Use of McGrath^(■) MAC Video Laryngoscope for Nasotracheal Intubation in Patients for Whom Intubation Was Expected to Be Difficult Due to the Limited Mouth Opening

McGrath? MAC video laryngoscope (McG) has been used for orotracheal intubation in both normal patients and patients for whom intubation was expected to be difficult, and has been reported to provide improved visibility of the glottis during tracheal intubation. There are some reports that normal nasotracheal intubation is easier with McG than with macintosh laryngoscope (ML). The usefulness of McG for nasotracheal intubation is beginning to be recognised. We experienced three cases using McG in patients for whom intubation was expected to be difficult due to the limited mouth opening and using McG for those patients enabled smooth nasotracheal intubation. McG provides good visual field during nasotracheal intubation, and is less invasive to the patient.

Intracortical screw insertion plus limited open reduction in treating type 31A3 irreducible intertrochanteric fractures in the elderly

BACKGROUND In most elderly patients with intertrochanteric fractures,satisfactory fracture reduction can be achieved by closed reduction using a traction table.However,intertrochanteric fractures cannot achieve satisfactory reduction in a few patients,which is called irreducible intertrochanteric fractures.Especially for type 31A3 irreducible intertrochanteric fractures,limited open reduction of the broken end with different intraoperative reduction methods is required to achieve satisfactory reduction and fixation.AIM To discuss clinical efficacy of intracortical screw insertion plus limited open reduction in type 31A3 irreducible intertrochanteric fractures in the elderly.METHODS A retrospective analysis was performed on 23 elderly patients with type 31A3 irreducible intertrochanteric fractures(12 males and 11 females,aged 65-89-yearsold)who received treatment at the orthopedics department.After type 31A3 irreducible intertrochanteric fractures were confirmed by intraoperative C-arm,all of these cases received intracortical screw insertion plus limited open reduction in the broken end with intramedullary screw internal fixation.The basic information of surgery,reduction effects,and functional recovery scores of the hip joint were assessed.RESULTS All patients were followed up for 13.8 mo on average.The operation time was 53.8±13.6 min(40-95 min).The intraoperative blood loss was 218.5±28.6 mL(170-320 mL).The average number of intraoperative X-rays was 22.8±4.6(18-33).The average time to fracture union was 4.8±0.7 mo.The reduction effect was assessed using Kim’s fracture reduction evaluation.Twenty cases achieved grade I fracture reduction and three cases grade II fracture reduction.All of them achieved excellent or good fracture reduction.Upon the last follow-up,the functional recovery scores score was 83.6±9.8,which was not significantly different from the functional recovery scores score(84.8±10.7)before the fracture(t=0.397,P=0.694).CONCLUSION With careful preoperative preparation,intracortical screw insertion plus limited open reduction contributed to high-quality fracture reduction and fixation.Good clinical outcomes were achieved without increasing operation time and intraoperative blood loss.