Surgical management of camel-related craniofacial injuries
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Abstract:
There are no studies focused on the types and management of camel-related craniofacial injuries.We aimed to analyze the pattern of injuries that required surgical management and their specific operative treatment.We prospectively collected data of all patients who were admitted to Al Ain Hospital with camel-related craniofacial injuries that were treated operatively during the period of January 2015 to January 2020.Eleven patients were studied; all were males having a median (range) age of 29 (19-66) years. Falling from a camel was the most common mechanism of injury (45.5 %) followed by camel bite (36.4 %). The most common injured region was the middle third of the face, which accounted for 56.5% of the bony fractures. Zygomatico-maxillary complex fractures were present in 60% of patients who fell while riding a camel. The most common surgical procedure performed in our patients was an open reduction with internal fixation (54.5%). There was no mortality.camel-related craniofacial injuries are complex. The main mechanism of injury is falling from a camel on the face causing fractures of the zygomatico-maxillary complex. These fractures usually need open reduction with internal fixation. Taking safety precautions may help in injury prevention.Keywords:
Falling (accident)
Osteosynthesis
Shoulder Fracture
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Seroma
Wound dehiscence
Incisional Hernia
Fat necrosis
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[Objective]To assess the efficacy of autograft fusion and anterior spinal stabilization as an alternative treatment for tuberculosis lesion of the lower cervical spine. [Methods]Thirty patients with tuberculosis of the lower cervical spine underwent anterior decompression and fusion.There were 22 male and 8 female with the age from 24 to 58 years(mean age,37 years).The involved area included 2 vertebral bodies in 21 patients,3 vertebral bodies in 9 patients.Combined chemotherapy was delivered to each patient for at least three weeks preoperatively.There were 5 patients with Frankel Grade B,5 with Grade C,13 with Grade D and 7 with Grade E.The mean kyphosis angle were 12°.[Results]The patiets stood surgery well.The operation time was 70～100 min and the bleeding during operation was 50～150ml.There was no postoperative complication.All patients were followed up for 24～36 months.At the last follow-up visit,5 cases with Frankel Grade B improved to Grade D,3 cases with Grade C improved to Grade D,2 cases with Grade C improved to Grade E,13 cases with Grade D improved to Grade E.There was no breakage of nails or failure of the internal fixation during the follow up.Stable bone union was observed in all cases and the average time required for fusion were 6.5 months.[Conclusion]Anterior debridement and autograft with internal fixation is a safe and effective method for treatment of the lower cervical tuberculosis.
Kyphosis
Debridement (dental)
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We reviewed a consecutive series of 16 patients above 60 years of age (mean age 71 years) who underwent reconstruction with pedicled flaps in the lower extremity. The soft tissue defects ranged from 9 to 50 cm and were caused in 11 patients (70%) by surgical complications from previous surgeries. Of these, 5 patients underwent a total joint replacement of the knee (4 cases) and of the ankle (1 case). Surgery consisted of 19 muscular flaps, and 3 fasciocutaneous flaps. Six patients were treated with a combination of 2 flaps. The overall surgical complication rate after reconstruction was 44%. There was no perioperative mortality and there were no medical complications. One patient required an above-the-knee amputation because of uncontrollable postoperative bleeding. A thrombectomy was performed in another patient to treat a postoperative popliteal artery occlusion with critical ischemia of the leg. Other complications included recurrent total joint replacement infections (2 cases), marginal flap necrosis (4 cases), and skin necrosis at the donor site (1 case). The mean hospitalization stay was 46 days. All patients but 1 completely healed, although secondary surgery was performed in 7 patients. The occurrence of complications was not correlated with the preoperative morbidity or an age above 75 years. The local complication rate was higher than reported for free flap in the same age category, but the lack of perioperative mortality and medical complications make it a low-risk option for reconstruction of small- to middle-sized defects in the elderly.
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Objective To investigate the surgical treatment of intra-articular calcaneal fractures and the measures for prevention and control of complications.Methods One hundred thirty-five intra-articular calcaneal fractures of 106 patients were treated by open reduction and internal fixation at the department of orthopaedics.The fractures were classified according to the Sanders system,including 51 type Ⅱ,62 type Ⅲ and 22 type Ⅳ.All patients were followed up for 5 to 20 months to observe the complications and postoperative functional recovery,and the therapeutic efficacy was evaluated.Results All fractures healed with good functional recovery.There were excellent in 58 cases,good in 38 cases,the rate of good and excellent outcomes was 90.57%.Delayed wound healing occurred in 4 cases,wound infection in 2 cases,and persistent postoperative pain in 4 cases.The incidence of complications was 9.43%.Conclusion Open reduction and internal fixation is an effective treatment for intra-articular calcaneal fractures.
Calcaneal fracture
Therapeutic effect
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Objective
To discuss the feasibility, the advantages and disadvantages, the clinical efficacy and the indications of minimally invasive transforaminal endoscopic debridement combined with allograft and posterial percutaneous internal fixation for thoracolumbar spinal tuberculosis.
Methods
All of 22 patients with thoracolumbar tuberculosis treated in our department from January 2012 to December 2013 were retrospectively reviewed. There are 11 male and female cases separately, with an average age of 54.1 ±10.2 years and with an average disease duration of 5.3 ± 1.9 months. Endoscopic lesion removal and allograft bone grafting combined with posterial percutaneous immobilization were performed on all these cases. The data of these patients were complete, and all patients had been followed up for more than 36 months. The clinical and radiographic results were recorded and analyzed.
Results
In this group, 22 patients were followed-up for 41.9±2.5 months(36-48 months). The spinal kyphosis was not improved 3 months after surgery (t=0.3546, P=0.7029), but the amount of blood loss (30.5±7.9 ml) was less in the operation, the amount of postoperative analgesics(0.3±0.1 g) was low and the bed time(1.5±0.3 days) was short. No recurrence and no internal fixation failure was found after long term follow-up. Good clinical outcomes were achieved with the fusion rate reached above grade 2 in all patients(95.5%) except one. The neuralgia was relieved, and the spinal cord injury was recovered to ASIA E. The VAS score and SF-36 score which were recorded 1 month and 3 months after operative were all improved significantly compared with those before operation, and patients’ life quality in the early period after operation was excellent. The incidence of complications was low (9.0%) , and the patients were satisfied with the treatment process.
Conclusion
It may be a potential way to treat spinal tuberculosis with minimally invasive transforaminal endoscopic debridement combined with allograft and percutaneous internal fixation, which could be a powerful supplement to other therapeutic measures, and is worthy of further research and development.
Key words:
Thoracic vertebrae; Lumbar vertebrae; Tuberculosis, spinal; Endoscopy; Spinal fusion
Kyphosis
Debridement (dental)
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Abstract Some 114 patients (median age 52 years) underwent laparoscopic hernia repair as a day-case procedure. Twenty-one patients had bilateral and 11 recurrent hernias. Some 113 patients underwent transabdominal preperitoneal mesh repair but one required conversion to open operation. Mean operating time was 24 min for unilateral and 38 min for bilateral repair. In an operating session of 3·5 h, up to five patients (mean 4·4) underwent surgery and as many as seven hernias were repaired. More than 10 per cent of patients were found to have a previously undiagnosed hernia on the opposite side. A total of 111 patients were discharged home on the day of surgery. Major complications included one omental bleed and one small bowel obstruction. Seroma was the commonest minor complication and occurred in 7 per cent of patients. More than 35 per cent of patients needed no postoperative analgesia. To date there has been one recurrence (follow-up range 2–18 months).
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Bleed
Hernia Repair
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Open reduction and internal fixation was performed on 50 displaced acetabular fractures in 49 patients by nine different attending surgeons over a 10-year period. At an average follow-up of 38 months, poor results were noted clinically in 38% and radiographically in 40%. The incidence of short- and long-term complications was greater than in other studies. Particularly distressing was the 58% incidence of heterotopic ossification (HO). Twenty-four percent had grade III or IV; five hips were autofused and the remainder had 40-60% loss of motion. There was no correlation of HO with age, sex, fracture type, degree of comminution, associated femoral head fracture or dislocation, delay to surgery, or operative time. However, 26 of 28 patients who had a trochanteric osteotomy as part of the operative exposure developed HO. Other complications included wound infection (12%), avascular necrosis of the femoral head (10%), nerve palsy (8%), and deep vein thrombosis/pulmonary embolism (8%). The data suggest formulation of specific treatment protocols, an awareness of surgical risks, and that staff specialization may reduce complications and improve outcome. Avoiding a trochanteric osteotomy at surgery and using prophylactic postoperative irradiation or indomethacin are suggested to reduce HO.
Avascular Necrosis
Acetabular fracture
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Incisional hernias develop in up to 11% of surgical abdominal wounds with a possible recurrence following repair of 44%. We describe our experience with a combined fascial and prosthetic mesh repair. Thirty-five patients (16M:19F) have been treated. The original operation was bowel related in 19 cases, gynaecological in 8, hepatopancreaticobiliary in 3 patients, aortic aneurysm repair in 2 and involved a thoraco-laparotomy in 3. The incisions were midline in 26 cases, transverse in 6, paramedian in 2 and rooftop in one patient. The hernias were considered subjectively to be large in 15, medium in 14 and small in 6 of the patients. A proforma was completed for each patient noting intra-operative and post-operative complications, post-operative hospital stay and analgesic requirements. Post-operative complications included seroma formation in 6 patients, deep vein thrombosis in one and a non-fatal pulmonary embolism in another. One patient developed a wound haematoma and one had a superficial wound infection. Post-operative in-hospital stay ranged from 1 to 27 days with a mean of 6.2 days. Of the 35 patients 33 were available for follow-up. Follow-up was for a median of 20.3 months (range 6.0 to 54.1 months). Two of these (6%) patients reported a persistent lump and one (3%) reported persistent pain but none of the remaining 33 was found to have a recurrence. We advocate this technique because it is applicable to all hernias, most of the mesh is behind the rectus sheath and has 2 points of fixation, it is relatively pain-free allowing early mobilisation, has a modest complication rate and a low recurrence rate.
Seroma
Incisional Hernia
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