Spinal injuries constitute about 3% of all injury cases and most of these injuries affect the thoracolumbar region, but thoracolumbar fracture-dislocations are much rarer. Dislocations (AO Type C injuries) of the thoracic and lumbar vertebrae, with or without associated fractures, happen due to very high energy trauma involving simultaneous, multidirectional, distractive and compressive forces across various spinal elements, which results in translational and rotational instability of the spinal column. Various reduction maneuvers have been described for thoracolumbar fracture-dislocations in the literature aiming to provide standardization in surgery for this situation. The aim of this review article is to systematically review the literature till date and describe various reduction maneuvers which help to achieve adequate sagittal and coronal balance as well as vertebral alignment with minimal soft tissue trauma. We searched the PubMed, the Cochrane Library (the most recent issue), Scopus, Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, Web of Science, International Clinical Trials Registry Platform (WHO), ClinicalTrials.gov and Google Scholar databases, besides other sources and general internet search. The strategy used in the search was briefly(''thoracolumbar'' OR ''dorsolumbar'') AND "dislocation" in PubMed. Similar searches were made in the other databases.Reference lists of the relevant papers were also examined and any further relevant studies, which were also included in the review.The initial search revealed 332 papers in Pubmed, out of which 302 were human studies. A similar search on Scopus revealed 528 documents and on WoS revealed 289 papers. Searching the Cochrane library revealed 9 trials, which were already revealed in Pubmed search results. All the references were imported into Endnote and we had 632 references after excluding duplicates and 126 papers were left in endnote after manual title screening and duplicate removal. Finally, 70 relevant papers were selected for consideration based on inclusion criteria, after excluding unrelated papers manually. We have summarised the published literature on the surgical management of thoraco-lumbar fracture dislocations and described the reduction maneuvers used in detail.
Background Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) remain low globally. Availability of newer drugs has given scope to develop regimens that can be patient-friendly, less toxic, with improved outcomes. We proposed to determine the effectiveness of an entirely oral, short-course regimen with bedaquiline and delamanid in treating MDR-TB with additional resistance to fluoroquinolones (MDR-TBFQ+) or second-line injectable (MDR-TBSLI+). Methods We prospectively determined the effectiveness and safety of combining 2 new drugs with 2 repurposed drugs—bedaquiline, delamanid, linezolid, and clofazimine—for 24–36 weeks in adults with pulmonary MDR-TBFQ+ and/or MDR-TBSLI+. The primary outcome was a favorable response at end of treatment, defined as 2 consecutive negative cultures taken 4 weeks apart. The unfavorable outcomes included bacteriologic or clinical failure during the treatment period. Results Of the 165 participants enrolled, 158 had MDR-TBFQ+. At the end of treatment, after excluding 12 patients due to baseline drug susceptibility and culture negatives, 139 of 153 patients (91%) had a favorable outcome. Fourteen patients (9%) had unfavorable outcomes: 4 deaths, 7 treatment changes, 2 bacteriological failures, and 1 withdrawal. During treatment, 85 patients (52%) developed myelosuppression, 69 (42%) reported peripheral neuropathy, and none had QTc(F) prolongation >500 ms. At 48 weeks of follow-up, 131 patients showed sustained treatment success with the resolution of adverse events in the majority. Conclusions After 24–36 weeks of treatment, this regimen resulted in a satisfactory favorable outcome in pulmonary MDR-TB patients with additional drug resistance. Cardiotoxicity was minimal, and myelosuppression, while common, was detected early and treated successfully. Clinical Trials Registration. ClinicalTrials Registry of India (CTRI/2019/01/017310).
The transpedicular approach to the presacral region is a safer option compared with other approaches to reach this region. It simultaneously allows decompression of cauda equina nerve roots by laminotomy without changing the position of the patient in the theater. The key to success with this approach is early diagnosis and early treatment.
The foot and ankle are rare sites of involvement for giant cell tumor of tendon sheath. We present three rare cases of giant cell tumor of tendon sheath arising from the tendon sheaths of the flexor hallucis longus, peroneus brevis, and extensor hallucis brevis tendons, along with a literature review of such cases in the foot and ankle region. All of the patients were treated with surgical excision of the mass and were asymptomatic after minimum follow-up of 18 months. Giant cell tumor of tendon sheath involving the foot and ankle region is a rare clinical entity, and good results can be expected after surgical excision.
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