Balaji Zacharia

By Balaji Zacharia, Dhiyaneswaran Subramaniyam and Muhammed Ayyub

Acetabular fractures are one of the rare injuries. They are usually occurring following a high energy trauma. The type of acetabular fractures is mainly depend on the position of the femoral head at the time of injury. The acetabular fracture are usually associated with visceral and neurovascular injuries. There can be anterior, posterior or central fracture dislocation associated with this injury. A closed degloving injury of the subcutaneous tissue which is detached from the underlying fascia-Morel-Lavelle lesion is also common feature. The sciatic nerve injury can be associated with posterior wall or column injuries. The most commonly used investigation are anteroposterior, Judet views and 2D/3D computerized tomography. Most commonly used classification is modified Judet and Letournel classification. They divided acetabular fractures into five simple fracture patterns and five associated fracture pattern. The Orthopedic trauma association modified Letournel classification and gave computerized coding. In this chapter, we are describing the clinical features and classification of acetabular fracture in a simple and vivid manner.

Part of the book: Trauma Surgery

By Balaji Zacharia and Antony Roy

Spondyloarthropathies are a group of disorders having some common features. They are characterised by inflammation of the attachment of tendons known as enthesitis. They are common in males. There is a familial occurrence. There is an association with HLA-B 27. Rheumatoid factor will be negative. Axial skeleton involvement in the form of sacroiliitis or spondylitis is common. The common conditions include ankylosing spondylitis, Reiter’s disease, psoriatic arthritis, enteropathic arthritis and reactive arthritis. In this chapter we are going to describe the clinical features, evaluation and management of common spondyloarthropathies.

Part of the book: Connective Tissue Disease

By Balaji Zacharia and Raj Vignesh Selvaraj

Acute compartment syndrome (ACS) occurs when the pressure within the closed osteo-fascial compartment raises above perfusion pressure leading to irreversible tissue ischemia and necrosis. Any closed compartment in the body can be affected by ACS. The leg is the commonest site. Trauma is the common cause of compartment syndrome in young patients. In older patients, medical causes can cause it. The diagnosis in a conscious patient can be made based on clinical features. Pain out of proportion to the injury is the most important symptom. Exacerbation of pain on stretching the affected muscles and paresthesia are the common signs. Compartment pressure measurement is important for the diagnosis in unconscious and uncooperative patients. The treatment of established ACS is emergency fasciotomy. Untreated compartment syndrome can lead to neurovascular injuries and muscle contractures. In this chapter, we will see the etiologies, clinical features, investigations, and management of acute compartment syndrome of the extremities and the paraspinal region.

Part of the book: Trauma and Emergency Surgery