Management of Proximal Femur Aneurysmal Bone Cyst with 10-year Follow-up - A Case Report.

Introduction: Aneurysmal bone cyst is a benign, most often non-neoplastic lesion affecting the bone. Malignant transformation is reported in certain cases, although rare. It commonly occurs in young adults with around 75% of the cases occurring in the first two decades and 95% occurring in the first 3 decades. The management depends on the individual case parameters with ABC occurring in a weight-bearing area of a bone warranting an aggressive treatment plan with the consideration of preventing a pathological fracture. Case Report: A 20-year-old male patient with no other comorbidities presented to us with complaints of atraumatic right hip pain of 9-month duration. On preliminary clinical examination and imaging studies with X-rays, CT scan, and MRI, the patient was diagnosed to have an aneurysmal bone cyst (ABC) of the right proximal femur. The patient was operated with intra-lesional excision with extended curettage and prophylactic fixation with DHS plating and kept on yearly follow-up. 10-year follow-up showed complete resolution of the lesion and implant removal was done after that. Conclusion: As is clear from this case, the treatment of an aneurysmal bone cyst needs to individualized based on the patient's age, complaints, and tumor behavior in terms of its aggressiveness, size, and its extent. Often, en bloc excision with extensive curettage is required along with bone grafting and prophylactic fixation to support the bone graft and to prevent a pathological fracture and further recurrence. Implant removal if indicated should be done after complete resolution of the lesion, patient willingness, and any other medical indication.

Giant Cell Tumor of the Second Metatarsal Managed with Ray Amputation: A Rare Case Report and Review of Literature.

Introduction: The giant cell tumor of bone (GCTB), also known as an osteoclastoma or a myeloid sarcoma, is a benign local aggressive osteolytic bone tumor that primarily affects skeletally mature young adults typically 20-40 years of age. Giant cell tumors (GCTs) are usually solitary tumors and very rarely are found in the metatarsal bones. The characteristic histological appearance of GCT displays a high number of osteoclast-like multinucleated giant cells, which resulted in the classification "osteoclastoma" or "giant cell tumor." Case Report: A 38-year-old male presented to the hospital with a firm swelling over the 2nd metatarsal slowly progressing over a period of 4 months, initial screening radiological investigations included X-rays, X-rays showed a tumorous growth involving the shaft of the 2nd metatarsal of the right foot, and the X-rays showed a characteristic soap bubble appearance. Magnetic resonance imaging. On gross assessment, the intraoperative sample showed that the GCTB has a dark brown-to-reddish appearance that is friable in texture. The gold standard for diagnosing a GCT is based on biopsy histopathological findings. The key histomorphologic feature is multinucleated giant cells. Conclusion: Giant cell tumors are frequently locally aggressive with high recurrence percentage, hence, excision was done. Nowadays, early radiological screening techniques help early detection of such rare occurrence of tumors such as the GCT and appropriate management. In conclusion, the giant cell tumor of the bone is a unique presentation of stromal cell and hematopoietic interaction in the bone.

Management of Neglected Developmental Dysplasia of the Left Hip in a 14-Year-Old Child with Staged Osteotomies Planned with 3D-Printed Model - A Case Report.

Introduction: Developmental dysplasia of hip (DDH) is abnormal development of hip joint causing mild subluxation to complete dislocation of femoral head from acetabulum. Incidence in India is 1-9.2/1000 . Typical risk factors for DDH are said to be female child, first born, breech position, positive family history, left hip, and unilateral involvement. Femoral head and acetabular compressive forces are mutually important stimulators for normal growth (both shape and depth). Deviation from above normal process due to subluxated or dislocated head since birth can lead to abnormal development of both acetabulum and femoral head. Diagnosis of the DDH is made at birth using clinical test and radiologically using ultrasound of hip joint. Management is based on the age of presentation and severity of the instability. Most hips are managed conservatively management depends on the age and symptoms of the patient. Case Report: A 14-year-old female child presented with the complaints of pain in the left hip and difficulty in walking. On clinical and radiological examination, she was diagnosed to have developmental dysplasia of the left hip with partial subluxation of the left hip. Thorough investigation and planning were done using CT PBH and 3D reconstruction of the pelvis to plan the osteotomy. Stages surgery was planned, first, triple innominate osteotomy was performed and later femoral varus derotation osteotomy 6 weeks later. At 3-year follow-up, the patient is pain free and is having no difficulty in doing day-to-day activities. X-ray showing complete coverage of the femoral head with no changes of arthritis in hip. Conclusion: Late presentations of neglected developmental dysplasia poses difficult challenges in management. It can be addressed with osteotomies for improving range of motion and preventing future early arthritis. In our case, good functional range of motion was restored at 3 years follow-up.

A Case Report on Surgical Excision of Intracapsular Osteochondroma of Femur Neck using Mini-Arthrotomy without Hip Dislocation in a Young Female with Hereditary Multiple Exostoses.

Introduction: Osteochondromas are the most common benign bone tumors. They probably are developmental malformations rather than true neoplasms and are thought to originate within the periosteum as small cartilaginous nodules. The lesions consist of a bony mass produced by progressive endochondral ossification of a growing cartilaginous cap. Osteochondromas usually are found on the metaphysis of a long bone near the physis such as distal femur, proximal tibia, and proximal humerus. Surgical treatment for femur neck osteochondroma is difficult due to the high risk of avascular necrosis following excision. These lesions in femur are in close proximity to important neurovascular bundle and can cause symptoms related to their compression. Furthermore, the symptoms related to labral tear and hip impingement are common. Recurrence is rare and is caused by failure to remove the entire cartilaginous cap. Case Report: A 25-year-old female presented with the complaints of pain in the right hip and difficulty in walking and running for 1 year. On radiological examination, the right femur neck osteochondroma was diagnosed, it was located along the posteroinferior margin of the femur neck. Surgical removal of the lesion was done in lateral decubitus position using posterolateral approach to hip without dislocation of the femur. Conclusion: Osteochondroma at femur neck can be safely removed without surgical hip dislocation. It's necessary to remove it completely to avoid recurrence.

Management of a Gap Non-union Patella Fracture Using Encirclage Wire and Tension Band Wiring with Quadriceps V-Y Plasty in an Elderly Patient: A Rare Case Report and Review of Literature.

Introduction: The management of gap non-union patella fractures continues to be a challenge in orthopedics. The incidence of these cases ranges between 2.7% and 12.5%. The quadriceps muscle attached to the proximal fractured fragment pulls it proximally leading to the gap at fracture site. If the gap is too large, there won't be any fibrous union resulting in failure of quadriceps mechanism and extension lag. The primary aim is to bring the fracture fragments together and restore the extensor mechanism. Most of the surgeons prefer single-stage procedure, in which mobilization of the proximal fragment, followed by fixing with the lower fragment is done using V-Y plasty or x lengthening with or without pie Crusting. Others use of pre-operative traction to the proximal fragment using pins or ilizarov method. In our case, we used single-stage procedure whose results were encouraging. Case Report: A 60-year-old male patient presented with pain in the left knee with difficulty in walking since 3 months. The patient had road traffic accident 3 months back and sustained trauma to left knee. On clinical examination, there was palpable gap of more than 5 cm between the fracture fragments, anterior surface of femur and condyles was palpated through fracture site and knee range of motion was between 30° and 90° of flexion, and X-ray suggests of patella fracture. Midline 15 cm longitudinal incision was taken. The insertion of the quadriceps tendon over proximal pole of patella was exposed and pie crusting was done on medial and lateral side and V-Y plasty was done. SS wire was used to hold the reduction of the fragments by encirclage wiring and anterior tension band wiring done. Retinaculum was repaired and wound closed in layers. Postoperatively, long rigid knee brace was given for 2 weeks and walking with partial weight-bearing started. After suture removal at 2 weeks, full weight-bearing initiated. At 3 weeks, knee range of motion started and continued till 8 weeks. At 3 months post-operative, the patient is able to do flexion up to 90° and no extension lag is present. Conclusion: Adequate quadriceps mobilization during the surgery along with pie crusting and V-Y plasty with TBW and encirclage combined gives good functional outcome in patella gap non-unions.