Functional Outcomes in Surgically Treated Clavicle Fractures: A Longitudinal Observational Study.

Introduction The clavicle is the most unique long bone and has a significant incidence in terms of fractures. Operative fixation for clavicle fractures has seen a steep rise in terms of technique as well as type of implant. Although extensive studies have been carried out in relation to clavicle fractures and their treatment modalities, no proper guidelines or approach has been identified as ideal, and hence, this study was carried out to evaluate operative fixation as a viable strategy. Objective The objective of this article was to assess functional outcomes of plate fixation in clavicle fractures. Materials and methods This longitudinal prospective observational study included 30 patients treated for clavicle fractures with plate fixation in the Orthopedics Department of Himalayan Institute Hospital Trust (HIHT), Jollygrant, Dehradun, over a period of one year. Functional outcomes were assessed as Constant-Murley shoulder scores, and complications were recorded. Radiological assessment was done on the basis of time to union through follow-up skiagrams. Statistical analysis was performed using the SPSS statistical package version 17.0 (IBM Inc., Armonk, New York). Continuous variables are presented as mean ± SD, and categorical variables are presented as absolute numbers and percentages. Continuous variables and constant score values over time within the groups were analyzed using repeated measures analysis of variance (ANOVA) followed by Bonferroni's post hoc testing. A p-value of <0.05 was considered statistically significant. Results The mean age of patients undergoing surgical fixation of clavicle fractures was 36 ± 12.53 years, ranging from 18-65 years. Of the entire study group, 83.3% were males and 16.7% were females. Road traffic accident (RTA) was the most common cause of clavicle fracture, constituting 76.7% of the entire study population, followed by fall on the floor (20.0%), and one patient sustained trauma by being hit by a bull (3.3%). Our study demonstrated a mean Constant score of 73.87 ± 2.64, 82.80 ± 2.20, and 92.40 ± 2.37 at one-month, two-month, and four-month follow-up times, respectively, which was found to be statistically significant in terms of progression (p value<0.001). The mean union time of clavicle fractures in our study population was 12.1 weeks. Two patients in our study developed implant impingement. Conclusion Our study revealed that patients with clavicle fractures treated with plate fixation had statistically significant good functional outcome (Constant) scores at sequential follow-ups, consistent with available literature. Mean union time was also comparable to existing literature. Non-union was not noted in our study, and only two cases developed implant impingement. Hence, we conclude that early primary plate fixation for displaced clavicle fractures is a promising technique with good overall functional outcomes and patient satisfaction, especially in young, active patients.

Intra-articular Osteoid Osteoma Involving the Femoral Neck in Pediatric Population: A Case Report of 2 Cases.

Introduction: An osteoid osteoma is a benign bone tumor. It is quite common and has become a known entity to most orthopedists and radiologists since it was first reported by Jaffe in 1935. Considering its incidence, it is at third position in the list of most common benign tumors, with prevalence up to 11% among the benign tumors and 3% among primary bone tumors. Case Report: Case 1 - A 15-year-old male presented with symptoms of left hip pain for 1 year. Radiographs were repeated by us at 1 year which revealed cortical thickening and sclerosis surrounding the central lucent nidus in the posterolateral aspect of femoral neck. The patient underwent en bloc resection of the lesion. Case 2 - A 13-year-old male presented with symptoms of left hip pain for 1½ years. Radiographs revealed an irregular lucent area surrounded by sclerosis in inferior aspect of femoral neck. By gradual removal of overlying reactive bone, the underlying nidus was exposed. Excision with curettage and burr was applied to the nidus, with bone chips used to fill the cortical defect. Results: Both the patients were followed for a period of 1 year from surgery as chances of recurrence of osteoid osteoma is within that period. In both the cases, Harris hip score improved from poor status pre-operatively to a score between 80 and 89 (good result) at 1 month, and >90 (excellent result) on further follow-ups. By 1 year, the lesion had healed and femoral neck size, neck shaft angle, and joint widening were also reduced to normal. Discussion and Conclusion: Intra-articular osteoid osteomas behave differently than extra-articular tumors. The radiological and clinical features are different from extra-articular lesions. Computed tomography (CT)-guided radiofrequency (RF) ablation is a safe, effective, simple method to treat osteoid osteoma. Open excision can be performed in the absence of CT-guided RF ablation.

Rare Presentation of Benign Osteochondroma: A Case Report.

INTRODUCTION: Osteochondromas are the most common benign bone tumors (accounting for 20-50% of all benign bone tumors). They are developmental malformations rather than true neoplasms and are thought to originate within the periosteum. They usually affect bones that develop by enchondral ossification and rarely originate from bones that develop by intramembranous ossification such as the scapula, pubic rami, clavicle, and ribs. CASE REPORT: We present a case of a 24-year-old male, who came with a swelling in the right side inguinal region for 2 years which was diagnosed to be osteochondroma by trocar biopsy. The site and presentation are rare. The patient had no visceral or vascular involvement though the lesion was very near many vital structures on superior pubic ramus. CONCLUSION: Osteochondroma arising from the pelvis is an unusual presentation which should be kept in mind as a differential diagnosis when evaluating mass in pelvis.

Step-cut osteotomy in neglected Monteggia fracture dislocation in pediatric and adolescent patients: A retrospective study.

INTRODUCTION: Neglected Monteggia fracture dislocation in children leads to significant restriction of daily activities by causing decreased range of motion at elbow, stiffness, deformity, and neurological compromise. Various treatment strategies have been described in the literature and one of them is ulnar osteotomy combined with reduction of radial head and annular ligament reconstruction. AIM: The aim of this study was to evaluate the results of step-cut osteotomy without the use of bone grafting with reconstruction of annular ligament in the management of neglected Monteggia fracture dislocation in children. MATERIALS AND METHODS: A retrospective study was conducted in six patients with neglected Monteggia fracture dislocation with a mean age of 8.83 years. The median interval between the original injury and the corrective surgery for 6 patients was 4.4 months (range 1-12 months). All children underwent step-cut osteotomy of ulna, open reduction of radial head, and annular ligament reconstruction. Mayo Elbow Performance Index (MEPI) score was used for evaluation. RESULTS: The ulnar osteotomies healed uneventfully without the need for a bone graft. Elbow range of motion improved post-op along with improved elbow functioning as indicated by raised MEPI score. The MEPI score was excellent in 5 cases and fair in 1 case. CONCLUSION: Step-cut osteotomy alone without the use of bone grafting and reinforcement with annular ligament repair is a simple yet effective technique for treating neglected Monteggia fracture dislocation.

Neglected anterior dislocation of shoulder with large Hillsach's lesion & deficient glenoid: Treated by autogenous bone graft & modified Latarjet procedure.

Neglected anterior dislocation of shoulder is rare in spite of the fact that the anterior dislocation of the shoulder is seen in around 90% of the acute cases. Most of the series of neglected dislocation describe posterior dislocation to be far more common.(1) (,2) We hereby report a case of the neglected anterior shoulder dislocation in a 15 year old boy who had a history of epilepsy. There was a large Hill Sachs lesion in humeral head which was impacted in glenoid inferiorly and glenoid was eburnated at that margin. The humeral head was reconstructed with a tricortical iliac graft. Glenoid was reconstructed by transfer of coracoids process of scapula to antero-inferior glenoid (modified Latarjet procedure). This case is unique because management of humeral head defect with bone graft is not mentioned in anterior dislocation.

Intramedullary nailing and plate osteosynthesis for fractures of the distal metaphyseal tibia and fibula.

PURPOSE: To assess the results of concurrent intramedullary nailing plus plate osteosynthesis for fractures of the distal tibia and fibula. METHODS: 15 men and 10 women (mean age, 35 years) with concurrent fractures of the distal tibia and fibula underwent intramedullary nailing (for the tibia) and plate osteosynthesis (for the fibula). 17 fractures were type A1, 6 type A2, and 2 type A3. Compound type IIIB or more extensive fractures were excluded. RESULTS: The mean follow-up duration was 2 years. The mean time to bone union was 20 weeks. Six patients underwent dynamisation and 4 bone grafting. Two patients had malalignment (angulation of >5 degrees in any plane), but none was rotational. No patient had shortening, hardware breakdown, or deep-seated infection. Two patients had superficial cellulitis at the site of the distal locking screws. CONCLUSION: Concurrent intramedullary nailing and plate osteosynthesis for fractures of the distal tibia and fibula is effective in preventing malalignment. Plate osteosynthesis for the fibula provides additional stability even when a single distal locking bolt is used to fix the intramedullary nail to the tibia.

Wide resection and stabilization of ulnar stump by extensor carpi ulnaris for giant cell tumor of distal ulna: two case reports.

The distal end of ulna is an extremely uncommon site for primary bone tumors in general and giant cell tumor in particular. Wide resection is usually indicated in such cases and at times it may be necessary to remove of a long segment of the distal ulna. Any ulnar resection proximal to the insertion of pronator quadratus can lead to instability in the form of radio-ulnar convergence and dorsal displacement (winging) of the ulnar stump. This can result in diminution of forearm rotation and weakness with grasp. Stabilization of the ulnar stump after resection for a giant cell tumor was described by Kayias & Drosos. We are adding two more cases to the literature. Both patients had excellent functional outcome and there were no instances of recurrence at three years of follow-up.