Optimizing Orthopedic Outcomes in Complex Bilateral Talus Fracture-dislocations with Medial Malleolus Injuries: A Comparative Analysis of Surgical Approaches and Long-term Results.

Introduction: Bilateral talar fracture- dislocations with concomitant medial malleolus fractures are rare and present complex challenges. Case Report: We present a case study of a 30-year-old male painter who sustained these injuries following a significant fall. The surgical intervention included open reduction and internal fixation with a cannulated cancellous (CC) screw on one side and percutaneous fixation after closed reduction on the other. Conclusion: The patient's patient's three3-year follow-up revealed excellent ankle function and minimal avascular necrosis changes, demonstrating the importance of well-planned delayed therapy over hasty acute procedures. Remarkably, both approaches yielded comparable and favorable outcomes, emphasizing the importance of surgical planning, soft soft-tissue management, and the choice of surgical approach in optimizing outcomes.

Fibular Autograft as Medial Support with Proximal Humerus Locking Plate Construct in Comminuted Proximal Humerus Fractures: A Retrospective Analysis.

Background: Varus collapse is one of the pivotal mechanisms of failure following surgical fixation of proximal humerus fractures. The aim of the present study was to evaluate functional and radiological outcomes of non-vascularized fibular autograft as medial support with locking plate construct for comminuted proximal humerus fractures (PHF's). Materials and methods: We retrospectively evaluated 18 patients with unstable PHF's in the age group 50-70 years with a minimum follow-up of two years. All the fracture patterns were classified according to Resch, Neer's and AO classification and either medial calcar compromise or comminution were present in all. Open reduction internal fixation (ORIF) with a locking plate was performed for all the patients along with intramedullary fibular autograft to support medial calcar. Radiological outcome was assessed by neck-shaft angle (NSA) graded according to the Paavolainen grading method and difference in the humeral head height (HHH). Functional outcome was assessed by shoulder range of motion (ROM), University of California-Los Angeles (UCLA) score and American shoulder and elbow surgeons score (ASES). Results: Radiological union at the fracture site was achieved in all the patients at mean of 8 months (range 6-12 months). Range of movements were mean flexion of 123.89, extension 35.28, internal rotation 66.94, external rotation 57.78 and abduction of 115° at final follow-up. The average NSA was in the range of 120°-130° and none of the patients showed difference in HHH of ≥ 4 mm in the immediate post-operative radiograph and that taken on final follow-up. The functional outcome assessed by ASES score (mean 89.44) and UCLA score (mean 29.61) suggested fair to good results. None of the patients has shown varus collapse and avascular necrosis. Neither there were any complications related to the donor area. Conclusions: In unstable proximal humerus fractures with calcar comminution or void, PHILOS plate fixation augmented with fibular autograft as a medial support reduces varus collapse and promotes early radiological union.

Biological Reconstruction of the Coracoclavicular Ligament with Semitendinosus Autograft and Repair of Distal Clavicle Fractures.

Most of the options available to treat distal clavicle fractures involve hardware-related complications and high failure rates. This study aims to determine the outcome of distal clavicle fractures treated by a technique that combines biological reconstruction of the coracoclavicular ligament with semitendinosus autograft with reinforced fibrous tissue tapes. In this retrospective study, 8 patients with displaced distal third clavicle fracture cho's IIB or II C were operated on with the described surgical technique between 2018 and 2021. The results were assessed by comparing the preoperative Constant Murley score and the postoperative DASH score. In addition to these variables, several other variables were also assessed, such as the coracoclavicular distance, the time until union, and all intraoperative and postoperative complications. The study included eight patients with an average age of 36.5 years, and the average time from surgery to recovery was five days. According to Cho's classification, all eight patients achieved radiographic union within 89 days. Of the eight cases, six were classified as II C and two as II B. The follow-up period was an average of 13 months. During the postoperative period, the Constant Murley score score increased from 22.2 preoperatively to 92.2 postoperatively. The mean DASH score was 89.6, and the mean postoperative DASH score was 7.75. In terms of the coracoclavicular distance, the mean preoperative was 20.2 mm, and the mean postoperative was 10.3 mm. One patient experienced a minor wound complication after surgery, treated with secondary suturing after the operation. No intraoperative complications occurred. There was no donor site morbidity observed in the patients. It has been demonstrated that the use of this technique in displaced unstable distal clavicle fractures using a fiber tape and a semitendinosus autograft results in a satisfactory union and excellent clinical outcomes with very few complications.

Combined Greater and Lesser Tuberosity Fracture of Proximal Humerus with Intact Humeral Head and Shaft - A Case Report.

Introduction: Combined fracture of greater and lesser tuberosity is an extremely rare injury. Such fracture pattern has not been described in the Neer's, AO Muller, and Jakob's classification system. Case Presentation: We report a unique fracture pattern consisting of combined greater and lesser tuberosity of the proximal humerus (PH) with intact humeral head and shaft in a 32-year-old female. Routine radiographs and computed tomography scan with three-dimensional reconstruction were advised for better understanding of the fracture pattern, later managed by open reduction and fixation with PH locking plate. The patient has excellent clinical, radiological, and functional outcome at the end of 2 years follow-up. Conclusion: This is one among the few case reports highlighting this unique variant of PH fracture, not much has been described in the literature about this injury. Anatomic reconstruction of the fractured tuberosities combined with stable construct by PH locking plate facilitates optimum bone healing and aggressive shoulder rehabilitation.

"Shimming a Plate" Technique to Correct the Coronal Malalignment in Metadiaphyseal Distal Femur Fracture: Case Report.

CASE: We present a case of 19-year-old male patient with right sided comminuted metadiaphyseal distal femur fracture. Fixation was done using distal femur condylar locking plate. Washers were used with the screws to shimming the plate to achieve the coronal alignment and prevent stress over the screws. 2-year follow-up shows good alignment, radiological union and functional outcome without any complications. "Shimming" a locking plate with washers helps to achieve the better coronal alignment in comminuted metadiaphyseal distal femur fractures with coronal malalignment. It reduces the stress over screws and prevents implant-related complications.

Mid-term Outcome of a Chronic Traumatic Bony Avulsion of Distal Triceps Treated with Tension Band Wiring Technique - A Case Report.

Introduction: Ideal treatment of chronic distal triceps rupture is controversial due to low occurrence of this injury. We report a unique case of chronic traumatic distal triceps rupture which was missed initially and then treated by tension band wiring. Case Report: A 30-year-old manual labor presented with 2-month-old injury and difficulty in complete extension of the elbow which was initially managed conservatively. He was clinic-radiologically diagnosed as complete distal triceps bony avulsion tear. He was operated using tension band wiring technique. His DASH score at the end of 2-year follow-up was 5.4 indicating excellent outcome. Conclusion: A strong clinical suspicion should be raised about triceps injury in patients with chronic elbow pain and weak extension. Tension band wiring technique gives good clinical and functional outcome in patients with bony avulsion along with distal triceps tear.

Case Report of Osteopoikilosis: Sparse Cause of Bone Pain and Mimicker of Metastasis on Radiographs.

INTRODUCTION: Osteopoikilosis (OPK) is an extremely rare benign condition with autosomal dominant inheritance characterized by sclerosing bony dysplasia with multiple benign enostoses. It is characterized by symmetrically distributed numerous, small, well-defined, homogenous circular or ovoid radiodensities clustered in epiphysis and metaphysis of long bones in periarticular region, and in some cases diffusely present throughout axial and appendicular skeleton. There is no age and sex predilection; age at the time of diagnosis ranges from 15 to 60 years. It is usually asymptomatic but rarely in 15-20% patients slight juxta-articular pain and joint effusions can be seen. These are incidental radiological findings in most of the cases, also sometimes confused as bony metastasis. There are no specific clinical features; histological features are similar to bony island and it may be associated with connective tissue disorders, synovial osteochondromatosis, and a rare bone condition melorheostosis. CASE REPORT: We present a case of OPK in a 32-year-old male with bilateral hip and shoulder pain, based on the available literature and focus on clinical significance, due to its mimicking capability of other more severe conditions such as bone metastases and an extremely uncommon cause of bone pain. CONCLUSION: OPK is an uncommon hereditary condition involving juxta-articular region of long bones with intricate etiopathogenesis, often discovered incidentally on radiographs. It is characterized by multiple, symmetrical ovoid radiodensities, and in most instances confused with osteoblastic metastasis. This concludes that OPK is a condition that should be kept in mind to avoid misdiagnosis, in particular osteoblastic metastasis and undue distress to both the patients and doctors.

Total Hip Arthroplasty after McMurray's Osteotomy - A Case Report and Review of Literature.

INTRODUCTION: Total hip arthroplasty after McMurray's osteotomy increases the operative difficulties and decreases the chances of better outcome. With the advent of modular femoral stems, minute changes can be done to individual joints, which allow intraoperative flexibility and better post-operative outcome. Thus, it should be considered as an option for complicated cases. CASE REPORT: We report a case of a 35-year-old female with chief complain of pain in the left hip while walking for the past 2 years. The patient also had difficulty in squatting and sitting cross legged. History of fracture in the left hip at 4 years of age for which McMurray's osteotomy was done. The patient was operated with total hip arthroplasty using modular Sivash range of motion (S-ROM) stem. CONCLUSION: Modular S-ROM total hip arthroplasty is a good option for treatment in cases with previous osteotomy in femur.

Factors Influencing the Varus Deformity of Humeral Head in Proximal Humerus Fractures and Its Relation to Functional Outcome.

BACKGROUND: Fractures of the proximal humerus represent approximately 4% of all fractures and 26% of humerus fractures. Proper reduction, stable internal fixation and early initiation of physiotherapy help to achieve a good functional outcome. Aim of this study was to evaluate varus fixation/malunion of proximal humerus fractures and its relation to functional outcome. MATERIALS AND METHODS: We retrospectively evaluated 32 patients with proximal humerus fractures who were surgically treated between 2015 and 2017 at tertiary care hospital. We divided the patients into three groups on the basis of the neck-shaft angle as valgus group, normal group and varus group to observe the influence of neck-shaft angle on efficacy. Patients were evaluated for functional outcome using the Constant-Murley score. RESULTS: Two-part fractures had better functional outcome (Constant score = 75.15) compared to three parts with the moderate functional outcome (Constant score = 68.81) and the four-part fracture had poor functional outcome (Constant score = 52.66). After 6 months of follow-up, 13 patients had a neck-shaft angle of less than 126°. The functional outcome is significantly better among patients with normal neck-shaft angle and had a mean Constant score of 76.63 as compared to patients with varus deformity had a mean Constant score 60 (p = 0.001). 10 patients did not have medial support, in which 08 patients had neck-shaft angle less than 126° and 2 had a normal neck-shaft angle. CONCLUSION: High fracture comminution, improper restoration of medial continuity causes varus deformity of the humeral head and it leads to poor functional outcome. The small sample size is the limitation of our study.

Bilateral Severe Genu Varum in Dyggve-Melchior-Clausen Syndrome - A Case Report.

INTRODUCTION: Dyggve-Melchior-Clausen (DMC) syndrome was described in 1962 as an autosomal recessive type of spondyloepimetaphyseal dysplasia associated with mental retardation. Dymeclin (DYM) gene on chromosome 18q12.1 that encodes for DYM protein which is expressed in cartilage, bone, and brain is mutated in DMC. CASE REPORT: A 6 year -old male child presented with bilateral gradually progressive genu varum deformity of 4 years' duration. There was no significant past medical and family history. A plain radiograph of his knee, pelvis, and spine shows some classical signs of skeletal dysplasia. A plain radiograph of the pelvis with both hips shows a classical semilunar, irregular lacy appearance around the iliac crest which is a pathognomonic radiological sign of this syndrome. CONCLUSION: The radiographic lacy appearance of iliac crests and generalized platyspondyly with double-humped end plates are pathognomonic of DMC.

Primary Hypothyroidism Presenting as Slipped Capital Femoral Epiphysis in an Adult Patient : A Case Report and Review of Literature.

Introduction: Slipped capital femoral epiphysis (SCFE) is rare in adults and is often associated with endocrine pathology. Case Report: We report a case of a 21-year-old male presenting with an acute on chronic left hip SCFE who was diagnosed with primary hypothyroidism on the investigation. The patient was treated for hypothyroidism and positional reduction with in-situ fixation was carried out with two cannulated cancellous screws for the SCFE. At the latest follow-up of 30 months, patient remains asymptomatic, euthyroid, with a nearly full range of motion in the hips, significant functional improvement, fused physis on radiographs, and no signs of avascular necrosis. Conclusion: SCFE is a potentially devastating but avoidable complication in children/adults with the endocrine disorder and there may be a possible role for a screening pelvic radiograph in detecting this condition earlier.

Incisional Hernia Secondary to Iliac Crest Bone Graft: A Rare Case Report and Review of Literature.

INTRODUCTION: Autologous bone graft is a commonly used procedure in orthopaedic surgery. Autologous bone is used to promote bone healing in fractures and to provide structural support for reconstructive surgery. Iliac bone is one of the common sites for harvesting autologous bone graft. Hernia through an iliac crest defect following bone graft harvesting is a major but very rare complication. CASE REPORT: An 80-year-old female patient operated for left subtrochanteric femur fracture with dynamic condylar screw and iliac bone graft. Ten months after the surgery, the patient came with the complaints of reducible swelling in the left flank over the incision site. On the basis of clinical examination and investigations, the swelling was diagnosed as an incisional hernia from the defect in the iliac bone graft site. CONCLUSION: Hernia through an iliac crest defect following bone graft harvesting is very rare but a major complication. Attention should be paid while harvesting bone graft to avoid this complication.