Brachymetatarsia with accessory navicular in right foot: A rare coincidental finding.

A 33 years old female patient presented with posttraumatic pain in the right foot for which radiographs of the right foot was advised. No fracture was detected on radiographs and patient was managed conservatively on medications and posterior splint immobilization. We found coincidentally a short fourth metatarsal and an accessory navicular bone in the right foot radiographs. After 3 weeks of immobilization, she underwent mobilization of the right foot, weight bearing and intensive physio- therapy for 6 weeks. After two months of injury she was still complaining of pain on the plantar aspect of right foot which was diagnosed as metatarsalgia and operated on by excision of the neuroma present in the 3rd web space of the right foot. After surgery she was completely relieved of pain and could do activities well related to the right foot.

Dysplasia epiphysealis hemimelica of talus mimicking posterior ankle impingement syndrome in a young male: a case report with review of the literature.

Dysplasia epiphysealis hemimelica is a rare skeletal developmental disorder representing an osteocartilaginous tumor arising from 1 or more epiphyses during childhood. We report a case of a young male who presented with complaints of pain and swelling in the posteromedial aspect of the left ankle with the clinical diagnosis of posterior impingement syndrome. Imaging studies, including radiography, computed tomography, and magnetic resonance imaging, suggested the possibility of localized juxta-articular dysplasia epiphysealis hemimelica arising from the talus. The patient was successfully treated by surgical excision. The postoperative histologic findings were consistent with osteochondroma. This case report emphasizes the possibility of dysplasia epiphysealis hemimelica in the differential diagnosis of impingement syndromes around the ankle. The aim of the present study was to familiarize clinicians with this rare entity, because the number of documented cases has been increasing.

Validation of use of transverse acetabular ligament and mechanical angle guide device to orient the acetabular cup.

AIM: To verify if transverse acetabular ligament (TAL) can be used as an anatomical landmark to reliably orient the cup in primary total hip arthroplasty and compare it to acetabular cups placed with the help of mechanical angle guide (MAG) device. MATERIALS AND METHODS: Thirty Five patients with primary total hip arthroplasty, all performed by the same surgeon were included in the study. All patients had undergone surgery by anterolateral approach and all were cementless total hip arthroplasty. TAL was used as a reference guide for positioning of the cup in one group while MAG device was used in the other. Post operatively CT was done to confirm the version and inclination of the acetabular cup and the femoral stem version. SPSS was used for statistical analysis. RESULTS: 18 males and 17 females were included. The most common etiological cause for THR was secondary osteoarthritis due to AVN (40%). At 18 months follow up, there was just 1 case of dislocation in group in which angle guide device was used. The mean anteversion of the acetabular cup on CT findings was 23.82° by using TAL while 18.35° with help of MAG device (P < 0.05). All were within Leweniks safe zone. CONCLUSIONS: The TAL and MAG device both can be effectively used to align the acetabulum component. TAL is patient specific intraoperative landmark which is not affected by patient positioning while angle guide device can give false positive assessment of cup version.

Case of Acute Onset Postpartum Paraplegia: Spontaneous Spinal Epidural Hematoma-A Rare Entity.

Study Design Present study is a case report. Objective This study was to present a rare case of acute postpartum paraplegia due to spontaneous spinal epidural hematoma (SSEH). Background SSEH with incidence rate of 0.1 per 100,000 per year is an extremely rare cause of sudden onset neurological deficit in postpartum patients with no predisposing factors or intrapartum factor causing SSEH resulting in paraplegia. Material and Methods We hereby present our case of acute onset postpartum paraplegia which on magnetic resonance imaging (MRI) shows epidural hematoma around thoracic 12 to lumbar 2 (T12-L2) vertebral regions with adjacent cord changes. MRI is the investigation of choice in such cases which helps in proper timely management of patient. We planned the patient for surgical decompression of hematoma. Results Patient showed rapid reversal of neurological symptoms in postoperative period. Conclusions Acute onset postpartum paraplegia in a healthy female with no significant past history, predisposing factors or intrapartum factors may be caused by SSEH and it should be managed on emergency basis as early and proper treatment has an excellent prognosis as seen in our case.

Neglected Type I Monteggia Fracture Dislocation in Adult.

Neglected Monteggia fracture dislocation is one of the challenging case and it becomes more of a therapeutic dilemma especially in adults. Several surgical techniques are described and in spite of this complication rate following surgery is high. This report concerns with management of three-month-old monteggia fracture dislocation in a 30-year-old male. Patient presented with complete loss of movement at elbow. Patient was managed surgically, with internal fixation of ulna and reduction of radial head with radio-capitellar Kirschner wires. Postoperatively at six months, ulna united and patient has achieved flexion from 50 to 115 degrees at elbow and supination pronation arc of 120 degrees. We do not see any indication for procedures directed at the reconstruction of annular ligament. The dilemma remains whether radial head preservation or excision gives better functional range of motion in adult neglected monteggia fracture dislocation.

Comparison of Outcomes of Single-Level Anterior Cervical Discectomy With Fusion and Single-Level Artificial Cervical Disc Replacement for Single-Level Cervical Degenerative Disc Disease.

STUDY DESIGN: A single-center, prospective comparative study of prospectively collected outcomes, with a minimum 12 months follow-up. OBJECTIVES: The primary purpose of the study is to investigate the clinical, functional, and radiological outcomes of cervical total disc replacement (CTDR) in comparison with anterior cervical discectomy and fusion (ACDF) in the treatment of single-level cervical disc degenerative disease, prospectively. SUMMARY OF BACKGROUND DATA: CTDR has recently been an alternative to ACDF in cervical disc degenerative disease to preserve the motion at the treated level. METHODS: This study included 34 patients, who underwent either single-level ACDF (n = 17) or single-level CTDR (n = 17) at C3 to C7 level for cervical disc degenerative disease between July 2012 to April 2014 with a minimum of 12 months of follow-up. RESULTS: Neck disability index, visual analog scale, and neck-arm pain score showed significant difference between the two groups at final follow-up of 12 months. Modified orthopedic association score and Nurick scale also showed the Japanese significant difference between the two groups at final follow-up of 12 months. Odom criteria were not statistically significant between the two groups at final follow-up. The changes in overall cervical sagittal angle (CSA) were significantly different between the two groups. The segmental angle (SA) was maintained at a significantly higher value in the CTDR group than in the ACDF group during the follow-up period (P < 0.05). The range of motion of the cervical spine and the treated level was well maintained and improved in the CTDR group as compared with ACDF group and showed extremely statistically significant difference between the two groups. CONCLUSION: CTDR was found to be a safe, effective, better, and efficient alternative to the traditional ACDF. CTDR using Prestige LP cervical disc provided a statistically significant clinical, functional, and radiological outcomes between the two groups after 1-year follow-up. LEVEL OF EVIDENCE: 2.

Physeal separation and complete resorption of femoral head associated with chronic osteomyelitis of femoral diaphysis in a young child: rare case report.

We report the case of a two and a half-year-old girl who presented with injury to the right thigh along with a discharging sinus in the midthigh region following a nonorthopaedic surgical procedure. Radiographs of the thigh indicated osteomyelitis of the femoral diaphysis with pathological fracture. During follow-up examination, shortening was observed in the affected limb, along with complete separation of the femoral epiphysis with partial resorption of the femoral head. A few cases of physeal separation of the femoral head following osteomyelitis of the femoral diaphysis have been reported in the published literature, but still it may go undiagnosed until late stages because of the lack of awareness among orthopaedicians about this entity. There was no history of any precipitating trauma to the hip. This case is of interest because of the difficulty in making differential diagnosis at the first evaluation; there was an orthopaedic misdiagnosis on the basis of the lack of complete preoperative imaging. Because of the devastating sequelae on immature skeleton including limb shortening, osteomyelitis, epiphyseal separation of proximal epiphysis and pathological fracture of shaft femur, the importance of early diagnosis, complete preoperative imaging and prompt treatment must be overemphasized.

Pseudo-winging of scapula due to benign lesions of ventral surface of scapula - Two unusual causes.

UNLABELLED: Winging of the scapula due to benign lesion of ventral surface of scapula is one of the rare cause and difficult to diagnose in first place. We present two unusual cases of pseudo winging of scapula due to benign lesions of scapula. First case was of 23 year old male with solitary osteochondroma of ventral surface of scapula. Second was 38 year old female with hemangioma involving subscapular muscles. Both the patients presented to us with dull aching pain over right scapular and shoulder region of 6 months duration with gradually increasing pseudo-winging of scapula. On examination there was mild tenderness over superomedial border of scapula with scapular snapping(5) or 'clunk' on hyper abduction of shoulder. Further radiographic evaluation of right scapular region revealed solitary osteochondroma of ventral surface of right scapula in first case whereas MRI revealed hemangioma of subscapular muscles in second case. Hemangioma was initially treated by weekly injecting sclerosing agent (Inj. Polidocanol) locally for 4 weeks. Both lesions were later treated by excision and subsequent follow up revealed disappearance of pain and winging of scapula. CONCLUSION: Winging of the scapula due to solitary osteochondroma and subscapular hemangioma of the scapula may present with an initial diagnostic difficulty but appropriate knowledge of literature and diagnostic acumen can give excellent results.

Posttraumatic osteonecrosis and nonunion of distal pole of scaphoid.

Posttraumatic osteonecrosis of distal pole of scaphoid is an extremely rare with only two reported cases so far. We present a case of a 30-year-old male with a 2-year-old posttraumatic osteonecrosis and nonunion of distal pole of scaphoid left wrist. He presented with complaints of pain and restriction of movements. There was no evidence of radiocarpal arthritis. He was managed with open reduction and internal fixation with k-wires, supplemented by a pronator quadratus based muscle pedicle bone graft. The fracture union was achieved at 6 months. After 2 years, he had almost complete range of wrist motion and had returned to his preinjury level of functional activity. His MRI (magnetic resonance imaging) scans showed evidence of revascularization suggesting successful incorporation of bone graft.