A 67-year-old male presented with a gradually progressive low back pain of 2 years duration. The patient was leading a retired life and there was no history of chronic fever or significant trauma. There was no radiati...A 67-year-old male presented with a gradually progressive low back pain of 2 years duration. The patient was leading a retired life and there was no history of chronic fever or significant trauma. There was no radiation of pain or any features suggestive of claudication. There was no history of any comorbidity. The pain was aggravated with extension of the spine and relieved with flexion. There was no swelling or neurological deficit, but muscle spasm was present. Radiographs of the spine revealed degenerative changes in the lumbosacral spine, along with articulation of spinous processes at in lumbar spine at all levels level suggestive of Baastrup's disease, commonly known as "kissing spine". Routine blood investigations were within normal limits. The patient was managed conservatively. He was given a week's course of analgesics and muscle relaxants and then started on spinal flexion exercises, with significant improvement being noted at 6 months follow up.展开更多
Purpose:Hip fractures in elderly have a high mortality.However,there is limited literature on the excess mortality seen in hip fractures compared to the normal population.The purpose of this study was to compare the m...Purpose:Hip fractures in elderly have a high mortality.However,there is limited literature on the excess mortality seen in hip fractures compared to the normal population.The purpose of this study was to compare the mortality of hip fractures with that of age and gender matched Indian population.Methods:There are 283 patients with hip fractures aged above 50 years admitted at single centre prospectively enrolled in this study.Patients were followed up for 1 year and the follow-up record was available for 279 patients.Mortality was assessed during the follow-up from chart review and/or by telephonic interview.One-year mortality of Indian population was obtained from public databases.Standardized mortality ratio(SMR)(observed mortality divided by expected mortality)was calculated.Kaplan-Meir analysis was used.Results:The overall 1-year mortality was 19.0%(53/279).Mortality increased with age(p<0.001)and the highest mortality was seen in those above 80 years(aged 50-59 years:5.0%,aged 60-69 years:19.7%,aged 70-79 years:15.8%,and aged over 80 years:33.3%).Expected mortality of Indian population of similar age and gender profile was 3.7%,giving a SMR of 5.5.SMR for different age quintiles were:3.9(aged 50-59 years),6.6(aged 60-69 years),2.2(aged 70-79 years);and 2.0(aged over 80 years).SMR in males and females were 5.7 and 5.3,respectively.Conclusions:Indian patients sustaining hip fractures were about 5 times more likely to die than the general population.Although mortality rates increased with age,the highest excess mortality was seen in relatively younger patients.Hip fracture mortality was even higher than that of myocardial infarction,breast cancer,and cervical cancer.展开更多
Intracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fra...Intracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fracture table is a prerequisite to facilitate fracture manipulation, traction, reduction and fluoroscopy assessment. However, positioning the limbs of bilateral above-knee amputees for internal fixation of related proximal femoral fractures is a difficult task, which requires customized inventory for effective limb positioning and fracture manipulation. This study reported a rare case following a crush injury of bilateral lower limb in a road traffic accident, and described some technical tips of acute femoral neck fractures in bilateral above-knee amputation. The patient was managed with immediate guillotine amputation and later secondary wound closure followed by internal fixation of the right-sided femoral neck fracture with multiple cancellous cannulated screws.展开更多
Bipolar clavicular dislocation is rare,and therefore its management is contentious.With an increase of patient’s physical demand and a near-normal shoulder function,there has been a shift in the paradigm of its manag...Bipolar clavicular dislocation is rare,and therefore its management is contentious.With an increase of patient’s physical demand and a near-normal shoulder function,there has been a shift in the paradigm of its management from a conservative one to a stabilized one of anatomical open reduction.Proposed methods of fixation have also evolved with the advent of more biological fixation devices,which elude implant or fixation related complications.This case report highlights the salient features of this rare case and details the management options along with the benefits of biological anatomical repair and reconstruction.展开更多
文摘A 67-year-old male presented with a gradually progressive low back pain of 2 years duration. The patient was leading a retired life and there was no history of chronic fever or significant trauma. There was no radiation of pain or any features suggestive of claudication. There was no history of any comorbidity. The pain was aggravated with extension of the spine and relieved with flexion. There was no swelling or neurological deficit, but muscle spasm was present. Radiographs of the spine revealed degenerative changes in the lumbosacral spine, along with articulation of spinous processes at in lumbar spine at all levels level suggestive of Baastrup's disease, commonly known as "kissing spine". Routine blood investigations were within normal limits. The patient was managed conservatively. He was given a week's course of analgesics and muscle relaxants and then started on spinal flexion exercises, with significant improvement being noted at 6 months follow up.
文摘Purpose:Hip fractures in elderly have a high mortality.However,there is limited literature on the excess mortality seen in hip fractures compared to the normal population.The purpose of this study was to compare the mortality of hip fractures with that of age and gender matched Indian population.Methods:There are 283 patients with hip fractures aged above 50 years admitted at single centre prospectively enrolled in this study.Patients were followed up for 1 year and the follow-up record was available for 279 patients.Mortality was assessed during the follow-up from chart review and/or by telephonic interview.One-year mortality of Indian population was obtained from public databases.Standardized mortality ratio(SMR)(observed mortality divided by expected mortality)was calculated.Kaplan-Meir analysis was used.Results:The overall 1-year mortality was 19.0%(53/279).Mortality increased with age(p<0.001)and the highest mortality was seen in those above 80 years(aged 50-59 years:5.0%,aged 60-69 years:19.7%,aged 70-79 years:15.8%,and aged over 80 years:33.3%).Expected mortality of Indian population of similar age and gender profile was 3.7%,giving a SMR of 5.5.SMR for different age quintiles were:3.9(aged 50-59 years),6.6(aged 60-69 years),2.2(aged 70-79 years);and 2.0(aged over 80 years).SMR in males and females were 5.7 and 5.3,respectively.Conclusions:Indian patients sustaining hip fractures were about 5 times more likely to die than the general population.Although mortality rates increased with age,the highest excess mortality was seen in relatively younger patients.Hip fracture mortality was even higher than that of myocardial infarction,breast cancer,and cervical cancer.
文摘Intracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fracture table is a prerequisite to facilitate fracture manipulation, traction, reduction and fluoroscopy assessment. However, positioning the limbs of bilateral above-knee amputees for internal fixation of related proximal femoral fractures is a difficult task, which requires customized inventory for effective limb positioning and fracture manipulation. This study reported a rare case following a crush injury of bilateral lower limb in a road traffic accident, and described some technical tips of acute femoral neck fractures in bilateral above-knee amputation. The patient was managed with immediate guillotine amputation and later secondary wound closure followed by internal fixation of the right-sided femoral neck fracture with multiple cancellous cannulated screws.
文摘Bipolar clavicular dislocation is rare,and therefore its management is contentious.With an increase of patient’s physical demand and a near-normal shoulder function,there has been a shift in the paradigm of its management from a conservative one to a stabilized one of anatomical open reduction.Proposed methods of fixation have also evolved with the advent of more biological fixation devices,which elude implant or fixation related complications.This case report highlights the salient features of this rare case and details the management options along with the benefits of biological anatomical repair and reconstruction.
