Assessing functional and radiological outcomes: open reduction and internal fixation vs. minimally invasive plate osteosynthesis for humerus shaft fractures - a prospective comparative study.

PURPOSE: To analyse and compare the functional and radiological outcome of different methods of surgical management of humerus shaft fractures in 30 patients treated by conventional open reduction and internal fixation (ORIF) or minimally invasive plate osteosynthesis (MIPO). METHODS: This prospective interventional study was conducted among 30 patients by dividing into two equal groups over one year and six months. All patients were followed up for a minimum of at least six months. Radiological outcome was assessed using fracture union in serial radiographs and functional outcome was measured using DASH scoring. RESULTS: The majority of patients (26.7%) were between 18 to 30 years, overall mean age was 44.4 years, most of the patients (50%) had 12A3 AO type fractures, and 73.3% of patients had injuries following two-wheeler road traffic accidents. On comparing multiple factors, we found a statistically significant reduction of intra-operative blood loss in MIPO compared to ORIF. Though time taken for fracture union, functional outcome and complication rate were better in MIPO when compared to ORIF, these differences were not statistically significant. two patients in the MIPO group and one patient in the ORIF group had a peri-implant fracture following slip and fall again within the study period and underwent Revision plating. Excluding cases of peri-implant fractures, out of 13 patients in the MIPO group, only one patient developed fracture non-union. Of 14 patients in the ORIF group, three developed fracture non-union. CONCLUSION: MIPO is a safe, reproducible, efficient and good if not a better alternative to ORIF as it offers good radiological and functional outcomes with advantages of minimal soft tissue damage, minimal blood loss, better cosmesis, no incidence of radial nerve palsy and with few concerns such as the need for fluoroscopy, and a learning curve.

Management of Ipsilateral Terrible Triad Injury of Elbow and Concomitant Proximal Humerus Fracture: A Case Report and Literature Review.

Introduction: A difficult pattern of injuries is Hotchkiss's terrible triad, which includes elbow dislocations with fracture of the coronoid and head of radius. It is uncommon to have a concurrent proximal humerus fracture, which makes clinical care even more difficult. Case Report: An injured worker, 33 years old, claimed to have fallen from a height and received several injuries when he arrived at our emergency center. On physical examination, the patient showed signs of deformity and had an open injury over his left elbow. The radiographic evaluation showed that the patient had a posterior elbow dislocation along with a fracture of the left coronoid, head of radius, and proximal humerus. Following the reduction in a closed manner, computed tomography of the left elbow was carried out for additional assessment. The patient had both the proximal humerus and elbow fixed, and then the elbow was immobilized for 2 weeks. Conclusion: Complex musculoskeletal injuries resulting from high-energy trauma require a thorough, multidisciplinary strategy to address since long-term results and any consequences will require ongoing monitoring and rehabilitation.

Unveiling the Enigma: Uncommon Hand Giant Cell Tumor within the Tendon Sheath.

Introduction: Giant cell tumor of tendon sheath (GCTTS), also known as tenosynovial giant cell tumor or pigmented villonodular tenosynovitis, is a rare benign soft-tissue tumor with an unclear cause. It is the second most frequent soft-tissue tumor in the hand after ganglion cyst. Case Report: We described a female patient, age 19, who has had a 3 cm × 2 cm firm swelling on the palmer aspect of the right second metacarpal region for 7 years. The bulge developed spontaneously and moved quite slowly. It is required to do a histological and radiographic evaluation to determine whether or not to pursue additional treatment. Excision surgery was done, and the tumor was entirely removed. According to histopathology, this mass was compatible with GCTTS without being malignant. Conclusion: It is an uncommon instance of GCTTS at the hand, to sum up. The tumor should be entirely excised due to its high risk of recurrence to lower the likelihood of recurrence and restore hand function.

Unraveling the Mystery of Parosteal Lipoma of the Distal Femur: A Rare Case Report.

Introduction: Among all the primary bone tumors and all the type of lipomas, parosteal lipomas stand for <0.1% and 0.3%, respectively, which mostly consists of fully developed adipose tissue with or without a bony component. Patients with this tumor usually have bony lesions (59.2%), necessitating a differential diagnosis of malignant tumors. Case Report: Here, we analyze a case report of a 9-year-old boy, who developed a parosteal lipoma in the distal femur. A massive, well-defined, lobulated, mostly fat-intensity lesion of 10 cm by 6 cm by 8 cm was seen on an magnetic resonance imaging scan of the right distal femur. After the lump was removed, the pathologically reveals a parosteal lipoma without any malignant changes. Conclusion: Finally, it should be noted that parosteal lipomas are less common neoplasias with no known malignant potential. Since these tumors can be removed with mild impact to nearby structures, the lower limb's functionality is kept intact.

Type III Monteggia Fracture-dislocation with Radial Nerve Injury in Adults - A Case Report of two Cases.

Introduction: Uncommon complication of Monteggia fracture is associated PIN palsy. The PIN palsy following Monteggia fracture-dislocation is neuropraxias and will recover spontaneously. Case Report: Two cases who were diagnosed as Monteggia fracture-dislocation with PIN palsy and associated superficial branch of radial nerve injury - Power 0/5 and sensations 0/2 were taken up for surgery (open reduction internal fixation of fracture of ulna + closed reduction of radial head). By the end of 7 weeks, both sensory and motor power were fully recovered spontaneously in both the cases. Discussion: Most of the PIN injuries following Monteggia fracture-dislocation are neuropraxias and will recover spontaneously after closed reduction of radial head without any intervention to the nerve. The nerve needs to be intervened if there are no signs of recovery by 3 months. The time frame for the nerve to be intervened remains controversial. Conclusion: In both of our cases, the injury is probably proximal to the terminal division of radial nerve and the injuries were neuropraxias and have recovered spontaneously. Hence, we suggest not exploring the nerve in all cases with Monteggia fracture-dislocation immediately even when there is associated sensory deficit.

Uncommon Yet Noteworthy: A Clear and Comprehensive Case Report on Pediatric Hip Dislocation.

Introduction: Children, especially those under the age of five, seldom get hip dislocations. Young children may sustain dislocations from minor accidents such as slips or falls from low heights, whereas adolescents typically do so from high-intensity events such as car crashes or collision sports. Posterior dislocation occurs 8-9 times more frequently than those in the anterior. Here, we describe about the acute posterior hip dislocation suffered by a 5-year-old boy in this case report. Case Report: A 5-year-old girl reported to ER with left hip pain and difficulty to walk after slipping and falling while playing football at home. About 90 min after the fall, she presented at the hospital. The injured hip showed internal rotation, adduction, and flexion. An immediate pelvis X-ray revealed a right hip posterior dislocation. Under intravenous anesthesia, the dislocation was successfully reduced utilizing the Allis technique in the emergency room 3 h after the accident. Post-reduction radiographs verified that the reduction was successful. After 15 days of immobilization and 2 weeks of bilateral skin traction, the youngster was able to resume full weight-bearing walking with excellent tolerance. Conclusion: To reduce the risk of avascular necrosis (AVN), pediatric hip dislocations require prompt reduction within 6 h. Soft-tissue injuries are found using post-reduction magnetic resource imaging. AVN requires constant observation for at least 2 years. Since traumatic hip dislocations in children under the age of five are rare, prompt diagnosis and treatment are essential.