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Summary Objective Incomplete uterine perforation after intrauterine device (IUD) insertion has occasionally been observed. We report on three patients who underwent flexible hysteroscopy for localization and retrieval of these intramural devices. Case Reports Three Taiwanese women presented with lower abdominal pain, discomfort during defecation and frequent urination. All used a Nova-T IUD for contraception. Sonography suggested dislocation of the IUD or perforation, and pelvic examination revealed missing strings. All the women underwent flexible hysteroscopy to localize and retrieve the devices. The hysteroscopic examination indicated partial perforation or embedding of the device into the cervical or uterine wall. Retrieval was smoothly performed without cervical dilatation or anesthesia in all three women. All devices were directly retrieved using the grasping forceps of the flexible hysterofibroscope. The subsequent courses were smooth and uneventful. Conclusion Flexible hysteroscopy is a simple and useful tool for diagnosis and retrieval of intramural IUDs. The instant removal of an IUD that has incompletely perforated the uterine wall might prevent complete uterine perforation.

The surgical method of repairing distal tibial fractures remains controversial. Open reduction and plating is a popular method that can result in good fixation and retention of the achieved position. The usual approach for open plating is anterior. Although it offers good exposure to the tibia, the medial plating is at high risk of wound problems and nonunions. Also, if fixation of the fibula is required, an additional incision must be made on the lateral side of the shin. Lateral plating using a single lateral approach for treating distal tibial and fibular fractures has been reported to have good results; however, most of these studies were small series. We retrospectively evaluated and compared the clinical outcomes of distal tibial fractures treated with medial plating using an anterior approach and lateral plating using a lateral approach. Eighty-eight patients with distal tibial fractures treated with medial or lateral plating were retrospectively reviewed. The 88 fractures were divided into 2 groups: the medial plating group used an anterior approach and included 49 patients and the lateral plating group used a lateral approach and included 39 patients. Both groups were similar with respect to injury mechanism, union rate, malunion rate, operative time, functional score, and range of ankle motion (P>or=.14). Both medial and lateral plating for treating distal tibial fractures achieved good functional outcomes with a low malunion rate; however, the lateral plating group had a lower complication rate (P=.047) and fewer hardware problems (P

Removal of intrauterine devices (IUDs) in early pregnancy, when the IUDs threads are not visible at the cervical canal and the patient wishes to continue her pregnancy, remains a problem. Thirty-three patients using IUDs with nonvisible filaments on examination under-went flexible hysteroscopy for retrieval of the devices and follow-up until delivery. In all cases, hysteroscopies were performed without cervical dilatation and anesthesia. In 30 patients, the devices were found within the uterine cavity, and 28 IUDs were removed. In the remaining 3 patients, no IUD was observed. Twenty-four healthy children have been born. Six other patients requested a dilatation and curettage (D & C) about 1–2 weeks later after successful IUD removal. In 2 women, examinations were done at 22 and 29 weeks antepartum, and these 2 patients were lost to follow up. Operative fiberoptic hysteroscopy is proposed as a useful and effective method of retrieval of IUDs in early pregnancy when the filaments of the IUD are ab...

According to Dr. Tatum H. J., et al.: the incidence of spontaneous abortion more than doubled when the IUD remained in utero. The chance of a livebirth being premature was four times greater when the IUD remained in situ that when it was removed. Besides, a certain number of authors have tried their best to remove IUDs in early pregnancies before suction curretage, and they can't follow up after D & C. So the policy at our hospital, in cases where a woman wishes to continue a pregnancy that has occurred with an IUD in situ, is to remove IUD as soon as possible.