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PROCEDURE OF COMPLETE CLOSED OBLIQUE MIDSHAFT LEFT FEMUR FRACTURE BY INTRAMEDULLARY PINNING ( INTERNAL FIXATION)

PROCEDURE OF COMPLETE CLOSED OBLIQUE MIDSHAFT LEFT FEMUR FRACTURE BY INTRAMEDULLARY PINNING ( INTERNAL FIXATION)

APPROACH : LATERAL APPROACH TO LEFT FEMUR

  1. After aseptic preparation of the site, a 5 cm incision was made on left aspect of left femur via subcutaneous from tensor fascia lata, vastus lateralis, biceps femoris and gluteus maximus to retract fracture ends. During the period anaesthesia, the fracture was immobilized by retrograde intramedullary pin of size 2.5 mm passed through the fracture end.
  2. The opening of the marrow cavity through the sub trochanteric fossa is accomplished using a large Steinmann pin.
  3. The finished product shows the advantages of small flexible pins in security a purchase in the distal fragment. Note the flaring of these pins as they impinge in the distal metaphysis. The pins should be at the level of or below the greater trochanters. This is accomplished with the mallet and pin set.
  4. This drawing shows the relation of the pins to the medullary cavity in the transverse plane.
  5. The musculature and skin was closed accordingly. The musculature fascia was sutured by simple continuous suture pattern with absorbable suture ecosorb 3/0. The subcutaneous layer was closed by intradermal suture pattern with absorbable suture ecosorb 3/0. The skin layer was sutured horizontal mattress suture pattern with non-absorbable suture Brilon 3/0.

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Retrograde Intramedullary Pinning

 

Clinical Case : Sporo

Sporo

         Sporotrichosis is known as Sporo. Sporotrichosis is a dimorphic fungi that exist in two distinct forms as a mould form in environment and as a yeast form in animals tissue. It is in the Moniliaceae family of Deuteromycete class of fungi. It is environmental acquired disease. It also known as ‘rose-growers’ disease. It is often observed in gardeners. It may develop via a thorn prick to the finger. The source of sporotrichosis is sphagnum moss. Commonly, the infection located in arms and can develop elsewhere.

Host range for infection :

  • human
  • horses
  • dogs
  • pig
  • cats
  • cattle
  • camels
  • fowl
  • rats
  • mice
  • hamster
  • mules ( cross of male donkey & female horse)

Sequence of Infection:

1. Inoculation with Sporothrix Schenckii via pricking of a finger

2. A pustule develops and ulcerates

3. Infection invades a pustule the lymphatic system and ascends the arms

4. Result of a chain of cutaneous ulcers.

6 factors important factors that influence the emergence of zoonotic disease :

1.Transportation of humans, animals between geographic locations.

2. Increased contact between animals and human.

3. Changes in the environment and husbandry practice.

4. A growing population of immunocompromised humans.

5. Increased awareness of zoonotic origin of many diseases

6. the identification of organisms that were not previously known.

2 important mechanism ( its potential to infect the mammalian host is maximised.)

1. Has ability to change phases to ascomycete telemorph that survives on living/ decaying plant materials.

2. Convert to yeast phase (after entering skin via puncture, bite, scratch)

Transmission :

1. Subacute-chronic cutaneous and subcutaneous infection.

2. Skin exposure by stratch, puncture wound, abrasion.

3. Development of a papule that enlarges to nodule & usually ulcerates over a period of 1-2 weeks.

4. If not treated, infection may progress to lymphatic system and cause the lymphocutaneous form of sporotrichosis.

5. Extracutaneous form of sporotrichosis often seen in patients :

  • alcoholism
  • diabetes mellitus
  • chronic obstructive pulmonary disease.
  • human immunodeficiency virus infection.

In cats, usually exposed via wound contamination or penetrating foreign bodies.

Clinical signs/syndromes in feline sporotrichosis :

  • localised (common in cats. It is confined to area of inoculation & develops after incubation period of approximately 1 month. If it is not treated, it will be progress into lymphcutaneous form. latter, cutaneous nodules progress to draining ulcers that affect skin, subcutis, regional lymphatics, lymph node) or fixed cutaneous lesions. ( cutaneous lesions often observed in legs, face and nasal plenum)
  • lymphocutaneous (common in cats).
  • multifocal disseminated sporotrichosis. ( lung and liver are primary site of disseminated sporotrichosis).

Differential diagnosis of skin lesions in cats may include :

  • bacteria pyoderma
  • mycobacteriosis
  • actinomycosis
  • cryptococcosis
  • sporotrochosis
  • foreign body
  • squamous cell membrane
  • immune-mediated carcinoma
  • immune-mediated disease
  • systemic lupus erythematosis
  • pemphigus vulguris
  • allergy
  • allergy to parasites
  • drug eruption

Diagnosis

  • Cytologic evaluation of sample ( aspiration of abscess/nodules, impression smear of ulcerated skin/ exudate, smear of swab specimen, skin scraping). Its characteristics : Oval, 3-5 mm in diameter, 5-9 mm in length, cigar-shaped, bu may appear as round budding yeast.
  • Fungal culture on Sabouraud mycologic medium ( swabs, biopsy specimen lesion) and incubated in both 25 C and 27 C for 10-14 days.
  • Serologic testing’
  • Indirect fluorescent antibody testing
  • Histologic  examination of fixed biopsy specimens of lesions.

Treatment :

  • Antimicrobial treatment
  • Sodium Iodide ( but it is replaced with more effective and safer antifungal drugs : Imidazoles )
  • Imidazoles
  • Ketaconzote ( not complete elimination, its effects are anorexia, weight loss)
  • Itraconazole ( orally : 5-10 mg/kg ( 2.5-4.5 mg/lb) every 12 hours)

Prevention and Control :

  • Always wear gloves when handling cats with ulcerative lesions or open draining tracts.
  • Wash hands and arms with antiseptic.

How to do CPR for animals

1. (A)-Airway
-pull the tongue of animals from mouth carefully to open airway.
-make sure the neck is straight.
-attempt 2 rescue breaths by closing the mouth and performing mouth-to-nose ventilation.

2. (B) -Breathing
-pull the tongue of animals from mouth carefully to open airway.
-make sure the neck is straight.
12 breaths per minute (1 every 5 seconds)
-proceed the circulation while continuing breathing support necessary.

3. (C) – Circulation
– Make sure there are no major points of bleeding. Control as necessary by applying pressure by your
hands.
– Check pulse at groin.
– Lay it at right side
-Locate your hands where its left elbow touches the chest
– Compress the chest 15 times followed by 2 rescue breaths (3 compression every 2 seconds)