Neglected Two-Week-Old Unstable Fracture-Dislocation of the Hip in a 60 Years Old, Managed with Hip Preservation Surgery.

INTRODUCTION: Hip joint fracture-dislocations are rare injuries and usually result from high energy trauma. Femoral head fractures account for only 7-16% of all hip fracture-dislocations. There is always a controversy regarding optimal surgical treatment modality and approach for the treatment of Pipkin type IV fractures. In a 60 years old individual, various reports favor primary hip arthroplasty as compared to open reduction and internal fixation (ORIF). The posterior approach is preferred because it provides adequate exposure of the acetabular fracture and an opportunity for simultaneous repair of the femoral head and acetabular fractures. Another benefit is that anterior vascular supply to the femoral head and abductor function can be preserved. CASE REPORT: In this case report, we present a neglected 15 days old rare injury (Pipkin type IV femoral head fracture) in a 60 years old male patient that was given a trial of hip preservation surgery by ORIF through posterior (Kocher-Langenbeck) approach. CONCLUSION: A neglected case of Pipkin type IV injury with chances of avascular necrosis and arthritis can be given a trial of hip preservation surgery because in an Indian scenario sitting cross legged and squatting are indispensable activities of daily lifestyle and appropriate surgical technique, adequate exposure, anatomic reduction, and stable internal fixation of the fractures are critical to achieve satisfactory clinical results.

A case report on rare occurrence of periosteal ganglion cyst in femoral intercondylar region.

Ganglions are the cysts derived from myxomatous degeneration of periarticular tissue, commonly found around wrist and foot. Ganglion cysts are uncommon in Knee region and if present their occurrence is mostly incidental and benign. Based on their location, this could be extraarticular or intraarticular. Lesions with similar pathology in subchondral region around joints are lesser common entity called Intraosseous ganglions. Rarer still is the lesion produced by myxomatous degeneration of periosteum of long bone, called periosteal ganglion. We here present a case of 35 year old Male with gradual onset, poorly localised pain behind left knee which was radiologically suggestive of periosteal ganglion, eroding the posterior aspect of femur and confirmed histopathologically following the excision of a lesion from posterior aspect of femoral condyles.

Articular Reconstruction using Subchondral Cementation and Threaded Kirschner-wires in Giant Cell Tumor: A Novel Technique.

INTRODUCTION: Giant Cell Tumor(GCT) is one of an infrequently encountered tumor by orthopaedic surgeons in clinical practice. It is described as 'locally malignant' tumor found in epimetaphyseal region of long bones, peculiarly around knee. We present a case of a solitary, benign Campanacci Grade 2 GCT in right lateral femoral condyle in 38 year old female and our treatment. CASE REPORT: A 38 year old female presented to our outpatient department with chief complaint of constant, moderate pain in right knee increasing in duration since 3 months. No history of precedent trauma. Radiological imaging with radiographs showed suspicious lytic lesion in lateral femoral condyle. MRI scan was done.On biopsy, histopathological evaluation showed presence of characteristic multinucleated giant- cells. After confirmation, tumor en bloc resection was done, followed by chemical cauterization with 5 % phenol. Articular margins were realigned under direct vision and fixed with 1.8 mm threaded K wires. PMMA cementing in bone defect was done after achieving adequate hemostasis. At two years follow-up, patient had good result in terms of pain, knee range of motion and weight bearing. CONCLUSION: Combination treatment of radical curettage, phenol irrigation, electrocautery and cementation is effective in preventing local recurrence. This can replace en bloc resection with a wide margin. Using subchondral threaded Kirschner wires to maintain articular margins is cheap alternative to costly implants in economically underprivileged patients.

Results of posterior dislocation of elbow associated with bony and soft tissue injury.

UNLABELLED: Elbow trauma is challenging to manage by virtue of its complex articular structure and capsuloligamentous and musculotendinous arrangements. We included 17 patients with elbow dislocation and associated injuries in this study. The study protocol included early elbow reduction and planned fixation of the medial or lateral condyle, coronoid and radial head. The sample was 73% male and 27% female with mean duration follow-up of 8 months, and mean age of 37 years. The mean Mayo Elbow Performance Score was 96 points at conclusion of follow-up, indicating an excellent result in 14 patients. Whenever the radial head was excised, we performed a strong transosseous ligamentous repair of the medial and lateral collateral ligaments. Fixation of the coronoid is essential for elbow stability. A small avulsed fragment can be fixed using an ACL jig. We found this technique very useful. Early planned intervention, stable fixation, and repair provide sufficient stability and enhance functional outcomes. KEY WORDS: elbow dislocation, ligament instability, coronoid fracture.