Giant Cell Tumor: A Case Series of Seven Patients with GCT at Atypical Sites.

Introduction: Giant cell tumor (GCT) represents 5% of all primary bone tumors and 20% of biopsy analyzed benign tumors. More than half of these lesions occur in the 3rd and 4th decades of life. There is no absolute treatment method selection. Techniques ranging from intralesional curettage to wide resection can be used. Goal is to eradicate the tumor, preserve limb function, and prevent local recurrence and distant metastasis. Case Report: We are presenting seven cases of GCT at five different and rare sites involving tibia, calcaneum, metatarsal, proximal humerus, and clavicle with tumor being limited to bone in all seven cases not involving the soft tissue. There were three male patients and four female patients. Six patients underwent intralesional curettage using high-speed burr and curette, along with adjuvant irrigation with hydrogen peroxide and normal saline followed by polymethyl methacrylate reconstruction. One patient with GCT clavicle underwent wide resection. Results: In all seven cases, we were able to able to remove the tumor completely. Six patients had a gradual and complete recovery with return to near normal activity within 6 month-1 year after surgery. One patient with proximal humerus GCT had a recurrence which got resolved with injection denosumab. All patients have been followed up for a minimum duration of 2 years. Conclusion: Intervention in the early stages can avoid radical procedures such as wide local excision or amputation. We recommend aggressive surgical approach with close follow-up to detect recurrence if any, at an early stage.

Postoperative Epidural Fibrosis Prevention: Which Is Better-Autologous Fat versus Gelfoam.

STUDY DESIGN: Prospective, randomized study of 100 patients with prolapsed intervertebral disc with an average of 12- to 18-month follow-up postoperatively. PURPOSE: To compare the role of Gelfoam and autologous fat in the prevention of postoperative epidural fibrosis (EF) after lumbar spine surgery. OVERVIEW OF LITERATURE: EF is a possible sequelae of lumbar disc surgery. Different treatments and surgical strategies have been attempted to prevent postoperative fibrosis without providing consistent long-term results. METHODS: The study was conducted on 100 adult patients. The patients were randomly allocated into two groups of 50 patients each: group A, autologous fat group, and group B, Gelfoam group. The postoperative follow-up was conducted at intervals of 6 weeks, 3 months, 6 months, and 12 months. Both groups were evaluated clinically (Oswestry Low Back Pain Disability Questionnaire [ODI], Visual Analog Scale [VAS], Straight Leg Raising Test [SLRT]) and radiologically (using Ross grading by contrast magnetic resonance imaging [MRI]) for development of radicular pain and hence EF. RESULTS: Based on the analysis, improvement in mean values of ODI score, VAS score, and SLRT were found to be statistically significant postoperatively at intervals of 6 weeks, 3 months, 6 months, and 12 months when compared individually in both groups. However, improvement was greater in the autologous fat group than in the Gelfoam group. Based on contrast-enhanced MRI, the number of patients who developed EF was smaller in the autologous fat group than in the Gelfoam group. CONCLUSIONS: In the present study, on clinical and radiological assessment, we conclude that both groups prevent radicular pain and postoperative EF individually but relatively autologous fat was found to be more effective than Gelfoam in the prevention of EF and hence radicular pain.

A Rare Case of Aneurysmal Bone Cyst - Navicular Bone Treated by Intralesional Sclerotherapy Agent Polidocanol.

INTRODUCTION: Aneurysmal bone cyst (ABC) is an intraosseous arteriovenous malformation, usually treated by surgical excision but with higher recurrence rates. The occurrence of this lesion in navicular bone is a rare entity. Repetitive sclerotherapy using 3% polidocanol is a minimally invasive, safer method of treatment for ABCs. METHODS: A patient of ABC of the navicular bone precisely diagnosed through X-ray, MRI, and biopsy was given periodic injections of 4 ml of 3% polidocanol under aseptic precautions from April 2018 to July 2018. A total of four injections given at an interval of 1 month. RESULTS: Regular follow-up done for 1 year. At the end of all the four injections, the lesion healed completely with a relief in presenting symptoms. No complications were reported. At 3 months post-therapy, the patient was able to walk without pain. After 1 year of follow-up, the patient was symptom-free with no signs of recurrence. CONCLUSION: Surgical resection/curettage has higher chances of recurrence; therefore, usage of intralesional sclerotherapy agent polidocanol should be considered the treatment of choice in the lesions smaller than 5 cm.

Comparing pattern of musculoskeletal injuries prior to and during COVID-19 lockdown: A time-trend case study from a tertiary level Trauma Center of Northern India.

BACKGROUND AND AIMS: In the COVID-19 times, Indian sub-continent is struggling to contain the epidemic and trying to strengthen the existing health infrastructure, the national level lockdown has raised concerns about the pattern of injuries whether it has remained the same or has changed over this period. This is the first study to compare injury pattern during the two months lockdown period with the data of corresponding months from years 2016-2020. Also we compared the age- and sex-wise distribution patterns of these injuries for the above mentioned period. METHODS: This retrospective cross sectional study was conducted by the Department of Orthopaedics in Guru Gobind Singh Medical College and Hospital (GGSMCH) in Faridkot, Punjab. Secondary data for patient's age and sex, mode of injury, and site of injury was collected through record review for the period of two months (24th March to 24th May) for five consecutive years of 2016-2020. Descriptive analysis and Chi-square test was used to see the association between age and sex with mode and type of injury. RESULTS: The five year injury trends reflected that the proportion of injuries in 2016 was 16.5% (n = 48) of the total musculoskeletal injuries (n = 291) which rose to 23.4% (n = 68) in 2020. Majority of the patients were males (80%), and belonged to adult age group (69.4%) followed by elderly (17.2%), adolescents (8.6%) and children (4.8%). The proportion of road traffic accidents out of all injuries significantly reduced during the lock down period of two months in 2020 (p = 0.001). On the contrary, the proportion of injuries due to falls as well as unspecified assault increased significantly in 2020 as compared to previous years. CONCLUSIONS: The proportion of musculoskeletal injuries have increased from 2016-2020. Unspecified assault and all types of falls pushed the road traffic accidents to third position during the lockdown period in 2020 as compared to previous four years. Injury surveillance needs to be integrated in routine hospital system for precise information and for more efficient functioning.

Traumatic Anterior Hip Dislocation in Elderly Male: An Atypical Case Report.

INTRODUCTION: Anterior dislocation of the hip joint is a rare presentation accounting for around 15% of all hip dislocations. Obturator (inferior) type traumatic anterior hip dislocation in adult is rare of all types of hip dislocation. Here, we described a case with same description. It can occur as a result of a high-energy trauma in circumstances such as a motor vehicle accident or a fall from a significant height. A delay in relocation of more than 6 h has been associated with a high risk of avascular necrosis of the femoral head. CASE REPORT: We reported the case of a 70-year-old man who suffered an anterior dislocation of his hip joint who was brought to the emergency room with a history of fall from the bicycle hit by a motorcyclist from his back. After examined clinically and radiologically, the patient was diagnosed with obturator type of anterior right hip dislocation. Closed reduction under short general anesthesia was planned. CONCLUSION: Inferior hip dislocations are very rarely seen injuries with severe high-energy trauma. The reduction must be done as soon as possible because it involves the functional prognosis of the hip by the risk of necrosis of the femoral head and subsequent osteoarthritis requiring long-term monitoring.

Correlation of acromial morphology in association with rotator cuff tear: a retrospective study.

PURPOSE: There have been many studies that have attempted to correlate radiographic acromial characteristics with rotator cuff tears, but the results have not been conclusive. Rotator cuff tears (RCT) are the common aetiology of shoulder pain. We assessed the association of rotator cuff tears with commonly used radiographic parameters of acromial morphology and their different radiographic characteristics. MATERIAL AND METHODS: From a retrospective study of 98 patients, we characterised acromial type and measured acromial thickness (AT), critical shoulder angle (CSA), lateral acromial angle (LAA), acromiohumeral distance (AHD), and acromion index (AI) on a 1.5T MRI, from 68 patients with partial or full-thickness supraspinatus tendon tears and 30 controls without tears. RESULTS: Out the 68 patients with rotator cuff tear, supraspinatus was the most commonly affected tendon, with 86% (59) cases showing abnormalities. The average age of the patients was 45.11 ± 21.45 years with male dominance (80%). Partial tears of rotator cuff were more common than complete tears. Forty-eight cases showed partial tears in supraspinatus as compared to 11 cases of complete tears. The acromial type did not show any correlation with any particular cuff lesion. The AT and AI of controls were significantly smaller than cuff-tear patients. The LAA of cuff-tear patients was significantly different from that of control patients. The impingement patients demonstrated a significantly greater acromial thickness, larger CSA, decreased AHD, and decreased LAA than their control counterparts. CONCLUSIONS: A higher prevalence of rotator cuff tears and impingement associated with low lateral acromial angle, larger CSA and decreased AHD was observed. AT and AI have a direct correlation with rotator cuff tear.

Giant-cell tumour of proximal radius in a 50-year-old female with wrist drop: a rare case report.

Giant-cell tumour is a locally aggressive tumour of long bones of epiphyseal region commonly occurring in adults aged 20-40 years. Most common location is distal femur, proximal tibia, and distal radius. Different treatment options being used are curettage with bone graft or bone cement, resection with arthrodesis, reconstruction, radiation, and chemotherapy. We are reporting a case of giant-cell tumour of right proximal radius in a 50-year-old female with posterior interosseous nerve palsy. It is very rare, and only four cases have been reported in the literature. It was treated by wide margin resection with fibular grafting, titanium elastic nail system along with cancellous bone graft reconstruction.

Broken Pieces of Circlage Wire Lying in Soft Tissue Envelope Around Knee Joint: A Case Report and Review of Literature.

INTRODUCTION: The migration of circlage wires used in tension band wiring construct of patella fractures in the posterior soft tissue envelope surrounding the knee joint has been rarely reported. CASE PRESENTATION: A 60-year-old woman presented to us with pain over medial aspect of right knee joint. She underwent open reduction and internal fixation for a patellar fracture which she sustained 4 years back and subsequently underwent kirschner wire(k wire) removal for the same around 2 years back. X-rays of the knee joint shows that the circlage wire used in tension band construct which was left in place had broken into multiple pieces and was lying in the soft tissue envelope surrounding the knee joint and one piece migrate to the popliteal fossa. On examination patient did not had distal neuro-vascular deficit. The pain of the patient was due to the osteo-arthritic changes in her medial side of knee joint rather than broken wire pieces. Patient was advised to undergo total knee replacement along with subsequent removal of broken wires but patient refused for any type of surgery and is kept on regular follow up. CONCLUSION: This case report summarizes a rare complication resulting from hardware failure used for fixing patella fractures and throws a light on potential unwarned complications due to broken wires along with early recogonition and removal of broken hardware by surgeons.

A Study of Visual and Musculoskeletal Health Disorders among Computer Professionals in NCR Delhi.

OBJECTIVE: To study the prevalence of health disorders among computer professionals and its association with working environment conditions. STUDY DESIGN: Cross sectional. MATERIALS AND METHODS: A sample size of 200 computer professionals, from Delhi and NCR which included software developers, call centre workers, and data entry workers. RESULT: The prevalence of visual problems in the study group was 76% (152/200), and musculoskeletal problems were reported by 76.5% (153/200). It was found that there was a gradual increase in visual complaints as the number of hours spent for working on computers daily increased and the same relation was found to be true for musculoskeletal problems as well. Visual problems were less in persons using antiglare screen, and those with adequate lighting in the room. Musculoskeletal problems were found to be significantly lesser among those using cushioned chairs and soft keypad. CONCLUSION: A significant proportion of the computer professionals were found to be having health problems and this denotes that the occupational health of the people working in the computer field needs to be emphasized as a field of concern in occupational health.