Thirty-day mortality of patients with hip fracture during COVID-19 pandemic and pre-pandemic periods: A systematic review and meta-analysis.

BACKGROUND: Timely intervention in hip fracture is essential to decrease the risks of perioperative morbidity and mortality. However, limitations of the resources, risk of disease transmission and redirection of medical attention to a more severe infective health problem during coronavirus disease 2019 (COVID-19) pandemic period have affected the quality of care even in a surgical emergency. AIM: To compare the 30-d mortality rate and complications of hip fracture patients treated during COVID-19 pandemic and pre-pandemic times. METHODS: The search of electronic databases on 1st August 2020 revealed 45 studies related to mortality of hip fracture during the COVID-19 pandemic and pre-pandemic times. After careful screening, eight studies were eligible for quantitative and qualitative analysis of data. RESULTS: The pooled data of eight studies (n = 1586) revealed no significant difference in 30-d mortality rate between the hip fracture patients treated during the pandemic and pre-pandemic periods [9.63% vs 6.33%; odds ratio (OR), 0.62; 95%CI, 0.33, 1.17; P = 0.14]. Even the 30-d mortality rate was not different between COVID-19 non-infected patients who were treated during the pandemic time, and all hip fracture patients treated during the pre-pandemic period (OR, 1.03; 95%CI, 0.61, 1.75; P = 0.91). A significant difference in mortality rate was observed between COVID-19 positive and COVID-19 negative patients (OR, 6.99; 95%CI, 3.45, 14.16; P < 0.00001). There was no difference in the duration of hospital stay (OR, -1.52, 95%CI, -3.85, 0.81; P = 0.20), overall complications (OR, 1.62; P = 0.15) and incidence of pulmonary complications (OR, 1.46; P = 0.38) in these two-time frames. Nevertheless, the preoperative morbidity was more severe, and there was less use of general anesthesia during the pandemic time. CONCLUSION: There was no difference in 30-d mortality rate between hip fracture patients treated during the pandemic and pre-pandemic periods. However, the mortality risk was higher in COVID-19 positive patients compared to COVID-19 negative patients. There was no difference in time to surgery, complications and hospitalization time between these two time periods.

Osteoid osteoma of the calcaneus misdiagnosed as subtalar sprain.

Osteoid osteoma of foot and ankle account for ten percent of benign bone tumors and commonly involve the talus and metatarsals. Its occurrence in calcaneus is extremely rare and can mimic ankle instability, subtalar arthritis, osteochondritis or plantar fasciitis leading to delay in diagnosis. We present the case of a 17 year old boy with periarticular osteoid osteoma in the calcaneum, who presented following an ankle sprain. He was successfully treated with CT guided percutaneous radiofrequency ablation and we feel that it is a safe, precise and effective treatment option for even periarticular osteoid osteoma in the foot and ankle region.

Longitudinal Midline Sacral Split Fracture - A Rare Entity.

Fractures involving the central canal of the sacrum are rare injuries and can be transverse or longitudinal. Transverse fractures are by far common and associated with high incidence of neurological injuries. On the contrary, longitudinal midline split fracture is an extremely rare injury with minimal or no neurological injury. They are always associated with anterior pelvic ring fracture and are vertically stable needing only fixation of the anterior pelvic injury. Plating of the anterior pelvic ring in two planes would be beneficial than single plate to prevent gradual loss of reduction.

A rare tumour of hand: angioleiomyoma.

Angioleiomyoma is a benign tumour composed of smooth muscle and vascular tissue. Because of the paucity of smooth muscles in the hand other than tunica media of the blood vessels, its occurrence is quite rare in the hand and only few cases are reported in the English literature. We present the case of a 49-year-old man with benign painless swelling on the dorsum of hand. Differential diagnosis of ganglion cyst and tendon sheath tumour were considered. However, excision biopsy revealed angioleiomyoma. At 2-year follow-up, the patient remained asymptomatic with no evidence of recurrence.

An isolated case of first metatarsal tuberculosis.

An apparently healthy adolescent presented to us with multiple discharging sinuses from his right foot for the past 1 year. All serological parameters were within normal limits. X-ray picture revealed an expansile osteolytic lesion of first metatarsal. Tissue biopsy and PCR confirmed it be of tubercular etiology. The incidence of isolated occurrence of metatarsal tuberculosis is very rare and the diagnostic dilemma it brings about is briefly discussed in the following report.

Giant cell rich osteosarcoma of the cuneiforms.

Osteosarcoma is the commonest primary malignant bone tumor in children and adolescents. Giant cell rich osteosarcoma is a rare subtype of conventional osteosarcoma. Osteosarcomas commonly involve the metaphysis and meta-diaphysis of long bones. We report a 19-year-old girl with giant cell rich osteosarcoma of the medial and intermediate cuneiform bones. Even though, giant cell rich osteosarcoma is frequently mistaken for osteoclastoma of the bone; age of onset, location of lesion, radiological features, and histological characteristics on a high power field helps to differentiate the two conditions. Appropriate and early diagnosis of this variant possibly averts severe morbidity and mortality to the patient. Nonmetastatic osteosarcomas in the foot have better prognosis and are amenable to limb salvage surgeries.

Correlation between the forearm plus little finger length and the femoral length.

PURPOSE. To assess the correlation between the forearm plus little finger length and the femoral length in 100 volunteers. METHODS. The forearm plus little finger length and the ipsilateral femoral length of 68 male and 32 female volunteers aged 19 to 55 (mean, 35.8) years were measured using a measuring tape. The forearm plus litter finger length was measured from the tip of the olecranon to the tip of the little finger, whereas the femoral length was measured from the tip of the greater trochanter to the level of proximal pole of the patella over the outer aspect of thigh. Two observers made the measurements on 2 separate occasions. Intra- and inter-observer variations were calculated. A value of 0.75 or greater indicated excellent agreement. RESULTS. The mean forearm plus little finger length and femoral length were 39.87 (SD, 2.73) and 39.85 (SD, 2.44) cm, respectively. The mean difference between these 2 measurements was 0.028 (95% CI, -0.109 to 0.165) cm. The correlation between these 2 measurements was 0.861 (p<0.001). Patient age, sex, and body mass index did not affect this correlation. The intra- and inter-observer reliability was excellent. CONCLUSION. The forearm plus little finger length correlated with the femoral length. This method is simple, radiation-free, and can be applied in day-today practice.

Ulnar buttress arthroplasty after enbloc resection of a giant cell tumor of the distal ulna.

Enbloc resection with or without ulnar stump stabilization is the recommended treatment for giant cell tumors (GCT) of the distal ulna. A few sporadic reports are available where authors have described various procedures to prevent ulnar stump instability and ulnar translation of carpal bones. We report a GCT of the distal ulna in a 43-year-old male which was resected enbloc. The distal radioulnar joint was reconstructed by fixing an iliac crest graft to the distal end of the radius (ulnar buttress arthroplasty) and the ulnar stump was stabilized with extensor carpi ulnaris tenodesis. After a followup at three years, there was no evidence of tumor recurrence or graft resorption; the patient had a normal range of movement of the wrist joint and the functional outcome was excellent as per the score of Ferracini et al.

Clinical and radiological outcome of percutaneous plating in extra-articular proximal tibia fractures: a prospective study.

BACKGROUND: Despite various techniques of fixation, proximal tibia fractures are associated with poor outcome and increased rates of complications. Minimal access and rigid fixation are the keys for optimal outcome in such fractures. Therefore, this study was designed to look for the clinical and radiological outcomes of percutaneous locked plating (PLP) in extra-articular proximal tibia fracture. METHODS: Between April 2008 and September 2010, 47 consecutive patients with 49 proximal third extra-articular tibial fractures (29 closed and 20 open injuries) underwent PLP. The patients were followed up at 6 weeks, 3 months, 6 months and 1 year. The union rate and complications of this fixation were evaluated. The clinico-radiological outcomes were assessed at 1 year of surgery. RESULTS: Four patients had infection in the postoperative period which needed repeated debridement, gentamycin bead application and prolonged antibiotic therapy. Three of these infective cases ended up with nonunion and needed cancellous bone grafting. All the remaining fractures united. The average time for union was 20 weeks in closed and type I open fracture and 25 weeks in type II and III fractures. No neurovascular injury, hardware failure or loss of fixation was documented till the last follow-up. The mean range of knee joint movement was 119°. The average lower extremity functional score (LEFS) was 59 (74%). There were 10 cases of malunion (20.14%), with six varus/valgus and five procurvatum/recurvatum (one having both sagittal and coronal malunion) angulations. There were no statistical differences between patients with malunion and normal alignment with regard to knee range of motion and LEFS. CONCLUSION: Minimally invasive osteosynthesis using PLP in extra-articular proximal tibia fractures showed a promising result with minimal complications.

Multicentric osteosarcoma.

Multicentric osteosarcoma is a rare type of osteosarcoma with a poor prognosis. It is usually described as the occurrence of tumorous lesions in more than one bone, but without pulmonary metastasis. It may be of a synchronous or metachronous variety. We report the case of a 12-year-old boy with a synchronous variety of multicentric osteosarcoma, although he did not have any risk factors for the disease. We also discuss the current debate on whether multicentric osteosarcoma represents multiple primary tumours or metastatic disease.

Ganglion cyst of the posterior cruciate ligament in a child.

Ganglion cysts are more commonly associated with the anterior cruciate ligament than the posterior cruciate ligament (PCL). A literature review showed that all reported cases of ganglion cysts to date involved adults. We report a rare case of ganglion cyst in the PCL of a four-year-old boy, and discuss its aetiology, clinical presentation, imaging features and management. Ganglion cysts of the PCL may be confused with meniscal cysts arising from tears of the posterior horn of the medial meniscus on magnetic resonance (MR) imaging. Hence, the posterior horn of the medial meniscus has to be carefully evaluated to rule out a tear. MR imaging is the method of choice to confirm diagnosis, and arthroscopic resection is a safe treatment modality even in children.