Transmalleolar approach to a tubercular lytic lesion of the talar body: a case report.

Tuberculosis of the talus is a rare condition, and the diagnosis can be difficult to make because of inconclusive laboratory and ancillary testing. In such cases, accurate diagnosis and appropriate treatment may require the use of a transmalleolar osteotomy to gain access to the involved portion of the talar body. In the case described in this article, a transmalleolar approach was used to gain access to a lytic lesion of the talar body so as to obtain microbiological and histopathological specimens for diagnostic purposes, and to thoroughly debride the lesion. After 6 years of postsurgical follow-up, the patient was leading a normal life with a full range of ankle and subtalar motion. The rarity of the diagnosis, and the use of the transmalleolar approach to a lytic and likely infected lesion in the body of the talus, makes this case worthy of public discussion.

Osteosynthesis of Common Acetabular Fractures Operated on Through a Single Posterior (Kocher-Langenbeck) Approach with or without Trochanteric Flip Osteotomy. A Case Series.

BACKGROUND: The Kocher-Langenbeck approach is recommended in the majority of common posterior acetabular injuries. Trochanteric osteotomy can be used to extend the exposure of the Kocher-Langenbeck approach superiorly and anteriorly. We evaluated the functional outcome of common acetabular fractures operated on through the Kocher-Langenbeck approach with or without trochanteric flip osteotomy. MATERIAL AND METHODS: This prospective study enrolled 42 patients with posterior wall, posterior column, transverse, posterior wall with posterior column, transverse with posterior wall and both column acetabular fractures. The Kocher-Langenbeck approach was used in 35 patients and trochanteric flip osteotomy was done in 7 patients. The radiological outcome was evaluated by Matta's criteria and the functional outcome was evaluated using modified Merle d'Aubigné and Postel criteria. RESULTS: D'Aubigne Postel scores at the final follow-up were excellent in 12 patients, good in 18, fair in 8 and poor in 4. Thirty-seven patients had congruent reduction (anatomical in 29, imperfect in 8) and 5 patients had non-congruent reduction on radiographs as per Matta's criteria. Radiographic congruity (88.09%, 37 out of 42 cases) correlated fairly well with the functional outcome (excellent or good functional outcome in 71.4%, 30 out of 42 cases). The complications included traumatic nerve palsy (3 cases), iatrogenic nerve palsy (2 cases), deep venous thrombosis (2 cases), wound infection (3 cases), non-congruent reduction (5 cases), 8 cases of osteoarthritis of hip, 2 cases of avascular necrosis of femoral head and 3 cases of heterotrophic ossification. CONCLUSIONS: 1. Surgical treatment of common acetabular fractures with major posterior involvement can be attempted via a single posterior approach (Kocher-Langen-beck with or without trochanteric flip osteo-tomy) and leads to good-to-excellent results in a majority of the cases. 2. It is superior to conservative management, which has been found to be accompanied by a much higher rate of complications. 3. A thorough study of the pre-opera-tive radiographs, Judet's views and 3D-reconstructed CT images helps in classifying the fracture and thereby assigning or not assigning it for the posterior approach.

Injuries from bear (Ursus thibetanus) attacks in Kashmir.

BACKGROUND: Strict conservation of wildlife and encroachment into its habitat have led to an increase in the number of wild animal-inflicted injuries and fatalities in Kashmir. The aim of this study was to report injuries inflicted during bear attacks and discuss their management and sequelae. METHODS: A retrospective study was conducted in the Department of Orthopedics Government Medical College Srinagar, University of Kashmir, from January 2003 to June 2007. A total of 254 cases (186 males, 68 females) with history of bear attacks were recorded over a period of 54 months. RESULTS: Eighty percent of victims were attacked in the maize fields and apple orchards and 20% in the dense forests while collecting firewood or tending to the cattle. Lacerations of the head and neck and fractures of the upper limbs and facial and skull bones were the striking observations. Permanent facial disfigurement, hearing loss, loss of digits, residual neurodeficit, and persistent psychological morbidity were the long-term sequelae in most of the patients. CONCLUSION: Wild animal-inflicted injuries are a neglected part of trauma. There should be a high index of suspicion when treating these injuries, as serious underlying bone or soft-tissue damage can be overlooked. Management of these injuries involves all subspecialties of trauma to achieve the best functional outcome.

A High-Grade Chondrosarcoma of Calcaneum Mimicking as a Benign Pathology: Delayed Diagnosis and Management.

UNLABELLED: This case is presented to highlight a rare case of chondrosarcoma of calcaneum in a young adult mimicking as a benign pathology and to highlight the diagnosis and early management of such cases to prevent complications and even death. Chondrosarcoma constitutes less than 10% of all primary malignancies of bone and occurs mostly in proximal locations such as pelvis, proximal femur, and proximal humerus. We present a case of high-grade chondrosarcoma at a very rare site, calcaneum of a 40-year-old male that was mimicking as a benign pathology. This case report highlights the importance of proper clinical examination, evaluation, and suspicion for benign occurring lesions to prevent complications related to a delay in diagnosis. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case study.

Giant osteochondroma of proximal fibula in a skeletally mature patient.

Osteochondroma are believed to be most common benign tumors. The growth of osteochondroma usually ceases when skeletal maturity is reached but becomes a matter of concern to the attending doctor if the lesion becomes painful and shows evidence of increased growth even after physeal closure, which may be an indication of sarcomatous change in the lesion. We present a case with substantial growth of an osteochondroma after attainment of skeletal maturity. The tumor turned out to be histologically benign, and patient had an uneventful recovery with no recurrence.

Ewing's sarcoma of the ilium mimicking inflammatory arthritis of the hip: a case report.

INTRODUCTION: Ewing's sarcoma is second most common primary malignant bone neoplasm in children and adolescents. We report a case of Ewing's sarcoma of ilium in an 18-year-old female mimicking clinically and radiologically inflammatory arthritis of hip joint, a rare entity not mentioned in literature. CASE PRESENTATION: An 18-year-old girl presented with pain hip, limp and fever off and on. Patient had restricted range of motion, raised erythrocyte sedimentation rate, leucocytosis and radiograph showed reduced joint space. Magnetic resonance imaging pelvis revealed an altered marrow signal of acetabulum with a large soft tissue component. Histopathology revealed a malignant round cell tumor consistent with Ewing's sarcoma. CONCLUSION: Classical clinical and radiological presentation of Ewing's sarcoma of ilium may not be the rule. One should be highly suspicious of the disease even if there is no direct pointer to the disease as was encountered in our case.

Humeral biepicondylar fracture dislocation in a child: A case report and review of the literature.

INTRODUCTION: Humeral biepicondylar fracture dislocation is a very rare injury reported only once in English literature by G R Taylor et al. We report a case of humeral biepicondylar fracture dislocation in a 13-year-old girl with a unique mechanism of injury. CASE PRESENTATION: A 13-year-old girl presented with trauma elbow. Radiographs showed biepicondylar fracture of humerus with dislocation of elbow. CONCLUSION: In humeral biepicondylar fracture dislocation, reduction is always unstable. So treatment is open reduction and internal fixation.

Open reduction and internal fixation in a case with transscaphoid perilunate dislocation 8 months after the injury: a patient with a 5-year follow-up.

The management of perilunate dislocations diagnosed later than three months continue to elicit debate with literature being scarce. We report a 22-year-old male with transscaphoid perilunate dislocation who reported to our hospital 8 months after sustaining the injury. Open reduction was done along with bone grafting. Five years after the surgery the patient is symptom-free with an excellent range of motion.

The dynamic condylar screw in the management of subtrochanteric fractures: does judicious use of biological fixation enhance overall results?

Subtrochanteric fractures are fraught with certain anatomic, biologic and biomechanical challenges. Evolution of implants like the Gamma nail, fixed-angle nail plates, compression hip screws and dynamic hip screws with trochanteric stabilization plates underlines a persistent quest for a better implant. We studied the dynamic condylar screw DCS as an implant on a series of 30 consecutive patients with subtrochanteric fractures. Our purpose was to assess this implant as a panacea for subtrochanteric fractures. All cases of AO type A and B were anatomically fixed, whereas type C was biologically plated. The idea was to assess the applicability and adaptability of the DCS. Fractures in 29 cases united, with one patient suffering from an implant failure. There were 17 excellent, 5 good, 5 fair and 3 poor results. The DCS is a definite advance over previous methods of treatment; when combined with the utilization of biological fixation techniques for comminuted fractures, can be relied upon to treat all types of subtrochanteric fractures.