Floating knee with early onset fat embolism: a case report

Fat embolism syndrome in young adults is most commonly associated with the long bone fractures most commonly femur and tibia. Its concomitance with floating knee is reported scarcely in reviewing the literature. Though it has been proposed that onset of fat embolism presents following an asymptomatic interval for about 24 to 72 hours, our patient developed onset within 8 hours following trauma. This case report is of first in this kind ever reported in the literature. We present a caseof 26 year old male patientwith floating knee Fraser type1 and Early Onset Fat Embolism syndrome who developed within 8 hours ofinjury underwent staged intramedullary nailing of femur and tibia with an excellent functional outcome without any sequelae of fat embolismat 2 year postoperative followup. Appropriate clinical judgement and awareness to suspect fat embolism syndrome and timely immobilisation with proper supportive care and serial reassessment and planned surgery preferably intramedullary nailing in young patient would benefit the patient in toto in case of floating knee with early onset fat embolism

Outcome analysis of cross-pinning versus lateral pinning and various lateral pinning configuration in the treatment of displaced paediatric supracondylar humerus fracture

Background: Supracondylar humerus fracture accounts for 3% of all the paediatric fractures. Displaced fractures need usually closed but rarely open reduction and stabilization with k-wires by either cross or lateral pinning technique. Controversies prevail regarding the type of pinning which will reduce complications (such as ulnar nerve palsy and loss of reduction which will lead to cubitus varus deformity) and provides better functional and radiological outcome. The aim of study was to analyse outcomes of various pinning techniques in displaced supracondylar humerus fracture treatment.Methods: This was a prospective study done in SRIHER, Chennai (January 2019 to September 2020) included children with displaced supracondylar humerus fracture (modified Gartland type 2B,3). Preop, postop and intraop assessment were done with respect to incidence of ulnar nerve palsy, Baumann's angle, Flynn criteria till 14 weeks postop period. The results of cross pinning and lateral pinning group were statistically compared.Results: There were totally 37 (male-25, female-12) patients. Mean age was 5.6. The mean change in Baumann’s angle of cross pin and lateral pin group at 14 weeks postop period comparing immediate postop period were 4.13 and 4.15 degrees, which was statistically insignificant using Mann Whitney test (p>0.05). Flynn criteria at 14 weeks postop period between two groups were also statistically insignificant. Difference in Baumann’s angle at 14 weeks postop period between divergent (2.82) and parallel (5.53) pin group was statistically significant using Mann Whitney test (0.01). There were no cases of ulnar nerve injury in both the groups.Conclusions: Lateral pinning technique with the use of 3 divergent pins for the treatment of displaced supracondylar humerus fracture gives stability as good as cross pin configuration and also avoids the risk of ulnar nerve injury

Is surgery the only option for unstable ankle fracture?

Background: Ankle fracture is one of the most common injuries in sports and daily activity. Unstable ankle fracture that are displaced fracture of the lateral malleolus and most bimalleolar or trimalleolar fractures need surgical reduction and fixation.Methods: It is a single centre study in which all unstable ankle fracture above the age of 18 and not associated with any other injury were included in the study. Following fixation patients were followed up at 6 weeks, 3 months and 6 months and functional outcome was assessed with American Orthopaedic Foot and Ankle score (AOFAS).Results: Supination external rotation injury was most common type. Mean AOFAS score at the end of six months was found to be best in supination adduction type. Posterior malleolus fixation with screw were found to have maximum AOFAS score.Conclusions: Surgical outcome in unstable ankle fracture are proved to have good functional outcome