An Unusual Bryan and Morrey Type IV Capitellum Fracture with Posterolateral Rotational Instability: A Case Report.

INTRODUCTION: Better understanding of disruption of bony and ligamentous constraints of the radiocapitellar joint in complex capitellum fracture is essential for optimizing the surgical care and outcome. This report highlights the need for modification in surgical fixation technique to address an unusual variant of this rare injury. CASE REPORT: We report a three-part capitellum fracture pattern with a Y-shaped split of distal humerus with a sheared anterior fragment and a single, large, non-articular posterolateral fragment in a young male patient. Articular fragment was fixed with two countersunk anterior-distal to posterior-proximal oblique screws. Additional screw was used to fix the posterolateral fragment to prevent posterolateral rotational instability. Mayo elbow performance score was 95 with no rotational instability at 2 years follow-up. CONCLUSION: Additional fixation of posterolateral fragment in this three-part variant of Bryan and Morrey Type IV capitellum fracture ensured rotational stability and good function.

Bilateral sequential femoral neck stress fractures in young adult with HIV infection on antiretroviral therapy: A case report.

BACKGROUND: Femoral neck stress fractures are rarely encountered among young adults and are often associated with either repetitive excessive loading or underlying bone pathology. Preliminary research has indicated human immunodeficiency virus (HIV)/antiretroviral therapy (ART) as predisposing agents to osteopenia and osteoporosis related complications. We report a case of HIV/ART induced insufficiency fracture in a resource limited setting in Central India. Our aim is to increase awareness and promote screening of HIV/ART related osteopenia and osteoporosis in order to prevent catastrophic orthopaedic complications. CASE SUMMARY: A 35-year-old HIV positive male presented with a stress fracture of left femoral neck. The patient was on ART and reported no comorbidities. He went on to be successfully managed surgically. However, during work-up osteopenia of the contralateral proximal femur was recognised using Singh's Index. Six months post-op the patient presented with right-sided femoral - neck stress fracture. At this stage the patient was nonconcordant with ART and denied surgical fixation. CONCLUSION: In the absence of co-morbidities, several mechanisms of HIV/antiretroviral therapy may have played a role in predisposing our patient towards such a presentation. We recommend routine screening all HIV-infected patients for osteopenia, especially in younger individuals. In low resource settings and district hospitals, pelvis radiograph & Singh's index can be used for screening.