Neglected volar Barton fracture in adult managed in a rural setting: a case report.

Introduction: Barton fractures are distal radius fractures that extend through the dorsal aspect of the articular surface, with associated dislocation of the radiocarpal joint. They are extremely unstable and require open reduction and internal fixation (ORIF). Delayed presentation is often encountered with difficulty in achieving reduction, and more extensive surgery may be needed. Here, we present a case of a 3-week-old neglected volar Barton fracture of the right wrist treated with the conventional method in a rural setting. Case presentation: A 32-year-old gentleman was initially denied surgical intervention for a distal radius fracture he sustained after a motor vehicle accident and was discharged with a long arm slab plus analgesics represented in the outpatient department and agreed upon surgical intervention after his condition did not improve with conservative treatment. The trans-FCR (flexor carpi radialis) approach was used for surgery under the brachial plexus block. The fragment was reduced by applying pressure volarly into the distal radius and was confirmed with imaging. A K-wire (Kirschner) was used to temporarily hold the fragment. A volar distal radius locking plate was used to buttress the distal fragment. Final fixation was made using altogether six screws. The wrist was splinted in a short dorsal slab. Skin sutures were removed after 2 weeks, and an active assisted range of motion of the wrist was begun after 6 postoperative weeks. Discussion: Volar Barton is an uncommon subset of intra-articular fractures and typically results from damage sustained at high speeds. The general agreement for neglected fractures is that 'fractures that are not handled or mishandled resulting in treatment delay, worsening of the fracture and even a disability' are to be considered neglected fractures. Rebuilding the damaged anatomy properly and enabling a prompt, problem-free recovery of hand function are the main objectives of treatment. As conservative therapy is often ineffective and rife with side effects, including early osteoarthrosis, deformity, subluxation, and instability, stabilization and anatomic reduction by surgery is the key to managing these fractures. Plating is one of the therapeutic modalities among various therapeutic modalities depicted in the literature that enables shorter time of immobilization and early restoration of wrist function through direct anatomic repair and stable internal fixation. In our case, the callus was relatively immature, and the original fracture site could easily be cleared. Also, there was no significant soft tissue shortening, and the volar fragment had not migrated proximally, in contrast to what is expected in prolonged neglected cases. Hence, the intraoperative reduction was possible, and the fracture was fixed with a volar locking plate as usual. Conclusion: Given the modest tissue shortening and young callus, such cases may be treated as conventional Barton's fractures and managed using conventional means of fixation with locking buttress plates. However, it makes sense to prepare for potential malreduction by carrying K wires and wrist distractions. To restore complete function to the injured wrist, adequate physiotherapy and postoperative splinting are essential components of postoperative rehabilitation.

Glycogen storage disease in two sisters: A case report.

Glycogen storage diseases (GSDs) are rare autosomal disorders that result from defects in glycogen metabolism. There are more than 12 types, each with distinct clinical features. Clinical scenario, biochemical abnormalities are useful for suspicion whereas liver biopsy and enzyme assay provides definite diagnosis. We report a case of two sisters with similar clinical symptoms suggestive of the disease.

Porokeratosis of gluteal region: A case report.

Genitogluteal porokeratosis is a rare localized disorder of keratinization. Due to the rarity of the case and non-specific keratotic lesion, it is often misdiagnosed until a histological examination is performed. Treatment of this condition can be challenging, which comprises various topical and systemic drugs, lasers, cryotherapy, phototherapy, and also surgical intervention. Regular follow-up is necessary in the view of this disorder being a premalignant condition.

Pure Sertoli cell tumor of the ovary: A case report.

Pure Sertoli cell tumors are an uncommon variant of rare ovarian Sertoli-Leydig cell tumors. Due to nonspecific clinical and imaging features, diagnosis is often made after histopathological examination. The prognosis is excellent as most are detected in the early stages and surgical resection is often curative in most cases.

Giant cell glioblastoma in 6-year-old kid: Report of an unusual case.

Pediatric giant cell glioblastoma, a highly malignant and lethal tumor, can only be distinguished from glioblastoma multiforme histologically. Though it is said to have a better prognosis, adequate evidence in favor is lacking. Early diagnosis with gross total resection and adjuvant chemotherapy might increase the survival period.

Bilateral ovarian edema with unilateral ovarian leiomyoma and double inferior vena cava: a case report.

BACKGROUND: Ovarian edema, ovarian leiomyoma, and double inferior vena cava are all rare clinical entities. The coexistence of all these entities has not been yet reported in the literature. CASE PRESENTATION: We report a case of a 25-year-old nulliparous tamang woman with all these rare clinical entities, who presented with a complaint of right-sided lower abdominal pain. After examination and investigation, an ovarian tumor was suspected and laparotomy was performed during which bilateral ovarian edema with a solid tumor on the left side was identified and left salpingo-oophorectomy was done preserving her right ovary. A histopathological examination confirmed the clinical findings. CONCLUSIONS: As ovarian edema is a rare entity, due to lack of clinical suspicion it is often overdiagnosed as a malignant tumor leading to radical surgery with subsequent loss of hormonal function and early infertility. A high degree of clinical suspicion during the intraoperative period is helpful for diagnosis to avoid unnecessary oophorectomy and infertility.

Calvarial Tuberculosis: A Diagnostic Quandary: A Case Report.

Primary Calvarial Tuberculosis, a rare entity of skull is even rarer after second decade of life in a healthy person without evidence of tuberculosis elsewhere in the body. Most of the cases are often misdiagnosed as osteomyelitis/syphilis/bony metastasis. We report a case of primary skull tuberculosis in 26-year-old male with complains of headache and swelling in the right frontal region with no history of previous tuberculosis. The patient was operated and the histopathological examination of excised tissue was suggestive of tubercular pathology. The patient is doing well after anti-tubercular therapy. Being a rare disease, tubercular osteomyelitis of skull bones is often missed and misdiagnosed due to lack of clinical suspicion and slow growth of mycobacterium cultures. Histopathological examination of biopsy material and demonstration of acid-fast bacilli in the pus are helpful for diagnosis and early management of the disease. Keywords: calvaria; Mycobacterium; osteomyelitis; tuberculosis.