Functional Outcome of Subtrochanteric Femoral Fracture Fixation by Intramedullary Interlocking Surgical Implant Generation Network Nail

Subtrochanteric femoral fractures are one of the common fractures encountered in today's Orthopaedic practice. High stress leads implant failure and produce varus collapse. From the perspective of biomechanics, intramedullary fixation has unique advantage which can better distribute stress and acting load-sharing implants. Biomechanically proximal wide canal and short segment provide less optimal fixation by conventional intramedullary nails. Intramedullary nail by Surgical Implant Generation Network (SIGN) has proximal interlocking that gain purchase through femoral neck and provide improved stability for proximal part. The aim of this study was to evaluate the functional outcome of subtrochanteric fractures fixation by intramedullary interlocking SIGN nail. This prospective study was conducted from July 2016 to June 2018 at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) through non randomized purposive sampling. Total 31 patients, aged above 18 years irrespective of sex with closed subtrochanteric fractures were included. Patients with pathological fracture, multiple injuries were excluded from the study. The mean age of the patients was 42.61±19.59 years with range 18-80 years. Most common fractures were Seinsheimer type III (51.6%) and average follows up 42.39 weeks (24-48 weeks). Union rate 93.55% with delayed union 6.45% and no nonunion. Functionally most of patient started early partial (77.42%) and full (64.52%) weight bearing with 61.29% have full knee ROM and 83.9% without limb shortening. Maximum patients regained walking (83.87%) and squatting (90.32%) and return to preinjury state (80.65%) of activities. Evaluation of outcome by Modified Harris Hip Score showed excellent (70.97%), good (22.58%), fair (3.23%) and poor (3.23%) thus satisfactory outcome were 93.55%. This study concludes that intramedullary interlocking SIGN nail is a safe and reliable implant for the treatment of subtrochanteric fractures with excellent functional outcome.

Result of Subtrochanteric Femoral Fracture Fixation by Intramedullary Interlocking Surgical Implant Generation Network (SIGN) Nail

Treatment of sub-trochanteric femoral fractures is a challenge to orthopaedic surgeons. High incidence of fixation failure and nonunion is due to thick cortical bone deserves special consideration of surgical treatment. Intramedullary nail by Surgical Implant Generation Network (SIGN) shows promising results in comparison to conventional fixation method because of its better strength, accuracy and surprisingly better results in infection and non-union. The aim of this study was to assess the rate and time taken for union of fractures by SIGN nail and determine peri-operative parameters. This prospective study was conducted from July 2016 to June 2018 at National Institute of Traumatology and Orthopaedic rehabilitation (NITOR) through non randomized purposive sampling. Total 31 patients, aged above 18 years irrespective of sex with closed subtrochanteric fractures were included. Patients with pathological fracture, multiple injuries were excluded from the study. Union status evaluated by Radiographic Union Score for Tibial (RUST) fracture where antero-posterior and lateral radiographs (X-ray) based assessment of healing of the four cortices done. The individual cortical scores were added to give a total score 4 being the minimum indicating fracture is definitely not healed and 12 being the maximum score indicating that the fracture is definitely healed. The mean age of the patients was 42.61±19.59 years with range 18-80 years. Majority of patients were male (68%) and most of injury (68%) due to road traffic accident with common fracture were Seinsheimer type III (51.6%). Average hospital stay period was 16.39 days and average follows up 42.39 weeks (24-48 weeks). Time taken for union was 14.16 weeks (11-28 weeks). According to RUST scores fracture union rate 93.55% with delayed union 6.45% and no nonunion. There was one patient with superficial wound infection, one unaccepted shortening and with no implant failure. This study concludes that intramedullary interlocking SIGN nail is a safe and reliable implant for the treatment of subtrochanteric femoral fractures.

Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

BACKGROUND

The safety and efficacy of antenatal glucocorticoids in women in low-resource countries who are at risk for preterm birth are uncertain.

METHODS

We conducted a multicountry, randomized trial involving pregnant women between 26 weeks 0 days and 33 weeks 6 days of gestation who were at risk for preterm birth. The participants were assigned to intramuscular dexamethasone or identical placebo. The primary outcomes were neonatal death alone, stillbirth or neonatal death, and possible maternal bacterial infection; neonatal death alone and stillbirth or neonatal death were evaluated with superiority analyses, and possible maternal bacterial infection was evaluated with a noninferiority analysis with the use of a prespecified margin of 1.25 on the relative scale.

RESULTS

A total of 2852 women (and their 3070 fetuses) from 29 secondary- and tertiary-level hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan underwent randomization. The trial was stopped for benefit at the second interim analysis. Neonatal death occurred in 278 of 1417 infants (19.6%) in the dexamethasone group and in 331 of 1406 infants (23.5%) in the placebo group (relative risk, 0.84; 95% confidence interval [CI], 0.72 to 0.97; P = 0.03). Stillbirth or neonatal death occurred in 393 of 1532 fetuses and infants (25.7%) and in 444 of 1519 fetuses and infants (29.2%), respectively (relative risk, 0.88; 95% CI, 0.78 to 0.99; P = 0.04); the incidence of possible maternal bacterial infection was 4.8% and 6.3%, respectively (relative risk, 0.76; 95% CI, 0.56 to 1.03). There was no significant between-group difference in the incidence of adverse events.

CONCLUSIONS

Among women in low-resource countries who were at risk for early preterm birth, the use of dexamethasone resulted in significantly lower risks of neonatal death alone and stillbirth or neonatal death than the use of placebo, without an increase in the incidence of possible maternal bacterial infection. (Funded by the Bill and Melinda Gates Foundation and the World Health Organization; Australian and New Zealand Clinical Trials Registry number, ACTRN12617000476336; Clinical Trials Registry-India number, CTRI/2017/04/008326.).

Mesenchymal Chondrosarcoma of the Parotid Gland

Mesenchymal Chondrosarcomas of the parotid are extremely rare tumours. They are broadly classified under extra skeletal form of mesenchymal chondrosarcomas and account for less than 1% of all sarcomas. It is characterized by a multinodular architecture, abundant myxoid matrix, and malignant chondroblast like cells arranged in cords. The tumor is an entity from chondrosarcomas of bones, commonly found in the soft tissues of the lower extremities at 80%. There are very limited reports of this tumor in the head and neck, especially in the parotid gland. We report a rare case of a parotid mesenchymal chondrosarcoma in a 55 years old man and discuss the pathogenesis, clinical presentation and management of such a rare tumour Bangladesh J Otorhinolaryngol; October 2020; 26(2): 158-160

Coblation versus Diode Laser Tonsillectomy in Children: A Randomized Controlled Trial

Objective: This study aimed to compare the efficacy of diode laser and coblation tonsillectomy in paediatric patients in relation to operative time, amount of blood loss, post operative pain, healing of tonsillar fossa and returns to normal diet. Methods: A total of 200 patients ,100 for coblaton and 100 for diode laser, aged 3-12 years with recurrent tonsillitis with or without snoring and sleep apnoea were recruited. Participants were prospectively randomised to diode laser and coblation tonsillectomy. Operative time and blood loss were recorded. Pain was recorded by VAS or assessed by using analgesic. Results: The operative time were recorded 07-15 minutes,mean 10 minutes in coblation group and 12-20 minutes ,mean 14 minutes in laser group., Blood loss was recorded 0-15 ml mean 8 ml in coblation group and 10-25 ml mean 13.5 ml in diode laser group . However, at post-operative day seven, the diode laser tonsillectomy group had significantly higher pain scores compared with coblationtonsillectomy groups.Coblation group started normal soft diet on day 5 whereas diode laser started on day 8 Conclusion: Coblation tonsillectomy is associated with less operative time and blood loss, early returns to normal diet and less pain score in comparison to Diode laser tonsillectomy Bangladesh J Otorhinolaryngol; October 2017; 23(2): 140-145

Difficulty in diagnosis of nasopharyngeal carcinoma

Due to difficult anatomical position nasopharyngeal carcinoma (NPC) is always challenging problems both from the diagnostic and therapeutic corner. A 24 years old lady came to our Department of Otolaryngology and Head-Neck Surgery with the complaints of epistaxis, right sided neck swelling, nasal obstruction and headache. On digital palpation Nasopharyngeal mass was found. We took biopsy from nasopharynx under indirect vision but report was not conclusive. Then we did CT scan, nasendoscopy. Nasendoscopy showed bilateral ethmoidal polyp with nasopharyngeal mass. We took biopsy from the nasopharyngeal mass and confirmed the diagnosis.