Cervico-thoracic Morel-Lavallée lesion.

Morel-Lavallée lesions (MLLs) result from high-energy trauma causing separation of subcutaneous tissue from the underlying tissue, most commonly in the gluteal region or thigh.We report the case of a woman in her 40s with a fluctuant collection of the cervico-thoracic region following trauma. Further imaging identified an MLL. An orthoplastic approach resulted in non-operative management with a spinal brace. Three months from initial injury, the lesion completely resolved. She was symptom free at final follow-up and discharged.We present the only recorded case of MLL developing in the cervico-thoracic region. Management posed difficultly as no literature currently exists. We demonstrated conservative management for cervico-thoracic MLL can be effective.We have described the first documented case of cervico-thoracic MLL. MLL is not exclusive to pelvic injuries and can develop in the cervico-thoracic region. We have shown conservative management is a viable treatment of atypical MLL.

Bizarre Parosteal Osteochondromatous Proliferation (Nora Lesion) in Upper and Lower Limbs: A Report of Three Cases and Review of Literature.

INTRODUCTION: Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare bone pathology affecting small bones of hand and feet. This benign lesion needs to be distinguished from many malignant bone tumors as it poses a diagnostic dilemma due to its clinical, radiological, and histological picture. We report three cases of BPOP affecting the hand and foot. CASE 1: A 21-year-old gentleman presented with painful swelling in the long finger of the right hand. A plain radiograph showed a radio dense mass which was later excised and diagnosis confirmed in histopathology. There was no recurrence in 2 years of follow-up. CASE 2: A 5-year-old boy presented with painful swelling over the right ankle with no history of antecedent trauma. Following radiological evaluation, the patient was successfully treated with excision. CASE 3: A 35-year-old lady presented with a painful swelling on the dorsal aspect of her hand which was gradually increasing in size. After radiological evaluation, the patient was successfully treated with excision and lesion confirmed to be BPOP on histological examination. She was symptom free without recurrence in up to 2 years of follow-up. CONCLUSION: Nora's lesion is a rare pathology requiring high index of suspicion. Excision is the recommended mode of treatment. All our cases responded well with excision with immediate pain relief following surgery and no recurrence in up to 2 years of follow-up.

Sequential spontaneous compartment syndrome in multiple limbs in a young adult with GYG1 gene mutation.

Compartment syndrome is a surgical emergency requiring immediate intervention. Majority of compartment syndromes are associated with trauma or surgery. Spontaneous compartment syndrome in multiple limbs is rare and alternative diagnosis should be sought. We report a young adult man who developed compartment syndrome in all four limbs sequentially over 4 years. On further evaluation, he was found to have a gene mutation in exon 3 of GYG1 gene. Spontaneous compartment syndrome in patients with GYG1 gene mutation does not appear to have been previously recognised. Although a direct causality cannot be confidently drawn, this gene is involved in muscle energy utilisation and is known to cause metabolic defect. Acute compartment syndrome, once diagnosed, warrants emergency surgical decompression. The subsequent management of spontaneous compartment syndrome demands a thorough medical assessment to identify any underlying metabolic or genetic predisposition.

Successful Reimplantation of an 18-cm-Long Extruded Femur in an Open Fracture: A Case Report.

CASE: A 45-year-old man presented with a Gustillo Anderson type III A open segmental right femur shaft fracture with intercondylar extension and with an 18-cm extruded segment of bone. After sterilization, the segment of bone was reimplanted. The fracture healed, and the patient is ambulant without support with no signs of any infection after 2 years of follow-up. CONCLUSIONS: In cases of open fracture with an extruded bone segment available, depending on the timing of presentation, soft tissue status, and level of contamination of the bone segment, reimplantation of the extruded bone can yield a satisfactory result.

Dieterich Disease Treated with Curettage and Bone Grafting: A Case Report.

INTRODUCTION: Avascular necrosis of metacarpal head is a rare entity. There are very few reported cases in the literature and most of them are isolated case reports. Multiple treatment options including successful conservative management are described in literature. CASE REPORT: We report a case of 57-year-old male who presented to us with a history of chronic pain over the index finger metacarpophalangeal joint. Clinical examination revealed painful range of movement of the affected joint. Radiographs revealed lytic foci. A magnetic resonance imaging scan to further evaluate the condition revealed decreased joint space, articular cartilage thinning, and subarticular cysts.A diagnosis of Dieterich's disease was madeand initial conservative treatment was given for 3months. Curettage of the lesion and autologous cancellous bone grafting from ipsilateral distal radius was done after failed conservative treatment. The patient was symptom free in up to 1-year follow-up. CONCLUSION: Non-specific pain of the metacarpals is often neglected. High index of suspicion and careful scrutiny of radiographs are needed to diagnose case of Dieterich's disease.Though uncommon Dieterich's disease should be considered as a probable diagnosis in metacarpal pain. Currettage with bone grafting gives satisfactory outcomein patientswith persistent symptoms after conservative treatment has failed.

Postoperative Cognitive Dysfunction in Indian Patients Undergoing Total Knee Replacement Under Spinal Anesthesia.

INTRODUCTION: Total knee replacement is a common surgical procedure in the elderly. The number of surgeries has increased owing to the increasing life expectancy of the population and better functional outcomes postsurgery. Postoperative cognitive dysfunction (POCD) is an identified entity postsurgery in elderly but most of the studies have been on patients undergoing cardiac and other nonorthopaedic surgeries. The studies have shown variable incidence due to selection bias. We studied the incidence and probable predictive factors of POCD in elderly Indian population undergoing total knee replacement under spinal anesthesia. MATERIALS AND METHODS: We designed a prospective, observational study at a single center including patients above 60 years of age undergoing total knee replacement under spinal anesthesia. Preoperative mini-mental scale examination, electrolytes, urea and creatinine levels were recorded. Postoperatively, mini mental scale evaluation (MMSE) was done 2 days postsurgery, at 3 months, 6 months, and 1 year follow-up. Laboratory values postoperatively were recorded. RESULTS: The average preoperative MMSE was 27 and declined to 25.4 on second postoperative day the value increased to 25.9, 26.6, and 27 at 3 months, 6 months, and 1-year follow-up, respectively. Sixty-three out of 600 patients developed POCD at second postoperative day. Forty-three patients showed recovery in subsequent visits and 20 patients had persistent dysfunction at the end of 1 year. Electrolyte imbalance, oxygen saturation, and age over 80 years were factors that showed statistically significant difference in multiple comparison analysis. CONCLUSION: In our study, we have found POCD to be a definitive entity which can cause short- and long-term cognitive defect in elderly Indian population undergoing total knee replacement and electrolyte imbalance, age, and oxygen saturation were the significant factors in the patients who developed POCD.

Bilateral Solitary Glomus Tumour of Thumb: A Case Report.

Glomus tumours are benign neoplastic lesions of glomus body, a thermoregulatory apparatus of cutaneous microvasculature. These tumours can arise at any location of the body but most commonly seen in subungual region of fingers. Bilateral solitary glomus tumour of hand is a rare entity. We report a case of 54-year-old female who presented with complaints of pain in the right thumb since three years and left thumb pain since 20 years. Clinical examination revealed acute tenderness of both the thumbs. Love's pin test and Hildreth's test were positive. MRI revealed characteristic features of glomus tumour. Excision of both the lesions was done and proceeds forwarded to histopathology which confirmed diagnosis. Patient was symptom free immediately following surgery. No nail deformities were noticed and there was no recurrence of symptoms in one year follow up. Glomus tumours of the hand are a rare entity and often missed.