Surgical Intervention and Rehabilitation of Pediatric Mandibular Fracture Following Dashboard Injury: A Case Report of a 12-Year-old Child | Chapter 14 | Medical Science: Recent Advances and Applications Vol. 3

Road traffic accidents (RTA) are responsible for major non-fatal injuries and also fatal injuries annually. Among such injuries, dashboard-related deceleration injuries may cause a wide spectrum of injuries, including complex facial injuries, blunt thoracoabdominal injuries, pelvic fractures, and lower extremity trauma. Paediatric maxillofacial fractures make up 1% - 15% of all facial fractures, which happen because of their distinct anatomical and developmental reasons. These include greater bone flexibility, the ratio between the cranial-to-facial volume, the paranasal sinuses' limited pneumatization, and protective features like the buccal fat pad and developing tooth buds. This report underscores paediatric mandibular fracture rehabilitation as a result of a dashboard injury. This article describes the surgical reconstruction of a 12-year-old child who was diagnosed with bilateral parasymphysial mandibular fractures caused by an unrestrained front-seat RTA. Multiple abrasions and contusions affect both the central and lateral face regions. A skull X-ray and multidetector CT scans were used to confirm the diagnosis. Under general anaesthesia, closed reduction with intermaxillary fixation (IMF) was conducted. IMF is a safe a cost-effective technique for pediatric maxillofacial fractures, as it avoids the complications of open reduction by titanium miniplates and screws, which delay bone growth on the affected side causing deformity. This technique is mainly useful in settings with few available resources or where advanced fixation methods are not available. Postoperative panorama for follow-up purposes was carried out, revealing proper reduction, normal healing with no complications. The success in treating the 12-year-old patient in this case shows the importance of early diagnosis, adequate surgical technique, and postoperative care in achieving maximum recovery.

 

Author (s) Details

 

Mekhaeel, Shehata Fakhry Mekhaeel
Peoples’ Friendship University of Russia Named after Patrice Lumumba (RUDN University), Medical Institute, Department of Operative Surgery and Clinical Anatomy Named after I.D. Kirpatovsky, Moscow, Russian Federation.

 

Salem, Mohamed Ahmed Eissa Sameh
Peoples’ Friendship University of Russia Named after Patrice Lumumba (RUDN University), Medical Institute, Department of Operative Surgery and Clinical Anatomy Named after I.D. Kirpatovsky, Moscow, Russian Federation.

 

Protasov, Vitalevitch Andrey
Peoples’ Friendship University of Russia Named after Patrice Lumumba (RUDN University), Medical Institute, Department of Operative Surgery and Clinical Anatomy Named after I.D. Kirpatovsky, Moscow, Russian Federation.

Taha, Nada Ahmed Mohamed Elsayed
Peoples’ Friendship University of Russia Named after Patrice Lumumba (RUDN University), Medical Institute, Department of Operative Surgery and Clinical Anatomy Named after I.D. Kirpatovsky, Moscow, Russian Federation.

 

Omar Kamal Sandouka
Peoples’ Friendship University of Russia Named after Patrice Lumumba (RUDN University), Medical Institute, Department of Operative Surgery and Clinical Anatomy Named after I.D. Kirpatovsky, Moscow, Russian Federation.

 

Ahmed Mohamed Sayed Kotb
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of the Russian Federation, Moscow, Russia.

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v3/5263

Assessment of Hand Function during the Period of Three Months after Surgical Intervention for Unstable Metacarpal and Phalangeal Fractures: A Comparison between Wide Awake Local Anesthesia No Tourniquet (WALANT) Versus Bier’s Block | Chapter 6 | Medical Science: Trends and Innovations Vol. 8

Background: Hand fractures are a common injury in the emergency department, and the majority of these are stable injuries that can be treated conservatively with excellent functional results. When respective injuries are characterized as unstable, surgical reduction and stabilization are necessary. The main purpose of surgical treatment of unstable hand fractures (metacarpal-phalangeal) is early mobilization to enhance hand functionality and to avoid stiffness functional incompetence. Generally, these operations are conducted under regional or general anesthesia to avoid pain and tourniquet for bloodless surgical fields. Wide Awake local anesthesia no tourniquet (WALANT) procedure is described as local injection of anesthetic agent and epinephrine without tourniquet application, with scope to allow local anesthesia without other sedation and at the same time hemostasis.

Aim: The purpose of the study is to compare the functional assessment of the hand function during a period of three months after surgical intervention for unstable metacarpal and phalangeal fractures under WALANT versus Biers block.

Materials and Methods: Between May 2021 to October 2022, 43 patients with unstable metacarpal and phalangeal fractures underwent open reduction and internal fixation, 21 cases with Biers block (BB) anesthesia and the rest with WALANT technique. Metacarpal fractures appeared in 29 cases and phalangeal fractures in 14 patients. Patients were operated on within the first week of the injury. According to implants they employed locking plates, screws and Kirschner wires in two groups. In both groups, examination with a C-arm intensifier was performed to check the final osteosynthesis and screw sizes. A standard rehabilitation protocol program from the first postoperative day was applied in all patients starting from adjacent joints. Patients were trained to follow a personalized home-based daily exercise program to increase the range of movement and enhance muscle strength and grip strength in a later phase. The mean quick DASH score and a Likert type of scale regarding satisfaction, three months after the operation were measured.

Results: At three months postoperatively, Quick Dash Score is better in the WALANT group while patients’ satisfaction does not differ between the two groups. In the WALANT group, the immediate postoperative median VA Score appeared 2/10, while in the Biers block group appeared to be 6/10. Patients who underwent the WALANT technique were discharged on the same day after the operation, while the patients with regional anesthesia were the next postoperative day. The mean duration of analgesic use was shorter in the WALANT group (2,3 days) than in the BB group (5,7 days).

Conclusion: Unstable metacarpal or phalangeal fractures are common injuries with the main treatment to be open or close reduction and internal fixations with locking plate or Kirshner wires. Οbjective of surgical treatment of unstable hand fractures (metacarpal-phalangeal) is early mobilization and enhanced hand functionality to avoid stiffness and tendon adhesions. Wide Awake Local Anesthesia No Tourniquet technique is an alternative sedative procedure which immediately offers postoperative numerous advantages (low-cost technique, no complication from tourniquet, decreased sensation of intra or postoperative pain) compared with Bier’s block anesthesia. Based on our results, it was concluded that the WALANT technique offers many benefits in the surgical treatment of hand fractures and is suggested as the first-choice anesthesiologist procedure.

 

Author (s) Details

 

Kastanis G
Reconstructive Hand Surgery Unit, General Hospital of Heraklion –Venizeleio, Crete, Greece and Department of Orthopaedic, General Hospital of Heraklion-Venizeleio, Crete, Greece.

 

Siligardou MK
Department of Orthopaedic, General Hospital of Heraklion-Venizeleio, Crete, Greece.

 

Chaniotakis C
Department of Orthopaedic, General Hospital of Heraklion-Venizeleio, Crete, Greece.

 

Tsioupros A
Department of Orthopaedic, General Hospital of Heraklion-Venizeleio, Crete, Greece.

 

Pantouvaki A
Reconstructive Hand Surgery Unit, General Hospital of Heraklion –Venizeleio, Crete, Greece, Department of Physiotherapy, General Hospital of Heraklion-Venizeleio, Crete, Greece and Department of Nursing, Hellenic Mediterranean University, Crete, Greece.

 

Kapsetakis P
Reconstructive Hand Surgery Unit, General Hospital of Heraklion –Venizeleio, Crete, Greece.

 

Stavrakakis I
Department of Orthopaedic, General Hospital of Heraklion-Venizeleio, Crete, Greece.

 

 

Please see the book here:- https://doi.org/10.9734/bpi/msti/v8/4479

Surgical Management of Clavicle Fracture: Functional Outcome of Open Reduction and Internal Fixation | Chapter 3 | New Visions in Medicine and Medical Science Vol. 2

 Background: Clavicle fracture is one of common bony injury; which is more common in young active individual. It accounts for approximately 5% to 10% of all fracture and up to 44% of injuries of shoulder girdle. It has been traditionally treated with non-operative method. This present study evaluates the role of the surgical management in the fresh middle third clavicle fracture.

 

Methods: 30 adult patients (21 male and 9 female) of the average age of 32 years presented with fresh middle third clavicle fracture treated surgically with open reduction and internal fixation with plate and screws and followed. This study was conducted between November 2011 to November 2012.

 

Results: In 27 patients, fracture were united at end of 12 weeks, in 2 patients, fracture were united at end of 24 weeks and 1 patient went for non-union. One patient had superficial infection. None of them had deep infection. One patient had plate loosening at 4week but fracture was united at the end of 24 weeks. 2 patients had persistent pain which is controlled with occasional analgesic but not effecting ordinary work. One patient had gross restriction of shoulder movement. Functional outcome assessed according to near shoulder scoring system. 24 patients had excellent result, 4 patients had satisfactory result, 1 patient had unsatisfactory result and 1 patient had failure. The advantage of rigid internal fixation and early mobilisation of fresh displaced clavicle fracture is that it gives immediate pain relief and prevents the development of shoulder stiffness and non-union.

 

Conclusions: The study showed rigid fixation with plate and screw for fresh middle third clavicle fracture especially displaced and comminuted give immediate pain relief and prevent the development of shoulder stiffness &non-union and give good functional outcome.

Author(s) Details:

Manju G. Pillai,
Department of Orthopaedics, Pushpagiri Institute of Medical Sciences and Research Center, Thiruvalla, Kerala, India.

Please see the link here: https://stm.bookpi.org/NVMMS-V2/article/view/13797

Surgical Management of Maxillofacial Trauma: Open Reduction and Internal Fixation with Intermaxillary Fixation Techniques and Outcomes | Chapter 6 | Key Flaps in Plastic Surgery

 This book chapter presents a case report and discussion on the use of open reduction and internal fixation (ORIF) with intermaxillary fixation (IMF) in the management of posttraumatic maxillofacial fractures. The chapter includes a detailed case presentation, operative procedure, and a comprehensive discussion of the surgical technique, advantages, limitations, and postoperative care associated with ORIF with IMF.

The case presentation describes a patient who sustained facial injuries in a road traffic accident, resulting in a Le Fort I maxillary fracture and a fracture of the right nasal bone. The diagnosis was confirmed through computed tomography with 3-D reconstruction. The surgical intervention involved ORIF with IMF, with an upper gingivobuccal sulcus incision used to access the fracture site. The maxillary alveolus was stabilized in class I occlusion using IMF, followed by the application of 3-D titanium miniplates for fixation. The postoperative period was uneventful, with satisfactory results observed during follow-up examinations.

The discussion section introduces ORIF with IMF as a commonly employed surgical procedure in the management of maxillofacial fractures. The surgical technique involves precise repositioning of fractured bone segments, internal fixation using various methods, and the use of intermaxillary fixation to stabilize the jaw. The advantages of ORIF with IMF, including precise fracture reduction, stable fixation, restoration of occlusion, and improved long-term outcomes, are discussed. The limitations, such as the requirement for surgical skill and experience, the need for an individualized approach, and potential complications, are also addressed.

In conclusion, this book chapter provides valuable insights into the use of ORIF with IMF for the management of posttraumatic maxillofacial fractures. Through a case report, operative details, and a comprehensive discussion, the chapter highlights the efficacy, considerations, and postoperative care associated with this surgical technique. This information can guide surgeons in making informed decisions and achieving successful outcomes in the treatment of maxillofacial fractures using ORIF with IMF.

Author(s) Details:

Mohd. Altaf Mir,
Department of Burns and Plastic Surgery, All India Institute of Medical Sciences (AIIMS),Bathinda-151001, India.

Jaya Jain,
All India Institute of Medical Sciences (AIIMS), Bathinda-151001, India.

Please see the link here: https://stm.bookpi.org/KFPS/article/view/11501

An Unusual Localization of Lunate in a Transcaphoid Volar Lunate Dislocation: Recent Development | Chapter 12 | Emerging Research in Medical Sciences Vol. 4

Perilunate dislocation and fracture dislocations are rare injuries corresponding to 10% of all carpal injuries. Usually come with high energy trauma, with associated injuries representing 61%. Volar lunate dislocation or fracture- dislocation accounts to 3% of perilunate injuries. We present a case of a 42 years old polytrauma male, transmitted in our department 48 hours after a car accident with a trans-scaphoid volar lunate dislocation. During operation the lunate was displaced volarly to the ulnar side of the wrist, forward to styloid process of distal ulna, while the scaphoid fracture appeared at waist with comminution and the proximal pole of scaphoid protruded under the dorsal capsule. Carpal injuries are often missed out in polytrauma patients and these injuries are underestimated because of the severity of the other visceral or extremity lesions. Untreated or improperly treated those injuries, leads to serious morbidity and loss of function. Therefore good functional prognosis with decreased percentage of complications can be achieved following early recognition and early open surgical repairing ligamentous complex.

Author (s) Details

G. Kastanis 
Department of Orthopaedic, General Hospital of Heraklion –Venizeleio, Crete, Greece

View Book :- http://bp.bookpi.org/index.php/bpi/catalog/book/167