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Wu CM, Liao HE, Lan SJ. Simultaneous bilateral floating knee: A case report. World J Clin Cases 2022; 10:10172-10179. [PMID: 36246811 PMCID: PMC9561588 DOI: 10.12998/wjcc.v10.i28.10172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/30/2022] [Accepted: 07/27/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The phrase “floating knee is a flail knee joint,” referring to ipsilateral femoral and tibial fractures, was first used by Blake and McBryde in 1975. This condition is often caused by a high-energy trauma with often extensive injury to the soft tissues, and is accompanied by life-threatening systemic complications, including head, chest or abdominal injuries and a high incidence of fat embolism. Floating knee is a severe and uncommon injury pattern.
CASE SUMMARY A 27-year-old man sustained multiple injuries when the electric motorcycle he was riding was hit by a van. His injuries included traumatic hypovolemic shock, comminuted and open type II fractures of the left femoral shaft, fracture of the right femoral shaft, comminuted fracture of the bilateral tibial and fibular shaft, and multiple lacerations and abrasions on his forehead, lower lip, neck and limbs. The diagnosis was simultaneous bilateral floating knee complicated with soft tissue injuries. After emergency treatment and the exclusion of life-threating complications, open reduction and internal fixation were successfully performed using plates and screws in the bilateral femoral and tibial shafts.
CONCLUSION Simultaneous bilateral floating knee is a rare and severe injury pattern. The treatment is challenging, and complications. We present a case report of a young adult who suffered from bilateral floating knees during road traffic accident. We also offer our treatment experience of this complex injury and review past literature.
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Affiliation(s)
- Chi-Ming Wu
- Department of Orthopaedic, Jen-Ai Hospital, Taichung 42481, Taiwan
- Department of Orthopaedic, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan
| | - Hung-En Liao
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan
| | - Shou-Jen Lan
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- School of Medical Science, Putian University, Putian 351100, Fujian Province, China
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Chaudhuri S, Nath S. Life-threatening Complications in Pregnancy in a Teaching Hospital in Kolkata, India. J Obstet Gynaecol India 2019; 69:115-122. [PMID: 30956464 DOI: 10.1007/s13224-018-1106-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 03/01/2018] [Indexed: 11/26/2022] Open
Abstract
Objectives To test the application of a clinical definition of life-threatening complications in pregnancy and determine the level of near miss maternal morbidity and mortality. Methods A prospective observational study was conducted in the obstetrics and gynaecology department, NRS Medical College, Kolkata, India, to identify life-threatening complications using a modification of the Mantel's criteria. The main outcome measures were validity of identification criteria, main causes and incidence of life-threatening complications in pregnancy, maternal near miss: case fatality rates, morbidity-mortality index and use rate of effective interventions. Results In total, 177 maternal near miss and 23 maternal deaths were identified in the screened 4400 women. The incidence of near miss was 4.02%. Main causes of maternal mortality were hypertensive disorders (43%) and renal failure (21%). Main causes of near miss were hypertensive disorders (55%), ectopic pregnancy (19%). Near miss mortality index was 7.7:1. Conclusions A high proportion of women with life-threatening complications and all women who died were referred from peripheral hospitals. This signals that there may have been important failures in the referral system relating to maternal care and there is a need for further investigation.
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Affiliation(s)
- Snehamay Chaudhuri
- 1Department of Obstetrics and Gynecology, NRS Medical College, 138 AJC Bose Road, Kolkata, West Bengal India
- 2Present Address: Obstetrics and Gynecology, Midnapore Medical College, Midnapore, India
- Kolkata, India
| | - Sumana Nath
- 1Department of Obstetrics and Gynecology, NRS Medical College, 138 AJC Bose Road, Kolkata, West Bengal India
- Present Address: Bankura Samiilani Medical College, Bankura, West Bengal India
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Barrera-Ochoa S, Nuñez JH, Domenech-Fernandez P, Bergua-Domingo JM, Knorr J, Soldado F. Medial third clavicular fracture in combination with a posterior sternoclavicular dislocation in skeletally immature patients: 2 cases of a new proximal clavicular injury. JSES Open Access 2019; 2:97-99. [PMID: 30675574 PMCID: PMC6334882 DOI: 10.1016/j.jses.2017.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Sergi Barrera-Ochoa
- Pediatric Hand Surgery and Microsurgery, Hospital Sant Joan de Déu, Barcelona, Spain
- Hand and Microsurgery Unit, Hospital Universitari Quiron-Dexeus, Barcelona, Spain
| | - Jorge H. Nuñez
- Traumatology and Orthopaedic Surgery Department, University Hospital of Vall d'Hebron, Barcelona, Spain
- Corresponding author: Jorge H. Nuñez, MD, University Hospital of Vall d'Hebron, Department of Traumatology and Orthopaedic Surgery. Passeig de la Vall d'Hebron, 119-129, E-08035 Barcelona, Spain. (J.H. Nuñez).
| | | | | | - Jorge Knorr
- Pediatric Orthopedic Surgery Hospital Sant Joan de Déu, Barcelona, Spain
| | - Francisco Soldado
- Pediatric Hand Surgery and Microsurgery, Hospital Sant Joan de Déu, Barcelona, Spain
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Hebra A, Kelly RE, Ferro MM, Yüksel M, Campos JRM, Nuss D. Life-threatening complications and mortality of minimally invasive pectus surgery. J Pediatr Surg 2018; 53:728-732. [PMID: 28822540 DOI: 10.1016/j.jpedsurg.2017.07.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/28/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED The prevalence and type of life-threatening complications related to the minimally invasive repair of pectus excavatum (MIRPE) and bar removal are unknown and underreported. The purpose of this communication is to make surgeons aware of the risk of these life threatening complications as well as the modifications which have been developed to prevent them. METHODS Data related to life-threatening complications of Pectus Excavatum (PE) patients was obtained from four sources: 1. A survey of Chest Wall International Group (CWIG) surgeons who specialize in repairing congenital chest wall malformations, 2. Papers and case reports presented at CWIG meetings, 3. Review of medico-legal cases from the USA and 4. A systematic review of the literature related to major complications post MIRPE. RESULTS From 1998 to 2016, we identified 27 published cases and 32 unreported life-threatening complications including: cardiac perforation, hemothorax, major vessel injury, lung injury, liver injury, gastrointestinal problems, and diaphragm injury. There were seven cases of major complications with bar removal (reported and non-reported) with two lethal outcomes. Mortality data with bar placement surgery: Four published death cases and seven unpublished death cases. The overall incidence of minor & major complications post MIRPE has been reported in the literature to be 2-20%. The true incidence of life-threatening complications and mortality is not known as we do not know the overall number of procedures performed worldwide. However, based on data extrapolated from survey information, the pectus bar manufacturer in the USA, literature reports, and data presented at CWIG meetings as to the number of cases performed we estimated that approximately fifty thousand cases have been performed and that the incidence of life-threatening complications is less than 0.1% with many occurring during the learning curve. Analysis of the cases identified in our survey revealed that previous chest surgery, pectus severity and inexperience were noted to be significant risk factors for mortality. CONCLUSIONS Published reports support the safety and efficacy of MIRPE; however major adverse outcomes are underreported. Although major complications with MIRPE and pectus bar removal surgery are very rare, awareness of the risk and mortality of life-threatening complications is essential to ensure optimal safety. Factors such as operative technique, patient age, pectus severity and asymmetry, previous chest surgery, and the surgeon's experience play a role in the overall incidence of such events. These preventable events can be avoided with proper training, mentoring, and the use of sternal elevation techniques. TYPE OF STUDY Treatment Study. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- André Hebra
- Nemours Children's Hospital, Orlando, FL, USA; Children's Hospital of the King's Daughters, Norfolk, VA, USA; Fundación Hospitalaria Children's Hospital, Buenos Aires, Argentina; University of Sao Paulo, Sao Paulo, SP, Brazil; Marmara University, Istanbul, Turkey.
| | - Robert E Kelly
- Nemours Children's Hospital, Orlando, FL, USA; Children's Hospital of the King's Daughters, Norfolk, VA, USA; Fundación Hospitalaria Children's Hospital, Buenos Aires, Argentina; University of Sao Paulo, Sao Paulo, SP, Brazil; Marmara University, Istanbul, Turkey
| | - Marcelo M Ferro
- Nemours Children's Hospital, Orlando, FL, USA; Children's Hospital of the King's Daughters, Norfolk, VA, USA; Fundación Hospitalaria Children's Hospital, Buenos Aires, Argentina; University of Sao Paulo, Sao Paulo, SP, Brazil; Marmara University, Istanbul, Turkey
| | - Mustafa Yüksel
- Nemours Children's Hospital, Orlando, FL, USA; Children's Hospital of the King's Daughters, Norfolk, VA, USA; Fundación Hospitalaria Children's Hospital, Buenos Aires, Argentina; University of Sao Paulo, Sao Paulo, SP, Brazil; Marmara University, Istanbul, Turkey
| | - Jose Ribas M Campos
- Nemours Children's Hospital, Orlando, FL, USA; Children's Hospital of the King's Daughters, Norfolk, VA, USA; Fundación Hospitalaria Children's Hospital, Buenos Aires, Argentina; University of Sao Paulo, Sao Paulo, SP, Brazil; Marmara University, Istanbul, Turkey
| | - Donald Nuss
- Nemours Children's Hospital, Orlando, FL, USA; Children's Hospital of the King's Daughters, Norfolk, VA, USA; Fundación Hospitalaria Children's Hospital, Buenos Aires, Argentina; University of Sao Paulo, Sao Paulo, SP, Brazil; Marmara University, Istanbul, Turkey
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Cordelli DM, Masetti R, Ricci E, Toni F, Zama D, Maffei M, Gentili A, Parmeggiani A, Pession A, Franzoni E. Life-threatening complications of posterior reversible encephalopathy syndrome in children. Eur J Paediatr Neurol 2014; 18:632-40. [PMID: 24814477 DOI: 10.1016/j.ejpn.2014.04.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/06/2014] [Accepted: 04/11/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although the posterior reversible encephalopathy syndrome (PRES) is considered to have a benign clinical outcome, the presentation of PRES can be associated with life-threatening complications such as severe cerebral hemorrhage, cerebellar herniation and refractory status epilepticus (SE). The aim of this paper is to report incidence, clinical features and outcome of life-threatening complications related to PRES in children. METHODS Patients who suffered from life-threatening complications were retrospectively identified from a group composed by 27 consecutive children diagnosed with PRES in our hospital between 2000 and 2012. The clinical, radiological and EEG features and the outcome of these patients were evaluated and compared to the characteristics of patients with no complications. RESULTS Five patients (18%) presented life-threatening complications: 2 cerebral hemorrhages with mass effect and midline shift (1 massive intraparenchymal hemorrhage and 1 subdural hemorrhage and intraparenchymal hemorrhage), 2 transforaminal cerebellar herniations and 1 refractory SE. Two children died because of complications and 2 children required urgent neurosurgical intervention. The infratentorial involvement at onset of PRES and the observation of focal neurological deficits other than visual disturbances were significantly more frequent in children with life-threatening complications (p < 0.01). CONCLUSIONS PRES is associated with a non-negligible incidence of life-threatening complications. A careful clinical, neuroradiological and EEG monitoring is necessary in order to improve the outcome especially in the case of focal neurological deficits and infratentorial involvement.
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Affiliation(s)
- Duccio M Cordelli
- Child Neurology Unit, University of Bologna, S. Orsola Malpighi Hospital, Via Massarenti 11, Bologna, Italy.
| | - Riccardo Masetti
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", University of Bologna, S. Orsola Malpighi Hospital, Via Massarenti 11, Bologna, Italy
| | - Emilia Ricci
- Child Neurology Unit, University of Bologna, S. Orsola Malpighi Hospital, Via Massarenti 11, Bologna, Italy
| | - Francesco Toni
- Neuroradiology Department, IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Daniele Zama
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", University of Bologna, S. Orsola Malpighi Hospital, Via Massarenti 11, Bologna, Italy
| | - Monica Maffei
- Neuroradiology Department, IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Andrea Gentili
- Pediatric Intensive Care Unit, University of Bologna, S. Orsola Malpighi Hospital, Via Massarenti 11, Bologna, Italy
| | - Antonia Parmeggiani
- Child Neurology Unit, University of Bologna, S. Orsola Malpighi Hospital, Via Massarenti 11, Bologna, Italy
| | - Andrea Pession
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", University of Bologna, S. Orsola Malpighi Hospital, Via Massarenti 11, Bologna, Italy
| | - Emilio Franzoni
- Child Neurology Unit, University of Bologna, S. Orsola Malpighi Hospital, Via Massarenti 11, Bologna, Italy
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