Riaz Ahmad

Dislocation of the fibular head in an unusual sports injury: a case report

IntroductionOne of the primary functions of the proximal tibiofibular joint is slight rotation to accommodate rotational stress at the ankle. Proximal tibiofibular joint dislocation is a rare injury and accounts for less than 1% of all knee injuries. This dislocation has been reported in patients who had been engaged in football, ballet dancing, equestrian jumping, parachuting and snowboarding.Case presentationA 20-year-old man was injured whilst playing football. He felt a pop in the right knee and was subsequently unable to bear weight on it. The range of movement in his knee joint was limited. Anterior-posterior and lateral X-rays of the knee revealed anterolateral dislocation of the proximal tibiofibular joint. Comparison views confirmed the anterolateral dislocation. He had a failed manipulation under anaesthesia and the joint needed an open reduction in which the fibular head was levered back into place. Operative findings revealed a horizontal type of joint.ConclusionAn exceedingly rare dislocation of a horizontal type of proximal tibiofibular joint was presented following a football injury. This dislocation was irreducible by a closed method.

latrogenic fracture of humerus – complication of a diagnostic error in a shoulder dislocation: a case report

Shoulder dislocation is the commonest dislocation presenting to the emergency department, anterior being more common than posterior. The latter being less common has a tendency of being missed; this is supported by many cases in the literature. Kochers method is one of the many methods of reducing anterior dislocation; there are many reported complications of employing this method.To the best of our knowledge we are reporting the first case of an iatrogenic fracture of the proximal humerus, due to the use of Kochers method of shoulder reduction in a posterior dislocation following a diagnostic error which led to an avoidable difficult surgical intervention. We also discuss the mechanism of the iatrogenic fracture and the measures that can be undertaken to prevent it.

A rare association of crossed fused renal ectopia

BackgroundThrombocytopenia and absent radius syndrome (TAR) is a rare genetic disorder. It is an autosomal recessive disorder characterised by radial aplasia and thrombocytopenia that may have additional anomalies. We report a case of TAR syndrome with crossed fused renal ectopia. This anomaly has not been previously reported in association with TAR syndrome.Case presentationA 24 years old female with Thrombocytopenia and absent radius syndrome admitted with pelvic fracture was investigated for recurrent urinary tract infections. Abdominal ultrasonography could not visualise the kidney on right side. Further extensive investigations in the form of intravenous urography (IVU), Magnetic resonance imaging (MRI) and renal isotope scans revealed a crossed fused renal ectopia.ConclusionThis report describes the new finding of a crossed fused renal ectopia associated with TAR syndrome that has not been reported before in the literature. Ectopic kidneys have increased susceptibility to develop complications like urinary infections, urolithiasis, and abdominal mass. There is a reported case of TAR syndrome with renal anomaly that developed Wilms tumor. Finding of crossed fused renal ectopia warrants complete urologic investigation to rule out surgically correctable pathology in the urinary tract.

Combined Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Transfer Results at a Follow-Up of 2 years.

Abstract There is limited data on the effectiveness of combined medial patellofemoral ligament (MPFL) reconstruction and tibial tubercle transfer (TTT) in patients with patella instability. The aim of our study was to analyze the functional outcome in patients treated with MPFL reconstruction and TTT. Between July 2008 and April 2013, 18 patients (21 knees) underwent combined MPFL reconstruction and TTT; 15 patients (16 knees) with a mean age of 24 years (16‐41) had a mean follow‐up of 30 months (26‐55). There was significant improvement in outcome scores in 12 out of 15 patients. KOOS score improved from 68.25 (44‐93.9) to 77.05 (48.8‐96.4) and KUJALA score improved from 63.3 (41‐88) to 78.06 (45‐99). Nine patients achieved at least a preinstability level of activity. Out of these nine patients, four had activity level better than the preinstability level. The remaining six patients had a lower activity level than preinstability level (2—lack of confidence and 4—lifestyle modification). Fourteen patients were satisfied and happy to recommend this procedure. There were three postoperative complications, with two cases of stiffness and one case of nonunion of the tibial tuberosity. Thus, the restoration of tibial tubercle to trochlear groove distance, patella height, and MPFL reconstruction yields good results in carefully selected patients.

Adequacy of consent in patients with distal radius fractures

Health professionals have a legal and ethical obligation to obtain a valid consent before any procedure. The aim of this study was to assess the adequacy of consent for treatment of distal radius fractures. It also outlines potential improvements that could be made. A study of patients undergoing treatment for distal radius fracture was undertaken. We analysed the risks and complications recorded on the consent form. The common recorded risks were infection (95.6%), vascular injuries (77.8%), nerve injuries (66.7%) and stiffness (42.2%); 31.1% of the consent forms had abbreviations. Junior doctors who consented the patients performed 6.7% of the procedures. The poor documentation of risks or complications indicates that patients are not given appropriate information to ensure that the consent is valid. Proper documentation and refining of consent forms is mandatory to ensure that all major risks are understood by patients. This could go a long way in preventing litigation.

Impact of intermittent pneumatic foot pumps on delay to surgery following ankle fracture

BACKGROUND Ankle fractures requiring open reduction and internal fixation (ORIF) are common and place considerable burden on inpatient beds. ORIF cannot be performed once the associated swelling is too excessive to permit tension-free wound closure. Where ORIF cannot be performed before the onset of swelling in the first 24-48h, patients typically require up to 7 days of inpatient bed-rest and elevation to reduce swelling to an acceptable level for ORIF. The primary aim of this study was to determine whether delay to ORIF could be reduced with the pre-operative application of an intermittent pneumatic foot pump (IPF). These devices were designed as anti-embolic adjuncts, but have also been shown to be effective in the reduction of swelling. We compared 12 patients managed with an IPF to 12 matched historical controls who were not. No previous studies have addressed this question in unselected patients requiring ankle ORIF. METHODS We performed a retrospective, controlled, before and after study of 24 patients who underwent ankle ORIF at our orthopaedic unit. Foot pumps were applied in the Accident and Emergency Department to ankle fracture patients requiring admission, and kept in place until ORIF. Data was collected from patient case notes for all patients. Patients were matched for age, gender, American Society of Anaesthesiologists (ASA) Grade, and pre-injury mobility. The primary outcome measure was time to surgery. We also recorded total hospital stay, and calculated cost savings. RESULTS Patients managed with IPFs had a statistically significant 50% reduction in time from presentation to surgery compared to those managed without (p=0.024), and had a reduced hospital stay (p=0.116). This resulted in a net saving of £10,480 (£953 per patient). CONCLUSIONS We conclude that foot pumps reduce the time to surgery and total hospital stay of patients requiring ankle ORIF, and are cost effective.

Open dislocation of the elbow with ipsilateral fracture of the radial head and distal radius: a rare combination without vascular injury.

Open elbow dislocation is a rare injury often associated with neurovascular damage. Common fractures associated with elbow dislocation are of the medial epicondyle, lateral epicondyle, radial head and coronoid process. There is only one reported case in the literature of an …

Calcaneal fracture with ipsilateral bi-malleolar and fourth and fifth metatarsal fractures

Calcaneal fracture is the most common fractured tarsal bone. The mechanism of injury is axial loading in which the talus is driven into the calcaneus, or a twisting injury. Over 20% of these patients suffer associated injuries of the spine, …

Vacuum phenomenon in a dislocated joint

A vacuum phenomenon is a radiolucent collection of gas that is present at the sites of negative pressure. When traction is applied to a joint or when a joint dislocates, blood gases composed primarily of nitrogen leak out …

Calcaneal fracture with ipsilateral bi-malleolar and fourth and fifth metatarsal fractures.

Calcaneal fracture is the most common fractured tarsal bone. The mechanism of injury is axial loading in which the talus is driven into the calcaneus, or a twisting injury. Over 20% of these patients …