This patient presented with acute cholecystitis, as confirmed at imaging. His pain resolved over a few days, but mildly elevated bilirubin levels persisted. Image obtained during ERCP shows smooth narrowing of the bile duct (arrow) at the site of insertion of the cystic duct (Mirizzi syndrome). Note the small calculus in the cystic duct. Courtesy of Dr. Ali Nawaz Khan.
Classification:
Type I - No fistula present
Type IA - Presence of the cystic duct
Type IB - Obliteration of the cystic duct
Types II-IV - Fistula present
Type II - Defect smaller than 33% of the CBD diameter
Type III - Defect 33-66% of the CBD diameter
Type IV - Defect larger than 66% of the CBD diameter
Indications:
1. Fractures with severe soft-tissue damage in which the wound can be left open for inspection and dressing.
2. Comminuted & Unstable fractures.
3. Fractures of pelvis.
4. Fractures associated with injuries of nerve & blood vessel.
5. Infected fractures.(eg. osteomyelitis)
6. Non-united fractures where the dead fragments can be excised and combine with elongation in normal shaft.
Indication:
1. Fracturees which cannot be reduced.
2. Unstable fractures & prone to redisplacement after reduction.
3. Pathological fractures in bone diseases.
4. Multiple fractures
5. Fractures which poorly unite. eg. femoral neck.
6. Fractures in patient with nursing difficulties.
5 types of
Physis Growth Plate Injuries.
Children are mostly affected.
Type 1 & 2 are uncommon for growth disturbances.
While
Type 3 may damage reproductive zone,
Type 4 causing aysmmetrical growth
Type 5 result from compression to the growth plate result
in growth cessation.
