Neglected posterior dislocation of elbow: A review.

Untreated traumatic posterior dislocation of the elbow joint, 3 weeks or older, is defined as "neglected posterior dislocation of the elbow". Around 90% of these are of posterolateral type. These are much more common in the developing and underdeveloped countries. Patients presents with a deformed, stiff and painful elbow with difficulty to perform activities of daily living. The clinical picture looks quite similar to malunited supracondylar fracture of the elbow. Diagnosis is usually confirmed radiographically. CT and MRI scan give additional information and are recommended before embarking on surgery. Treatment is quite challenging due to the significant soft tissue contractures, ligamentous insufficiencies and fibrosis, with possible associated nerve injuries, myositis ossificans, non-compliant patients and the need for long-term postoperative physiotherapy. Goal of surgical treatment is to achieve a painless, stable and mobile elbow with a congruent joint space. We have reviewed the literature and present our view on the prognosis and recommended surgical technique to treat this condition.

Recurrence of Giant Cell Tumor in Fibular Graft Used for Treatment in Primary Giant Cell Tumor of Distal End Radius: A Case Report and Surgical Treatment with Excision of Tumor with Proximal Row Carpectomy with Ulnocarpal Fusion.

INTRODUCTION: Giant cell tumor (GCT) at Distal End Radius (DER) have relatively aggressive nature and higher recurrence rate and malignant transformation than their other counterparts. There is no case reported till now of GCT recurrence in grafted fibula used for reconstruction in managing primary DER-GCT. The purpose of the study is to report the recurrence of GCTin fibular graft used for treatment in primary GCT of DER. CASE REPORT: A 40-year-old female was diagnosed with Campanacci Type 3 GCT-DER 7-year back. The patient was operated and treated by excision of tumor and reconstruction with contralateral fibular grafting with K-wire fixation of DER7-year back and biopsy of growth was sent. After 7 years, the patient again developed swelling over the right wrist and radiological diagnosis of GCT Campanacci Grade 3 is made. She is managed by resection of tumor tissue by volar approach to DER with proximal row carpectomy with ulnocarpal fusion with retrograde K-wire fixation of the 3rd metacarpal resulting in centralization of ulna. CONCLUSION: Recurrence in GCT also occurs at donor fibula used in reconstruction for primary treatment and could be safely managed by wide excision and centralization of ulna with good results.

Is it necessary to use chemoprophylaxis in Indian patients after hip surgery?

AIM: To know the incidence of postoperative deep vein thrombosis after hip surgery in Indian patients. METHOD: Our study comprises 108 patients undergoing major lower limb orthopaedic surgery. Evaluation by colour Doppler ultrasonography to detect DVT was performed on both lower limbs between seventh and 14th postoperative day. There were 15 total hip replacements (THR), 50 bipolar hemiarthroplasties and 43 proximal femoral fixations by intra-/extra-medullary implant. Only 17 (15.74%) patients showed Colour Doppler evidence of DVT without any complication. RESULTS: In THR patients, incidence of DVT is 20%; in bipolar hemiarthoplasty, it is 16%; and in the proximal femoral fixation, it is 13.95%. No case developed pulmonary embolism, and the current figure for the incidence of DVT is 15.74%. CONCLUSIONS: From our study, it appears to be the difference in incidence of DVT in our country and in western countries, but incidence is not rare. Hence, chemoprophylaxis is necessary in Indian patients.

Fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures.

PURPOSE: To review the outcomes of fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures. METHODS: 44 men and 28 women aged 17 to 50 years with neglected femoral neck fractures of the subcapital (n=12), transcervical (n=57), or basal (n=3) types underwent closed (n=39) or open (n=33) reduction and fixation with a single cancellous screw with double fibular strut grafts (n=24) or fixation with double cancellous screws with a single fibular strut graft (n=48). The mean time from injury to surgery was 10 weeks; the delay was 22 to 35 days in 43 patients and >35 days in 29 patients. Double fibular strut grafts were used for 18 patients with longer delay and resorption of the femoral neck, and 18 patients with posterior comminution of the femoral neck. The outcome was assessed using the Harris hip score. RESULTS: Patients were followed up for a mean of 3 years. The time to bone union was 3 to 4 months in 48 patients, 4 to 5 months in 15, and 5 to 6 months in 5; nonunion was noted in 4 patients. In 18 patients with resorption of the femoral neck, bone union took a longer time. The Harris hip score was excellent (90-100) in 30 patients, good (80-89) in 20, fair (70-79) in 15, and poor (<70) in 7. Of the latter, 4 had nonunion and 3 developed avascular necrosis of the femoral head; they had persistent pain and restriction of hip joint movement. CONCLUSION: Fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures is cost-effective and technically less demanding, and associated with good outcomes.

Fat Embolism Syndrome in Fracture Tibia Treated By Unreamed Interlocking Nail.

Incidence of Fat embolism syndrome (FES) in fractures is about 16.3 but sometimes it is as high as 50% to 62%. The fat embolism is common in fatty bed ridden patients and in whom reamed interlocking is performed under tourniquet with prolonged injury-surgery interval. However in the case discussed here FES occurred under the exact opposite circumstances. In this 23 year lean and thin female with closed tibia fracture unreamed interlocking was performed without tourniquet & the operative procedure was done within 4 hours after trauma. Her pre-operative investigation were within normal limit. We want to discuss by this case report to highlight that even when risk factors are absent outlier events of FES can occur in any case and symptoms should not be discounted.