Open Displaced Fracture of Acromion with Associated Complete Supraspinatus Tear: A Rare Case Report.

Introduction: Isolated acromion fractures are rare and in that too, orthopaedicians rarely come across open acromial fractures. Hence literature regarding their management, outcome and any associated complications is obscure. In an extensive search for literature related to our case we found very few articles. We hereby report a case of Gustilo IIIA open acromial fracture with associated supraspinatus, deltoid and capsular injury managed with tension band wiring (TBW) and soft tissue repair with 6 month follow up. Case Report: A 21-year-old male was admitted in our hospital for wound of right shoulder with pain and inability to move this arm with a history of direct trauma with sharp object 3 days back. On examination, a wound 15 cm in length on the superior aspect of the right shoulder with its depth extending up to the glenohumeral joint was noted. The glenohumeral joint was exposed with a Gustilo Anderson type IIIA acromion fracture and injury of supraspinatus and capsule with no associated vascular or neurological injury. Wound was thoroughly irrigated and was used to approach the fracture site for repair. Capsule of shoulder was carefully closed with absorbable suture followed by suturing of supraspinatus with non-absorbable suture. Our initial plan to fix the acromial fracture to spinous process of scapula with 2 4 mm cannulated cancellous screw placed orthogonal to fracture site was modified intraoperative due to screw cut out and we went ahead with TBW with 1 screw and 1 Kirschner wire to prevent further fragmentation of the fragment. Wound was healing and healthy. Patient was started on a passive pendular exercises after 4 weeks and active exercises at 6 weeks. Six months postoperatively patient had complete range of shoulder rotation with forward flexion of 80° and abduction possible till 45°. Patient was able to do most of his activities of daily living barring overhead activities. Conclusion: As there are very limited cases of this sort of injury, this case report will cast a light on management options and outcomes of such injuries. We received fair results in our study with good healing and painless functional shoulder joint. However, long term and multi centric studies are required for further information pertaining to such scenarios.

Simple Bone Cyst (Benign Osteolytic Lesion) of 1st Metacarpal: A Rare Case Report.

Introduction: A benign cystic lesion, the simple bone cyst (unicameral/essential bone cyst), it may be found in any long bone (most commonly found in femur and proximal humerus), usually in immature skeletal persons. Metacarpal simple bone cyst is an exceedingly rare occurrence and few treatment options have been described for the same. Case Report: A 42-year-old manual laborer male (right hand dominant) came with history of trivial trauma to right hand thumb with hammer. He complained of mild swelling and pain since trauma. On imaging the right hand, an expansive lytic lesion was seen in the metaphyseo-diahyseal region of the first metacarpal. There was thinning of the cortex with break in cortex visible at mid diaphyseal region. There was absence of any soft-tissue involvement or periosteal reaction. Magnetic resonance imaging reported a T2 hyperintense and T1 isointense benign osteolytic lesion with pathological fracture. On aspiration, a reddish tinged fluid was found. A closed fixation was performed with the help of an intramedullary k-wire. Conclusion: Simple bone cyst, although rare in metacarpal bone, is an important differential diagnosis in cases with cystic lesion. Simple bone cyst, although a benign lesion, can cause extensive involvement of the metacarpal bones and destroy the entire diaphysis. It requires adequate treatment which is simple and effective.

Acute on Chronic Osteomyelitis of the Humerus - A Case Report on a Neglected Case of Chronic Osteomyelitis with Bone Cement In Situ.

Introduction: Chronic osteomyelitis is the bane of orthopedics. Along with being difficult to treat for surgeons, it also impacts the patient's life immensely, severely restricting their life in all the aspects. Treatment with antibiotic coated cement spacers, which are removed after a duration of 6-8 weeks for the definitive surgery, is a frequently done procedure in conjunction with an adequate debridement of the necrotic tissues and prolonged IV antibiotics. We report a case of acute osteomyelitis superimposed on the chronic osteomyelitis of the left proximal humerus. Case Presentation: An immunocompetent and otherwise healthy 14-year old Indian male who was operated 1 year ago for chronic osteomyelitis presented to us with an acute tense swelling, unbearable pain, and toxemia, with a cement spacer and multiple cement beads in situ. With regards to his initial injury, he had history of fall from height with a puncture wound, possible humerus fracture, treatment by local healers as well as surgical procedures in an outside facility with debridement and placement of cements spacer and beads. On presentation to our facility, removal of retained cement plus debridement was carried out, and after serial surgeries, the defect was successfully treated with the use of antibiotic loaded absorbable calcium sulfate. Conclusion: A basic knowledge about the ideal practices for taking treatment is still inadequate in many population groups within India . It is important to spread awareness of proper healthcare seeking practices among people so that the disability associated time and loss of activity related to injury is significantly reduced. Furthermore, calcium sulfate can be an effective option for treatment of bone defects associated with chronic osteomyelitis.