Percutaneous elevation of depressed lunate fossa: A surgical technique.

Die-punch fractures or impaction fractures of distal radius articular surface are difficult to treat and hard to achieve satisfactory reduction. We present a unique, percutaneous and minimally invasive technique to elevate the depressed lunate fossa and maintain the reduction of the elevated fragment with no need of grafting in such fractures. This technique is simple, reproducible and can be executed with simple instrumentations. We think it deserves a variety of implications in the treatment of distal radius fractures.

Rupture of the triceps tendon - A case series.

Triceps rupture is the least common among all tendon injuries. The usual mechanism of injury is a fall on an outstretched hand, although direct contact injuries have also been reported to cause this injury. The diagnosis of acute triceps tendon rupture may be missed, which can result in prolonged disability and delayed operative management. We presented three cases of acute triceps tendon rupture each at different site showing the spectrum of injury to the muscle and mechanism of injury and management were also discussed.

Triple modified French osteotomy: a possible answer to cubitus varus deformity. A technical note.

BACKGROUND: Cubitus varus is the most common delayed complication of pediatric supracondylar humerus fractures. We developed a new technique, the triple modified French osteotomy, that we believe may be the answer to this common but yet unsolved deformity. MATERIALS AND METHODS: Ten patients aged between 6 and 12 years with post-traumatic cubitus varus deformity were operated on with the triple modified French technique. A varus angle of more than 10° measured on the radiograph was an indication for surgery. RESULTS: The radiologic union at the osteotomy site took place in a mean period of 5.5 weeks (range, 4.5-7 weeks). The average correction achieved by the osteotomy was 27°. There were no cases with complications of radial or ulnar nerve palsy or joint stiffness. CONCLUSION: The triple modified lateral closing wedge French osteotomy is a simple and cosmetically effective method of treating cubitus varus deformity in children. It may obviate the need for more complex procedures; at the same time, it also addresses the potential drawbacks of a simple closing wedge osteotomy.

Scapulothoracic and scapholunate dissociation in the ipsilateral upper limb of a trauma victim.

Scapulothoracic dissociation is a rare and complex injury pattern with varied presentation. Here we describe a case of a 32-year-old male who presented with scapulothoracic dissociation associated with brachial plexus injury, along with scapholunate dissociation. We also propose an injury mechanism that might link the two injury patterns, suggesting that the association might be more than by chance. The patient was managed according to established trauma care and resuscitation protocols followed by open reduction and internal fixation of the clavicle fracture, and fixation of scapholunate dissociation and had a successful outcome at follow-up.

Triple plating of tibia in a complex bicondylar tibial plateau fracture.

High-energy tibial plateau fracture poses a significant challenge and difficulty for orthopaedic surgeons. Fracture of tibial plateau involves major weight bearing joint and may alter knee kinematics. Anatomic reconstruction of the proximal tibial articular surfaces, restoration of the limb axis (limb alignment) and stable fixation permitting early joint motion are the goals of the treatment. In cases of complex bicondylar tibial plateau fractures, isolated lateral plating is frequently associated with varus malalignment and better results have been obtained with bilateral plating through dual incisions. However sometimes a complex type of bicondylar tibial plateau fractures is encountered in which medial plateau has a biplaner fracture in posterior coronal plane as well as sagittal plane. In such fractures it is imperative to fix the medial plateau with buttressing in both planes. One such fracture pattern of the proximal tibia managed by triple plating through dual posteromedial and anterolateral incisions is discussed in this case report with emphasis on mechanisms of this type of injury, surgical approach and management.

Ipsilateral intertrochantric and femoral head fracture without dislocation of the hip. Potentially misleading radiograph: a case report and review of literature.

BACKGROUND: Traumatic femoral head fracture without dislocation with ipsilateral intertrochanteric fracture is an extremely rare injury and has not been reported in the literature. CASE REPORT: We reported a case of simultaneous ipsilateral femoral head and intertrochantric fracture without dislocation of the hip in a 74-year-old woman. The patient presented with a history of road traffic accident. Radiographs and computerised tomography scans revealed a right intertrochantric fracture and femoral head fracture without dislocation of the hip. CONCLUSIONS: The case was managed by uncemented modular bipolar arthroplasty using LINK reconstruction prosthesis. In the case report we described this unusual pattern, mechanism of injury, and management of such cases.

Acute pediatric septic arthritis: a systematic review of literature and current controversies.

We present a review of the current literature and the author's opinion regarding Septic arthritis in the pediatric age group. The etiopathogenesis, clinical features, the laboratory parameters for diagnosis and monitoring of treatment, radiological features, are discussed along-with the debatable issues pertaining to the choice of antibiotics, their duration, and the need and mode of surgical drainage and mobilization of the joint.

Neglected foreign body in contralateral limb in a traumatic transfemoral amputee---radiographs can be misleading.

Missed or neglected foreign bodies are not infrequent in surgical practice. This case report highlights the fact that thorough clinical examination and detailed evaluation of trauma patients are very necessary so that any associated injuries or foreign bodies will not be missed and any unforeseen clinical or medico-legal complications can be prevented. We present a case of a 35-year- old male patient who had traumatic transfemoral amputation of the right lower limb with a clean laceration (size 2 cm multiply 1 cm) over the medial aspect of the left thigh. Radiographs suggested a single radioopaque foreign body which proved misleading, as during surgical removal multiple radiolucent and radiopaque foreign bodies were discovered. Postoperative ultrasound was performed and showed no retained foreign bodies. A secondary closure of the right thigh amputation was done and patient was discharged. At the last follow-up, 9 months after injury, the patient had no complaints, and both the amputation stump and the wound over the left thigh were healthy. Thus in the cases of retained foreign bodies, in addition to thorough clinical examination and radiography, ultrasonograpy should be supplemented. And if required, use of CT scan as well as MRI should be also considered.

First rib fractures: not always a hallmark of severe trauma---a report of three cases.

According to medical literature, fracture of the first rib is quite rare and the bilateral condition is especially rare. This type of fracture is usually associated with severe intrathoracic trauma and other bony or neurovascular injuries, thus can be considered as a harbinger of major trauma. However here we present three cases of low velocity first rib fractures without any major trauma or multisystem injuries. All the three patients were treated conservatively and did well on simple analgesics and rest and had no early or late complications. It can be seen that not all the first rib fractures are associated with major trauma or multisystem injuries. There is a variant of first rib fracture with low velocity injuries which is not associated with any major complications in contrast to majority of first rib fractures associated with high velocity injuries. Causative factor of such injuries may be violent muscular contraction of scalenus anterior or serratus anterior, but not direct trauma.

Tubercular arthritis of the elbow joint following olecranon fracture fixation and the role of TGF-beta in its pathogenesis.

Tuberculosis (TB) occurring after a closed bone fracture in the patient with no history of TB and no evidence of TB infection at the time of initial fracture is a rare entity. We report one such case of a 48-year-old female, who presented in the emergency department with an olecranon fracture which was open reduced and internally fixed with tension band wiring. Patient presented in the outpatient department with serosanguineous discharge at 3 weeks after surgery. The discharge was sent for culture and sensitivity tests, and the patient was managed by antibiotics and daily dressings. There was wound dehiscence and the underlying implant was exposed, which was removed at 12 weeks after surgery. Repeat debridements and dressings continued for 6 months, but the discharge from the wound site continued. X-rays of the elbow performed at 6 months raised the suspicion of TB, which was confirmed by Ziel-Neelsen staining and histopathological examination of the debrided tissue. Following the confirmation, patient was put on antitubercular drugs. The patient responded to antitubercular drug therapy (ATT), the purulent discharge from the wound ceased, and eventually the wound healed after 2 months of starting ATT.

Complete palmer lunate enucleation---is proximal row carpectomy or wrist arthrodesis the only choice?

Perilunate dislocations are rare injuries of the wrist and complete dislocation of the lunate is also rare. There is controversy in literature regarding the optimal management of such injuries. Complete lunate enucleation is associated with high rate of osteonecrosis of lunate thus wrist arthrodesis or proximal row carpectomy has been advocated as primary treatment for such injuries. We report a case of transradial styloid complete palmar lunate enucleation in a 25-year-old male patient who sustained injury to the left wrist due to fall on outstretched hand. Carpal row salvage surgery initially by closed reduction and wrist distractor application followed by open reduction and internal fixation with K-wires along with ligamentous repair resulted in restoration of normal wrist anatomy and good functional outcome. As many of these injuries are missed on initial presentation and outcome is poor for missed injuries, prompt diagnosis and early surgical management to restore vascularity of lunate is recommended.

Bilateral traumatic proximal humerus fractures managed by open reduction and internal fixation with locked plates.

Fractures of the proximal humerus are uncommon in young patients. Although bilateral fracture of proximal humerus itself is rare, association with epilepsy and electrocution is frequent. Only one case of traumatic bilateral proximal humerus fracture has been reported in the literature. We report a rare case of bilateral traumatic displaced proximal humerus fractures in a 40 years old male patient, which was treated by means of open reduction and internal fixation with proximal humerus locked pates on both sides and obtained a good functional outcome.

A Prospective Study Comparing the Functional Outcome of Bipolar Hemiarthroplasty Versus Total Hip Replacement in Elderly Patients With Fracture of the Neck of Femur.

Introduction Displaced fractures of the neck of femur in elderly patients usually require surgical intervention, with either bipolar hemiarthroplasty (BHA) or total hip replacement (THR). However, there is still controversy regarding the optimal prosthesis. The present study was performed to compare the functional outcome of BHA versus THR in elderly patients with displaced fracture of the neck of femur. Materials and methods This prospective study was conducted between December 2019 and December 2021. This study included 40 patients with displaced fracture of the neck of femur. All patients were more than 60 years of age. The patients were randomly allocated to be treated with either BHA or THR. Functional assessment was done using Harris hip scores at one month, three months, six months, and one year postoperatively. Results In our study, at all follow-ups, the Harris hip score was found to be more in patients in the THR group than in the BHA group. In the BHA group, the mean Harris hip scores were 59.95, 66.25, 68.80, and 75.70 at the follow-up visits at one month, three months, six months, and one year, respectively, while in the THR group, the mean Harris hip scores were 65.06, 69.40 72.50, and 78.19, respectively. Conclusion THR is a better option as compared to BHA in the management of elderly patients with fracture of the neck of femur on account of less complication rates and higher Harris hip scores.

Retrospective analysis of open reduction and internal fixation of coronal plane fractures of the capitellum and trochlea using the anterolateral approach.

INTRODUCTION: Coronal plane distal humeral injuries are relatively rare. Numerous classification systems have been proposed as the complexity of these fractures has been realized. We in the present series of ten patients describe the surgical technique of Open Reduction and Internal Fixation of Coronal plane fractures of the distal humerus with headless compression screws performed using the anterolateral approach. MATERIAL AND METHOD: It was a retrospective study, the data collected from March 2010 to 2015 was analysed and the final outcome was assessed using the DASH score. Out of a total of 13 patients with distal humerus coronal plane fractures, 10 patients were available for follow up. The X-rays and CT scans were reviewed and the fractures were classified according to Dubberley and Bryan and Morrey classification. Radiographic were evaluated for presence of union or nonunion, avascular necrosis, joint line step-off (none/1-mm/>1-mm), hardware failure and instability. RESULTS: The average age was 41 years. The average DASH score in our study was around 24. The time to union ranged between 8-12 weeks with the average time being around 10 weeks. One patient had post traumatic Arthritis radiologically classified as Broberg and Morrey Type 2 and one patient had Heterotrophic ossification Brooker Grade 1. CONCLUSION: Open reduction and internal fixation of coronal shear fractures of capitellum and trochlea using headless screw compression via the antero-lateral approach is a reliable treatment modality and results in stable fixation with restoration of a functional arc of motion. LEVEL OF EVIDENCE: IV.

Compound posterior cruciate ligament and popliteal artery injury due to dog bite: A case report.

Injuries due to dog bites are a common occurrence and are mostly trivial. Severe dog bite injuries requiring hospitalization and complex reconstructive procedures are more common in children. We present the case of a five year old child with popliteal artery thrombosis and compound Posterior Cruciate ligament injury due to a dog bite. The child was managed by immediate thrombectomy, meticulous debridement and knee spanning external fixation followed by Skin Grafting. At one year post surgery range of motion was 10-110°, with no distal neurovascular deficit and no sign of instability.

Evaluation of osteosynthesis with dual fibular bone grafting for neglected femoral neck fractures.

BACKGROUND: Femoral neck fractures in young adults is an unsolved problem and neglected femoral neck fractures presents more challenge to the orthopaedics surgeon if femoral head salvage is attempted. We reviewed the operative results of neglected femoral neck fractures in young adults with fixation with dual fibular bone grafting Purpose of study was evaluation of epidemiological, clinical, functional, rehabilitative outcome and complications in such patients. METHODS: Twentyeight patients in age group 18-50 years were operated having fracture neck femur by dual fibular bone grafting in the Department of Orthopaedics, S.N. Medical College, Agra in (May 2005-February 2008) and divided into two groups. Group A: comprised of 8 patients treated by dual fibular bone grafting alone and Group B: comprised of 18 patients treated by dual fibular bone grafting with single cancellous hip screw. RESULTS: All the patients of the present series were having neglected intracapsular fracture, neck femur which were treated by dual fibular bone grafting with or without cancellous hip screw fixation. Majority of the patients had good to fair result according to Larson method with average time of union 16 weeks. All patients had useful range of movement at hip. Satisfactory union was achieved in all patients except two. CONCLUSION: Double bone grafting is a simple and cost effective modality of treatment for late femoral neck fracture with good results. It is a stable and biological method of fixation with preservation of natural femoral head with fewer complications.