Congenital Posterior Dislocation of Fibula with Pes Valgus Deformity.

Congenital posterior dislocation of fibula with pes valgus deformity is a rare disorder in children and has not been reported in English literature. The parents recognize it when the child starts to bears weight as the foot appears normal non-weight bearing but on standing or bearing weight it goes into valgus. As the foot is manually correctable to neutral plaster correction does not suffice and surgery becomes essential. The differential diagnosis of this condition is the well-described congenital diastasis of inferior tibiofibular joint, where the foot is with equinovarus deformity. We are reporting a child of 2 years of age who presented to us walking on the medial border of sole, a valgus deformity on walking and no other congenital anomalies. We operated upon this case of congenital posterior dislocation of fibula with pes valgus deformity and are reporting it for the abnormal patho-anatomy, surgical steps followed and treatment protocol adopted by us.

Distal Femur Tumor Megaprosthesis for Non-union of Supracondylar Femur Fracture after Failed Osteosynthesis. An Ingenious Solution.

Introduction: Incidence of non-union of fracture involving the supracondylar region of femur in an elderly is increasing due to bone loss from trauma and availability of poor quality bone in geriatric population. Distal femur megaprosthesis can provide a single stage solution for resistant non-union of supracondylar femur. Case Report: We are reporting two cases of non-union of supracondylar femur with implant failure treated with distal femoral tumor megaprosthesis. We achieved excellent improvement of the Knee Society Score from 15 to 75; Knee Society Function Score from 0 to 60, good range of motion, and pain free ambulation without support at 3 months follow-up. Conclusion: Management of non-union of supracondylar femur with implant failure is challenging task. Distal femur replacement using tumor megaprosthesis is useful option for such resistant cases in achieving early ambulation and overall good functional outcome.

Outcomes of Tumor Resection and Reconstruction by Megaprosthesis around Knee: Our Experience.

Introduction: In this modern era, limb reconstructive surgeries have become a standardized procedure for malignant tumor of lower limbs. We performed limb salvage surgeries for tumor around the knee with en bloc resection and subsequent reconstruction with a megaprosthesis. Methods: A total of six cases of malignant and locally aggressive tumor around the knee were operated on from 2017 to 2018, with resection and mega prosthetic reconstruction. Interpretation of functional outcome after surgery was performed with musculoskeletal tumor society (MSTS) score. Complications such as infection, local recurrence of tumor, implant failure, and distant metastases were evaluated during each follow-up. Results: Postoperatively, one patient developed superficial infection; one local recurrence with metastasis and the rest cases were uneventful. Patients were regularly followed for atleast1 year, and none of them developed any sign of deep infection, implant failure,or loosening. At the beginning of treatment, the average MSTS score was 8.83, which showed a significant increment to 25.83 after 12 months of follow-up. Conclusion: Albeit few cases were operated on, we draw this inference from our short-term experience that mega prosthesis acts as a boon to orthopedic surgeons in musculoskeletal tumor management, thereby uplifting the quality of life of patients even during terminal care.

Giant Ewing's Sarcoma of the Body of the Scapula.

INTRODUCTION: Ewing sarcoma is a malignant neoplasm occurring usually in bones such as femur, tibia, and iliac wing. We are here reporting a case of same arising from scapula. Of all the tumors arising from scapula, Ewing's sarcoma contributed to only 8%. CASE REPORT: A male patient presented to us with pain and swelling over right scapular region. After initial investigation, biopsy was performed. Biopsy reveals uniform small-sized cells arranged in layers with high nucleus to cytoplasmic ratio. Provisional diagnosis of Ewing sarcoma was made which was later confirmed on immunohistochemistry. The patient underwent planned surgery after neoadjuvant chemotherapy, and swelling along with partial scapula was resected. CONCLUSION: Although Ewing sarcoma is common neoplasm, it rarely arises from flat bone-like scapula. Henceforth, reporting of such a case is not only imperative but also mandatory.