Quality of Life After Proximal Femoral Fractures Treated With Gamma Nail in Sudan.

Background Hip fracture is a public health problem globally, and it poses one of the biggest challenges in healthcare due to its associated complications. Objectives The aim of this study is to investigate the quality of life in adult patients in Khartoum State, Sudan, after they have undergone treatment using a gamma nail for proximal femoral fractures. Methodology This cross-sectional descriptive hospital-based study was conducted at Ibrahim Malik, Omdurman, and Bahri Teaching Hospitals over six months, from April to October 2022. The data were collected using an interview questionnaire that covered relevant aspects of the study. The data were analyzed using IBM SPSS Statistics for Windows, V. 26.0 (IBM Corp., Armonk, NY). The study was approved by the Sudan Medical Specialization Board, and ethical clearance was obtained. Results The study included 37 patients. More than half of the patients (59.5%, n=22) were women. The mean age of cases was 66.7 years (standard deviation, ±15.6). The mean time from the time of the fracture to the time of surgery was eight days (±15). Twenty-three (62.2%, n=23) (JRB1) of the patients started weight bearing on the second postoperative day. Regarding the health-related quality of life, 21.6% of the patients had a good health-related quality of life, 67.6% had a fair health-related quality of life, and 10.8% had a poor health-related quality of life. None of the patients reported an excellent quality of life. Based on the Oxford Hip Score, 54.1% of the patients had satisfactory joint function, 29.7% had mild to moderate hip joint function, 13.5% had moderate to severe hip joint function disturbance, and one patient (2.7%) had severe hip joint function problems. Conclusion In this study, the vast majority of the patients who underwent gamma nail surgery for hip fracture had quality of life scores in the fair to good range afterward. The results indicate that nailing is associated with good outcomes regarding quality of life and is an acceptable option for femoral fracture surgeries in Sudan.

Malignant, fungating giant-cell tumor of the tendon sheath (GCT-TS) of the foot: A case report.

Giant-cell tumors of the tendon sheath (GCT-TS) are relatively common benign tumors that arise in close proximity to joints and tendons. Malignant GCT-TS are extremely rare. Surgery with wide resection remains the cornerstone for treating malignant giant-cell tumors of the tendon sheath especially in large tumor cases.

Actinomycetoma distal radius mimic osteosarcoma: A case report of a rare presentation.

Key Clinical Message: Actinmomycetma is a granulomatous infection with a presentation was very similar to osteosarccoma. Multidisciplinary team and triple assessments are extremely important to prevent misdiagnosis, surgical treatment in combination with medical treatment followed by regular clinical and radiological follow-up can be a limb-saving procedure in such cases. Abstract: Various conditions may mimic osteosarcoma. The differential diagnosis of osteosarcoma is broad; Includes tumors, infection, trauma, and inflammatory processes arising from the musculoskeletal system. A proper history, examination, diagnostic imaging studies, and pathological analysis are essential to establish a precise diagnosis. This case report serves to illustrate the significance of recognizing the similarities between these two lesions and other rare features that will help to differentiate between actinomycetoma and osteosarcoma, to prevent late or misdiagnosis.

Wide resection and reconstruction in a low resource area, cemented nail technique knee arthrodesis; a report of case and surgical technique.

INTRODUCTION AND IMPORTANCE: Osteosarcomas are primary malignant bone tumors that are driven from bone-forming mesenchymal cells and account for nearly 20 % of primary bone tumors. CASE PRESENTATION: A 16-year-old female presented with chief complaint of pain and swelling on her right knee for 6 months with history of trauma. Her knee mobility and ROM was limited due to pain and the mass. Physical examination revealed a 15 × 22 cm mass on distal part of right femur with visible dilated veins. There was normal distal motor, sensory functions. Imaging revealed distal femur mass with mixed lytic and blastic features, wide transitional zone with hair and periosteal reaction; features suggestive of osteosarcoma that was confirmed by histopathological examinations as intramedullary osteosarcoma. She undergone surgical treatment consisting of surgical excision of the mass with safety margins and knee reconstruction by knee arthrodesis using femoral-nail and bone cement technique with excellent outcome. CLINICAL DISCUSSION: Osteosarcoma is best investigated through plain imaging, MRI and possible CT with histology being confirmatory. It is best approached with meticulous dissection to ensure clear margins or if necessary, amputation. Following resection, reconstruction can be done. In this specific case, the tumor was on the distal femur and the underlying knee was arthrodesed using cemented nail technique in which a cemented intramedullary nail was inserted with excellent clinical outcome. CONCLUSION: Surgical approach to osteosarcoma can be performed through limb salvage or amputation. Arthrodesis with cemented nail technique using an intramedullary nail can be performed in some patients with excellent clinical outcome.

Schistosomiasis as causative organism for chronic osteomyelitis. Case report.

INTRODUCTION AND IMPORTANCE: Osteomyelitis is an infection of the bone mainly caused by bacteria and rarely by fungi and parasites. Parasitic osteomyelitis (schistosoma) is a very rare and unique condition with a few literatures. CASE PRESENTATION: A 14-year- old boy presented with right upper arm sinus for 4 years and exposed bone for 1 year. He has a history of hematuria. Blood tests were normal, urine general was normal and no Ova was seen. In Radiological assessment, X-ray showed Sequestrum in the anterior part of the upper humerus with Involucrum, MRI showed abnormal expansion, cortical thickening and diffuse altered marrow signal in the shaft of humerus with multiple cortical defects, sinus tracts, peri-osseus enhancing sheets and collections. The patient underwent Sequestrectomy and samples were collected for culture & sensitivity and showed no growth, Acid Fast Bacilli was negative, Histopathology test showed marked mixed inflammatory infiltrate composed mainly of eosinophils surrounding numerous Ova of Schistosoma haematobium, the patient was shifted to Praziquantel, wound care and regular follow-up. Long term clinical & radiological follow up showed good healing and the patient was satisfied. CLINICAL DISCUSSION: Parasitic osteomyelitis caused by Schistosoma is a very rare, and unique condition with a limited published cases in literature. Janet.T.Scott et al. stated that Schistosoma Haematobium is associated with chronic Osteomyelitis during investigation about potential risk factors of Buruli ulcer, which recognized as emerging public health problem by WHO in 1997 in West Africa, that lead to severe complications like amputations. CONCLUSION: Schistosomiasis can cause chronic osteomyelitis, good history taking and examination, high index of suspicious, collection of adequate tissue samples and sending them to a reliable laboratory are the corner stone of diagnosis.

Osteosarcoma of the distal fibula and reconstruction of the ankle using inverted fibula, a case report.

INTRODUCTION AND IMPORTANCE: Osteosarcomas are malignant primary bone tumors of mesenchymal origin producing osteoid material and has peak incidence in adolescents. Distal lower limb tumors are rare and can negatively affect ankle joint stability. CASE PRESENTATION: A 24-year-old female who has newly graduated from college presented with distal fibular mass measuring around 5 × 15 cm located on the lateral aspect of the right ankle over a period of 2 months. The mass located on the lateral aspect of the right ankle that was hard, oval and measuring around 5 × 15 cm and originating from the fibula. The overlying skin was normal with no discharging sinuses. Distal neurovascular examination was normal with no lymphadenopathy. Imaging using X-rays and MRI as well as pathological examinations thereafter has proven the diagnosis. She was planned for wide surgical resection at distal fibula and ankle reconstruction after neoadjuvant chemotherapy, then for adjuvant chemotherapy. Ankle reconstruction using fibular autograft was used after its reversal and was then stabilization by syndesmotic screws. She has clinically good outcome. CLINICAL DISCUSSION: Surgery with extensive and meticulous dissection remains the cornerstone for treating osteosarcomas affecting distal fibula. Neoadjuvant and adjuvant chemotherapy are important for managing micro-metastasis. Ankle reconstruction and be performed using different methods with good outcomes. CONCLUSION: Lesson learnt is that ankle reconstruction using fibular autograft can be used after reversal and stabilization by screws with good outcome for managing distal fibular osteosarcomas. However, this finding needs to be strengthened with future reports.

Biomechanical Analysis of a Novel Acetabulum Reconstruction Technique with Acetabulum Reconstruction Cage and Threaded Rods after Type II Pelvic Resections.

Background. Periacetabular resections with reconstruction has high rates of complications due to the complexity of the reconstruction. We have improvised a novel technique of reconstruction for type II and type II + III pelvic resections with the use of a commercially available acetabulum reconstruction cage (gap II, Stryker) and threaded rods. Objectives. The aim of our study is to determine the biomechanical strength of our reconstruction compared to the traditional cemented total hip replacement (THR) designs in normal acetabulum and establish its mode of failure. Methods. Five sets of hemipelvises were biomechanically tested (Instron® 3848, MA, USA). These constructs were subjected to cyclic loading and load to failure. Results. The reconstructed acetabulum was stiffer and required a higher load to failure compared to the intact pelvis with a standard THR. The mean stiffness of the reconstructed pelvis was 1738.6 ± 200.3 Nmm(-1) compared to the intact pelvis, which was 911.4 ± 172.7 Nmm(-1) (P value = 0.01). The mean load to failure for the standard acetabular cup construct was 3297.3 ± 117.7 N while that of the reconstructed pelvis with the acetabulum cage and threaded rods was 4863.8 ± 7.0 N. Conclusion. Reconstruction of the pelvis with an acetabular reconstruction cage and threaded rods is a biomechanical viable option.

Deep Infections after Endoprosthetic Replacement Operations in Orthopedic Oncology Patients.

BACKGROUND: Numerous studies have described various complications after endoprosthetic reconstructive operations. However, there are limited reports that focus specifically on deep infections (e.g., deep incisional surgical site infections), which remain one of the most dreaded complications of these operations, with rates ranging from 10% to 17%. Thus, this study was undertaken to determine the deep infection rates and to analyze possible risk factors, clinico-pathologic characteristics, and treatment modalities of endoprosthetic infections. METHODS: We reviewed retrospectively the records of 105 consecutive patients who underwent endoprosthesis replacements from January 2007 to September 2011, with a minimal follow-up period of 32 mo. Comparison was made between patients with and without endoprosthetic infections. RESULTS: Thirteen of the 150 patients (12.38%) who underwent endoprosthetic operations developed deep infections. Ninety-seven (92.4%) patients presented with a primary bone/soft tissue tumor, 5 (4.8%) with bone metastasis, and 3 (2.9%) with non-tumor conditions. Distal femoral was the most common implant location (42%). The majority of the infections (6/13) occurred within 3 mo post-operation. An elevated C-reactive protein concentration or erythrocyte sedimentation rate were present consistently in all patients at time of diagnosis, whereas clinical presentations and leukocytosis were inconsistent in determining infection. Staphylococcus aureus and coagulase-negative staphylococci (CoNS) were the most common organisms isolated, with high numbers demonstrating methicillin-resistance. Overall, multi-drug resistance was noted in 52.6% of the isolated strains. Four risk factors were associated independently with deep infection by multivariable analysis (p<0.05) and these were proximal tibia endoprosthesis, pelvic endoprosthesis, pre-operative duration of hospitalization of more than 48 h, and additional surgical procedures performed after the initial endoprosthetic insertion. Overall, infection was eradicated successfully in 53.8% (7/13) of the patients. Two-stage revision successfully treated the infection in 80% (4/5) of the patients, whereas surgical debridement without a change of implant was successful in only 42.8% (3/7) of patients. Amputation was performed in three patients. CONCLUSIONS: Patients undergoing endoprosthetic replacement for various orthopedic oncologic conditions have high infection rates. The present study allows early identification of such patients in view of the high morbidity associated with this condition. This report also highlights the high rate of multi-drug-resistant infections, especially methicillin-resistant strains of S. aureus and CoNS encountered, which complicates further the management of these patients.