Inadvertent injection of potassium chloride instead of sodium chloride during treatment of chronic low back ache with epidural injection leading to paraplegia

Epidural injection of steroid is given for back pain resistant to other conservative management. Normal saline (NS) is used as diluent in 80 mg methylprednisolone and a local anesthetic. Due to a similar looking ampoule of NS and potassium chloride (KCl), there is a probability of accidental use of KCl instead of NS. We present a case of a 50 year old male patient having low back ache refractory to other conservative treatments. Epidural injection of steroid was given, but accidently KCl was mixed with methylprednisolone instead of NS. He developed severe cramps in the lower limbs, pruritus, and sweating, and finally paraplegia. Electrocardiography and blood showed features suggestive of hyperkalemia. He was given calcium gluconate and potassium chelating agent along with supportive measures. The patient recovered within 8 h. It is concluded that calcium gluconate and potassium chelating agent can be used if accidentally KCl is injected in epidural space

Lipoma arborescens: is it the cause or effect?

Lipoma arborescens is benign villous lipomatous proliferation of the synovium. The fronds-like masses are non-neoplastic fatty deposits on the synovium. The word arborescens is a Latin term meaning ′tree-forming′ or ′tree-like′. This article presents two cases of young adults who presented with pain and swelling around knee joint and were diagnosed on the basis of characteristic MRI findings, and hence signifies the role of MRI in diagnosing the cause of inflammatory synovitis in young patients. In addition, MRI helped in deciding the management of these patients. There was significant symptomatic improvement seen on follow-up, which further helps to strengthen the hypothesis that underlying lipoma arborescens could be a rare underlying cause for undiagnosed inflammatory synovitis in young adults

Delayed fixation of displaced type II and III pediatric femoral neck fractures

BACKGROUND: Time from injury to fixation of femoral neck fractures has been postulated as a vital determinant for rate of complications; however, no prospective study is available in the English literature. Delay, unfortunately, is inevitable in developing countries. The aim of the present study is to retrospectively review the outcome after delayed fixation of displaced type II and III femoral neck fractures in children. MATERIALS AND METHODS: Using a standard assessment chart, we retrospectively reviewed medical records of all pediatric patients having femoral neck fractures presenting to our institution from June 1999 to May 2006. Inclusion criteria were children between 5 and 15 years of age sustaining displaced Delbet type II and III femoral neck fractures having a complete follow-up of at least 2 years. Patients with known metabolic disease, poliomyelitis or cerebral palsy, were excluded from the study. After application of inclusion and exclusion criteria, 22 patients having 22 fractures (13 type II and 9 type III) were studied. Surgery could be performed after a mean delay of 11.22 days (ranging from 2 to 21 days). Closed reduction was achieved in 14 cases and 8 cases required open reduction through anterolateral approach. RESULT: Osteonecrosis was noted in eight patients (36.37%) who included two of nine patients (22.22%) operated in the first week, three of eight patients (37.51%) operated in the second week, and three of five patients (60%) operated in the third week of injury. Nonunion was seen in four (18.18%) cases, and two of them were associated with failure of implants. One was treated by valgus osteotomy and the other by Meyer's procedure. Fractures united in both children but the latter developed avascular necrosis. Functional results, as assessed using Ratliff's criteria, were good in 14 (63.63%), fair in 2 (9%), and poor in 6 (27.27%) patients. CONCLUSION: Delay in fixation, type of fracture, and ability to achieve and maintain reduction are factors primarily responsible for the outcome. We also found that delay after the first week further adversely affects the outcome

Lateral versus crossed K wire fixation for Displaced Supracondylar Fracture Humerus in Children: Our Experience

Background: Lateral entry and crossed Kirschner (K) wire fixation configuration for treating  displaced suprcondylar humerus fracture in children has always been shrouded in controversy as to which is superior. As the closed K wire fixation is the standard of treatment for these fractures, we performed a prospective study comparing the two methods.Method: A prospective study comparing any reduction loss between the two groups was undertaken. Major end points documented were loss of fracture reduction and ulnar nerve injury, in addition clinical alignment, Flynn grade, range of motion, function, and complications. The operative procedure was standardized.Result: Sixty two patients were studied, 32 and 30 in cross K wire and lateral K wire entry group respectively. Two cases of iatrogenic ulnar nerve injury was documented in crossed K wire fixation group but it was insignificant (p value=0.336). No significant difference was observed in terms of change in Baumann or humerocapitellar angle, carrying angle, elbow range of movement.Conclusions : Both techniques are equally effective. Ulnar nerve injury can be minimized by taking certain precaution as in text

Does an Adjustable-Loop Device Loosen following ACL Reconstruction with a Hamstring Graft? A Retrospective Study with a Follow-Up of Two Years

Arthroscopic anatomic anterior cruciate ligament reconstruction (ACLR) is the gold standard treatment for an ACL tear and requires the use of fixed or adjustable-loop devices to fix a femoral-side graft. Although the adjustable mechanism is designed to provide one-way tensioning, there is a concern that the adjustable loop will loosen and lengthen during cyclic loads, creating graft laxity. The present paper is a retrospective study of patients who underwent ACLR with the fixation of a hamstring graft with an adjustable loop on the femoral side from November 2016 to October 2018. The knee’s functional outcome was evaluated using an International Knee Documentation Committee (IKDC) score, Lysholm score, Lachman test, and pivot shift test. The patients were assessed preoperatively and finally postoperatively after two years of surgery. Thirty-two patients were analyzed. Significant improvement was obtained in the final clinical outcome of the patients. Twenty-seven patients (84.4%) were Lachman negative, and twenty-eight patients (87.5%) were pivot shift test negative, the mean Lysholm score was 96.91, and the IKDC score was 91.47 (p < 0.001). There was no infection, graft failure, or flexion restriction. Arthroscopic ACLR with an adjustable-loop suspensory device is a successful fixation method for femoral-side graft fixation and offers a similar functional outcome as with fixed-loop devices