Lateral clavicle fracture-plating options and considerations.

Clavicle fractures are among the most prevalent types of fractures with numerous treatment strategies that have evolved over time. In the realm of lateral-third clavicle fracture management, several surgical methods are available, with plate and screw constructs being one of the most frequently employed options. Within this construct, numerous choices exist for fixing the fracture. This editorial provides an overview of the common plate options utilized in the management of distal third clavicle fractures underscoring the critical considerations and approaches that guide clinicians in selecting the most appropriate fixation techniques, considering the complex landscape of clavicle fractures and their challenging management.

Bilateral erector spinae plane block for postoperative pain relief in lumbar spine surgery: A PRISMA-compliant updated systematic review & meta-analysis.

Study design: Systematic review. Objective: Erector spinae plane block (ESPB) is growing in popularity over the recent past as an adjuvant modality in multimodal analgesic management following lumbar spine surgery (LSS). The current updated meta-analysis was performed to analyze the efficacy of ESPB for postoperative analgesia in patients undergoing LSS. Methods: We conducted independent and duplicate electronic database searches including PubMed, Embase and Cochrane Library till June 2023 for randomized controlled trials (RCTs) analyzing the efficacy of bilateral ESPB for postoperative pain relief in lumbar spine surgeries. Post-operative pain scores, total analgesic consumption, first analgesic requirement time, length of stay and complications were the outcomes evaluated. Statistical analysis was performed using STATA 17 software. Results: 32 RCTs including 1464 patients (ESPB/Control = 1077/1069) were included in the analysis. There was a significant pain relief in ESPB group, as compared to placebo across all timelines such as during immediate post-operative period (p < 0.001), 4 h (p < 0.001), 8 h (p < 0.001), 12 h (p < 0.001), 24 h (p = 0.001) post-surgery. Similarly, ESPB group showed a significant reduction in analgesic requirement at 8 h (p < 0.001), 12 h (p = 0.001), and 24 h (p < 0.001). However, no difference was noted in the first analgesic requirement time, time to ambulate or total length of stay in the hospital. ESPB demonstrated significantly improved overall satisfaction score for the analgesic management (p < 0.001), reduced intensive care stay (p < 0.05) with significantly reduced post-operative nausea and vomiting (p < 0.001) compared to controls. Conclusion: ESPB offers prolonged post-operative pain relief compared to controls, thereby reducing the need for opioid consumption and its related complications.

Tenosynovitis of hand: Causes and complications.

Tenosynovitis represents a common clinical condition characterized by inflammation of the synovium that encases the tendon sheath. Although tenosynovities may be noted in any tendon in the body, extremities such as hand, and foot remain the sites of high predilection to acquire this condition. The predominant cause of this predilection rests in the intricate tendon arrangements in these extremities that permit fine motor actions. This editorial explores the common causes and the complications associated with this condition to improve the understanding of the readers of this common condition encountered in our everyday clinical practice.

Delay in Time to Diagnosis of Idiopathic Transient Osteoporosis of the Hip with Radiographs: Diagnostic Insights from a Series of 10 Cases.

Introduction: Transient osteoporosis of the hip (TOH) is a poorly recognized self-limiting clinical entity. Due to a lack of awareness among the clinicians, the condition is often misdiagnosed leading to inappropriate treatment, thereby lengthening the time to diagnosis (TTD). In this study, we analyze the delay in TTD of TOH using plain radiographs and present the optimal management strategy. Case Report: We retrospectively collected the data of patients who were diagnosed with TOH from March 2017 to March 2022. A total of 10 patients with a mean age of 43.7 years (range 33-56 years) were included in the study. The mean time to presentation from the onset of symptoms was 4 weeks (range 2-8 weeks) Radiologic evaluation with radiographs was sensitive in only 8 patients with osteopenia, whereas magnetic resonance imaging (MRI) was sensitive in all the patients and aided in early diagnosis of TOH. Radiographic evaluation alone leads to a mean delay in TTD of 1.6 weeks (range 0-8 weeks) in our study. All the patients were treated conservatively without any major complications. Conclusion: Plain radiographs were not sensitive in the early detection of TOH and increased the TTD by 1.6 weeks, however, MRI imaging was found to be highly sensitive and specific in diagnosing TOH.

Cross-beam Non-vascular Fibular Graft Reconstruction in the Management of Long Bone Giant Aneurysmal Bone Cyst - A Case Series.

Introduction: Aneurysmal bone cyst (ABC) is a benign expansile osteolytic lesion, characterized by a blood-filled cavity in the bone. Giant ABC (GABC) is an uncommon condition due to the delayed presentation of an ABC that is difficult to handle when it occurs in long weight-bearing bones due to its aggressive nature. The common treatment relies on total resection of tumor with reconstruction of the resultant defect. Case Report: We present the results of 5 cases of GABCs of long bones managed with non-vascularized fibular graft in a cross-beam fashion along with internal fixation. All patients achieved complete consolidation of the lesion by 12 months along with full incorporation of the graft with good-excellent musculoskeletal tumor society scores. None of the patients had recurrence/pathological fracture till 2 years of follow-up. Conclusion: We suggest the method of using a non-vascularized fibula graft in a cross-beam fashion to reconstruct the void from the resection of long-bone GABC as a safe, reliable technique with excellent functional and radiological results.

Novel Multimodal Treatment Regimen for the Management of Primary Sacrococcygeal Cystic Echinococcosis.

Introduction: Osseous hydatidosis is a rare condition most commonly involving the spine. Among spinal segments, sacrococcygeal involvement is even rarer. Moreover, the lesion is more prone to recurrence owing to the infiltrative nature of microvesicular lesions involving the spine. In this case report, we describe an effective multimodal management approach toward the management of primary sacrococcygeal cystic echinococcosis. Case Report: A 56-year-old female presented with complaints of severe back pain and urinary incontinence for 3 months. She presented with a slow-onset cauda equina syndrome with radiating pain to both lower limbs. Radiographic evaluation showed an expansile lytic lesion affecting the right iliac wing with near-complete cortical bone destruction of the sacrum. Magnetic resonance imaging revealed neural involvement with sacral destruction by a multiloculated cystic mass, extending to the spinal canal. No coexisting lesions were noted anywhere. Echinococcosis was diagnosed with serum enzyme-linked immunosorbent assay. She underwent neoadjuvant therapy with albendazole and praziquantel, followed by ultrasound-guided percutaneous aspiration injection and reaspiration (PAIR) with hypertonic saline followed by sclerosant (95% ethyl alcohol) into the residual cyst cavity. Later, she open excision of the residual multiloculated cystic mass was performed. Adjuvant medical therapy was continued for 3 months post-surgery. The patient regained her neurological functions by 6 months without any residual sequelae or symptomatic recurrence until 4 years of follow-up. Conclusion: Multimodal treatment regimen comprising of oral medical therapy by albendazole and praziquantel along with PAIR and surgical in toto excision of the cyst followed by post-operative oral medical therapy for 3 months has given excellent results in sacrococcygeal cystic echinococcosis.

Recurrence-free management of type 2 variant of giant cell tumour of extensor tendon sheath of thumb.

A 30-year-old woman presented with swelling in her right thumb of 3-month duration which was slow-growing in nature without a history of trauma. On examination, firm non-tender swelling with ill-defined border over the dorsomedial aspect of the first metacarpal was noted. The swelling was mobile only in the vertical plane with restricted adduction and abduction. Plain X-ray revealed mild erosion of the first metacarpal head. Diagnostic ultrasound confirmed the lesion to arise from the extensor tendon sheath of diffuse type without any bony involvement. A wide local excision biopsy of the swelling was planned. Intraoperatively, a 3×2 cm greyish-white mass, bony hard in consistency with lobulated surface was found arising from the tendon sheath of the extensor tendon of the thumb; it was completely excised with a wide margin. Histopathological examination revealed polyhedral cells admixed with osteoclastic type giant cells. Biopsy from the first metatarsal was normal. The patient is on follow-up for the last 5 years with no evidence of recurrence.