Iatrogenic Brachial Artery Injury During Long Proximal Humeral Interlocking System (PHILOS) Plating.

Iatrogenic vascular injuries are rare but potentially serious complications that can occur during orthopedic procedures involving the proximal humerus. We present a case report of a patient who sustained a brachial artery injury during a long Proximal Humeral Interlocking System (PHILOS) plating procedure for a proximal humeral fracture. A 62-year-old female patient with a left humerus proximal 1/3 shaft fracture underwent open reduction and internal fixation with a long PHILOS plate. During the procedure, difficulty was encountered in achieving adequate plate positioning due to osteoporotic bone and fracture comminution. Upon insertion of a distal second last screw, brisk brachial artery bleeding was encountered. Immediate hemostasis measures were taken, and a plastic surgeon was consulted. The brachial artery injury was identified and repaired with a cephalic vein graft harvested and flushed. Postoperatively, the patient developed median nerve neuropraxia. This case highlights the risk of iatrogenic brachial artery injury during left humerus proximal 1/3 shaft fracture fixation, especially in cases with technical challenges due to osteoporotic bone or comminution. Prompt recognition, involvement of vascular surgery, and appropriate management are crucial in mitigating potential devastating consequences. Associated neurological complications, such as nerve injuries, can also occur and should be monitored. Meticulous surgical technique, anatomical awareness, and vigilant monitoring are essential to minimize the risk of vascular and neurological complications during these procedures. Iatrogenic brachial artery injury is a rare but potentially serious complication of humerus proximal 1/3 shaft fracture. Early recognition, multidisciplinary involvement, and appropriate management strategies are crucial in optimizing patient outcomes and preventing long-term morbidity.

Outcomes of Femoral Neck System in Treating Intra-capsular Neck of Femur Fractures in a Young Adult: A Case Report.

The introduction of the Femoral Neck System (FNS) represents a promising alternative to traditional cancellous cannulated (CC) screw fixation for managing intra-capsular neck of femur (ICNF) fractures. This case report aims to validate its safety and report the outcomes in a young patient. The findings demonstrate that the FNS possesses excellent biomechanical properties and provides significantly greater overall construct stability bearing in mind, that it was used in a Pauwels Classification Grade 3 ICNF fracture.

Optimizing Fixation and Biologic Augmentation in Aseptic Femoral Nonunion Management: A Retrospective Case Series.

Nonunion poses significant difficulties for both patients and orthopedic surgeons, often requiring intricate reconstructive surgeries to achieve bone healing and eliminate infections. Surgeons must navigate numerous contributing factors to nonunion, and they also face challenging hardware issues during revision procedures. These issues can include infections, loose or failing hardware, misaligned components, or inappropriate hardware configurations. This case series includes five cases of nonunion femur fractures and the goal is to carefully analyze the best treatment option for treating nonunion. All the cases underwent the removal of whole or part of the hardware followed by bone grafting and attainment of the stable construct with load-sharing devices and augmentation with neutralizing plates. All the cases had a radiological bone union at an average of four to seven months with improvement of Harris Hip Score.

A Prospective Study on Fixation of Syndesmotic Ankle Injury: Tight Rope Versus Screw Fixation.

Background Syndesmotic injury can result in significant instability and long-term complications if not treated correctly. Traditional management has involved transyndesmotic screw fixation, but a newer technique, the tight rope system, has been developed to mitigate some of the issues related to screw fixation, such as hardware discomfort and the necessity for hardware removal. Methods In this randomized, prospective study, 32 patients with ankle injuries requiring syndesmotic fixation were equally divided into two groups: one receiving the tight rope system (n=16) and the other undergoing screw fixation (n=16). The patients were monitored for six months following surgery. The study measured outcomes such as time to weight-bearing, range of motion, pain levels, functional outcomes using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, and complication rates. Results Both groups had comparable demographic and injury profiles. The tight rope group achieved weight-bearing significantly earlier (6.19 ± 0.9 weeks vs. 7.13 ± 0.95 weeks, p=0.008) and had better functional outcomes at six months (87.5% excellent AOFAS scores vs. 37.5%, p=0.003) compared to the screw fixation group. The range of motion and pain scores were similar between the groups. Different complications were observed: screw breakage was more common in the screw fixation group, while the tight rope group experienced more laxity. Overall complication rates were similar. Conclusion Both techniques were effective in reducing pain and maintaining range of motion. However, the tight rope system allowed for earlier weight-bearing and better functional outcomes at six months. These results indicate that the tight rope system may provide certain advantages in treating syndesmotic injuries, although the choice of technique should be tailored to the specific injury and patient factors.

The Posterior Dislocation of the Shoulder With Reverse Hill-Sachs Lesion and Humerus Lesser and Greater Tuberosity Fracture.

Posterior shoulder dislocations are the rarest of all shoulder dislocations. They are commonly associated with seizures, electric shocks, or trauma. This case report presents a 60-year-old male with a posterior shoulder dislocation complicated by fractures of the greater tuberosity (GT) and lesser tuberosity (LT) and a reverse Hill-Sachs lesion. The patient was treated surgically using a modified McLaughlin procedure. This case highlights the importance of the early recognition and appropriate surgical management of complex posterior shoulder dislocations to prevent recurrent instability and ensure optimal functional recovery.

Acute Bony Bankart Injury With Glenoid Rim Fracture Treated by Arthroscopic Bankart Repair.

A bony Bankart lesion is a torn labrocapsular complex with a glenoid rim fracture. In this case report, a patient with an acute bony Bankart injury presented with severe shoulder pain and limited range of motion following a road traffic accident. The injury was diagnosed through imaging studies and required arthroscopic bony Bankart repair. The post-surgery rehabilitation program restored the patient's shoulder mobility, strength, and stability, significantly improving pain relief and functional ability. Overall, the case report highlights the importance of prompt diagnosis and appropriate surgical intervention in acute bony Bankart injuries, followed by a well-structured rehabilitation program to achieve optimal outcomes in pain relief, range of motion, and functional ability.

A Neglected Fracture of Acetabulum Treated With Total Hip Replacement.

Total hip replacement (THR) for osteoarthritis or inflammatory arthritis yields better outcomes than THR for patients with neglected acetabular fractures. The inferior clinical results mostly arise from an unforeseen bone deficit, making the treatment more time-consuming and complex for instances requiring acetabular restoration and bone grafting. There is a lack of research on the clinical results of THR in cases where acetabular fractures have been overlooked. A 55-year-old male patient presented with a malunited anterior column of the acetabulum, non-union of the posterior column with protrusion, and a significant impaction fracture in the femoral head. He was then treated with open reduction and internal fixation (ORIF) of acetabular columns, along with the use of a reconstruction cage and bone grafting. At the five-year follow-up, the patient had a good outcome. The keys to success include meticulous preoperative planning using radiography and computed tomography (CT) scans, sufficient exposure to define the fracture pattern, and the availability of a full range of devices and backup implants. If there are any prior implants, they should only be removed if they are infected or in the way of cup implantation. However, if there is a significant amount of bone loss, complex fractures may require extensive repair using revision total hip arthroplasty (THA) implants.

An Unusual Pattern of Scapular Avulsion Fracture in the Spine: A Case Study.

Acromion fractures, particularly isolated cases, are uncommon but significant in shoulder injuries. There is no universally accepted treatment protocol, but the classification of the fracture helps to guide clinical decisions. We present a case report aiming to contribute to the understanding of treatment options for acromion fractures. A 22-year-old male sustained a left shoulder injury during a wrestling match, resulting in a type 2 acromion fracture. Conservative treatment was initiated with regular follow-ups. Serial imaging showed no further displacement. Gradual rehabilitation exercises were introduced based on healing progress. The rarity of isolated acromion fractures complicates their management. Conservative management, coupled with rehabilitation exercises, yielded positive outcomes in our case, suggesting its efficacy as a primary treatment option for isolated displaced acromion fractures. Further research is needed to establish standardized protocols for managing such fractures, but until then, conservative care remains a viable approach, potentially preferred over surgical intervention.

Treatment of Failed Proximal Femoral Nail Anti-rotation Asia (PFNA2) in a Severely Osteoporotic Patient With a Revision Stem.

An intertrochanteric fracture is a prevalent and perilous kind of fracture that often affects older persons. A customized implant, proximal femoral nail anti-rotation Asia (PFNA2) is being used expressly in unstable intertrochanteric fractures in people with osteoporosis. In this case report, we examined a female osteoporosis patient, age 74, who underwent a failed PFNA2 procedure. Subsequently, the patient had bipolar hemiarthroplasty as a treatment. To prevent mechanical failure, it is crucial to strive for a high level of reduction quality and precise alignment of the central blade throughout hip X-ray procedures. Improved surgical proficiency and skill are crucial for managing patients with severe osteoporosis and prolonged weight-bearing requirements, hence reducing the occurrence of postoperative problems. Depending on the cause of the failure and the individual circumstances of the patient when internal fixation fails, it is recommended to either replace the joint with a prosthetic or reapply fixation. These interventions may facilitate the production of beneficial healing outcomes.

A Case of Modified McLaughlin Procedure in Neglected Posterior Shoulder Fracture Dislocation.

A Hill-Sachs lesion, a posterolateral bony defect of the proximal humerus, occurs when the humerus head collides with the anterior region of the glenoid during an anterior shoulder dislocation. A posteriorly dislocated shoulder may cause a reverse Hill-Sachs lesion, which is a deficiency on the anteromedial part of the humeral head due to impaction. Avascular necrosis could result from this lesion if detection and repair are not carried out. The subscapularis tendon is separated from the smaller tuberosity using an open technique in the original McLaughlin procedure, which was initially described in 1952. In neglected cases of patients undergoing surgery after three weeks, there is no commonly accepted standard of care. Glenohumeral joint stabilization and early and full functional recovery are the two objectives of the procedure. This case report describes a modified McLaughlin surgery where the subscapularis tendon and lesser tuberosity are transferred to the reverse Hill-Sachs defect for stability. The clinical significance of our case report is that it accentuates the role of early detection and appropriate management of reverse Hill-Sachs lesion, which is often overlooked and missed in a case of posterior shoulder dislocation. The use of the modified McLaughlin procedure not only covers the defect with a bone chunk and the subscapularis tendon transfer over the head of the humerus but the stable fixation with the anchor and cannulated cancellous screw helps in early rehabilitation of the shoulder joint.

A Rare Case of Giant Cell Tumour of Tendon Sheath and Its Arthroscopic In Toto Excision.

The aim of this study is to bring attention to a unique occurrence in an uncommon location and to describe our approach to treatment in this context. We describe a case of a 36-year-old male who presented with complaints of pain in his left knee for three months, with a restricted range of motion, without a prior history of trauma. A thorough knee examination was performed, which was unremarkable except for a restricted range of motion and tenderness along the medial joint line. A plain radiograph of the knee revealed no bony injury. MRI was done to assess the extension and it confirmed a soft tissue mass beneath the patella. The patient was taken up for surgery after a pre-anesthetic checkup and the mass was removed arthroscopically in toto using a higher accessory antero-medial portal. The mass was removed with the help of a spatula without damaging it and sent for histopathological analysis. Histopathology confirmed that it was a giant cell tumour of the tendon sheath. The procedure was uneventful, and the patient achieved a full range of motion post-operatively.

Comparative Study of Postoperative Outcomes of Clavicle Midshaft Fracture Treated by Nailing vs. Plating.

Background A midshaft clavicle fracture is a prevalent form of injury of the upper extremity that affects one's quality of life. Several treatment modalities facilitate fixation of the displaced midshaft clavicle to decrease nonunion and malunion of the clavicle fracture. Still, numerous factors influence choosing an optimal surgical intervention. Thus, this study investigates the functional outcome of two standard fixation techniques, titanium elastic nails (TENs) and locking plates, as a prospective comparative study for surgical management of displaced midshaft clavicle fractures. Methods We performed closed/open reduction and internal fixation in 62 patients (40 male and 22 female) with TENs and locking plates, respectively, which were followed up at regular intervals following the surgery (at two, six, 12, 24, and 48 weeks). The surgical outcome was assessed both from functional and radiological standpoints. The influence of surgical fixation on functional outcome was evaluated based on the Constant-Murley score and the fracture recuperation based on union times. Results When compared to plate fixation, TENs had lesser union times. Still, there was no statistical difference in union time between the two groups. The functional assessment graded by Constant-Murley score had a similar distribution of scores between the two groups.With a follow-up of twelve months, the Constant-Murley scores between the groups were not statistically different. While the average score for plate fixation was slightly higher than that of TENs, the nonunion rate was found to be similar in both groups. Conclusion Surgical interventions using both TENs and plate fixation are suitable for managing clavicle midshaft fractures as they have a similar functional outcome. However, considering early recovery with minimal surgical complications, TENs can be a preferred treatment choice for managing displaced midshaft clavicle fractures.

A Rare Case of Preiser Disease Affecting a Young Female.

Avascular necrosis of the carpal scaphoid is known as Preiser disease. Avascular necrosis is usually caused by non-traumatic or idiopathic etiology. In this case report, we present the case of a 23-year-old female patient who came to our outpatient department with complaints of pain and swelling over the left wrist joint for seven months. The patient did not give any history of trauma or long-term steroid intake. Clinically, the patient had tenderness over the left anatomical snuff box. A plain radiograph of the wrist joint did not suggest any abnormality. MRI was done to confirm the diagnosis. MRI showed altered marrow signals in the scaphoid, which was suggestive of avascular necrosis of the scaphoid, also known as Preiser disease. Proximal row carpectomy was done for the patient, and wrist range of motion exercises were started after one week postoperatively. Full range of motion of the wrist joint was achieved at three weeks postoperatively without no residual deformity.

Tibial Avulsion with Intra-Articular Entrapment of Medial Collateral Ligament with Posterior Cruciate Ligament Tear with Posterior Root Medial Meniscus Tear: A Case Report of an Unusual Injury Triad.

INTRODUCTION: The medial collateral ligament (MCL) is the most commonly injured ligament of the knee joint; however, its displacement into the medial knee compartment is rare. Traumatic posterior root of medial meniscus (PRMM) tears are commonly found in high-grade injuries involving anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) tears along with MCL tears. Diagnosis of these injuries can be made by a preoperative magnetic resonance imaging (MRI), but they can be missed at times due to severe soft-tissue swelling in the acute phase. CASE REPORT: A 25-year-old gentleman presented with injury to the front of his left knee 5 days back. On examination, he had a Grade 3 effusion with valgus stress test and posterior drawer test being positive and medial joint line tenderness was present. A firm localized swelling was palpable on the medial joint line. MRI scan revealed a mid-substance PCL tear, ACL sprain, PRMM tear, and tibial side rupture of superficial MCL with proximally migrated wavy MCL fibers lying below the medial meniscus confirmed on arthroscopy. Medial meniscus root repair by pull through technique and PCL reconstruction with a 3-strand peroneus longus graft followed by open MCL repair with augmentation using a semitendinosus graft was performed. Postoperatively, the knee was kept in a straight knee brace for 4 weeks, followed by a hinged knee brace and appropriate physiotherapy were started. At 2 years follow-up, the patient had attained full range of knee motion with good quadriceps strength, tibial step off maintained, and negative posterior drawer test and valgus stress test. Displacement of torn MCL into the medial knee compartment is an extremely rare injury. Proximal or distal avulsion of MCL with intra-articular incarceration has been reported in isolation or associated with ACL tear. Such an injury triad as reported here has not been reported in the literature to the best of our review. CONCLUSION: In our case, we report a very unusual injury triad of PCL tear, PRMM tear, and distal MCL tear with intra-articular entrapment below the medial meniscus operated by a single-stage surgery with excellent outcomes.