Blunt Hohman-Lever Technique for Reduction of Intertrochanteric Fracture – A Surgical Technique

We present a 60 years old patient who presented to us with history of domestic fall and sustained injury to the right hip and was diagnosed with trochanteric fracture right side. As closed reduction was not acceptable and bone spike was not available in the set, we designed our own technique of using a bone lever introduced from the same incision from where reaming/nail insertion was done. To the best of our knowledge this technique has never been described before in english literature.Since our first case we have tried it in 6 other patients and without any issues

Bilateral Transolecranon Fracture-Dislocation Elbow with Bilateral Coronoid and Radial Head Fractures – A Rare Complex Elbow Injury: A Case Report and Review of Literature

Bilateral olecranon fractures are a rare occurrence. Direct trauma usually results in comminuted fractures and indirect trauma in transverse fractures. We describe a case of bilateral olecranon fracture with a radial head comminuted fracture with coronoid fracture without the involvement of collaterals. Olecranon fractures are usually a result of direct trauma (fall from height/motor vehicle accidents) or indirect trauma. A 22year old male patient presented to the emergency department with complaints of pain and swelling around both elbows following a motor vehicle accident. The patient also sustained trauma to the head and had a history of transient loss of consciousness. CT brain at the time of presentation was normal and the patient was conscious. The Olecranon Fracture was fixed with a pre-contoured olecranon locking compression plate (Synthes, USA). In our case, the collaterals were intact and as the radial head was comminuted, we excised the radial head. The radial head being secondary stabilizer of the elbow in injuries to the medial collateral ligament complex. The excision of the radial head would not cause any instability. Bilateral olecranon fractures need to be fixed anatomically, the comminuted radial head was excised and the anterior capsule was repaired

Evaluation of pattern and prognostic factors of head injury cases in a tertiary care centre

Background: Head injury is a major public health problem worldwide and requires appropriate attention both regionally and globally. This study was done to find the patterns and to evaluate prognostic factors for final outcome of cranio-cerebral trauma.Methods: A prospective study of 200 cases of head injury was conducted in a tertiary care hospital during one year duration. Apart from patient’s demographic profile detailed history and examination was recorded. Final outcome of all patients was noted at discharge and during follow up, various prognostic factors were studied by taking Glasgow outcome scale (GOS) at 3 months of head injury.Results: This study included 156 (78%) males and 44 (22%) females with average age of 35.95 years. Assault followed by RTI was the main cause of TBI. The factors which correlated with poor prognosis are presence of increasing age, less GCS at admission, alcohol intoxication and multiple lesions on CT scan.Conclusions: Prognostication of patients with head injury will help to provide timely multimodality approach which will ultimately help in improving outcome of these patients.

Bilateral Elbow Dislocation with Radial Head Fractures in a 33 Year Male – A Rare Case Report

The authors report a rare case of bilateral elbow dislocation with associated radial head fractures in a 33 year male who presented to our hospital following a road traffic accident. The elbow dislocations were reduced in the emergency room, the left radial head fracture was treated conservatively in an above elbow slab for four weeks and the right radial head and neck fracture was treated operatively with Herbert screw fixation for the radial head fracture andbuttress plating for the radial neck fracture. At six months follow-up, the patient was pain free and had functional range of flexion and extension of both elbows with pronation and supination of the right elbow up to 50°and 40° and that of the left elbow up to 60° and 45° respectively.

Os Acromiale-unusual Manifestation as Superior Spur and Bursitis-A Case Report

An Os acromiale is a condition that results from the failure of fusion of the anterior acromial apophysis. It can be asymptomatic. It can also result in subacromial impingement and rotator cuff tear. In this case report of a 39year-old lady we would like to present the management of the painful bursitis and spur formation on the superior surface of a meso-type of os acromiale. Conservative management in the form of rest, anti-inflammatory drugs and physiotherapy did not provide symptomatic relief. Patient then underwent surgical excision of the superior spur. Open reduction and internal fixation was not carried out. Patient had resolution of pain and no recurrence of symptoms or features of impingement at 6 months follow up. To the best of our knowledge there are limited reportsin English literature about this rare subset of patients with symptomatic os acromiale with superior spur formation and with no features of impingement or cuff pathology.

Distal Humeral Shear Fracture - A Modified Technique for Exposure

Coronal shear fractures of the distal humerusare rare, complex fractures that can be technically challenging even in the best of hands. Their peak incidence is seen in elderly females and is usually the result of low energy fall. The injury is usually part of complex elbow injury and in rare instances can be isolated entity. Complex injury pattern is characterized by shear fracture combined with fracture of radial head and collateral ligament injury. The preferred treatment for this complex fracture is Open reduction and internal fixation. The usual recommendation is a two-incision approach. We report a rare case in which fracture could not be classified using the traditional classification systems and in which entire fracture was managed via a single approach

Osteoid Osteoma of the Sacrum - Case Report and Review of Literature

Sacrum is an extremely rare site for osteoid osteoma. We present a 25 year-old male, a computer operator who presented with chronic back pain of 4 years duration. He was initially investigated with routine x-rays and lab investigations and was treated for chronic back pain at another facility. Extensive work up at our clinic revealed a diagnosis of Osteoid Osteoma of Right 2ndSacral vertebral arch Interlesionalresection of the tumor was done and this was verified on histopathology. The patient had complete relief of pain following surgery. Repeat CT scan done at one year follow up. It showed complete removal of the Nidus. To the best of our knowledge there have not been many case reports in English Literature from the Indian subcontinent. There are many studies in which tumor of lumbar region is one of the causes of radiating pain in lower extremities but to the best of our knowledge this finding is unique and can also be an important cause of radicular pain

Early Infection of Bilateral Total Knee Arthroplasty with Salmonella typhi: Case Report and Review of Literature

Acute Salmonella typhiprosthetic joint infection (PJI) is a rare event. In Endemic areas one needs to be cautious if the patient is immunocompromised. We report a case of bilateral simultaneous PJI of the knee in a 60-year-old lady who was not immunocompromised. The patient presented on Post op Day 5 with Fever and local signs suggestive of infection. As this was an Early PJI she was successfully treated with Debridement, Poly exchange and Intravenous and oral antibiotics for 6 weeks. This case highlights the fact that in patients living in these areas and in seasons where incidence of enteric fever is high, patients should be screened preoperatively for Salmonella infection by history and stool cultures. To our knowledge this is the first case report of Early Bilateral Simultaneous infection with Salmonella typhi

Tibial Blowout”- A Complication of Arthroscopic Anterior Cruciate Ligament Reconstruction.

The reconstruction of anterior cruciate ligament (ACL) has become the standard of care for a torn ACL in active, young athletes. Various technical complications during the surgery are documented. Of the complications pertaining to the bony tunnel preparation, the posterior femoral blow out is common. In this report we describe a complication that can occur while preparing the tibial tunnel – “tibial blow out”. This is a complication of anterior placement of the tibial tunnel and this has not been reported in the literature. We describe the identification, the possible mechanism, prevention and management of such an intraoperative complication.

Role of dynamic external fixator in the management of fractures of distal end of radius.

The intra-articular fracture of radius has been an enigma for orthopaedic surgeons since time immemorial. It is a dilemma as to when to use the fixator, when to mobilise after fixator or simply treat it by conservative means. Numerous fixators are in vogue depending on the preference of the surgeon--in the present prospective study the results of dynamic external fixator--which, based on the principle of ligamentotaxis, were evaluated over a 3-year period and the results showed that although excellent radiological results were seen in 90% of the cases yet only 75% of the cases had a excellent functional result.

Arthroscopic evaluation of refractory knee pain.

The aim of this study was to evaluate the conditions of the articular cartilage and other intra-articular structures in patients with refractory knee pain. A total of 50 patients were taken up for this study based on specific inclusion criteria. Arthroscopy was done using a 30 degrees scope and was introduced most commonly via anterolateral approach after a thorough clinical and radiological evaluation of the affected joint. It was observed that majority (76%) had grade I articular lesion and 10% had grade IV lesion. Arthroscopically 78% of the patients had a meniscal tear while 12% had cyst of lateral meniscus while clinically, meniscal tear was present in 22% of the cases and cyst in 2% cases only. Arthroscopy also detects other intra-articular lesions, which are missed clinically, thus modifying further management of the patient.