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http://www.webmedcentral.com/images/Header_Logo.giftext/html2010-09-10T16:08:20+01:00http://www.webmedcentral.com/Ms. Chrysi TsiouriRemodelling Through The Growth Plate- An Experimental Study In Rats
http://www.webmedcentral.com/article_view/589
The ability of the skeleton to remodel itself has long been recognized and studied. There has been great controversy among scientists as to whether remodeling takes place mainly in the fracture site or in the growth cartilage. In this study the activity of the two halves of the growth plate of 56 laboratory rats is measured and compared and it seems that the half that is adjacent to the concave side of the fracture shows increased activity as compared to the opposite part.text/html2010-09-07T15:27:47+01:00http://www.webmedcentral.com/Dr. S S SureshSupracondylar Process Congenitalis Of The Femur
http://www.webmedcentral.com/article_view/544
The author reports a case of supracondylar process of the femur in a patient who presented with trauma to the left knee in a road traffic accident. The patient was not symptomatic and the process was detected incidentally while doing the trauma series radiographs. Hence no intervention was suggested to the patient.text/html2010-09-22T16:38:52+01:00http://www.webmedcentral.com/Mr. Adeel AqilPhysical therapy or Platelet Rich Plasma Injections in the Treatment of Tennis Elbow: A Randomised Clinical Trial
http://www.webmedcentral.com/article_view/701
Chronic painful tendon disorders are common in athletic and sedentary individuals. They are common in middle age, and with increasing sports participation at increasing ages (1-4). Tendon regeneration may be improved by injecting autologous growth factors obtained from the patient’s own blood. Autologous growth factors can be injected with autologous whole blood or platelet- rich plasma (PRP) (5).
At present there is evidence which suggests conservative treatment such as the use of heavy load eccentric training programmes is effective (6). However conventional conservative therapy is ineffective in around 25% of patients (7). In these patients, surgery can be performed, but it is not always successful, and the post-operative rehabilitation is slow and time consuming (3-4, 6-8). To reduce the need for surgery, more effective conservative therapies are required (5).text/html2010-10-09T07:15:19+01:00http://www.webmedcentral.com/Dr. Vishal KumarBilateral Shaft Humerus Nonunion With Acceptable Function - Case Report And Review Of Literature
http://www.webmedcentral.com/article_view/928
Nonunion of the humeral shaft is rarely seen and reported in literature. Possible etiology being osteoporosis, osteomalacia, anti-epileptics and other metabolic bone diseases with poor stabilization are sporadically reported in literature. Non-union of humerus leads to major disability of patient because of inability to perform day today activities and always demand treatment. We report a case of bilateral idiopathic nonunion of the humeral shaft in a 56 year old healthy female with acceptable function, who refused surgery and is doing fine at home .text/html2010-10-12T15:34:31+01:00http://www.webmedcentral.com/Dr. Vishal KumarCombined Talar Body And Medial Malleolus Fracture: A Case Report
http://www.webmedcentral.com/article_view/952
The combination of ipsilateral talar body and medial malleolus fracture is rare to occur.Radiographs and Computed tomograms are main diagnostic aids.With initial conservative management till swelling subsides,open reduction and adequate internal fixation followed by supervised aggressive physiotherapy gives good functional outcome as in this case.text/html2011-05-18T10:22:56+01:00http://www.webmedcentral.com/Dr. Stephen R ManningMetalwork Fracture Following Total Hip Arthroplasty
http://www.webmedcentral.com/article_view/1934
Herein is presented a case of an unusual injury following a total hip replacement. Many of us would consider the metal implant to be the strongest, most resilient part of a hip joint after replacement. This may not always be the case, as the following case illustrates, metal may break when force is applied leaving the bone intact.text/html2010-07-28T23:08:41+01:00http://www.webmedcentral.com/Mr. Vinay Kumar Singh\"Trauma Registry\"- A Necessity Of Modern Clinical Practice
http://www.webmedcentral.com/article_view/456
Authors along with the input from informational and technology department established a hospital based trauma database which could enable us to put data of all the trauma patients admitted to hospital electronically into a secured hard drive.
We generated a system based on Microsoft Access program which enabled us to create a main table for all admissions and in-house referral which was fed through an ‘Admission Form’. From this main table there are sub tables to enter patients age, sex, date of birth, date of admission, ASA, associated medical comorbidities, diagnosis, associated injury, planed surgery, planned date of surgery and admitting consultant. Once patients are operated and date of operation and any associated intraoperative complications are entered on database it takes the patients off the system and all the information is stored in secured drive.
This system is in use for since April 2006 and has helped immensely in audits and research projects by generating a good trauma data. It has also helped in giving the real-time feedback of our work and performance for trauma patients.text/html2010-09-12T00:21:16+01:00http://www.webmedcentral.com/Dr. Bhavuk Garg\"Radio-Ulnar Synostosis Following Isolated Fracture Of Shaft Of Ulna And Its Treatment By Radical Excision And Interposition Of Tensor Fascia Lata Graft\"
http://www.webmedcentral.com/article_view/596
Radioulnar synostosis is a well recognized and disabling complication of fractures of forearm bones; however it is very rare following single forearm bone fracture. Excision of synostosis alone carries a high potential for recurrence. Therefore interposition of varieties of foreign or biologic materials has been recommended. We describe a patient with a fixed type II diaphyseal radioulnar synostosis following an isolated fracture of ulna treated with radical bony excision and tensor fascia lata graft interposition.text/html2010-09-25T20:44:19+01:00http://www.webmedcentral.com/Dr. S S SureshOs Radiostyloideum- Misdiagnosed as fracture in the Emergency Room
http://www.webmedcentral.com/article_view/751
The author reports a case of Os radiostyloideum, misdiagnosed as fracture of the radial styloid, and subsequently managed with a back slab, in the emergency room.text/html2010-09-28T19:12:17+01:00http://www.webmedcentral.com/Dr. Ahidjo KawuBladder Stones in Catheterized Spinal Cord Injured Patients in Nigeria
http://www.webmedcentral.com/article_view/779
Objective: To determine the incidence of bladder stone in patients with spinal cord injury (SCI) and to assess if catheter encrustation and positive urinary culture of Proteus mirabilis is predictive of bladder stone.
Background: Bladder stones are common urological complication in those with spinal cord injury (SCI) managed with indwelling urinary catheter. Detection and removal of bladder stones are important to prevent possible further complications.
Design: Prospective cohort study.
Methods: Ultrasound findings in persons with SCI seen from 1st January to 31st December 2009 who had indwelling urethral catheter at 3 month post injury. Indwelling urethral catheters were examined for encrustation at the time of removal, urine culture taken specifically for Proteus mirabilis and ultrasound scan done to detect stone.
Results: There were 89 patients with spinal cord injury and 68 patients were evaluated during the review period. Twenty-nine (42.6%) patients had bladder stones and 22 patients had catheter encrustation. Of these 22 patients with catheter encrustation, 18 also had bladder stones. Catheter encrustation had a positive result for bladder stones 81.8% of the time. Forty-six (67.6%) patients had no catheter encrustation. Of these, 7 (14.7%) were found to have bladder stones. Thirty-seven (38.2%) urine cultures were positive for Proteus mirabilis. Of these 37 (54.4%) patients, 27 also had bladder stones. Catheter encrustation and positive urine culture of Proteus mirabilis in patients with encrusted catheter is highly predictive of the presence of bladder stone.
Conclusions: This study suggests that ultrasound scan for presence of stone should be scheduled if catheter encrustation and a positive urine culture of Proteus mirabilis are notedtext/html2010-09-30T19:04:03+01:00http://www.webmedcentral.com/Dr. Ahidjo KawuRisk Factors Predicting Mortality in Spinal Cord Injury in Nigeria
http://www.webmedcentral.com/article_view/807
Objectives: Among spinal cord injured patients managed conservatively in Nigeria, to determine the number of death within the 6 month of injury and to identify risk factors that may be associated with such mortality.
Design and setting: A retrospective cohort study set in Nigeria
Methods: Patients were identified from the hospital trauma database. Over 11-year period (January 1997- December 2007) mortality within the first 6 month of spinal cord injury was determined and risk factors examined.
Results: 582 patients were eligible for the study and data were obtained for 422 (72.5%) patients with a mean age of 37.2 (±14.2) years at 6 months follow-up. There were a total of 144 (34.1%) deaths during the period reviewed. Significant risk factors associated with such mortality were age, presentation after 24hrs, multiple hospital presentation, injury severity score (ISS), cervical spine injury, and complete neurologic deficit at presentation.
Conclusion: This study identified prognostic factors that may assist clinicians in identifying and categorizing patients into treatment plan that could reduce mortality.text/html2010-10-01T23:12:22+01:00http://www.webmedcentral.com/Dr. Ahidjo KawuThoracic Spine Fractures Following Motorcycle Accidents in Nigeria
http://www.webmedcentral.com/article_view/872
Background: Thoracic spine (T1-T12) fracture following motorcycle accident (MCA) is not uncommon injury and the topic has not been reported on in Nigeria.
Objective: The aim of this study is to report on the demographic pattern of presentation and the short term neurologic outcome of conservative treatment of thoracic spine fractures following MCA in Abuja Nigeria.
Methods: Age, sex, fracture pattern, region of fracture, neurologic status at presentation and outcome of patients treated conservatively for thoracic spine fractures following MCA from 1997 to 2007 were retrospectively studied from case notes.
Results: There were 27 patients (25M, 2F, M/F 12.5: 1) with mean age of 28.2± 10.8 years over the 10-year period. The seventh thoracic spine T7 (22.2%) and the fourth to seventh thoracic spine (T4-T7) were the commonest level and region of injury respectively. Fracture-dislocation was the commonest fracture pattern noted. Fifteen (55.6%) patients had complete neurologic deficit. Seven (25.9%) patients left against medical advice and 5(18.5%) died during the review interval. Frankel’s grading improved in 4 (14.8%) patients at least 2 levels at 6 month of evaluations. The mean duration of hospitalization was 69.5± 20.7 days.
Conclusion: Thoracic spine fracture following MCA is not uncommon and a significant cause of morbidity and mortality. The patients were predominantly young economic active, male adults. The T7 and T4-T7 appears to be the commonest level and region of injury respectively. Fracture-dislocation was the commonest fracture pattern. The short term neurologic outcome was satisfactory in a small minority (14.8%) of the patients.text/html2010-10-16T22:45:55+01:00http://www.webmedcentral.com/Dr. Vishal KumarFoot Drop Following Smith Peterson Approach For Greater Trochanter Osteochondroma Excision:a Case Report
http://www.webmedcentral.com/article_view/1017
Hereditary osteochondromatosis is an autosomal dominant disorder with incomplete penetrance.We did not find a single case of sciatic nerve palsy resulting in foot drop following Smith Peterson approach to hip for osteochondroma excision at extensive internet search.The cause still remains to be determined.text/html2010-10-27T14:33:06+01:00http://www.webmedcentral.com/Dr. S S SureshDumbbell Ganglion Of The Foot: Case Report
http://www.webmedcentral.com/article_view/1079
Ganglions are common tumors of the dorsum of the foot. The authors report a case of dumbbell ganglion of the foot in a 32-year-old lady, whose main concern was the cosmetic disfigurement due to the displacement of the second toe. The mass was excised through a dorsal approach. The patient remained asymptomatic at 14 month follow up.text/html2010-11-08T22:11:13+01:00http://www.webmedcentral.com/Dr. Vishal KumarExtended Curettage And Internal Fixation In A Recurrent Proximal Femur Simple Bone Cyst:a Case Report And Review Of Literature
http://www.webmedcentral.com/article_view/1127
Simple bone cyst appears to be a reactive or developmental disorder characterised by a solitary cavity lined by membrane of variable thickness and filled with a clear,yellow fluid.
We report a sixteen years old female who presented with recurrence of lesion despite curettage and fibular grafting:extended curettage with removal of fibrous membrane and use of abundant allograft to fill the cavity alongwith stabilisation with dynamic hip screw yielded satisfactory results till date in terms of hip function and radiographic union.text/html2010-11-08T22:13:28+01:00http://www.webmedcentral.com/Dr. Sarvdeep DhattBilateral Sarcoid Arthritis Treated By Total Hip Replacement: A Case Report
http://www.webmedcentral.com/article_view/1133
Sarcoidosis is a multisystem disorder which rarely affects the musculoskeletal system. The presentation as chronic arthritis is even rarer and leads to significant disability in patients with large joint involvement, who already have a compromised respiratory reserve. We report a case of bilateral hip sarcoid arthritis treated by total hip replacement which led to a good functional outcome. Total hip replacement leads to significant lifestyle improvement by reducing the total energy expenditure involved in activities of daily living.text/html2010-11-13T17:39:20+01:00http://www.webmedcentral.com/Dr. Sarvdeep DhattHypertrophic Pubic Ramus Nonunion: Does Conservative Treatment Helpful?
http://www.webmedcentral.com/article_view/1158
The treatment of pubic ramus nonunion is usually surgical. We report the successful healing of a hypertrophic nonunion of pubic ramus in a 46 year old active male patient who was treated conservatively with a lumbo-sacral corset. We believe that understanding the injury mechanics in pelvic injury is more important to employ a particular treatment method than to follow the conventional ways of treatment. text/html2010-11-13T17:37:39+01:00http://www.webmedcentral.com/Dr. Vikas BachhalBladder Herniation Due To Implant Failure In A Type B-1 Pubic Symphyseal Diastasis
http://www.webmedcentral.com/article_view/1159
Internal Fixation of pubic diastasis is a safe procedure relatively free of serious complications and is a standard treatment choice for tile's type B-1 injuries. We present one interesting case of late implant failure in an adequately fixed pubic diastasis leading to bladder herniation.text/html2010-11-15T18:10:48+01:00http://www.webmedcentral.com/Dr. Sujit K TripathyLegg-calve-perthes Disease Current Concepts
http://www.webmedcentral.com/article_view/1173
Perthes is a serious but self-limited disorder. If it is a self limiting disease, then why one should think of treating it. The aim of treatment is to prevent femoral head deformity and subsequent osteoarthrosis. There is still no clear guideline for the management of Perthes disease. This is because of the controversies in all most all the aspects of the disease; etiology, classification, natural course of the disease, management and its outcome. Catteral emphasized the importance of proper hip examination in Perthes of younger age group, as the femoral head still remains concentric and rounded despite an adverse looking X-ray early on. The outlook of Perthes becomes more serious in older child or early adolescent, as the femoral head lacks the regenerative capacity during this period. Whatever controversies may be there, management principle still remains the same. Before any operation in Perthes’, action must be taken to unstiffen the hip. Containment procedures will fail if performed on a stiff hip and even salvage procedures are best performed on a hip that has been loosened as much as possible. Surgeons need to recall that it is better not to intervene in a Perthes child where the surgical outcome is grave and make the child a candidate for an early hip replacement. It should be remembered that most untreated Perthes’ do not require intervention until the age of forty.text/html2010-11-22T16:27:05+01:00http://www.webmedcentral.com/Dr. Nirmal RajTreatment Of Fibrous Dysplasia With Zoledronic Acid Infusion Case Report, Review Of Literature And Future Prospectives
http://www.webmedcentral.com/article_view/1206
Several studies have shown that bisphosphonates are useful in alleviating chronic pain in patients with fibrous dysplasia,but further studies are necessary to confirm these promising results. Being the most potent bisphosphonate we treated one patient of distal femur fibrous dysplasia with Zoledronic acid and would like to share our experience as a case report. 52 years old male patient presented in out-patient department complaining of pain and swelling of left thigh lower aspect for approximately eight months. An open biopsy was performed and diagnosis of fibrous dysplasia was confirmed. Due to location of lesion and financial restraints patient was treated with intravenous Zoledronic acid. There was significant functional improvement and reduction of alkaline phosphatase level to normal within a period of six months. Hence it was considered to report this case as it may add up to the available data of usage of Zoledronic acid in treating fibrous dysplasia.text/html2010-11-29T20:29:08+01:00http://www.webmedcentral.com/Dr. Sarvdeep DhattExcision And Endoprosthesis Implantation For Proximal Femur Giant Cell Tumor
http://www.webmedcentral.com/article_view/1236
We report a case proximal femur giant cell tumor in an active young male who presented with pathological fracture. The tumor was excised with a wide margin and the defect was reconstructed successfully with a custom made endoprosthesis. After three years, the patient had an excellent functional outcome with Musculoskeletal Tumor Society Functional score of 26.7.text/html2010-11-29T20:29:57+01:00http://www.webmedcentral.com/Dr. Sakthivel Rajan Rajaram ManoharanSurgical Excision Of A Large Sessile Osteochondroma Of The Lesser Trochanter Of Femur: A Case Report
http://www.webmedcentral.com/article_view/1237
The presentation of osteochondroma lesion in proximal femur is infrequently encountered as most are usually asymptomatic. Here we present a case of large sessile osteochondroma from the lesser trochanter. A 24 year old male patient presented in our department with a large swelling around the right hip since 2 years. Plain Radiographs , Computed Tomography and Magnetic Resonance Imaging were performed to assess the exact site and extent of the lesion. Excision of the lesion along with the base of lesser trochanter was performed. The histopathological examination confirmed the nature of the tumor. The patient was kept non-weight bearing for a period of 4 weeks. The patient returned to his routine activities after a period of 6 weeks. At the latest follow up the patient was pain free and there was no evidence of any recurrence. Hence we emphasize that a removal of the mass along with the base of lesser trochanter will help in removal of islands of the lesion and help in preventing subsequent recurrence.text/html2010-11-29T20:31:34+01:00http://www.webmedcentral.com/Dr. Daljit SinghDesmoplastic Fibroma Of Proximal Femur - Surgical Reconstruction. A Case Report And A Brief Review Of Management
http://www.webmedcentral.com/article_view/1242
Desmoplastic fibroma is a very rare bone tumor which histopathologically and biologically very much similar to extra-abdominal desmoid tumor of the soft tissue. En bloc resection is the treatment of choice in view of the high incidence of recurrence after curettage, but when the lesion is located at sites like proximal femur, resection of the tumour needs reconstruction of the defect either with endoprosthesis, autograft or allograft. Reconstruction of desmoplastic fibroma which is extending from neck of femur up to middle third of remur femur is not reported in literature. We report a case of an eighteen year old male presented with massive tumour of the proximal femur extending from neck up to middle of shaft that was widely resected and reconstructed by using structural fibula and cortico-cancellous graft supported by dynamic condylar screw and side plate. At five years follow up, there was excellent remodelling of the bone with no tumor recurrence.text/html2010-12-03T17:41:26+01:00http://www.webmedcentral.com/Dr. Dharm S MeenaScaphoid Fractures- Anatomy And Diagnosis: A Systemic Review Of Literature
http://www.webmedcentral.com/article_view/1268
Scaphoid fractures are commonly seen in orthopedic practice. An organized and thoughtful approach to diagnosis and treatment can facilitate good outcomes. Anatomical knowledge of the scaphoid is important both for the treatment and prognosis. The blood supply to scaphoid is from distal to proximal pole. Clinical suspicion is of paramount importance. X ray is most important to confirm the diagnosis with aids of MRI and bone scan.text/html2010-12-03T17:55:38+01:00http://www.webmedcentral.com/Dr. Susheel ChaudharyChondrosarcoma Of Distal Radius- A Case Report And Brief Review Of Literature
http://www.webmedcentral.com/article_view/1274
A 55 years old patient male presented with progressively enlarging, painful swelling over right wrist. Excision biopsy showed well differentiated chondrosarcoma of distal radius, which is rare and less reported at this location. Excision of the tumour was done with no recurrence detected at the latest follow up of two years.text/html2010-12-05T18:30:14+01:00http://www.webmedcentral.com/Dr. Dharm S MeenaDiaphyseal Small Cell Osteosarcoma: A Case Report And Review Of Literature
http://www.webmedcentral.com/article_view/1276
Osteosarcoma is commonest primary tumor of the bone1. Within its strict histologic definition, osteosarcoma consists of a group of lesions with considerable diversity in histologic features and grade. It may occur anywhere around the bone starting from intramedullary or intracortical to periosteal and extraosseous2. It mostly occurs in the long bones in the second decade of life. It most commonly presents with pain and soft tissue swelling of 1-8 months duration as intramedullary type. Pathologic fractures are present in only 5% of cases. With combination chemotherapy and surgery, cure rates as high as 70-80% have been obtained when prior to this, only 10-20% 5 year survival rates were achieved. Conventional intramedullary osteosarcomas comprise 90% of all osteosarcomas but there are several other variants which lead to difficulty in diagnosis. Small cell osteosarcoma is the rare variety of it3. Here, we are presenting a rare case of diaphyseal small cell osteosarcoma in a young male patient.text/html2010-12-07T21:35:20+01:00http://www.webmedcentral.com/Dr. Daljit SinghOsteosarcoma Of Calcaneum A Case Series Of Rare Tumour Presenting A Diagnostic Dilemma
http://www.webmedcentral.com/article_view/1273
Osteosarcomas of the calcaneum are rare. Owing to the rarity at this site, the diagnosis is often delayed or missed leading to the delay in treatment. We present a series of three cases of osteosarcoma of calcaneum, the difficulties in their diagnosis, their clinical, radiological and histological features that aid in the diagnosis and the management of these tumours.text/html2010-12-07T21:34:45+01:00http://www.webmedcentral.com/Dr. Dharm S MeenaScaphoid Fractures- Anatomy And Diagnosis: A Systemic Review Of Literature
http://www.webmedcentral.com/article_view/1290
Scaphoid fractures are commonly seen in orthopedic practice. An organized and thoughtful approach to diagnosis and treatment can facilitate good outcomes. Anatomical knowledge of the scaphoid is important both for the treatment and prognosis. The blood supply to scaphoid is from distal to proximal pole. Clinical suspicion is of paramount importance. X ray is most important to confirm the diagnosis with aids of MRI and bone scan.text/html2010-12-07T21:31:44+01:00http://www.webmedcentral.com/Dr. Dharm S MeenaGiant Cell Tumor Of Bones: A Systemic Review Of Literature
http://www.webmedcentral.com/article_view/1293
Giant cell tumour (GCT) of bone, or osteoclastoma, is classically described as a locally invasive tumour that occurs close to the joint of a mature bone. It makes 5 to 7% of primary bone tumours according to available literature1-3. It usually occurs around the knee joint and distal radius with incidence of about 75%. It is generally considered to be a benign tumour. The incidence of bone GCT also varies depending on the reporting centre. It involves predominately males in age group of 20 to 40 years after physeal closure. Treatment options include curettage of tumour through a bone window with autologous bone grafting or cementing to fill the gap wherever possible. The reconstruction of the bone defect following wide excision is done depending on site of lesion.text/html2010-12-24T10:54:10+01:00http://www.webmedcentral.com/Dr. Nirmal RajNeglected Intra-articular Proximal Tibia Fracture : Good Functional Outcome After Operative Stabilisation
http://www.webmedcentral.com/article_view/1430
Introduction:We consider worthwhile reporting a case of neglected intra-articular fracture treated surgically after a period of 8 months, since it was hard to find a literature regarding surgical management of neglected fractures around proximal tibia.Case report:Our patient is a 45 years old gentleman who presented with a fracture proximal tibia 8 months old, treated by traditional bone setter. He was not able to use his right lower limb and on examination there was fracture proximal tibia which was intra-articular with gross displacement. Since the position was not acceptable with gross deformity we decided to reduce surgically. On one year follow up there was a good functional outcome post surgically with minimal lateral collateral ligament laxity. Conclusion:To conclude, surgical stabilisation of a neglected proximal tibia fracture can yield good functional outcome. Although our patient had a good functional outcome, we need more number of cases to come to a conclusion regarding management of neglected intra-articular proximal tibia fractures and to formulate a protocol.text/html2011-01-01T19:26:48+01:00http://www.webmedcentral.com/Dr. Sankar R RenganathanValgus Slipped Capital Femoral Epiphysis - A Case Report
http://www.webmedcentral.com/article_view/1395
Slipped capital femoral epiphysis [SCFE] is most common hip problem in adolescent child and usually occurs around the growth spurt. There is a sheering force around the hip which favours the slip. However in the vast majority of cases the slip occurs in the varus direction. Valgus slipped capital femoral epiphysis as such is an uncommon entity. Not much literature has been published so for on this entity. This condition is not mentioned in standard orthopedics textbook. One such case report is presented over here along with the review of the available literature.
text/html2011-01-08T19:33:42+01:00http://www.webmedcentral.com/Dr. Nirmal RajAggressive Distal Femoral Giant Cell Tumour: Resection And Reconstruction With Custom Mega-prosthesis: Report Of A Case And Review Of Literature
http://www.webmedcentral.com/article_view/1456
Introduction:We consider worthwhile reporting a case of distal femoral aggressive GCT treated by enbloc excision and reconstruction with custom mega prosthesis with good functional outcome.Case report:A 30 years old female was admitted with aggressive distal femoral GCT for which resection and reconstruction with custom megaprosthesis was performed. Although there are studies available mentioning various treatment modalities, their advantages and disadvantages, definitive criteriae were not laid down regarding treatment. Conclusion:To conclude, achieving complete ablation of the tumor and preserving a functional extremity at the same time proves to be a daunting task. Custom mega prosthetic arthroplasty is effective in achieving the desired goals of reconstruction with good functional results and least complications in selected patients.
text/html2011-02-25T22:17:49+01:00http://www.webmedcentral.com/Dr. Nasir MuzaffarThe Complete Subtalar Release In Ctev Correction; Does It Address All Deformities?
http://www.webmedcentral.com/article_view/1607
Background: Adequate surgical correction of congenital talipes equinovarus (CTEV) is a challenge to orthopedicians aiming to address all aspects of this complex foot deformity. Various exposures have been elucidated with varying results. This study discusses the Cincinnati approach advocated by McKay and whether it addresses the various aspects of clubfoot correction.Methods: Complete subtalar release using the circumferential Cincinnati incision was done in 43 feet of 30 patients aged between 6 months to 3 years. The right side was involved in 11, the left in 6 and bilateral involvement present in 13 cases. All cases were found to be resistant to correction by the conservative method proposed by Ponseti.Results: The patients were followed up for a minimum period of 2.4 years. Excellent results were seen in 18%, good in 46%, fair in 20% and poor in 14% cases. More than half of the cases had a preop talocalcaneal index of 21-30 percent which converted to 51-60 percent after surgery.Conclusion: The Cincinnati approach is ideal to achieve pantalar reduction, is cosmetically more acceptable and gives a better range of motion.
text/html2011-02-26T21:51:10+01:00http://www.webmedcentral.com/Dr. Aravind s HampannavarPagets Disease of Humerus Presenting with Recurrent Fractures: A Case Report.
http://www.webmedcentral.com/article_view/1624
Pagets disease of bone is a rare condition in India and other Asian countries, although it is a common metabolic bone disorder in west. The disease affects elderly and exact etiology is not known. It clinically presents as longstanding bone pain and deformity. We report a case of pagets disease in India affecting humerus and presented with pathological fracture twice before being diagnosed as pagets disease. Fracture was treated conservatively and patient was started on alendronate. Patient responded favourably at the end of six months of treatment.text/html2011-02-27T18:49:16+01:00http://www.webmedcentral.com/Dr. Nasir MuzaffarLpsilateral Fracture of the Femoral Neck, Trochanter And Shaft: A Unique Case
http://www.webmedcentral.com/article_view/1628
Fractures of the femoral neck with ipsilateral femoral shaft fractures are relatively common. Ipsilateral fractures of the femoral neck and trochanter are rarely reported with just over a dozen cases reported so far. However, there is no report in literature which encompasses the ipsilateral fractures of the neck, trochanter and shaft in a patient. We report such a case for the rarity of the plethora of fractures in a single bone.text/html2011-03-02T19:01:42+01:00http://www.webmedcentral.com/Dr. Aravind s HampannavarPagets Disease of Humerus Presenting with Recurrent Fractures: A Case Report.
http://www.webmedcentral.com/article_view/1622
Pagets disease of bone is a rare condition in India and other Asian countries, although it is a common metabolic bone disorder in west. The disease affects elderly and exact etiology is not known. It clinically presents as longstanding bone pain and deformity. We report a case of pagets disease in India affecting humerus and presented with pathological fracture twice before being diagnosed as pagets disease. Fracture was treated conservatively and patient was started on alendronate. Patient responded favourably at the end of six months of treatment.text/html2011-03-16T22:22:00+01:00http://www.webmedcentral.com/Dr. Nasir MuzaffarConcomitant Ulnar Shaft and Humeral Condylar Fracture in a 6 Year Old Child
http://www.webmedcentral.com/article_view/1762
We present a case of a 6 year old child with a history of mild trauma to the elbow which turned out to have ipsilateral undisplaced ulnar shaft and humeral condylar mass fractures. The fractures were managed conservatively and the patient recovered without any residual deficit. This is a rare injury with only 5 similar cases reported in literature. It may be considered a Monteggia variant.text/html2011-03-30T10:39:41+01:00http://www.webmedcentral.com/Dr. Nasir MuzaffarBilateral Type 1 Radial Head Fractures in a Volleyball Player
http://www.webmedcentral.com/article_view/1812
Radial head and neck fractures are common in young to middle age adults and are seen in nearly 20 % of acute elbow injuries in this age group. Isolated radial head fractures are less common (nearly 2 % of all elbow fractures). Bilateral radial head fractures are rare and are mostly seen in situations when the patient has a fall on outstretched, supinated hands. The treatment of these fractures maybe conservative or operative, depending upon the degree of head comminution, the percentage of articular surface involved, presence of loose intra-articular fragments and angulation between the radial neck and proximal shaft. We present a patient with bilateral type 1 radial head fractures managed with brief immobilization followed by active physiotherapy and full, uneventful recovery.text/html2011-06-15T16:00:46+01:00http://www.webmedcentral.com/Dr. William KentShoulder Arthroplasty: Pioneers, Choices and Controversy
http://www.webmedcentral.com/article_view/1981
Shoulder arthroplasty is an important orthopaedic topic. This paper provides an introduction to the key issues, which will allow readers to approach the topic with confidence. A brief discussion of the history and development of shoulder replacements is included along with an outline of the indications and types of prosthesis available. The controversies and limitations of the evidence regarding the appropriate choice of prosthesis are also discussed to highlight the need for further research in this area. An outline of the rehabilitation procedure is presented because this vital part of the procedure is poorly covered in medical textbooks and curriculum.text/html2011-07-20T17:41:35+01:00http://www.webmedcentral.com/Dr. Nipun JindalFracture Dislocation of the Thoracic Spine : A Peculiar Mode of Trauma
http://www.webmedcentral.com/article_view/2033
Fractures and dislocations of the spine are a result of high energy impacts. The most common causes of spinal trauma are road traffic accidents and fall from height. The energy delivered to the spine and the magnitude and direction of forces that cause the injury determine the type of fracture that follows. We report a cause of non osteoporotic young spine dislocated by a trivial trauma.text/html2011-09-02T16:41:00+01:00http://www.webmedcentral.com/Dr. Nasir MuzaffarOsteotomy of the Tibial Tuberosity To Facilitate Removal of an Incarcerated Tibial Nail
http://www.webmedcentral.com/article_view/2142
Removal of orthopedic hardware is mostly easier said than done. Bony overgrowth, worn out screw threads and heads, stuck nails, broken implants and ingress of bone into all possible crevices of the implants make extrication difficult and exasperating for the surgeon. Of these, intramedullary nail removal is considered a routine procedure but may prove to be challenging. We present a case of a 32-year-old patient with an incarcerated tibial V- nail and describe a salvage procedure for tibia nail. It is imperative to discuss all the possible options with the patient prior to surgery. The patient usually considers the removal to be easier than the initial surgery and is usually unaware of the difficulties that can be encountered during removal and the fact that it may need a major procedure followed by a prolonged recovery time.text/html2011-09-05T18:10:22+01:00http://www.webmedcentral.com/Dr. Nasir MuzaffarLuxatio Erecta: A Rare Case of Inferior Dislocation of the Shoulder
http://www.webmedcentral.com/article_view/2156
Luxatio erecta humeri is an uncommon form of glenohumeral dislocation, resulting in the inferior displacement of the humeral head. The inferior dislocation of the shoulder is a rare injury that concerns only 0.5% of the total number of shoulder dislocations. Treatment with traction-counter traction techniques is usually successful in reduction of the humeral head. These cases maybe complicated by neurological deficits due to traction injury to the brachial plexus. We present such a case; there was axillary neuropraxia which was transient and the patient eventually made a full recovery.text/html2011-09-06T14:12:56+01:00http://www.webmedcentral.com/Dr. Nasir MuzaffarOpen Anterior Hip Fracture Dislocation in a Young Adult with Exposed Femoral Head: A Case Report
http://www.webmedcentral.com/article_view/2170
Anterior hip dislocations are seen infrequently as compared to posterior dislocations, comprising 12-18% of all hip dislocations. Anterior hip dislocation is commoner in younger adults and is due to high energy trauma such as high-velocity motor vehicle accidents or falls from great heights. Of these, open anterior hip dislocations are extremely rare and occur due to high energy trauma and are usually associated with other soft tissue and bony injuries. These dislocations have been reported just twice previously in literature in the adult age group. We report a case of an open anterior-superior hip fracture dislocation and associated acetabular fracture with normal neurovascular status.text/html2011-12-05T08:43:29+01:00http://www.webmedcentral.com/Dr. S SaseendarOutcomes and Complications of Fibular Head Resection
http://www.webmedcentral.com/article_view/2509
Fibular head is often resected for reconstruction of defects of the distal radius. However little is known on the safety of such a procedure. We aim to evaluate the long-term donor-site morbidity following proximal fibular resection.Patients and methods: Fourteen patients who underwent simple or marginal resection of the proximal fibula between 1990 and 2007 were reviewed. Subjective donor-site morbidity, knee and ankle range of motion and instability, sensory/ motor loss, gait, fibular regeneration were assessed.Results: Mean age at surgery was 25 years; 6 were male, 8 were female; mean follow-up was 11 years. Abnormal clinical findings were present in 10 patients (71.4%): nine patients (64.3%) had Grade 2 varus laxity at the knee confirmed by stress radiographs; one had sensory loss in the distribution of the superficial peroneal nerve. Patients with varus laxity had significantly higher mean age at surgery than those without varus laxity (p=0.001). None had deformity of knee or ankle; range of movements was normal; all had normal tibio-talar angle; none had proximal migration of fibula. One patient demonstrated near-complete regeneration of the fibula. Conclusion: Donor-site morbidity following simple and marginal resection of the proximal fibula is acceptable. Older patients had significantly higher risk of demonstrable clinical varus laxity. Proximal fibula resection in children appears to be safe, though a larger study is warranted before the results are extrapolated to larger populations.Keywords: fibular head resection, varus laxity knee, fibula regenerationtext/html2012-01-28T10:25:48+01:00http://www.webmedcentral.com/Dr. Iftikhar H WaniA Ganglion Cyst at the Foot Causing Tarsal Tunnel Syndrome Detected by Magnetic Resonance Imaging
http://www.webmedcentral.com/article_view/1130
Tarsal tunnel syndrome (TTS) is caused by compression of the posterior tibial nerve as it passes through the posterior tarsal tunnel. It is much more common in the posterior tarsal tunnel than in the anterior by compression of the deep peroneal nerve as it passes beneath the superficial fascia of the ankle [1]. TTS may be associated with exacerbation of symptoms at night, by exercise or rest, or by elevating or lowering the extremity, and symptoms confined to the lateral planter nerve, medial planter nerve, or medial calcaneal nerve [2]. Failure to diagnose and treat neuropathies effectively can cause permanent neuropathic pain and functional disability In most cases, TTS develops from unknown causes and can be treated conservatively. However, early surgical intervention is mandatory when neuropathy arises from a progressing occult pathology to avoid, repeated steroid injections, prescription of several medication for neuropathic pain, and to prevent permanent neuropathic pain. MRI and electromyography, together with clinical history and physical examination, can help to make the differential diagnosis.text/html2012-03-26T12:41:27+01:00http://www.webmedcentral.com/Mr. Muhammed R SiddiquiMetal on Metal Vs Other Bearing Surfaces in Total Hip Replacement
http://www.webmedcentral.com/article_view/1843
Hip replacements are one of the most commonest orthopaedic procedures performed with over 50,000 performed annually (1). The earliest known hip replacement was done in 1891 using an ivory ball joint and nickel screws (2).
In a total hip replacement, the hip joint is replaced by an artificial prosthesis.
Osteoarthritis (OA) is the main indication for a hip replacement and this was the primary diagnosis in 94% of hip replacement operations in England during 2005 (2). Other indications include rheumatoid arthritis, avascular necrosis and hip fractures. Women outnumber men by a ratio of nearly 2:1 for the over 65 age groupĀ (3).
OA is the most common form of arthritis and is a syndrome characterised by joint pain and varying degrees of functional limitation and reduced quality of life (QoL) (9). Common peripheral sites affected are the knees, hips and hand (9). Structural changes to the joints may occur without any symptoms and may involve all joint tissues. Pathological changes that occur include loss of articular cartilage and osteophyte formation (new bone formation) at joint sites (9). The effects on society and at an individual level can be substantial. It costs the UK economy over 1% of its gross national product per year and 36million lost working days amounting to over a Ā£3 billion loss (4).
The primary cause of OA is unknown. However, there are many secondary causes.
OA has numerous risk factors and these are split into three categories:
Genetic factors. This is thought to cause between 40-60% of hand, knee and hip OA (9).
Constitutional factors. This is ageing, female gender and obesityĀ (9).
Biomechanical risk factors. This includes joint injury, occupation and reduced muscle strength (9).
Many of the risk factors can be reversible or avoidable and thus reduce the risk of OA developing.
Over 8 million people in the UK are affected by joint pain which may be attributed by OA (5). Most people over the age of 60 will have radiological evidence for it even though they may be asymptomatic (13).
X-rays can confirm the presence of changes which would aid in the diagnosis of OA. These would typically show loss of joint space, osteophytes, subchondral scelerosis, and subchondral cystsĀ (6). Other investigations can include MRI and arthroscopy (13).Ā The NICE guideline development group considered a working diagnosis if a patient had persistent joint pain that is worse with use, aged over 45 and morning stiffness lasting no more than half an hourĀ (9).
All patients with OA should be assessed holistically. NICE recommends that before any pharmacological therapy is initiated, patients should be advised and educated on the physical measures that can be taken to prevent further OA. For obese patients, interventions that results in weight loss should be recommendedĀ (9).
Pharmacological intervention is aimed at reducing pain and patients should be offered paracetamol and/or topical NSAIDS. Patients could then be offered an oral NSAID with a proton pump inhibitor, COX-2 inhibitors or opioids. Intra-articular injections of corticosteroids have been found to be useful due to their anti-inflammatory effectsĀ (9).
Those patients who despite pharmacological intervention still experience symptoms that have a substantial effect on their QoL should be referred for joint replacement surgeryĀ (9).
OA of the hip has the worst outcome compared to the knees or hands as a significant number of people will need a hip replacement within 1 to 5 years. However some hips do heal spontaneously with improvements in radiographic appearances and symptomsĀ (9).
Hip replacements can either be a total hip arthroplasty or a hemiarthroplasty.Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā
Total hip arthroplasty involves replacement of the articular surfaces of the acetabulum and replacement of the femoral head and neck. During a resurfacing total hip arthroplasty, only the surface of the femoral head is replaced (11).
For a total hip arthroplasty indications include:
Pain and disability due to degenerative osteoarthritis or inflammatory arthritis where other non surgical methods have failed.
Fracture of the proximal femur in particular the intra-capsular part of the neck (8).
Young patients with osteoarthritis and good bone stock may be considered for a resurfacing total hip arthroplasty as this has the advantage of preserving the femoral neck for any future surgery when the patient outlives the prostheses (5).
A variety of prostheses are used and include metal, polyethylene and ceramic. Fixation methods include polymethylmethacrylate cement, screw fixation, cementless press fit and porous ingrowth fixation (9).
There are more than 60 prostheses available to the NHS with the costs varying greatlyĀ (5). Due to variation in prostheses design, they are classified into whether they are cemented, uncemented or hybrid (cemented stem with a cementless cup) (10).Ā Ā Approximately 90-95% of prostheses used in hip replacements are cementedĀ (5). NICE recommends to use the best prostheses available which have a revision rate of 10% or less at 10 yearsĀ (5).
Infection and loosening of the prostheses are the most serious common complications (11). However, the complication rate for hip replacements is around 1% (13).Ā Furthermore, the 30 day mortality rate is about 0.5% Ā (12).text/html2012-05-14T12:23:12+01:00http://www.webmedcentral.com/Dr. Iftikhar H WaniUnreamed Solid Locked Nailing in the Treatment of Compound Diaphyseal Fractures of Tibia
http://www.webmedcentral.com/article_view/3372
This is a prospective study based on 30 cases of compound tibial diaphyseal fractures fulfilling our inclusion criteria and stabilised with primary unreamed solid AO tibial locked nailing with a follow up ranging from 6-18 months. Open fractures were classified as per Gustillo’s. Road traffic accidents were responsible for most of the fractures(80%) followed by fall from height(10%). All the fractures united in an average period of 22weeks. As per criteria laid down by Johner & Wruhs 40% cases had excellent result, 50% good results, 10% cases fair & none had poor result.
On the basis of above study it was concluded that unreamed solid AO locked nailing is a good mode of primary internal fixation of compound fractures of tibia(grade I-IIIB) and has proved to be a one time procedure, which allows early weight bearing, minimises the chances of infection and delayed union.text/html2012-07-31T18:27:28+01:00http://www.webmedcentral.com/Dr. Arndt P SchulzDetermination of Material Properties Related to Quantitative CT in Human Femoral Bone for Patient Specific Finite Element Analysis - A Comparison of Material Laws
http://www.webmedcentral.com/article_view/3456
Aim of this study was the determination of transverse-isotropic elastic properties of the human femoral diaphysis and the evaluation of density-elasticity laws from literature with the acquired data. Five specimens of cortical bone were extracted from human cadaveric femora and mechanically tested via three point bending and compression tests, in order to determine the Young’s modulus in proximal-distal and in transverse direction respectively. Bone mineral density was determined via quantitative Computed Tomography for all samples and material properties were calculated according to the available regression laws from literature. Deviations of the calculated and experimentally determined Young’s moduli were analyzed. Some elasticity density laws showed good correlation to the acquired data in anterior-posterior direction, such as the law of Morgan et al. (2003) and the law of Carter & Hayes (1977). The results indicate high importance of an adequate determination of bone mineral density.text/html2012-06-20T21:07:11+01:00http://www.webmedcentral.com/Dr. Fadwa ChamiBipartite Patella: Two Cases Reports
http://www.webmedcentral.com/article_view/3501
Kneecaps bipartite are defined as being a single kneecap the nucleus of secondary ossification of which did not merge with the rest of the kneecap. Some etiology are evoked. The patella bipartite is classically asymptomatic. The treatment is initially orthopaedic who can become surgical with satisfactory results. We bring report two cases of patella bipartita admitted in the service of surgery "B" of children's Hospital of Rabat-MORROCCO.text/html2012-06-27T19:10:16+01:00http://www.webmedcentral.com/Dr. Najib AlidrissiChondromatoses the of the large joints (A Report of 8 cases)
http://www.webmedcentral.com/article_view/3525
We report eight cases of chondromatosis of the knee treated surgically. The aim of our work is to attract the attention of clinicians on the importance of early detection of disease to prevent progression of osteoarthritis. the therapeutic decision was facilitated by the use of the classification of Milgram. We observed superiority of arthroscopy compared to open surgery.text/html2013-02-14T06:35:54+01:00http://www.webmedcentral.com/Dr. T SanthamoorthyProximal Femoral Nailing for Unstable Trochanteric Functional Scores and Complications: A Prospective Study
http://www.webmedcentral.com/article_view/2805
Purpose: The purpose of the study was to assess the functional outcome and complications pertaining to unstable trochanteric fractures treated by proximal femoral nailMethods: 11 consecutive unstable type of intertrochanteric and subtrochanteric fractures were selected prospectively between 2007 to 2009 after excluding patients with Comminution at the entry point in greater trochanter, Severe co morbidities precluding anesthesia and Open fractures. Parker and palmer mobility score, Barthel index and Salvati-Wilson hip scoring system were used for functional assessment.Results: The mean Parker & Palmer score was 8.1.The Barthel Index at 6 weeks and 3 months were 70 and 90. All patients had excellent or good functional hip scoring according to Salvati-Wilson hip scoring system. Implant related complications occurred in 3 patients.Conclusion: Proximal Femoral Nail is a better implant for unstable type of intertrochanteric and subtrochanteric fractures as our study shows excellent and good functional results with acceptable implant related complications.text/html2012-10-05T17:38:33+01:00http://www.webmedcentral.com/Mr. Chetan S ModiCompliance with Sleep Instructions After Total Hip Arthroplasty
http://www.webmedcentral.com/article_view/2164
Background
The aim of this study was to prospectively investigate the patient-reported compliance and effects upon sleep quality of postoperative sleep protocols after primary total hip arthroplasty.
Materials and Methods
All patients attending their 12-week follow up appointment after primary total hip arthroplasty were recruited during the study period. Patients completed a self-reported questionnaire regarding compliance with the postoperative sleep protocol, details regarding reasons for non-compliance and complications experienced.
Results
Fifty-four patients were recruited and completed questionnaires at their 12-week follow-up. Only 18 (33%) patients were able to sleep supine for the full 12-week period without difficulties. Twenty-four patients slept supine for a mean period of 6.8 weeks and reported discomfort and inability to sleep. There were no significant complications within this study group in association with non-compliance.
Conclusion
We believe that this study has highlighted a significant problem experienced by patients undergoing primary total hip arthroplasty which requires further investigation as to whether specific sleeping instructions are necessary in the postoperative period.text/html2012-10-06T17:30:52+01:00http://www.webmedcentral.com/Mr. Chetan S ModiOffice-based Versus Radiologist-based Ultrasonography for the Diagnosis of Rotator Cuff Tears
http://www.webmedcentral.com/article_view/3756
Aim
The aim of this systematic review is to compare the accuracy of ultrasonography in the diagnosis of rotator cuff tears between office-based scanning by an orthopaedic surgeon and scanning by a specialist trained radiologist.
Methods
A literature search using multiple databases was performed with eligible studies being critically appraised using a validated scoring system and data pooling performed where appropriate.
Results
Seventeen studies with varying sample sizes and quality were identified. Ultrasonography was performed within the clinic setting in eight studies and by radiologists in nine studies. The best evidence within both the office-based (level 1b) and radiology department (level 2b) settings suggests that ultrasonography is a powerful tool for ruling in and ruling out full thickness (FT) tears. The best evidence for the detection of partial thickness (PT) tears (level 1b) suggests that ultrasonography is able to rule in these tears but less predictable at ruling them out with better results when performed by a radiologist (level 2b).
Conclusion
The systematic review suggests that ultrasonography is a powerful tool for the diagnosis of rotator cuff tears. The audit within the upper limb unit identified deficiencies in the detection of FT tears which requires further investigation as to the possible reasons. The evidence suggests that scanning performed within the clinic setting may improve the identification of FT tears to enable appropriate counselling of patients and treatment planning.text/html2012-12-11T13:41:53+01:00http://www.webmedcentral.com/Dr. Prafulla G HerodeIntramedullary Nailing Of Fibrous Dysplasia Of Femur-A Case Report
http://www.webmedcentral.com/article_view/3882
Introduction: Fibrous dysplasia—a benign, nonfamilial disorder characterized by the presence of expanding intramedullary fibro-osseous tissue in one or more bones. The incidence of fibrous dysplasia is not known, but it is not an uncommon primary bone tumor. It occurs more frequently in girls than in boys.
Case report: A 14 year male who had experienced intermittent hip pain since childhood with progressive deformity in right thigh and limping. After a trivial fall he experienced severe pain with segmental fracture right femur, who responded well after osteotomy and internal fixation with kuntscher nail. Herein, we report this case for the rarity of its occurrence.
Conclusion: Bone curette and multiple level ostetomy internally fixed with kutscher nail can be kept in mind as a effective treatment modality for treating fibrous dysplasia of femur.text/html2012-12-19T17:31:26+01:00http://www.webmedcentral.com/Dr. Rahul P MehtaComparative Study of Treatment of Proximal Femoral Fractures in Elderly Osteoporotic Patients with PFN Vs Cemented Hemiarthroplasty Based on Pre-operative Traction Reduction and Grade of Osteoporosis- 50 Cases
http://www.webmedcentral.com/article_view/3900
Context: Most Inter-trochanteric fractures occur in elderly people (above 65 yrs) with high mortality rates. Problems with osteoporotic bone fractures includes geometry (grossly comminuted), high instability and difficult to treat. Conservative treatment in such patients demanding prolonged immobilization lands up with complications.
Aim: To study the efficacy of PFN Vs Cemented Hemiarthroplasty in proximal femoral fractures in elderly patients with severe osteoporosis.
Methods and Material: We prospectively compared the two modalities viz. PFN & cemented hemi-arthroplasty. Modality used depends upon two criteria: 1) Singh index & 2) reducibility and alignment achieved with skeletal traction. Patients with Singh index >3 and with traction x-ray showing reducible fracture and good alignment were treated with PFN. Patients with singh index <3 & with traction x-ray showing irreducible and unstable fracture and not showing good alignment were treated with cemented hemi-arthroplasty.
Results: Total 50 cases with mean age of 79.5 yrs. Mean Harris hip score 78.28 for PFN and 76.84 for Hemiarthroplasty. Mean intra-operative blood loss 530 ml in hemi-arthroplasty and 180 ml in PFN cases. 4 cases died of medical complications earliest being 3 months and late being 18 months. 2 hemi-arthroplasty cases had superficial infection treated with oral antibiotics and 1 case of screw back-out due to collapse in PFN case treated with revision surgery with cemented hemi-arthroplasty. Mean time for radiological union for PFN cases was 12.04 weeks.
Conclusions: By following the above mentioned criteria we can treat IT fractures with either PFN or cemented Hemiarthroplasty with equally good results.text/html2012-12-27T10:36:43+01:00http://www.webmedcentral.com/Dr. Faiyaz KhanPathological Fracture of Femur - A Case Report
http://www.webmedcentral.com/article_view/3917
Background: Fractures of the subtrochanteric region of the femur provide several challenges to the operating surgeon due to anatomic and biomechanical peculiarities inherent to this region. These challenges are compounded several times in a severely osteoporotic bone.
Case presentation: We report a case of pathological fracture following Vitamin D3 deficiency. The patient had sustained a subtrochanteric fracture of left femur & incomplete fracture of right tibia which was managed with a DHS (Dynamic Hip Screw) and PTB (Patella Tendon Bearing) cast respectively for the two different fractures.
Conclusion: This highlights the fact that pathological fracture can be due to Vitamin D3 deficiency, but needs to be differentiated from other causes of pathological fracture like infection or neoplastic conditions. While DHS provides a viable alternative in the management of fractures of the subtrochanteric region of femur in severe osteoporosis, incomplete fracture of tibia can be treated with PTB cast.text/html2012-12-31T18:27:17+01:00http://www.webmedcentral.com/Dr. Furqan R MirMaffucci Syndrome- A Rare Case Report.
http://www.webmedcentral.com/article_view/3919
A 30 year male presented with multiple swellings of both hands which he noticed at the age of 4. On examination both his hands had firm, non-tender, multiple swellings, making it difficult for him to make fists. He had multiple diffuse bluish compressible swellings on both forearm. X ray confirmed multiple enchondromas in both hands. Large tumors in both hands were curetted. Soft tissue swelling from forearm was also excised. Both the specimens were sent for Histopathological Examination. One piece of forearm swelling was harder and was x-rayed which confirmed a calcified tissue as phelebolith. Histopathlogical report confirmed the presence of spindle cell haemangioendothelioma with enchondromas; the two pathlogical entities associated with Maffucci syndrome.text/html2013-02-15T12:37:06+01:00http://www.webmedcentral.com/Dr. Om P LakhwaniOsteomyelitis of Pubis Unusual Complication and Dilemma
http://www.webmedcentral.com/article_view/4030
Osteomyelitis of pubic symphysis and Osteitis pubis are rare complication of surgery around inguinal and groin region. Both entities commonly confused with each other. Rarity of condition nonspecific signs and symptoms has leaded to misdiagnosed, undiagnosed and delay in the management. Tubercular osteomyelitis of the symphysis pubis is very unusual and the clinical presentation can resemble osteitis pubis and osteomyelitis pubis. We have reported such unusual case and discuss early recognition of such condition and management.Key Messages: Pain in groin and syphyseal tenderness after hernia repair warrant careful examination and skigram to rule out osteitis/ osteomyelitis pubis and its prompt treatment.text/html2013-08-26T05:27:20+01:00http://www.webmedcentral.com/Dr. Sanjay S DeoSciatica due to Osteochondroma of Proximal Femur: A Case report
http://www.webmedcentral.com/article_view/4379
A 68 year old female patient presented with bony swelling on the proximal part of the posterior aspect of thigh from childhood, Since 6 months she started complaining tingling and numbness in distribution of sciatic nerve. The X ray and later the MRI confirmed it to be Osteochondroma. The surgical excision of the osteochondroma confirmed the diagnosis histopathologically. Post operatively patient was relieved of all symptoms and recovered uneventfully.text/html2013-09-02T04:08:58+01:00http://www.webmedcentral.com/Dr. Carlos G. RubinRadiographic Evaluation of Glenoid Components and its Survivorship
http://www.webmedcentral.com/article_view/4386
Introduction: This study evaluated the survivorship of pegged versus keeled cemented, all-polyethylene glenoid components using modern cementing and glenoid preparation techniques. Survival of glenoid design was determined according to severity of radiolucencies on follow-up radiographs.
Methods: Between April 22, 1999, and February 17, 2009, retrospective chart review was performed on 194 total shoulder arthroplasties. A minimum of 3-year follow-up was established. Scapular plane anteroposterior radiographs (Grashey view) were analyzed and graded for the degree of radiolucency surrounding the glenoid anchor using Franklin’s method for keeled components and a modification of that method for pegged components. Radiographs were evaluated by 3 raters. Unpaired 2-tailed t-test was used to calculate significance, p < 0.05. Interobserver correlation was computed using the intraclass correlation coefficient (ICC) 2-way mixed model with measures of absolute agreement to analyze the measurement reliability. Values of ICC range from 0 to 1, with a higher value indicating better reliability. Active forward elevation (AFE) and active external rotation (AER) were recorded before and after surgery. The range of motion scores for pegged glenoids was compared to keeled glenoids, as well as grading lucency from 0-1 to >1 lucency.
Results: Fifty-two total shoulders met the inclusion criteria, with 36 pegged glenoid components and 16 keeled components. Average length of follow up was 67 months. Average radiolucency was 1.01 on a modified Franklin scale of 0 to 5 in the pegged glenoid component group, compared to 1.90 in the keeled group, (p<0.01). Interobserver correlation coefficient was 0.31. For the pegged group, AFE increased from 123° to 150°, and AER increased from 24° to 59°. For the keeled group, AFE increased from 105° to 148°, and AER increased from 14° to 59°. For grade 0-1 lucency, AFE increased from 120° to 151°, and AER increased from 20° to 56°. For grade >1 lucency, AFE increased from 114° to 148°, and AER increased from 21° to 61°.
Conclusions: Significantly greater component survival was found with pegged as opposed to keeled anchoring design. Poor interobserver reliability was noted. There did not appear to be a difference in range of motion between pegged and keeled glenoids or with respect to degree of radiolucency.text/html2014-01-07T05:23:48+01:00http://www.webmedcentral.com/Dr. Jeewan S PrakashMicrocellular Rubber Insole in Management of Knee Osteoarthritis
http://www.webmedcentral.com/article_view/4505
Orthotic devices inside footwear have been used for long for various indications . Literature is available comparing shoe insoles made of various materials. We present our observations from a prospective study wherein for the first time microcellular rubber insoles were prescribed and used by 44 patients afflicted with osteoarthritis in 84 knees . Outcome analyses were based on WOMAC’s index. The preliminary study on management of knee OA using microcellular rubber insoles bore effective and encouraging results.
Key words: Microcellular rubber, insoles, knee osteoarthritis, WOMAC scoretext/html2014-01-07T07:08:18+01:00http://www.webmedcentral.com/Dr. Jeewan S PrakashComputer Usage and Musculoskeletal Disorders [MSD\'s]
http://www.webmedcentral.com/article_view/4506
Wide spread usage and heavy dependence on computers and computer based gadgets and life styles have given rise to a number of musculoskeletal disorders [MSD’s] associated with computer usage. These health problems are not yet described in standard text books for their etiological association with computer usage.On one hand not many orthopaedists are aware of these conditions, on the other, very few studies have been carried out. The studies are on computer professionals and university students. Needs are felt for studies on other subpopulations and for sensitization of treating health care professionals.text/html2014-02-07T10:48:19+01:00http://www.webmedcentral.com/Dr. Shreerang JoshiLaser Assisted Arthroscopic Surgery for Bilateral Psoriatic Arthropathy of Knee in a Middle Age Housewife
http://www.webmedcentral.com/article_view/4547
Joint involvement is common in patients with Psoriasis. Although the mainstay of treatment is drug therapy, we may be required to intervene surgically in patients with florid, painful synovitis. This is done to obtain pain relief and functional improvement, as also to prevent destruction of articular cartilage by the synovial invasion. This philosophy is similar to what we use in Rheumatoid Arthritis.Obviously now, Arthroscopic surgery is the method of choice and we do not even discuss the possibility of an open debridement of the joint, as was done in the past. However, in Rheumatoid as well as in Psoriatic arthritis, the major problem is the extreme vascularity of the diseased tissue, leading to reactionary post-operative haemorrhage when we use conventional operating tools. This can compromise the rehabilitation process to a large extent.With the advent of LASER, this issue is taken care of. We can now hope for rapid return to function, provided we intervene early, provided the articular cartilage is largely intact and if we can ensure excellent control of disease with drug therapy.We present a typical case of bilateral knee involvement in Psoriasis in a middle-aged housewife to clearly illustrate the benefit of using modern surgical modalities.text/html2014-02-21T15:08:33+01:00http://www.webmedcentral.com/Dr. Jeewan S PrakashMusculo skeletal Disorders associated with Computer Usage among Healthcare College Students : A preliminary report
http://www.webmedcentral.com/article_view/4560
Musculoskeletal disorders [MSD’s] following computer usage comprise a broad array of conditions: some well defined repetitive stress like conditions and others still being identified and investigated for their etiologic association. Available literature reports studies carried out mostly on IT or computer students or professionals and university/college students. We report our observations on healthcare students from 4 constituent colleges at Christian Medical College, Ludhiana, India.
text/html2014-05-12T10:28:56+01:00http://www.webmedcentral.com/Dr. Arockia X DossCase Series Report: Ultrasound Guided Autologous Liquid Platelet Rich Plasma - A new treatment option for Complex Regional Pain Syndrome and Reflex Sympathetic Dystrophy?
http://www.webmedcentral.com/article_view/4621
Complex Regional Pain Syndrome (CRPS) is a poorly understood and treated pain syndrome that typically occur after limb trauma. CRPS affects the peripheral nervous system with dysregulation of the sympathetic system, aberrant inflammation, vasomotor dysfunction and poorly adapted neuroplasticity. This report describes two female patients aged 37 and 46 years, disabled with CRPS Type 1 and 2 for about 10 months and 60 months duration respectively, subsequent to ankle injury. They were treated with ultrasound guided autologous liquid photo activated platelet rich plasma (PAPRP) and were followed up for 3 months and 13 months respectively. There was meaningful clinical improvement in pain, restoration of peripheral neuropathy and striking improvement in sympathetic dystrophic symptoms of nocturnal swelling and skin discolouration. Possible mechanisms of action of PAPRP in CRPS include correction of sympathetic dysregulation, neoangiogenesis, neuropeptide and cytokine mediated anti-inflammatory effect, neural regeneration and macrostructural augmentation of damaged cartilage and ligaments. There is an urgent need for large studies to evaluate the safety and efficacy of PRP in CRPS.text/html2014-05-14T08:29:44+01:00http://www.webmedcentral.com/Dr. Bassir Rida AllahAvulsion of anterior tibial tuberosity in a young athlete: Case report and literature review
http://www.webmedcentral.com/article_view/4591
Avulsion of the anterior tibial tuberosity is a rare injury. When they do occur, it is usually in an adolescent athletic male. The age range of the injury corresponds to the time of growth plate closure and maturation of the ?bro-cartillagenous attachment of the tuberosity. We report a case of 17-year-old sports amateur, who presents an avulsion of the anterior tibial tuberosity, treated by surgery. Epidemiologic, etiopathogenic, therapeutic and pronostic aspects are analysed.text/html2014-05-19T06:07:21+01:00http://www.webmedcentral.com/Dr. Aniss ChagouBrachial Plexus Palsy Secondary to False Axillar Aneurysm
http://www.webmedcentral.com/article_view/4637
The etiologies of brachial plexus palsy are numerous. In adults, they are dominated by blunt trauma and wounds. We report the case of a 20 year-old patient who consulted for left upper limb palsy lasting for four months without notion of trauma. The etiologic investigation identified a false compressive aneurysm of the axillary artery secondary to Behcet
The etiologies of brachial plexus palsy are numerous. In adults, they are dominated by blunt trauma and wounds. We report the case of a 20 year-old patient who consulted for left upper limb palsy lasting for four months without notion of trauma. The etiologic investigation identified a false compressive aneurysm of the axillary artery secondary to Behcet's disease. The developer mode and the rarity of this etiology incited us to report this interesting observation.text/html2014-05-19T05:15:02+01:00http://www.webmedcentral.com/Dr. Pablo G. RubinIntertrochanteric fracture after Hip Resurfacing Arthroplasty: Successful non operative treatment
http://www.webmedcentral.com/article_view/4638
Traumatic periprosthetic fractures adjacent a Hip Resurfacing Prosthesis are rare, and their treatment is, at times, challenging. We present a case report of a 55-year-old patient who sustained a traumatic intertrochanteric hip fracture 6 years after hip resurfacing and our successful non operative management. The patient has returned to his normal level of activities and the prosthesis is reatined and well fixed. We have shown that non operative treatment may be a good option for non displaced intertrochanteric fractures and those where a stable anatomical reduction can be obtained.text/html2015-02-07T07:13:06+01:00http://www.webmedcentral.com/Dr. Raghavendra S KembhaviOld un reduced posteromedial elbow dislocation: A rare case report
http://www.webmedcentral.com/article_view/4823
Posteromedial elbow dislocation is a rare injury when compared to posterolateral elbow dislocations.In developing countries like India old unreduced dislocations are not uncommon due to lack of medical facilities in villages. When elbow dislocation are old, management options include conservative, closed or open reduction, arthrodesis, excision arthroplasty and total elbow replacement. Treatment option depends mainly duration of injury, available functional range of movement and nature of articular surfaces. This is a case report of such old unreduced elbow dislocation which was posteromedial in 49 year old female who initially got treated with traditional bonesetter resulting in stiffness and pain . We managed patient with open reduction of elbow through posterior approach and strict postoperative rehabilitation. Functional assessment with Mayo Elbow Performance Score showed excellent results. text/html2015-02-24T10:52:36+01:00http://www.webmedcentral.com/Dr. Tushar AhluwaliaHow debridement, definitive fixation and final coverage determine the infection rate in grade III B open fractures of long bones managed with primary internal fixation
http://www.webmedcentral.com/article_view/4839
The management of grade III open fractures remains controversial. While the time tested external fixators have their advantages of ease of application and facilitating repeated debridements in extensive uncovered open wounds, their use has been marred with pin tract infections, delayed union, non-union, joint stiffness and patient discomfort. Advantages of internal fixation include access for soft tissue care, secure control of alignment and rotation and early weight bearing. But surgeons have feared using internal fixators in grade III open wounds for the risk of deep infection. With lack of adequate data regarding time to first debridement, number of debridements, time to definitive fixation, mode of final coverage and time to coverage affecting the final infection rate, this study plans to study these variables in the use of internal fixation in grade III B open fractures of long bones.text/html2015-02-26T06:59:57+01:00http://www.webmedcentral.com/Dr. Tushar AhluwaliaRole of antibiotics and cultures in decreasing infection rate in grade III B open fractures of long bones managed with primary internal fixation
http://www.webmedcentral.com/article_view/4841
The management of grade III open fractures remains controversial. While the time tested external fixators have their advantages of ease of application and facilitating repeated debridements in extensive uncovered open wounds, their use has been marred with pin tract infections, delayed union, non-union, joint stiffness and patient discomfort. Advantages of internal fixation include access for soft tissue care, secure control of alignment and rotation and early weight bearing. But surgeons have feared using internal fixators in grade III open wounds for the risk of deep infection. With lack of adequate data regarding time to first debridement, number of debridements, time to definitive fixation, mode of final coverage and time to coverage affecting the final infection rate, this study plans to study these variables in the use of internal fixation in grade III B open fractures of long bonestext/html2015-04-24T12:04:12+01:00http://www.webmedcentral.com/Dr. Raghavendra S KembhaviA rare injury of posterior four part fracture dislocation of shoulder following electrical injury- Did infection had role in humeral head salvage?
http://www.webmedcentral.com/article_view/4883
Posterior dislocation of shoulder and fracture dislocations are rare injuries. Seizure disorders, high energy trauma and electrical shock are important etiologies for such injuries especially in bilateral cases. In four part fracture dislocations and in electrical shock injuries, chances avascular necrosis of humeral head is really high. In this article, we report posterior four part fracture dislocation of shoulder with anatomical neck completely displaced posteriorly following electrical shock in 36 year old female.Patient was operated with open reduction and internal fixation with minimal implants. Patient developed infection postoperatively with methicillin resistant staphylococcus aureaus(MRSA) and emergency debridement was done. Four month postoperative, infection healed completely and radiology showed partial union of fractures with no signs of humeral head avascular necrosis.Constant-Murley Clinical Method of Functional Assessment of the Shoulder showed a average score of 54(out of 100) at four months. There have been reports on infections leading to increased bony vascularity and hence we assume that infection might had a role in humeral head salvaging as seen in our case.text/html2015-07-27T09:37:51+01:00http://www.webmedcentral.com/Dr. Qazi ManaanThe effect of pharmacological management on the recovery of patients with acute low back ache
http://www.webmedcentral.com/article_view/4944
Background: Back pain affects about 40% of people at some point in their lives. Medications are recommended for the duration that they are helpful. The symptoms of low back pain usually improve within a few weeks from the time they start. Our study was undertaken to study the effect of analgesics in the management of pain, as well as overall and complete recovery of patient and the return to normal life.
Methods: Our study is a randomised controlled trial involving 40 people with severe acute lower back ache, who were divided into 2 groups of 20 each and were observed over 6 weeks for pain relief and return to normal activities.
Results: The duration of moderate or severe pain was on an average 4.1 days in analgesic group and 6.3 days in placebo group. But the time to total relief from pain (even mild) was almost the same in both groups (2w6d and 2w3d). The time to return to normal activities was also almost the same.
Conclusions: Though pain killers may be useful in the management of moderate to severe pain, their role in mild pain is less obvious and their usefulness in returning the patient to normal routine is also not obvious.text/html2015-07-28T11:37:59+01:00http://www.webmedcentral.com/Dr. Irfan MalikBilateral Total Hip Arthroplasty in a case of unusual presentation of fibro Cartilagenous Dysplasia of Bilateral Proximal Femur
http://www.webmedcentral.com/article_view/4943
Fibro cartilagenous dysplasia is a variant of fibrous dysplasia in which extensive cartilage differntiation is seen.Fibrous dysplasia is an anomaly in skeletal development accounting approximately 5 to 7 percent of all benign bone tumors,resulting in defective bone forming mesenchyma leading to defective osteoblastic differentiation and maturation.It exists in two forms ,monoostotic and poly ostotic fibrous dyspalsias whereas fibrocartilagenous dysplasia occurs commonly in polyostotic form.It commonly occurs in proximal femur at metaphyseal areas i.e intertrochentric regions ,sub trochantric region and neck.Due to repeated micro fractures at these sites various deformities like shepherd crook deformity can occur.It usually doesnot involve the epiphyseal region of head of femur.we are presenting a case of fibrocartilagenous dysplasia of bilateral proximal femora involving the neck and extending upto the articular surface of head of femur ,which is an unusual site and bilateral total hip arthroplasty was performed in this case.text/html2015-07-30T11:27:50+01:00http://www.webmedcentral.com/Dr. Qazi ManaanImmediate and early injuries associated with traumatic posterior hip dislocation: A retrospective study.
http://www.webmedcentral.com/article_view/4951
Traumatic dislocation and fracture-dislocation of the hip is an orthopaedic emergency. A delay in recognition and reduction leads to grave complications and morbidity.
We undertook a retrospective study of 1 year and found 37 patients with posterior dislocation of the hip. Hospital records were studied for immediate and early complications and associated injuries.
Our study found that a high percentage of patients with posterior dislocation of hip had an associated significant injury, also requiring urgent attention at least, if not urgent management.text/html2015-08-11T10:05:19+01:00http://www.webmedcentral.com/Dr. Jeewan S PrakashAcross wrist external fixation for distal radius fractures in adults
http://www.webmedcentral.com/article_view/4959
Distal radius fractures , closed or open , are common upper limb injuries . Many classifications help understand them from different perspectives including correlations and comparisons between various management modalities , their outcome , complications etc . Over a period of 5 years 32 adults with 35 distal radius fractures managed with 35 across wrist external fixators were followed up for an average period of 85.9 weeks [1.65yrs] in a retrospective and prospective study.text/html2015-09-15T13:44:35+01:00http://www.webmedcentral.com/Dr. Irfan MalikComparative study of management of distal femoral fractures managed by dynamic condylar screw and distal femoral locking compression plate
http://www.webmedcentral.com/article_view/4976
Background:Distal femoral fractures are much less common than hip fractures and account for 7% of all femoral fractures. Distal femoral fractures are difficult to treat and ideal treatment of such fractures will include anatomical reduction, rigid fixation of articular surfaces and early mobilization of knee joint. Our study aims to compare the outcome of fifty distal femoral fractures which were treated by two different implants i.e dynamic condylar screw and distal femoral locking compression plate.
Materials and methods : Fifty consecutive patients were included in the study with minimum follow up of one year, twenty five of them were managed by surgery with dynamic condylar screw, so they were placed in group A i.e DCS group and another twenty five patients were managed by surgery with distal femoral locking compression plate hence placed in group B i.e DFLCP group. The assessment of result was done with criteria laid down by Schatzker and Lambert which was based on the union of fractures, amount of range of motion of knee joint and by assessing the complications of each implant
Results: In the present study, in both the DCS and DFLCP groups showed 76% of patients with good or excellent results.
Based on type of fracture,for Type-A fractures, in DCS group total of 91% patients had good to excellent results, whereas in DFLCP group, total of 80% patients showed good to excellent results.
For Type-B fractures, in both DCS and DFLCP group total of 80% of cases had good to excellent results.
For Type-C fractures, under DCS group, 55% cases had good to excellent results and in DFLCP group 70% patients had good to excellent results.
Conclusion It was concluded that dynamic condylar screw and distal femoral locking plate have similar results except that distal femoral locking plate is better in comminuted distal fractures.text/html2015-09-15T13:59:44+01:00http://www.webmedcentral.com/Dr. Irfan MalikTranstibal versus anteromedial portal technique of arthoscopic Anterior cruciate ligament Reconstruction:A Prospective Randomised Trial
http://www.webmedcentral.com/article_view/4977
Background. Although the true natural history remains unclear, ACL disruptions are functionally disabling, they predispose the knee to subsequent injuries such as tears of the menisci, and they are associated with the early onset of osteoarthritis.The objective of the study is to compare the results of ACL reconstruction by two different techniques i.e anteromedial portal technique and transtibial technique.
Material and Methods The study was conducted on 60 clinico radiological cases of ACL tear which were rendomly divided into two groups,half of them were operated by anteromedial technique(AMP) and another half by transtibial technique(TT) of ACL reconstruction.Assesment was done preoperatively and immediate postoperatively by clinical examination of the knee, Lysholm score, IKDC scale and MRI.Follow up assesment was done by knee examination, Lysholm score and IKDC scale.Results The difference between mean Lysholm score and IKDC scale after 12 to 17 months of follow up was not statistically significant.The pivot shift test was negative in all cases in both TT and AMP group whereas Lachmans test was negative in 77 % of TT group patients and 80% of AMP group patients. On post op MRI mean inclination angles of ACL in sagittal view were 53.22º in normal knees, 55.85º in TT and 53.81º in AMP group of patients. And in coronal views they were 72.77º, 77º and 70.63º in normal, TT and AMP group respectively. In both sagittal and coronal views the difference between normal and TT group, and TT vs AMP group was significant. But it was not statistically significant between normal and AMP group.Conclusion post operative mri showed that TT produces more vertical and non anatomical tunnel whereas AMP produces more anatomical tunnel but the difference in functional score was statistically not significant.Therefore this study doesn’t guarantee the superiorty of one technique over the other.text/html2015-09-21T13:36:37+01:00http://www.webmedcentral.com/Dr. Irfan MalikCongenital incomplete failure of separation of Proximal Phalanx of middle & ring finger: An Unknown case
http://www.webmedcentral.com/article_view/4980
Complex syndactyly or Synostosis can be described as a condition in which inter digital bony fusions is seen.. We are presenting a case of synostosis of proximal phalynx of third and fourth finger. Synostosis of distal phalynx of hand is described in literature but synostosis of proximal phalynx of hand has not been mentioned in the literature.text/html2015-10-26T11:24:32+01:00http://www.webmedcentral.com/Dr. Mohit K JindalTuberculous Dactylitis Presenting as a pathological Fracture a case report
http://www.webmedcentral.com/article_view/4994
Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and manifested by formation of granulomas associated with caseous necrosis in tissues. In the musculoskeletal system, Tuberculous Spondylitis is the most typical form of the disease; however joint changes in extraspinal sites such as the hip, knee, wrist and elbow also may occur. Tuberculosis of the metacarpals, metatarsals and phalanges is an uncommon disease. Tuberculous infection of metacarpals, metatarsals and phalanges is known as Tuberculous Dactylitis. There is a spindle shaped expansion of the short tubular bones due to tuberculous granuloma. Hence it is also known as SpinaVentosa (spina ventosa derives from spina = short bone and ventosa =expanded with air).
In our case a 8 year old male presented to us with an isolated swelling in his Rt little finger associated with a sinus and skin excoriation and active discharge since 3 months. This entity is very rare in children more than 5 years of age but in the Indian context possibility for the same is to be considered . FNAC of the swelling was done which yielded granulomas, lymphocytosis against a background of caseous necrosis, a typical picture seen in Tuberculosis. A diagnosis of Spina ventosa was made.text/html2015-11-10T08:16:23+01:00http://www.webmedcentral.com/Dr. Mohit K JindalUse Of Deep Freezeed Allogenic Bone Graft In Management Of Proximal Humerus Cystic Lesion With Pathological Fracture.
http://www.webmedcentral.com/article_view/4996
Pathological fractures do commonly follow cystic lesions of humerus such as unicameral bone cyst and aneurysmal bone cyst. Proximal humerus is the most common site for unicameral bone cyst with 85% of cases occuring in the first two decades of life of which 2/3rd of patients presenting with pathological fracture.1 Aneurysmal bone cysts are locally destructive blood-filled reactive lesions of bones which account for about 1% of all biopsied tumours and tumour-like lesions of bone2 and most commonly affect proximal humerus, distal femur, proximal tibia and spine. Various treatment options for unicameral bone cyst range from steroid injections for smaller lesions3 to aspiration and curettage ( with or without bone grafting and internal fixation ) for lesions associated with pathological fractures. Bone graft substitutes such as calcium sulphate and high porosity hydroxyapatite4 have also been used in place of auto or allogenic bone graft. For aneurysmal bone cysts extended curettage and bone grafting has been found to give satisfactory results.1
We successfully treated at our centre a case of proximal humerus cystic lesion associated with pathological fracture in a 14 year old boy with curettage and grafting using deep freezed allogenic bone graft and internal fixation using titanium expandable nailing system. On follow-up of 4 weeks patient had satisfactory fracture union and range of motion. text/html2015-11-18T13:27:27+01:00http://www.webmedcentral.com/Dr. Mohit K JindalBilateral cubitus varus due to ulnar exostoses- a case report
http://www.webmedcentral.com/article_view/5019
Osteochondroma or exostosis is most common primary benign bony tumor comprising of more than one third of the total occurrences. Osteochondromas are considered as an aberration in the normal physial growth plate and originate from the metaphysis of long bone with more than third (35-46%) of cases affecting the bone around the knee( Lower end femur> Upper end Tibia), 10% cases involve the small bones of the hand and 5% involve the pelvis and flat bones like scapula(4-6%)are least involved. These tumors usually affect the growing skeleton and cease to increase in size after skeletal maturity. These are usually painless and do not cause any symptoms or functional impairment. Hereditary multiple exostosis is an autosomal dominant disorder manifested by the presence of multiple osteochondromas . Although exostoses are benign lesions, they are often associated with characteristic progressive skeletal deformities and may cause clinical symptoms. The most common deformities include short stature, limb-length discrepancies, valgus deformities of the knee and ankle, asymmetry of the pectoral and pelvic girdles, bowing of the radius with ulnar deviation of the wrist, and subluxation of the radiocapitellar joint.
CASE REPORT
A 8 year old girl came to our out patient department with bilateral cubitus varus deformity with associated manus varus bilaterally since 3 years duration1 . A skiagram of bilateral elbow joints and wrist revealed bilateral ulnar osteochondromas with associated ulnar shortening and radial bowing. Other skiagrams were done to reveal any other bony exostoses. There was no associated family history. The condition caused no functional impairment to the patient clinically and the patient was explained regarding the condition and kept for regular 6 monthly follow up to look for any increase in deformity or development of newer deformities..
DISCUSSION AND CONCLUSION We concluded that surgical management in a case of bilateral elbow and hand deformities due to multiple exostoses is not always required and should be delayed till the patient attains the age of at least 12 years as it will prevent post surgical recurrence of deformities and newer deformities which develop can be tackled simultaneously.text/html2015-12-02T05:47:20+01:00http://www.webmedcentral.com/Dr. Mohit K JindalCrossed Steinmann Pin Fixation In Supracondylar Femur Fractures In Adults A Case Series
http://www.webmedcentral.com/article_view/5027
Supracondylar femur fractures in adults is a complex fracture constitutes approximately 1% of total fractures and 4-7% of all femoral fractures (Kolmert, 1982)1. There is a bimodal distribution, with young patients with high energy trauma and elderly patients with low-energy falls. Approximately 85% of these fractures occur in patients over fifty years old (Shewring, 1992)2 Treatment of the fracture depends on the fracture pattern, the amount of displacement and comorbid illness. Although internal fixation with plating devices is recommended by current orthopaedic guidelines in management of orthopaedic trauma, but in certain conditions like in an osteoporotic skeleton (old age patients which constitute the second and most affected peak as per the bimodal age distribution for this fracture) wherein these implants are expected to fail due to inadequate cortical hold resulting in screw back out . Also in open cases and in otherwise immunocompromised individuals wherein there is a high risk of post surgical wound infection and in cases wherein the comorbodities of the patient makes it impossible to carry out such invasive procedures and in highly comminuted fractures where it is impossible to maintain adequate reduction treatment with cross Steinmann pin fixation is a viable option. Cross Steinmann fixation technique is least invasive technique while still offers a considerable deal of rotational and vertical stability to such fractures. Moreover it’s use in pediatric distal femoral physeal injury is accepted as per AO guidelines. We used crossed Steinmann pin fixation in 20 adult patients of supracondylar femur fractures for indications as stated above and found acceptable union rates comparable with those obtained using internal fixation devices.text/html2016-02-29T08:01:48+01:00http://www.webmedcentral.com/Dr. Mohit K JindalDelayed presentation of osteochondroma at superior angle of scapula- a case report
http://www.webmedcentral.com/article_view/5040
INTRODUCTION: Osteochondroma or exostosis is most common primary benign bony tumor comprising of more than one third of the total occurrences. Osteochondromas are considered as an aberration in the normal physial growth plate and originate from the metaphysis of long bone with more than third (35-46%) of cases affecting the bone around the knee( Lower end femur> Upper end Tibia), 10% cases involve the small bones of the hand and 5% involve the pelvis and flat bones like scapula(4-6%)are least involved. These tumors usually affect the growing skeleton and cease to increase in size after skeletal maturity. These are usually painless but may become painful due to neurovascular entrapment/ compression, fracture at the stalk, bursal inflammation or malignant transformation.
CASE PRESENTATION This article is to present a case of Osteochondroma on superior angle of scapula in a 23 years old male presented with pseudo winging and snapping of scapula, crepitus on scapulothoracic motion and occasional pain since 5 years. However there was no increase in size of the swelling or local and systemic signs of malignant transformation. X-ray demonstrated a pedunculated exophytic mass on supero medial aspect of right scapula. The findings were confirmed on CT and excision of the lesion was done. The patient demonstrated full painless range of motion after 1 month and no recurrence was demonstrated in his 1 year follow up.
KEY WORDS Scapular exostosis; delayed presentation osteochondroma, pseudowinging scapula
KEY MESSAGE/ CONCLUSION
Scapular osteochondroma is a relatively rare condition. Usually a patient presents in early to late childhood however in some cases it may be presented in adults. Growth after maturity is indicative of a metastatic transformation. So an excision of the same should be accompanied with Histopathological examinations.text/html2018-02-02T05:04:20+01:00http://www.webmedcentral.com/Dr. Carlos G. RubinSciatic neuritis due to fibrovascular bands and myxoid neurofibroma. Arthroscopic decompression and excision
http://www.webmedcentral.com/article_view/5434
A 34-year-old lady was referred to our clinic due to a chronic hip and leg pain that did not improve with rehabilitation and after three corticosteroid injections. The MRI showed sciatic neuritis and sciatic entrapment due to type 3 fibrovascular bands. Arthroscopic surgery was indicated to release the nerve entrapment. A small part of piriformis was also released. During surgery, a myxoid neurofibroma 1cm long was found at one of sciatic branches, and was excised and sent to patholgy. 6 months after surgery patient was pain free and she was able to do a normal life, including minor sports like walking fast and mountain hiking.
Sciatic nerve entrapment is a relatively new patology. In the last years, new MRI protocols and technology have given us the opportunity to diagnose small areas of inflammation and nerve entrapments. Also, new arthroscopic instruments and devices let us release these entrapments during endoscopic procedures with very few complications and risks.
We are showing a case of sciatic nerve entrapment and neuritis due to fibrovascular bands and a myxoid neurofibroma. Six months after endoscopic release and excision, patient was pain free and totally recovered.text/html2019-04-30T05:05:38+01:00http://www.webmedcentral.com/Dr. Pulak VatsyaISOLATED OSTEOCHONDROMA OF PROXIMAL FEMORAL METAPHYSIS PRESENTING AS A MECHANICAL BLOCK TO HIP RANGE OF MOTION AND PAIN
http://www.webmedcentral.com/article_view/5566
Osteochondromas are the commonest bone tumors. They cease to grow post skeletal maturity and are rarely malignant(1%), thus making the indications for their excision very minimal. Diagnosis is usually confirmed on a radiograph, since most are asymptomatic, a conservative protocol is followed. Rapid increase in size, especially after skeletal maturity, pain, a cartilage cap of more than 2cm are all indications of a malignant lesion and need definitive diagnosis and surgery. Our case, presented with a lesion in an unusual location for osteochondroma, which was large enough to be symptomatic, thus leading to our management being aggressive, including excision, biopsy with a definitive diagnosis and plate fixation. Thus emphasizing the need to suspect osteochondromas in unusual locations and surge for definitive diagnosis in aggressive lesions.
text/html2019-05-20T08:33:52+01:00http://www.webmedcentral.com/Dr. Karthick S.rCongenital Vertical Talus - Etiology, Pathogenesis and Current Updates in Management.
http://www.webmedcentral.com/article_view/5569
Congenital Verical Talus (CVT) is a rare foot deformity which is most often unrecognised/ misdiagnosed at birth. Inadequate management leads to abnormal gait, shoe wear problems, callosities, pain and functional limitations. Etiology is heterogenous - genetic disorder associated, neuro muscular or idiopathic. Restoration of normal alignment of bones of foot and weight bearing capacity of first ray are primarily aims of treatment. Depending on severity and rigidity of deformities multiple extensive as well as minimal invasive surgical procedures have been described for CVT. In recent times, management has drastically changed from earlier methods of extensive soft-tissue release procedures to the serial manipulation, casting and minimal invasive surgery for Talo navicular joint reduction.text/html2022-03-22T07:32:36+01:00http://www.webmedcentral.com/Dr. Jeewan S PrakashA study on across knee external fixation in adults
http://www.webmedcentral.com/article_view/5758
External fixation is a commonly performed orthopedic surgical intervention . Across knee external fixation is carried out for various indications related to bones , joints and soft tissues . We report our observations on 41 across knee external fixators applied on 39 patients studied over a period of 4 years .text/html2022-03-22T07:32:27+01:00http://www.webmedcentral.com/Dr. Jeewan S PrakashA study on across knee external fixation in adults
http://www.webmedcentral.com/article_view/5773
External fixation is a commonly performed orthopedic surgical intervention . Across knee external fixation is carried out for various indications related to bones , joints and soft tissues . We report our observations on 41 across knee external fixators applied on 39 patients studied over a period of 4 years .