm. There are no clear guidelines on the management of these and typically partial tears are treated conservatively whilst full thickness tears are treated with primary surgical repair. We aim to review the literature on the methods for triceps repair and propose a novel surgical technique.
Methods: A “Medline” and “Embase” literature search of titles and abstracts combining “triceps brachii muscle,” “reconstruct/ed” or “reconstruction” alongside “reconstructive surgical procedures,” and further cross referenced with “repair/s/ed.” Excluded those related to brachial plexus injuries or general elbow trauma and removing duplicate results. 32 English results within 10 years were relevant and reviewed.
Results: A 50-year-old gentleman with a 4-month-old full thickness triceps tear was repaired with a novel surgical technique of using an Achilles bone-tendon allograft fashioned into a “shark-fin” pyramidal shape and secured to the proximal ulnar in a lock and key type construct. The tendon was secured to the triceps remnant using a Krackow stitch. Complete radiological and clinical recovery was made by 18 months postoperatively with return to full physical activity.
The literature review concluded no consensus in the method of treatment for delayed triceps reconstruction.
Conclusion: The use of the bone-tendon allograft specifically shaped to fit congruently into an olecranon osteotomy site allows for direct bone-to-bone healing has not previously been mentioned in the literature. Results have been encouraging and the technique described is easily reproducible.
Keywords: Triceps rupture, delayed, reconstruction, achilles allograft, surgical technique, literature review.
Compulsory female sterilisation in Brazil: reproductive rights for whom?
Authors: Menandro Leila Marchezi Tavares , Barrett Hazel Rose
Published: August 2021

Family planning programmes have been implemented throughout the world since the mid-20th century. In Brazil, the act governing family planning has been law for 25 years. However, the concept does not seem to be well known, being understood as contraceptives distribution. This article discusses Brazilian family planning policies, using a compulsory sterilisation lawsuit – reported by the media – to illustrate one of the many facets of gender-based violence in Brazil. This article is based on documentary research and uses a qualitative approach, applying content analysis to three selected texts. Only the news report that made the case public directly mentions the Family Planning Law and questions the suppression of reproductive rights. It was clear that conservatism was present in the actions of the judiciary, which appeared to be selective when choosing whose rights should be protected, denying poor women’s reproductive rights and upholding coercive birth control for the most deprived groups in the population.
Evidence for hidden leprosy in a high leprosy-endemic setting, Eastern Ethiopia: The application of active case-finding and contact screening
Authors: Urgesa Kedir , Bobosha Kidist , Seyoum Berhanu , Weldegebreal Fitsum , Mihret Adane , Howe Rawleigh , Geda Biftu , Kaba Mirgissa , Aseffa Abraham
Published: September 2021

Leprosy or Hansen’s disease is a disabling infectious disease caused by Mycobacterium leprae. Reliance on the self-presentation of patients to the health services results in many numbers of leprosy cases remaining hidden in the community, which in turn results in a longer delay of presentation and therefore leading to more patients with disabilities. Although studies in Ethiopia show pockets of endemic leprosy, the extent of hidden leprosy in such pockets remains unexplored. This study determined the magnitude of hidden leprosy among the general population in Fedis District, eastern Ethiopia. A community-based cross-sectional study was conducted in six randomly selected leprosy-endemic villages in 2019. Health extension workers identified study participants from the selected villages through active case findings and household contact screening. All consenting individuals were enrolled and underwent a standardized physical examination for diagnosis of leprosy. Overall, 262 individuals (214 with skin lesions suspected for leprosy and 48 household contacts of newly diagnosed leprosy cases) were identified for confirmatory investigation. The slit skin smear technique was employed to perform a bacteriological examination. Data on socio-demographic characteristics and clinical profiles were obtained through a structured questionnaire. Descriptive statistics and binary logistic regression were used to assess the association between the outcome variable and predictor variables, and the P-value was set at 0.05. From the 268 individuals identified in the survey, 6 declined consent and 262 (97.8%) were investigated for leprosy. Fifteen cases were confirmed as leprosy, giving a detection rate of 5.7% (95%, CI: 3%, 9%). The prevalence of hidden leprosy cases was 9.3 per 10,000 of the population (15/16107). The majority (93.3%) of the cases were of the multi-bacillary type, and three cases were under 15 years of age. Three cases presented with grade II disability at initial diagnosis. The extent of hidden leprosy was not statistically different based on their sex and contact history difference (p > 0.05). High numbers of leprosy cases were hidden in the community. Active cases findings, and contact screening strategies, play an important role in discovering hidden leprosy. Therefore, targeting all populations living in leprosy pocket areas is required for achieving the leprosy elimination target.
Vibrio cholerae O139 persists in Dhaka, Bangladesh since 1993
Authors: Parvin Irin , Shahid Abu Sadat Mohammad Sayeem Bin , Das Subhasish , Shahrin Lubaba , Ackhter Mst. Mahmuda , Alam Tahmina , Khan Soroar Hossain , Chisti Mohammod Jobayer , Clemens John D. , Ahmed Tahmeed , Sack David A. , Faruque Abu Syed Golam
Published: September 2021

Background

After a multi-country Asian outbreak of cholera due to Vibrio cholerae serogroup O139 which started in 1992, it is rarely detected from any country in Asia and has not been detected from patients in Africa.

Methodology/Principal findings

We extracted surveillance data from the Dhaka and Matlab Hospitals of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) to review trends in isolation of Vibrio cholerae O139 in Bangladesh. Data from the Dhaka Hospital is a 2% sample of > 100,000 diarrhoeal patients treated annually. Data from the Matlab Hospital includes all diarrhoeal patients who hail from the villages included in the Matlab Health and Demographic Surveillance System. Vibrio cholerae O139 was first isolated in Dhaka in 1993 and had been isolated every year since then except for a gap between 2005 and 2008. An average of thirteen isolates was detected annually from the Dhaka Hospital during the last ten years, yielding an estimated 650 cases annually at this hospital. During the last ten years, cases due to serogroup O139 represented 0.47% of all cholera cases; the others being due to serogroup O1. No cases with serogroup O139 were identified at Matlab since 2006. Clinical signs and symptoms of cholera due to serogroup O139 were similar to cases due to serogroup O1 though more of the O139 cases were not dehydrated. Most isolates of O139 remained sensitive to tetracycline, ciprofloxacin, and azithromycin, but they became resistant to erythromycin starting in 2009.

Conclusions/Significance

Cholera due to Vibrio cholerae serogroup O139 continues to cause typical cholera in Dhaka, Bangladesh.
Coronary heart disease and stroke mortality trends in Brazil 2000–2018
Authors: Moreira Patrícia Vasconcelos Leitão , de Arruda Neta Adélia da Costa Pereira , Ferreira Sara Silva , Ferreira Flávia Emília Leite Lima , de Lima Rafaela Lira Formiga Cavalcanti , de Toledo Vianna Rodrigo Pinheiro , de Araújo Jevuks Matheus , de Alencar Rodrigues Rômulo Eufrosino , da Silva Neto José Moreira , O’Flaherty Martin
Published: September 2021

Objective

To analyse the mortality rate trend due to coronary heart disease (CHD) and stroke in the adult population in Brazil.

Methods

From 2000 to 2018, a time trend study with joinpoint regression was conducted among Brazilian men and women aged 35 years and over. Age-adjusted and age, sex specific CHD and stroke trend rate mortality were measured.

Results

Crude mortality rates from CHD decreased in both sexes and in all age groups, except for males over 85 years old with an increase of 1.78%. The most accentuated declining occurred for age range 35 to 44 years for both men (52.1%) and women (53.2%) due to stroke and in men (33%) due to CHD, and among women (32%) aged 65 to 74 years due to CHD. Age-adjusted mortality rates for CHD and stroke decreased in both sexes, in the period from 2000 to 2018. The average annual rate for CHD went from 97.09 during 2000–2008 to 78.75 during 2016–2018, whereas the highest percentage of change was observed during 2008 to 2013 (APC -2.5%; 95% CI). The average annual rate for stroke decreased from 104.96 to 69.93, between 2000–2008 and 2016–2018, and the highest percentage of change occurred during the periods from 2008 to 2013 and 2016 to 2018 (APC 4.7%; 95% CI).

Conclusion

The downward trend CHD and stroke mortality rates is continuing. Policy intervention directed to strengthen care provision and improve population diets and lifestyles might explain the continued progress, but there is no room for complacency.