Abstract

Understanding basic physics behind open fractures leads to a better understanding of mechanism of injury, open fractures pathophysiology and management.

Explaining local changes in viability of open fracture involved tissues, importance of debridement and reconsidering contamination risks will be ultimate objectives after going through this review.

The controversy is still there between minimal / conservative debridement of open fracture wounds in favour of direct closure of soft tissue on the same session against generous debridement and delayed closure by more complicated choices on the reconstructive ladder to avoid infection, delayed healing, wound chronicity, limb loss and prolonged hospital stay.

In the article, basic physics behind open fractures is highlighted to gain a deeper understanding of tissue viability changes and contamination risks after injury.

Abstract

Introduction:

After the introduction of DaVinci Robotic System more and more general surgical procedures are performed using robo. Various energy devices are used for this purpose.

Methodology:

We used a monopolar hook, monopolar scissors and harmonic to perform rectal cancer resections. Each energy device has its own merits and demerits. We are presenting here the Anterior resection performed using all the 3 devices.

Results:

Dissection with monopolar scissors was more accurate and ergonomically efficient in a closed pelvic space.

Discussion:

If surgeons wanted a cost effective method of performing rectal cancer surgery , then, it is better to use monopolar scissors.

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Recent Publications (minimum 5)

1. Dickson EA, Penna M, Cunningham C, et al. Carbon Dioxide Embolism Associated With Transanal Total Mesorectal Excision Surgery: A Report From the International Registries. Dis Colon Rectum. 2019;62(7):794-801. doi:10.1097/DCR.0000000000001410
2. Mahendran B, Bracey T, Kochupapy RT. A Midgut Duplication Cyst Lined by Respiratory Epithelium. Case Rep Surg. 2018;2018:2678782. Published 2018 Mar 12. doi:10.1155/2018/2678782
3. Kochupapy RT, Ranganathan G, Dias S, Shanahan D. Aetiology of femoral hernias revisited: bilateral femoral hernia in a young male (two cases). Ann R Coll Surg Engl. 2013 Jan;95(1):e14-6. doi: 10.1308/003588413x13511609955733. PMID: 23317716; PMCID: PMC3964665.
4. Francis N, Penna M, Carter F, Mortensen NJ, Hompes R; ACPGBI Pilot National TaTME Training Initiative Steering Group. Development and early outcomes of the national training initiative for transanal total mesorectal excision in the UK. Colorectal Dis. 2020;22(7):756-767. doi:10.1111/codi.15022

Abstract

Audit  on  Lumbar Spine Radiography on Lower Back Pain

Background:

The 2016 NICE guidance on management of low back pain with or without sciatica, proposes no useful role for lumbar radiography.  The 2016 NICE guidance recommends to think about alternative diagnoses when examining or reviewing people with low back pain, particularly if they develop new or changed symptoms, and to exclude specific causes of low back pain, for example, cancer, infection, trauma or inflammatory disease such as spondyloarthritis [1]. This definition does not include radicular pain resulting from possible nerve root compression or cauda equina syndrome. iRefer provides guidance on the indications for lumbar radiography. In patients with chronic lumbar back pain (>6 weeks) with no clinical or serological indicators of infection or neoplasia (ie, no red flags) x-ray is only indicated if presentation suggests osteoporotic collapse in the elderly [2].

By reducing the number of lumbar spine radiographs performed inappropriately for low back pain patients can reach important points in the care pathway more rapidly also avoiding unnecessary radiation dose.

References: 

1. Low back pain and sciatica in over 16s: assessment and management.  NICE guideline [NG59] Published date: November 2016. https://www.nice.org.uk/guidance/ng59 [accessed 11 April 2018]
2. Royal College of Radiologists. iRefer: Making the best use of clinical radiology. RCR iRefer Guidelines v. 8. 2017. https://www.irefer.org.uk/  [accessed 11 April 2018]

Submitted by: 

1. Mr Hassan Shafiq

MBBS, MRCS

ST2 Trauma and Orthopaedics

Royal London Hospital, London

2. Dr So Hee Kim

MBBS

Foundation year 1 trainee

Newham University Hospital, London

An interesting association between Recurrent Acute Pancreatitis and Myotonic Dystrophy, a case report.

Kesav Vijayagopal ,Mohamed Issa, Matthew Fok, Shafique Javed, Wirral University Teaching Hospital

Myotonic Dystrophy(MD) is autosomal dominant genetic condition affecting the musculoskeletal system. Recurrent acute pancreatitis(RAP) is a frequent presentation in the emergency surgical scenario with two or more episodes of established acute pancreatitis separated by a minimum 3 month periods. We report here a case of a patient presenting with a background of Myotonic Dystrophy with a third episode of RAP. Diagnositc work up led to the discovery of microlithiasis as the cause of possible pancreatitis in our patient. Literature review shows us the association between MD and many other conditions such as cardiac conduction defects however the association between pancreatitis and MD is limited to only two other case reports at the time of writing. In our case report, we discuss the association between MD and RAP through exploration of the pathophysiology of MD and it’s affect on the smooth muscles in the Gastrointestinal system.