Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified techn...Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas over the world.展开更多
Background: COVID-19 was initially described to affect the respiratory system, it is now known to affect other systems and present in a myriad of ways. This has often proved to be a diagnostic and therapeutic challeng...Background: COVID-19 was initially described to affect the respiratory system, it is now known to affect other systems and present in a myriad of ways. This has often proved to be a diagnostic and therapeutic challenge to clinicians and stretched healthcare resources, sometimes with poor outcomes. We report on an atypical presentation of SARS-CoV-2 infection as an acute exacerbation of myasthenia gravis in a low resource setting. Case Presentation: A middle aged male with myasthenia gravis presented with a three weeks’ history of worsening generalized weakness and three days’ history of new-onset dysphagia with no history of fever and cough. After a few days of apparent improvement, the patient developed progressive respiratory distress. Further evaluation confirmed bilateral pneumonia and COVID-19. Conclusion: There is a need for clinicians and health service providers to have a low threshold for suspicion and testing for COVID-19 in patients with pre-existing medical conditions and immunomodulatory therapy such as Myasthenia gravis.展开更多
文摘Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas over the world.
文摘Background: COVID-19 was initially described to affect the respiratory system, it is now known to affect other systems and present in a myriad of ways. This has often proved to be a diagnostic and therapeutic challenge to clinicians and stretched healthcare resources, sometimes with poor outcomes. We report on an atypical presentation of SARS-CoV-2 infection as an acute exacerbation of myasthenia gravis in a low resource setting. Case Presentation: A middle aged male with myasthenia gravis presented with a three weeks’ history of worsening generalized weakness and three days’ history of new-onset dysphagia with no history of fever and cough. After a few days of apparent improvement, the patient developed progressive respiratory distress. Further evaluation confirmed bilateral pneumonia and COVID-19. Conclusion: There is a need for clinicians and health service providers to have a low threshold for suspicion and testing for COVID-19 in patients with pre-existing medical conditions and immunomodulatory therapy such as Myasthenia gravis.
