Bipolar Hemiarthroplasty With a Calcar Stem for the Management of a Failed Proximal Femoral Nail Anti-rotation Asia (PFNA2) in a Case of Geriatric Unstable Intertrochanteric Femur Fracture.

Intertrochanteric (IT) femur fractures in the elderly population comprise a major part of geriatric trauma and fractures. There are various modalities of surgical management, ranging from intramedullary fixation and extramedullary fixation to even replacing the hip joint. Apart from the surgeon's choice, other factors, such as geriatric age, bone quality and osteoporosis, medical comorbidities, life expectancy, pre-operative ambulatory status, muscle strength, type and pattern of fracture, and mental health of the patient, play vital roles in determining the ideal modality of management and the long-term outcome. The present case is a 75-year-old lady who had an IT fracture due to a domestic fall, managed surgically with a proximal femoral nail anti-rotation Asia (PFNA2) for an unstable fracture. She presented with blade back-out on the 11th day postoperatively. The patient was investigated thoroughly, and infection was ruled out. She was managed by the removal of the nail, followed by a cemented calcar-replacing bipolar hemiarthroplasty for an unstable comminuted IT fracture. The patient was ambulatory with a walker by the seventh postoperative day and without a walker by the sixth week, and she was self-sufficient in her activities of daily living. Every geriatric IT fracture must be evaluated thoroughly for contributing factors, such as osteoporosis and fracture pattern, to predict outcomes, and a tailor-made strategy of surgical management and stepwise physiotherapy must be provided to the patient for the best results.

Cemented Bipolar Hemiarthroplasty as a Treatment Modality for Pathological Fracture in the Proximal Femur Metastasis Without the Recurrence of Primary Breast Cancer: A Case Report.

Metastatic lesions in the proximal femur are well-known in the literature and are important since they can progress to pathological fractures and impair the patient's mobility. We present the case of a middle-aged female with a history of breast carcinoma 20 years ago, who experienced diffuse chronic hip pain for the past two months. Radiographs, MRI, and PET scans revealed a metastatic lesion in her proximal femur. After consulting with an oncologist, it was determined that adjuvant chemoradiotherapy was unnecessary. The treatment strategy was dependent on the preoperative general health condition, the life expectancy, amount of metastasis, bone quality, pathological fractures and factors affecting the union and capacity to ambulate the patient postoperatively. The patient underwent a cemented bipolar hemiarthroplasty to excise all metastatic tissue and provide a painless, functional, and mobile joint. Bipolar hemiarthroplasties articulate at two levels, and this dual-bearing design is believed to reduce acetabular wear. The bipolar hemiarthroplasty also eliminated the risk of complications associated with the acetabular component, which would necessitate early revision surgery. Modular bipolar hemiarthroplasty is a good modality of replacement associated with fewer complications and improves quality of life.

Acromioclavicular Ganglion Cyst: A Rare Case Report.

Acromioclavicular ganglion cysts are uncommon, with only a limited number of cases reported in the medical literature. This case report presents a unique instance of an acromioclavicular ganglion cyst in an 81-year-old male patient, outlining the clinical presentation, diagnostic approach, and successful surgical management. The purpose of this report is to contribute to the existing body of knowledge on this rare condition and highlight the importance of accurate diagnosis and appropriate intervention.

Restoring Wrist Harmony: A Case Report of Ulnar Osteotomy for Correcting the Radius Malunion.

A 41-year-old female patient sought medical attention due to a malunited distal radius fracture with a positive ulnar variance, experiencing wrist pain and limited range of motion. The patient was successfully treated with an isolated ulnar osteotomy and bone grafting, resulting in significant alleviation of symptoms and improved wrist mobility. Various surgical methods have been proposed to address malunited radius fractures, and ulnar osteotomy has shown promise as an effective technique for such cases.

Functional Outcome of Closed Reduction and Extension Casting in Forearm Fractures in Children.

Introduction Fractures in children are extremely common scenarios encountered by orthopedicians. Conservative treatment has been the most preferred choice for the management of diaphyseal forearm fractures. Traditionally, pediatric forearm fractures are treated by above elbow plaster cast with the elbow flexed to 90 degrees. The purpose of this study was to evaluate the functional and radiological outcomes of children treated with closed reduction and extension casting for forearm fractures. Patient and methods This is a prospective study evaluating the functional and radiological outcomes of 30 children of less than the age of 14 years and without pathological fractures, treated with closed reduction and extension casting for forearm fractures, either both radius and ulna or radius or ulna at middle third level, who reported to the Department of Orthopedics, Dr. D.Y. Patil Medical College, Hospital, and Research Center, Pune, India, between September 2019 and March 2022. Results The mean pre-operative angulation in radius (antero-posterior {AP}) was 22.7, radius (lateral {LAT}) was 24.2, ulna (AP) was 31.2, and ulna (LAT) was 29.2. The immediate post-operative angulation of radius (AP) was 0.7, radius (LAT) was 3.2, ulna (AP) was 0.6, and ulna (LAT) was 4.9. Cast status at two weeks, 83.3% had intact cast and 16.7% had loosened casts. Post removal, most patients had a good rotation of motion (ROM) at three and six weeks. Conclusion Casting with extended elbow is much better as compared to flexion casting in the hands of a trainee doctor. Furthermore, chances of loss of reduction are negligible in extension casting as compared to flexion casting.

Assessment of Surgical Outcome in Three- and Four-Part Proximal Humerus Fracture Treated With Proximal Humerus Internal Locking System (PHILOS) Plate Versus Neer's Prosthesis in Elderly Patients.

BACKGROUND: With an incidence of 50% of humerus fractures, proximal humerus fractures (PHFs) can significantly impact one's quality of life. Moreover, management of highly comminuted or displaced PHFs poses a significant challenge amongst elderly population due to poor bone quality. Prosthetic replacement of humeral head or its stabilization using external plates is a commonly employed intervention for treating three- and four-part PHFs. Thus, these two methods were compared in this study to identify a preferable intervention. METHODS: Patients were randomly divided into two groups to receive proximal humerus internal locking system (PHILOS®, Synthes, Switzerland) plating and Neer's hemiarthroplasty. The deltopectoral approach was deployed as the surgical method. Their surgical outcome was assessed from functional range of motion (ROM) and Constant-Murley scores at regular intervals of three, six, twelve, and twenty-four weeks. RESULTS: Twenty patients were divided into two groups who received PHILOS® plating and Neer's hemiarthroplasty, averaged 67.2 years and 72.8 years. The ROM pertaining to flexion, extension, abduction, internal rotation, and external rotation for individuals with PHILOS® plating was 20%, 12.5%, 14.7%, 11.5%, and 18.5% higher than those who received Neer's hemiarthroplasty. Moreover, the Murley score was also 8.7 units higher for individuals with PHILOS® plating. CONCLUSIONS: Prognosis following PHILOS® plate osteosynthesis had a better overall outcome than hemiarthroplasty with Neer's prosthesis. Although hemiarthroplasty yielded a consistent functional outcome, PHILOS® plate osteosynthesis tends to restore a greater ROM. Thus, PHILOS® plating is recommended as the suitable method to manage three- and four-part PHF for people above fifty-five years of age.