Ruptured noncommunicating rudimentary horn of unicornuate uterus at 12 weeks

Pregnancy in a rudimentary horn of a unicornuate uterus is rare but ruptured horn has a mortality rate of 5%. We report a case of 26-year-old G4P3 L3 with previous full-term vaginal deliveries, who presented at 12-week gestation with severe abdominal pain. Transvaginal ultrasound imaging was suggestive of ruptured right ectopic pregnancy and patient was taken up for emergency laparotomy. Intraoperatively, 2500 cc hemoperitoneum was present and ruptured right rudimentary horn in the posterolateral part was found, with fetus in the pouch of Douglas, the uterus was of unicornuate type. Excision of ruptured right rudimentary horn along with the right salpingectomy was done. Despite advances in imaging, in developing countries where the prerupture diagnosis is unlikely, a high index of suspicion is crucial in saving mother's life

Ruptured noncommunicating rudimentary horn of unicornuate uterus at 12 weeks

Pregnancy in a rudimentary horn of a unicornuate uterus is rare but ruptured horn has a mortality rate of 5%. We report a case of 26-year-old G4P3 L3 with previous full-term vaginal deliveries, who presented at 12-week gestation with severe abdominal pain. Transvaginal ultrasound imaging was suggestive of ruptured right ectopic pregnancy and patient was taken up for emergency laparotomy. Intraoperatively, 2500 cc hemoperitoneum was present and ruptured right rudimentary horn in the posterolateral part was found, with fetus in the pouch of Douglas, the uterus was of unicornuate type. Excision of ruptured right rudimentary horn along with the right salpingectomy was done. Despite advances in imaging, in developing countries where the prerupture diagnosis is unlikely, a high index of suspicion is crucial in saving mother's life

A case report on Felty′s syndrome

A 35 years old female came to orthopedic OPD with multiple joint pain since 1 year with history of fever and morning stiffness without any history of trauma and previous infection. On examination there was small joint tenderness involving metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints with splenomegaly. Routine investigation revealed neutropenia and rheumatoid factor (RF) was positive. Patient was diagnosed to be suffering from Felty′s syndrome. Treatment was initiated with methotrexate. Overall treatment was tolerated well, except for the development of mild fever, mild arthritis and transient thrombocytopenia. She is currently on methotrexate with reasonable control of her symptoms

A rare case presentaion of osteochondroma of scapula

A 17-year-old female presented with complains of swelling in left scapular region since the age of 5 years, which had progressively increased in size. This condition was asymptomatic, but caused visible cosmetic concern to the patient and her parents as she was approaching a marriageable age. An En bloc excision of exostoses scapula was done; the patient had full functional recovery with no visible swelling. Histopathology, the diagnosis of osteochondroma was established. The patient was satisfied after the surgical resection of the tumor as, cosmetically, she looked near normal

Antepartum Eclampsia and Partial HELLP Syndrome in a Patient with Bell's Palsy

Bell's palsy affects pregnant women three times more often than nonpregnant women, with majority of cases occurring in the third trimester (71%) and early postpartum period (21%). Bell's palsy during pregnancy has been associated with preeclampsia, with 22% of these women developing preeclampsia. A 26-year-old G3P1 L1A1 diagnosed with Bell's palsy 2 weeks earlier, presented at 33-week period of gestation with a chief complaint of progressive bilateral pedal edema for 1 week, blood pressure (BP) - 150/100 mmHg and dipstick urine - 3+. Laboratory screening of HELLP syndrome was normal. Six days later, she had an episode of generalized tonic–clonic convulsion, magnesium sulfate was given, and emergency laboratory investigations revealed partial HELLP syndrome (platelet - 80,000, serum glutamic oxaloacetic transaminase/serum glutamic pyruvic transaminase - 281/222 U/L) with normal coagulation profile. Lower segment caesarean section was performed with delivery of a 2ks neonate with APGAR of 7/10 and 9/10 at 1 and 5 minute respectively. Postoperative day 3, all laboratory reports including magnetic resonance imaging brain were normal. BP was stabilized and she was discharged on the third postnatal day, with some right-sided residual facial weakness. All obstetricians must be aware of association of Bell's palsy with hypertensive disorders of pregnancy and aggressively screen for the same as soon as diagnosed, to prevent complications such as eclampsia and HELLP. Since Bell's palsy is not associated with adverse perinatal outcomes, it should not prompt obstetricians for hastening deliveries prematurely

Role of suprascapular nerve block in chronic shoulder pain: A comparative study of 60 cases

Background: Suprascapular nerve block using anatomical landmark has been shown to be a safe and effective treatment for chronic shoulder pain from rheumatoid and degenerative arthritis. This can be performed as an outpatient procedure that reduces pain and disability. Aims and Objectives: To access efficacy of suprascapular nerve block in chronic shoulder pain. To compare results between placebo and use of methyl prednisolone with bupivacaine for nerve block . Materials and Methods: 60 patients with chronic shoulder pain were taken up for the trial. In the study group, all patients received the block through the anatomical landmark approach, with a single sitting suprascapular nerve block. On randomized basis, 30 patients were given 10 ml of 0.5% bupivacaine and 40 mg of methyl prednisolone acetate (depo medrol) to block the suprascapular nerve. Another 30 patients were injected with 11 ml of 0.9% saline. Patients were followed up on 2 nd day, 7 th day, and 21 st day and 3 months for the status of relief of pain and improvement of movement of joint. Results: Evaluation of the efficacy of the block was achieved by comparing verbal pain scores and improvement in range of movements at 2, 7, 21 days and 3 months after the injection. Significant pain relief is defined as improvement of more than 70% on verbal and visual analog pain scale scores. Results were consistent with VAS score of pain. Maximum improvement was noted in the bupivacaine+methyl prednisolone mixed group. Conclusion: The result of this study shows a clear benefit of methyl prednisolone + bupivacaine for suprascapular nerve block in cases of chronic shoulder pain. There was statistically and clinically significant reduction in pain and improvement in range of movements

Management of closed tibial plateau fractures with percutaneous cancellous screw fixation

Background: Tibial plateau fractures, intra-articular in nature and caused by high-velocity trauma, constitute approximately 1% of all fractures. Primary goal in the management of proximal tibial articular fracture aims for a stable, congruous, pain-free, mobile joint. Objective: To study the technique, results, and complications of percutaneous cancellous screw fixation for tibial plateau fractures. Materials and Methods: Twenty-three men and seven women aged 18-65 years (mean = 36.8 years) underwent closed reduction and percutaneous screw fixation for closed tibial plateau fractures with <5 mm depression. According to the Schatzker classification, patients were grouped as type I (n = 18), type II (n = 4), type III (n = 0), type IV (n = 8), type V (n = 2), and type VI (n = 1). Closed reduction was achieved by manual ligamentotaxis technique under image intensifier control and fixed percutaneously with two cancellous screws (6.5 mm) with or without washers in a parallel fashion. Results: Functional outcome was evaluated using the Mason Hohl evaluation system. A total score of 19-24 was considered as excellent, 13-18 as good, 7-12 as fair, and <6 as poor. Outcomes were excellent in 10 patients, good in 15, fair in 4, and poor in 1 patient. Patients were allowed partial weight bearing with walker after 1 month and full weight bearing after radiological union in approximately 3-4 months. The mean period of hospital stay was 5 (range 2-15) days. All the fractures united radiologically after a mean of 3 (range 2.5- 5) months. Patients were evaluated at a mean of 3 years after injury. No patient had any complication like infection, wound dehiscence, or hardware problem. Conclusion: Percutaneous cancellous screw fixation for closed tibial plateau fractures is minimally invasive. It reduces hospital stay and cost, enables early mobilization with minimal instrumentation, and achieves satisfactory outcomes

Comparative study between reamed versus unreamed interlocking intramedullary nailing in compound fractures of shaft tibia

Background: Tibia is the commonest bones to sustain open injury because of subcutaneous position. Treatment of open fractures requires simultaneous management of both skeletal and soft tissue injury. Intramedullary nailing with reaming is generally considered to be contraindicated for open fractures tibia, because it damages the endosteal blood supply which will lead to non-union, deep infection. However, recent studies with or without reaming in open fracture tibia shows no influence in healing of fracture. Purpose: To compare the clinical and radiological results of intramedullary interlocking nailing of open fractures of the tibial shaft after reaming versus unreamed medullary canal. Materials and Methods: Between 2008 and 2011, we have treated 40 patients with compound tibia fracture (type I, II, IIIA) by simultaneous care of wound and skeletal injury. Primary fixation for fracture stabilization was done by closed intramedullary interlock nailing either reamed or unreamed; the allocation to the two groups made on alternating basis. Wound was managed by thorough debridement with primary/delayed primary closure by suturing, split thickness skin grafting or fasciocutaneous flap cover. Active, non-weight bearing exercises were started from next post-op day. Partial weight bearing after suture removal was started on 12 th day. Further follow-up was done at 6 weeks interval for union. Results: Open fractures of shaft of tibia treated with unreamed/reamed interlocking nailing gave excellent results. In present series, 19 fractures (95%) treated by unreamed and 19 (95%) fractures treated by reamed technique, united within 6 months of injury. Delay in union was noticed in one patient treated by unreamed technique who had segmental and extensive soft tissue injury and in reamed nailing there was one patient with deep infection, which was treated with antibiotic coated nail. Conclusion: Time to complete union was similar in both groups. Adequate debridement of wound and adequate soft tissue coverage is the key to minimize deep infection irrespective of whether the bone is reamed or not

Operative management of fracture of shaft humerus by dynamic compression plate versus interlocking intramedullary nailing: A comparative prospective study of 30 cases

Background: Uncomplicated diaphyseal fractures of the humerus successfully healed in over 90% of cases when treated conservatively by reduction and immobilization. Open reduction with internal fixation, is preferred for open, segmental and pathological fractures. Objective: To compare functional outcomes, union and complication rates in patients treated with locked intramedullary nailing or dynamic compression plating for humeral shaft fractures. Materials and Methods: We randomized prospectively 30 patients with fractures of the shaft of the humerus were treated by open reduction and internal fixation by dynamic compression plate (DCP) in 15 cases and closed reduction and internal fixation with interlocking intramedullary nail in 15 cases. Patients were followed up for a minimum of six months. Result: There were no significant differences in the function of the shoulder and elbow, as determined by the American Shoulder and Elbow Surgeons′ score, the visual analogue pain score, range of movement, or the time taken to return to normal activity. In our study, complications in DCP and IMN groups common were radial nerve injury and shoulder impingement. We had to perform secondary surgery on four patients in the IMN group, but on only one in the DCP group. Conclusion: Our findings suggest that open reduction and internal fixation with a DCP remains a better treatment option for fractures of the shaft humerus. Fixation by IMN may be indicated for specific situations, but is technically more demanding and has a higher rate of complications

Study of correlation between clinical, magnetic resonance imaging, and arthroscopic findings in meniscal and anterior cruciate ligament injuries

Background: Approx. 28% of patients presents to orthopedic OPD with complaints of knee pain. Common medical complications include an unstable knee, chronic knee pain, and post traumatic arthritis. Aim: To study the correlation between clinical, magnetic resonance imaging (MRI), and arthroscopic findings in knee injuries. Materials and Methods: About 30 cases with history of rotational injury having knee pain and recurrent swelling were subjected to study. Results: MRI had better sensitivity (0.95 vs. 0.85) and specificity (1.0 vs. 0.5) in comparison with clinical examination for medial meniscus. In lateral meniscus injury (sensitivity 0.65 vs. 0.61 and specificity 0.95 vs. 0.92) and in ACL injury (Sensitivity 0.77 vs. 0.8 and specificity 1.0 vs. 0.96) the sensitivity and specificity of MRI versus clinical examination showed minimal difference. Conclusion: Our conclusion is that carefully performed clinical examination can give equal or better diagnosis of meniscal and ACL injuries in comparison with MRI scan. MRI may be used as an additional tool for diagnosis