Management of Short Proximal Femur Nail Peri-Implant Fracture of Femur Shaft with Implant Removal and Long Distal Femur Locking Plate and Bone Grafting - A Case Report.

Introduction: The rising demographic trend towards elderly population and increased incidence of osteosynthesis of proximal femur fractures are associated with increased recurrent falls and rise in incidence of peri- implant fractures. Case Report: Here, we present a difficult case of a peri-implant femur shaft fracture in a 55-year-old male, with stuck short proximal femur nail (PFN) removal followed by long distal femur plating with bone grafting showing good fracture union at 1 year with satisfactory functional outcome. Conclusion: Peri- implant femur fractures are quite rare and more commonly occur in elderly. Among all treatment modalities for intertrochanteric femur fracture fixation, the literature shows short PFN having highest comparative risk for peri-implant fractures. Implant removal followed by locking plates for long spiral fractures provides a stable, anatomical, and reliable fixation. Bone grafting augments bony union, especially in cases of bone defects .

Surgical Management of Aggressive Knee Tuberculosis with Open Subtotal Synovectomy - A Case Report and Review of Literature.

Introduction: Skeletal tuberculosis (TB) accounts for approximately 10-35% of the extra-pulmonary cases, where knee TB accounts for around 8% of extra-pulmonary TB cases after hip and spine. In about one-third of patients with extra-pulmonary TB, pulmonary TB is concomitantly found. The management of knee TB poses an initial diagnostic challenge due to its non-specific symptoms and absence of constitutional symptoms after which depending on the response to AKT - surgical intervention open or arthroscopic could be contemplated. Case Report: We have a 30-year-old female patient diagnosed with the right-sided knee TB on synovial biopsy started on anti-tubercular treatment. After 1 month of conservative middle path regimen, She presented to us with worsening knee pain and swelling over the right knee and difficulty in standing and moving out of bed as well as inability to sleep and night cries affecting significantly her activities of daily living. The patient was managed with open arthrotomy and subtotal synovectomy was done along with thorough debridement resulting in significant reduction in the pain and swelling in the post-operative period with return of range of motion with daily activities. Conclusion: As clear in our case, apart from the conventional chemotherapeutic regimen for TB, surgical management is sometimes indicated in patients with an aggressive joint infection with severe impairment in performing activities of daily living. It also helps to decrease the disease load which provides symptomatic relief to the patient and helps in recovery, thereby improving the quality of life.

Bilateral Severe Genu Varum in Dyggve-Melchior-Clausen Syndrome - A Case Report.

INTRODUCTION: Dyggve-Melchior-Clausen (DMC) syndrome was described in 1962 as an autosomal recessive type of spondyloepimetaphyseal dysplasia associated with mental retardation. Dymeclin (DYM) gene on chromosome 18q12.1 that encodes for DYM protein which is expressed in cartilage, bone, and brain is mutated in DMC. CASE REPORT: A 6 year -old male child presented with bilateral gradually progressive genu varum deformity of 4 years' duration. There was no significant past medical and family history. A plain radiograph of his knee, pelvis, and spine shows some classical signs of skeletal dysplasia. A plain radiograph of the pelvis with both hips shows a classical semilunar, irregular lacy appearance around the iliac crest which is a pathognomonic radiological sign of this syndrome. CONCLUSION: The radiographic lacy appearance of iliac crests and generalized platyspondyly with double-humped end plates are pathognomonic of DMC.