Comparison of Clinical and Functional Outcomes after Platelet-Rich Plasma Injection and Corticosteroid Injection for the Treatment of de Quervain's Tenosynovitis.

Background Platelet-rich plasma (PRP) has local anti-inflammatory actions, which is being used as a treatment in various tendinopathies. Purpose The aim of the study is to compare the clinical results of PRP injection and corticosteroid injection in the management of de Quervain's tenosynovitis (DQTSV). Patients and Methods In this prospective study, 60 patients of DQTSV, fulfilling the predefined inclusion and exclusion criteria, were randomised into two groups. In group 1 ( n = 30), patients received a single injection of autologous PRP and in group 2 ( n = 30) they received a single injection of corticosteroid (methylprednisolone). All patients were followed up at 1 month, 3 months, 6 months, and 1 year for evaluation by Finkelstein test, visual analogue scale (VAS), DASH (Disabilities of the Arm, Shoulder and Hand) score, and Modified Mayo Wrist score (MMWS). Results In both the groups improvement occurred in Finkelstein test, VAS score, DASH score, and MMWS which were found to be statistically significant at all points of follow-ups when compared to the pre-intervention values. Comparison of scores between the two groups did not show any statistical significance. No complications were reported in PRP group. Statistically significant complications ( p -value = 0.026) like subcutaneous fat atrophy, depigmentation, and temporary increase in pain were seen in eight patients in the corticosteroid group with an overall complication rate of 26.67%. Conclusion Both the modalities are equally effective in the management of DQTSV remittance. PRP is equally effective as corticosteroid in reducing symptoms of first dorsal compartment stenosing tenosynovitis. PRP may have a lower complication profile, however, this benefit should be weighed against the slight increase in cost and time of PRP preparation and injection. Level of Evidence Level 2, prospective comparative study.

Step-Cut Subtrochanteric Osteotomy Combined with Total Hip Arthroplasty for Neglected Traumatic Hip Dislocations.

Background: Total Hip Arthroplasty remains the standard treatment protocol for patients with neglected traumatic dislocations of the hip with arthritis. A total hip arthroplasty needs to be frequently combined with a subtrochanteric shortening femoral osteotomy to aid in the reduction of the hip joint in such cases. Still long-term stable implant fixation, rigid construct, and favorable functional outcome remain a challenge. In respect to subtrochanteric shortening osteotomy, various techniques have been described in the literature, including the step-cut, double chevron, transverse, and oblique osteotomies. Out of these types, a subtrochanteric step-cut osteotomy provides a better rotational stability and a larger surface of contact to aid in union. As there is a paucity in the literature regarding the step-cut osteotomy for traumatic dislocations of the hip, we designed this study to evaluate the outcomes of this procedure. Methods: We prospectively evaluated 24 patients with neglected traumatic dislocations of the hip, who underwent total hip arthroplasty with a step-cut subtrochanteric shortening osteotomy using a long modular stem within a span of 4 years. The indications were severe pain and difficulty in walking and performing activities of daily living. Patients fulfilling the inclusion criteria were evaluated in terms of Harris Hip Score, leg length discrepancy, neurological status, union of the osteotomy, and implant stability. Results: The mean Harris Hip Score significantly improved from 33.4 preoperatively to 89.2 postoperatively at the latest follow-up. At the final follow-up, all patients showed union at the osteotomy site and there were no cases of implant loosening or instability. No neurological complications were reported. Conclusions: Total hip arthroplasty combined with a step-cut subtrochanteric femoral shortening osteotomy in patients with neglected dislocations of the hip was associated with good functional outcome and higher success rates in terms of stable implant fixation and union at the site of osteotomy.

Cell-free tumor DNA, CA125 and HE4 for the objective assessment of tumor burden in patients with advanced high-grade serous ovarian cancer.

BACKGROUND: The present prospective study aimed at determining the impact of cell-free tumor DNA (ct-DNA), CA125 and HE4 from blood and ascites for quantification of tumor burden in patients with advanced high-grade serous epithelial ovarian cancer (EOC). METHODS: Genomic DNA was extracted from tumor FFPE and ct-DNA from plasma before surgery and on subsequent post-surgical days. Extracted DNA was subjected to hybrid-capture based next generation sequencing. Blood and ascites were sampled before surgery and on subsequent post-surgical days. 20 patients (10 undergoing complete resection (TR0), 10 undergoing incomplete resection (TR>0)) were included. RESULTS: The minor allele frequency (MAF) of TP53 mutations in ct-DNA of all patients with TR0 decreased significantly, compared to only one patient with TR>0. It was not possible to distinguish between patients with TR0 and patients with TR>0, using CA125 and HE4 from blood and ascites. CONCLUSIONS: Based upon the present findings, ct-DNA assessment in patients with high-grade serous EOC might help to better determine disease burden compared to standard tumor markers. Further studies should prospectively evaluate whether this enhancement of accuracy can help to optimize management of patients with EOC.

Unilateral limb orthosis for maintenance of deformity correction following treatment of clubfoot with Ponseti technique: a systematic review.

The systematic review study aimed to investigate the following details in the clubfoot children treated with the Ponseti technique: (1) to review the various designs and prescriptions of unilateral limb orthosis described in literature; (2) to find the outcome following use of this orthosis, especially patient adherence and recurrence; (3) comparison with standard bilateral limb foot abduction orthosis. A literature search was performed for articles published in 'Pubmed (includes Medline indexed journals)' electronic databases for broad key words: 'Clubfoot or CTEV or congenital talipes equinovarus', 'orthosis or brace or splint'. Included were studies that addressed the treatment of idiopathic clubfoot in children up to 2 years of age using the Ponseti technique and use of unilateral limb orthosis for the subsequent maintenance phase. We excluded studies reporting Ponseti technique for nonidiopathic clubfoot, child age older than 2 years at the time of primary treatment, studies where unilateral limb orthosis was used as a tool for primary correction of all or some components of clubfoot and design descriptions of orthosis without practical usage data. Of the 1537 articles from the database, 10 articles were included in the final review. Most studies were retrospective, underpowered and had a short term follow-up. In some series, the use of this orthosis was driven by personal experiences and regional preferences rather than a just scientific explanation. The tested designs were variable and nonstandardized. Being less restrictive, unilateral limb orthosis may have an edge over bilateral limb orthosis in terms of patient adherence. The available comparative studies however showed inferiority of unilateral orthoses when compared to the bilateral limb orthosis in preventing recurrences in clubfoot treatment. There is insufficient evidence to support use of unilateral limb orthosis for maintenance of deformity correction following treatment of clubfoot with the Ponseti technique. Their use was found associated with high recurrence rates.

Recurrent Epithelioid Hemangioendothelioma of Calcaneum: A Case Report of a Rare Tumor.

Epithelioid hemangioendothelioma (EHE) is an uncommon malignant vascular tumor characterized by epithelioid or histiocytoid endothelial appearance. Here we present the case of a 65-year-old female with recurrent EHE of the left calcaneum. The patient had developed soft-tissue swelling over the lateral aspect of the left hindfoot three years ago, which was previously managed by excisional biopsy as per medical records and the histopathological examination (HPE) had revealed an EHE. A year later, she again developed a painful swelling with superficial ulceration over the same region and presented to us. A plain radiograph of the foot showed a soft-tissue swelling with cortical breach over the lateral aspect of calcaneum. MRI revealed a mass encasing peroneus tendons, with extension into the lateral surface of calcaneum. CT angiography revealed a mass eroding the lateral cortex of calcaneum and receiving blood supply from calcaneal branches of peroneal artery. PET-CT scan did not reveal any other primary or metastatic site. Core needle biopsy of calcaneum was suggestive of EHE. Limb salvage was difficult as the tumor was recurrent and involved the skin and the weight-bearing part of the calcaneum. The patient was managed with trans-tibial amputation. Immunohistochemical (IHC) staining of the excised tissue was positive for CD34, Vimentin, SMA, and Fli-1. The margins were negative for any tumor cells and she did not require any adjuvant therapy. At two years follow-up, she was free of any further recurrence or metastasis. Recurrent tumors of this variety are fast-growing with metastatic potential and may cause mortality. Hence, they need to be managed aggressively.

Spontaneous subcapital femoral neck fracture complicating osteonecrosis of femoral head.

Spontaneous subcapital fracture (SSF) of femoral neck in pre-existent osteonecrosis of femoral head (ONFH) is a rare presentation. Only a few cases have been reported so far and majority of them have been reported to have unilateral hip involvement. We retrospectively reviewed clinical-radiological data of 10 patients (12 hips) with SSF complicating ONFH. All of them underwent uncemented total hip arthroplasty. All the available publications in the English language based medical literature were critically reviewed and results were summarized. The median age of presentation was 32 years (range : 24 years to 61 years). They were followed up for a mean duration of 25 months (range : 12 months to 59 months). The most common risk factor was corticosteroid consumption (7 out of 10 patients). All except one (modified Ficat and Arlet stage II) belonged to advanced stage of ONFH {stage III 3 patients (3 hips), stage IV 6 patients (8 hips)}. The mean time lag of ONFH to presentation was 22.3 months (range : 5 months to 60 months), and SSF to presentation was 13.8 days (range : 1 day to 28 days). Mean pre- operative Harris Hip Score was 10.8 (range : 8 to 14), which improved to 93 (range : 91 to 96) after total hip arthroplasty when last followed up (p<0.05). Corticosteroids induced ONFH has a propensity to develop SSF. This entity should find a place in existing classification system.

Tuberculous osteomyelitis of tibial diaphysis following saphenous vein graft harvest for coronary artery bypass: a case report.

Tuberculosis in the tibial diaphysis following saphenous vein graft harvest for coronary artery bypass grafting has not been reported, to the best of authors' knowledge. We report the first such clinical case in view of its clinical rarity and as a complication of the simple procedure like saphenous vein graft harvest.

Lateral Buttress Plate Along with Cancellous Screw Fixation for Hoffa Fracture Using Swashbuckler Approach.

Coronal plane fracture of the posterior femoral condyle, Hoffa fracture is a rare injury pattern. We report a case of a 32-year-old male with closed Lateral Hoffa fracture along with patella and medial condyle of tibia fracture. Patient was treated using 02 cannulated cancellous screws and a lateral recon plate for Hoffa fracture, tension band wiring for patella fracture and 02 cannulated cancellous screws for tibia fracture through modified swashbuckler approach. Twenty-four months postoperatively, the range of movement in the knee was 0°-130°. In this complex case, our technique provided stable fixation of the fragments and a satisfactory final functional outcome.

Osteoblastoma of Talus: A Diagnostic Dilemma.

The critical biomechanical importance of talus and nonspecific clinical features of talus lesion warrants a meticulous diagnostic work-up for specific management, particularly when the talus lesion is associated with concomitant soft tissue and joint abnormalities. We present a rare case of osteoblastoma of talus with concomitant tenosynovitis of tibialis anterior, ankle joint effusion, varicose vein and moderate distal arterial stenosis.

A Rare Case Report of Chondroblastoma Pisiform in Adolescent.

INTRODUCTION: Chondroblastoma is a rare primary benign tumor of bone with male predominance and is typically seen in an epiphyseal location. The pisiform is a carpal bone and chondroblastoma of the pisiform has not been reported in the literature to the best of our knowledge. CASE PRESENTATION: An 18-year-old male presented with painful swelling over his right wrist with restriction of ulnar deviation. Based on magnetic resonance imaging findings, two diagnostic possibilities were entertained, namely, giant cell tumor of bone and chondroblastoma. Wide local excision was performed, and histopathology confirmed the diagnosis of chondroblastoma of the pisiform. After 2 years of follow-up, the patient has gained pain-free wrist movements post excision, and there are no signs of recurrence. The Modified Mayo Wrist Score of 75 (fair) improved to 100 (excellent). CONCLUSION: Surgeon should always keep in mind the possibility of the tumor at the rare site and accurately diagnose the tumor with the help of imaging modalities and biopsy.

Winging of Scapula: An Uncommon Presentation of a Common Tumor.

Neuromuscular causes of winging of scapula are well known, but winging and snapping of scapula may rarely be caused by space-occupying lesion of the thoracic wall. Although osteochondroma of scapula is rare, it is the most common neoplasm of scapula, and osteochondroma of ventral scapula may lead to pseudo-winging, snapping, and rib erosion on the same side. Owing to its rarity, we report two cases of osteochondroma of ventral scapula with complains of difficult scapulothoracic movement (snapping scapula) and pseudo-winging. After initial clinical and radiological investigations, wide local excision was done and diagnosis confirmed histopathologically. In a two-year follow-up, there is no recurrence, and symptoms of snapping and pseudo-winging disappeared completely. Pertaining to its asymptomatic nature and rare location, diagnosis of osteochondroma may be missed initially searching for some other neuromuscular disorders, and these cases should be reported to increase awareness and to execute proper surgical management.

Primary hydatidosis of distal femur masquerading malignancy -A rare case.

Hydatidosis is relatively uncommon entity and it rarely affects bone and joints. A rare case of primary hydatidosis (Echhinococcus granulosus infection) involving the distal femur and the knee joint in a 53 years old female is reported here. This presented as a pathological supracondylar fracture of femur. On establishment of a clinical diagnosis she was treated preoperatively with Albendazole 600 mg, daily for 3 cycles each of 21 days with a gap of 1 weeks between cycles. Two stage surgery was carried out, the first being a meticulous debridement and second a total knee replacement with cemented tumor mega-prosthesis. Postoperatively the wound healed completely without any evidence of infection and albendazole therapy was continued for three months following surgery. During the follow-up period of two and a half year, no recurrence of hydatidosis was noticed.

Concordance between Comprehensive Cancer Genome Profiling in Plasma and Tumor Specimens.

INTRODUCTION: Detection of somatic genomic alterations in the plasma of patients with cancer ("liquid biopsy") are increasingly being used in the clinic. However, the concordance of alterations identified in liquid biopsies with those detected in cancer specimens is not routinely being determined. METHODS: We sought to systematically compare alterations found by a massively parallel sequencing liquid biopsy assay covering 39 genes (NEOliquid [NEO New Oncology GmbH, Köln, Germany]) with those identified through routine diagnostic testing in a certified central pathology laboratory in a cohort of patients with nonsquamous NSCLC. NEOliquid is based on enrichment of the genomic territory of interest by hybrid capture and is thus capable of detecting point mutations, small insertions and deletions, copy number alterations, and gene rearrangements/fusions in a single assay. RESULTS: In a cohort of 82 patients with matched blood/tissue samples, the concordance between NEOliquid and tissue-based routine testing was 98%, the sensitivity of NEOliquid was higher than 70%, and the specificity was 100%. Discordant cases included those with insufficient amounts of circulaating tumor DNA in plasma and cases in which known driver mutations (e.g., isocitrate dehydrogenase (NADP(+)), 1 systolic gene [IDH1] R132H, kinesin family member 5B gene [KIF5b-ret proto-oncogene [RET], or MNNG HOS Transforming gene [MET] exon 14) were found in the plasma but were not interrogated by routine tissue analyses. CONCLUSIONS: In summary, NEOliquid offers accurate and reliable detection of clinically relevant driver alterations in plasma of patients with cancer.

Ipsilateral open anterior hip dislocation and open posterior elbow dislocation in an adult.

Open anterior dislocation of the hip is a very rare injury, especially in adults. It is a hyperabduction, external rotation and extension injury. Its combination with open posterior dislocation of the elbow has not been described in English language-based medical literature. Primary resuscitation, debridement, urgent reduction of dislocation, and adequate antibiotic support resulted in good clinical outcome in our patient. At 18 months follow-up, no signs of avascular necrosis of the femoral head or infection were observed.

Radiographic changes in nutritional ricket hips in children in response to treatment.

PURPOSE: To review radiographic changes in the proximal femurs of children of different ages during the course of treatment for nutritional rickets. METHODS: Pelvic radiographs of 161 children aged ≤ 13 years with nutritional rickets were retrospectively reviewed. Patients were treated with dietary counselling and vitamin D and calcium supplementation. Patients were followed up at week 3 and thereafter at a 2-month interval until ulnar convexity was achieved. Sequential radiographs of the hips in children of different ages were reviewed for each growth plate in terms of (1) the direction of growth, (2) active areas, (3) contribution of growth, and (4) the structure of the epiphysis. Radiographs were superimposed for comparison by matching the triradiate cartilage and the ischial portion of the obturator foramen. RESULTS: The direction of growth of the growth plates was from the physeal plate that is the longitudinal growth plate of the neck (LGP), the femoral neck isthmus (FNI), and the trochanteric growth plate (TGP) to the diaphyseal region, and from the perichondrium to the ossification centre in the proximal femoral epiphysis. Before the age of one year, the growth zone of the proximal femur was homogenous, with no differentiation between the LGP, FNI, and TGP. By the age of 2 years, the differentiation was more clearly established; the FNI was usually smaller than the TGP and LGP. By the age of 3 years, the FNI became prominent and the TGP remained small. By the age of 4 years, the ossification centre of the greater trochanter appeared, and the LGP extended medially as a medial overhang (MOH). During the children's growth, the LGP, FNI, or TGP remained active to a variable extent and were distinct until the age of 6 years. Gradually, the periphery of the LGP became less active than the centre of the LGP and gave rise to the 'eye sign'. The MOH generally ceased to be active beyond the age 9 years. By the age of 12 years, the TGP and FNI were minimally active and only the centre of the LGP remained active. CONCLUSION: The mineralisation process of healing rickets provides a useful biological marker for patterns of growth. Knowledge of the quantitative contribution of various growth plates of the proximal femur in childhood may increase the understanding of the pathomechanism of hip deformations.

Systematic curation and analysis of genomic variations and their potential functional consequences in snoRNA loci.

Small nucleolar RNAs (snoRNAs) are a class of noncoding functional RNAs which are involved in RNA modifications, like methylation and pseudouridylation of other RNAs. The snoRNA species of RNAs are characterized by conserved structural motifs they harbor which are also intricately related to their functionality. Though there have been reports of the involvement of snoRNAs in disease processes and anecdotal reports of genomic variations in snoRNA loci and their effects in modulating snoRNA function, there has been no systematic collection and analysis of variations in snoRNA loci. In this manuscript, we present the most comprehensive curation of genomic single nucleotide variations in human snoRNA loci, and their systematic computational analysis to reveal potential single nucleotide variations which could have functional effects. We show six single nucleotide variations in snoRNA loci could significantly alter snoRNA structure and could have potential implications in their functions. The compilation is available at the snoRNA locus specific variation database: http://genome.igib.res.in/snolovd conforming to the HGVS standards for nomenclature of genomic variants.

Congenital diastasis of the inferior tibiofibular joint with clubfoot and imperforate anus.

Congenital diastasis of the inferior tibiofibular joint is a rare condition of unknown etiology, first described in 1972. Although its clinical presentation at birth is a talipes equinovarus deformity of the foot, it may be associated with limb length discrepancy and other skeletal and visceral abnormalities. We present one such case of congenital inferior tibiofibular diastasis of Onimus type A variety (vertical diastasis) with talipes equinovarus, high imperforate anus, short first ray of the foot, intact superior tibiofibular joint, and no limb length discrepancy. Closed manipulation and casting had been unsuccessful, and at this time, the patient had not pursued any treatment during the past one year. A colostomy for the imperforate anus had been performed 36 hours after his birth and was planned for subsequent posterior sagittal anorectalplasty to reestablish continuity. His ankle joint was reconstructed along with soft tissue release for talipes equinovarus. Two years after surgery, he has a plantigrade stable foot with no limb length discrepancy. We propose that if the reconstructed joint is carried out in early childhood, it will provide better reciprocal joint surfaces with less chances of degenerative arthritis in later life. However, leg length inequality and recurrence of the deformities are not uncommon, necessitating further surgical interventions.