Neglected Dorsal Proximal Interphalangeal Joint Dislocation Treated by Volar Plate Arthroplasty: A Case Series.

Chronic unreduced dislocations of the proximal interphalangeal joint are uncommon, and management principles for these injuries have not been defined. The dislocation can be volar or dorsal and closed reduction is rarely successful owing to soft tissue contractures. Treatment options in literature reviews for such rare injuries included open reduction of pip joint with volar plate arthroplasty, extension block pinning, hemi hamate arthroplasty, pip joint arthrodesis, Suzuki dynamic frame fixation, open reduction and repair of capsule and collateral ligaments with suture anchors. Few cases of amputation following treatment were even reported in literature emphasizing the role of meticulous soft tissue handling in such neglected cases of hand. We report six cases of neglected (more than three months old) dorsal dislocation of the PIP joint of the hand, treated with volar plate arthroplasty and extension block pinning. A functional range of motion with a stable joint can be achieved in such injuries with volar plate arthroplasty, as long as the articular cartilage is relatively preserved and bone loss is <30%.

Multiple Lower Limb Fractures in a Child With Spinal Muscular Atrophy Type 2: A Preventable Complication.

Patients with spinal muscular atrophy (SMA) are at risk of poor bone health and fractures. We report a child with SMA type 2, presenting with acute pain and swelling of both lower limbs following physiotherapy, and found to have multiple fractures in both lower limbs. Literature on fractures in children with SMA is limited. Awareness of risk assessment and appropriate preventive measures among healthcare providers caring for children with SMA is essential.

Tubercular osteomyelitis of calcaneum in an immunocompetent adult.

Tuberculosis (TB) affecting calcaneum is relatively rare in immunocompetent adults. Due to its nonspecific presentation and the absence of constitutional symptoms of TB, diagnosis is often delayed. The authors present a case of TB of calcaneum in a young male. A 20-year-old male presented with persistent pain and mild swelling of the right heel for 6 months. Upon evaluation with radiographs, a lytic lesion was noted in the posteromedial aspect of the right calcaneum. Magnetic resonance imaging was done and was reported as subacute osteomyelitis with Brodie's abscess. An open biopsy was performed and the obtained tissue was sent for histopathological examination. Histopathology showed features suggestive of Koch's etiology. All the microbiological investigations, including polymerase chain reaction for TB were negative. The patient was started on antitubercular therapy (ATT) based on weight. After 4 months of ATT, the patient developed multiple discharging sinuses over a previous open biopsy scar for which repeat debridement was done. After 12 months of ATT, the patient was asymptomatic, and radiologically, the lesion was healed. Early diagnosis and treatment with ATT will prevent massive destruction and collapse of the calcaneal body and further spread into the subtalar joint. Repeated debridements may be needed in case of nonhealing discharging sinuses to decrease the local infection load.

Flexor tenosynovitis of the wrist with carpal tunnel syndrome.

Tubercular tenosynovitis of the wrist with carpal tunnel syndrome (CTS) is a rare occurrence. The authors present a case of tubercular flexor tenosynovitis of the wrist with CTS. A 60-year-old female presented with complaints of swelling in the volar aspect of the right wrist with numbness of the first three fingers for the past 6 months. Clinical and radiological diagnosis of chronic flexor tenosynovitis with median nerve compression neuropathy was made. The patient was operated with carpal tunnel release and total tenosynovectomy. Histopathology showed features suggestive of Koch's etiology. The patient was started with antitubercular therapy (ATT) and followed up regularly. Carpal tunnel symptoms subsided immediately after surgery and there was no recurrence of swelling at the last follow-up. Carpal tunnel release and tenosynovectomy should be performed at the earliest possible and followed up with ATT for better outcomes in tubercular tenosynovitis of the wrist with CTS.

Increased Frequency of Low Back Pain in Recent Times: Does the Answer Lie in COVID-19?

Background The COVID-19 pandemic has impacted many people's activities of daily living and health. It has also created economic burdens and caused mental turmoil across the world. Musculoskeletal symptoms, especially low back pain, have been observed in subjects of post-COVID-19 infection and post-vaccination. Aim In this study, we aimed to investigate the relationship between low back pain and COVID-19 infection and vaccination, as well as associated factors and characteristics. Methods We conducted a questionnaire-based cross-sectional observational study at All India Institute of Medical Science (AIIMS) Bibinagar between September 2021 and March 2022. We collected data from individuals through physical and Google Forms (Google, Mountain View, California).  Results We included a total of 535 individuals in the study: 274 (51.2%) were previously positive for COVID-19 infection (group A), and 261 (48.8%) were vaccinated against COVID-19 without a history of COVID-19 infection (group B). Each group was divided into two categories based on whether they had low back pain before COVID-19 infection or vaccination. In group A, 90.1% of individuals experienced an aggravation of low back pain after COVID-19 infection, which was found to be significant (p<0.001). In group B, there was an insignificant increase in low back pain following COVID-19 vaccination (p=0.275). The study also revealed a significant association between comorbidities and low back pain in both groups (p<0.001). Additionally, several differences were observed between the two groups, including duration (p<0.001), severity (p=0.012), and intensity (p<0.001) of low back pain, usage of a back support or brace (p=0.043), and intake of vitamin D (p=0.002).  Conclusion Low back pain is an ignored feature of one of the musculoskeletal symptoms of COVID-19 and was aggravated by COVID-19 infection in our patients compared to those who received the vaccination. The findings of this study have implications for raising awareness, improving management and rehabilitation, and guiding future research in this area.

Parsonage-Turner Syndrome Following Covishield (AstraZeneca ChAdOx1 nCoV-19) Vaccination: A Case Report.

Parsonage-Turner Syndrome (PTS) is a rare neurological disorder involving brachial plexus and periscapular muscles following viral infection, surgery, and vaccination. We hereby describe the first case of PTS from India following Covishield (AstraZeneca ChAdOx1 nCoV-19) COVID-19 vaccination. A 21-year-old healthy male presented to us with complaints of pain and weakness in the right shoulder five weeks after Covishield vaccination on the contralateral deltoid. There was no history of injury or constitutional symptoms. On examination, hyperalgesia over the area innervated by the axillary nerve and wasting of the deltoid, supra, and infraspinatus muscles were noted. An MRI scan of the shoulder, cervical spine, and brachial plexus neurogram were normal. Decreased motor amplitude in right axillary and musculocutaneous nerve was recorded in the nerve conduction study (NCS). High titers of SARS-COV-2 IgG neutralizing antibodies were noted after a single dose of vaccination and SARS CoV-2 IgM antibodies were negative. Having been diagnosed with post-vaccination PTS, the right shoulder was splinted and an intravenous injection of 1g methylprednisolone was administered for three days followed by oral steroids for three weeks. NCS and electromyography at 10 weeks showed insignificant differences between the two sides suggesting early neurological recovery. Currently, the patient is being followed up regularly for complete neurological recovery. PTS is a known side effect of vaccination. We report the index case of PTS following the administration of Covishield vaccination from India to aid in early diagnosis and management, further evaluation, and public health safety.

Osteitis Condensans Ilii: A Case Series.

Osteitis condensans ilii (OCI) is a rare self-limiting low back pain syndrome. It is an incidental imaging discovery around sacroiliac joints with distinctive sclerotic lesions. We present three case reports as a series. In the first case, a 38-year-old female presented with unresolved chronic low back pain for eight years. She had bilateral triangular sclerosis of the ilium abutting sacroiliac joints and other causes of back pain were ruled out. Non-operative management was successful. In the second case, a 38-year-old female presented with acute exacerbation of low back pain for one year. She suffered low back pain during her pregnancy and postpartum period 16 years ago and intermittently after that. Bilateral radiodensity around sacroiliac joints was noted in the radiograph and she had successful remission with non-operative management. In the third case, a 45-year-old female presented with chronic low back for six years. On radiographs, she had bilateral sclerotic lesions around sacroiliac joints and responded well to non-operative management. OCI is a benign, idiopathic cause of axial low back pain. It is a diagnosis of exclusion and the pelvic radiographs classically show areas of sclerosis in the ilium adjacent to sacroiliac joints bilaterally. Treatment for OCI is essentially non-operative.

Campanacci Grade III Giant Cell Tumors of Distal End Radius Treated With Wide Excision and Reconstruction: A Retrospective Case Series.

Introduction Campanacci Grade III Giant Cell tumors of the distal radius are difficult to manage as they are associated with a high recurrence rate. Wide excision of the distal radius and reconstruction with an ipsilateral proximal fibula or ulnar translocation reduces the recurrence rate significantly and gives acceptable function to the hand and wrist. Methods and materials This was a retrospective study of eight patients with Campanacci grade III giant cell tumors of distal radius treated with wide excision of distal radius followed by reconstruction at our institute. Four cases were operated on with ulnar translocation and four cases were operated on with ipsilateral proximal fibula grafting after wide excision of the distal radius. Patients were studied for the Musculoskeletal Tumor Society (MSTS) score and visual analogue scale (VAS) score for pain at one year, recurrence, and complications. Results The mean MSTS score of the total series was 24.75 ± 1.6. The mean VAS score for the total series was 1.62 ± 0.4. Of the eight cases, two cases had a recurrence, one patient had persistent wrist paint, and two patients had wrist subluxation. Conclusion Wide excision of the distal radius followed by reconstruction with a proximal fibula or ulnar translocation is a good option to avoid repeated surgeries in patients with Campanacci grade III giant cell tumors of the distal radius and achieve acceptable functional results for the wrist and hand.

Stress Fracture of Bilateral Neck of Femur in a Healthy Non-athletic Young Adult - A Case Report With Review of Literature.

Stress fractures of femoral neck are rare injuries and are usually seen in military recruits, marathon runners, and elderly with osteoporosis, renal rickets, steroid abuse, and metabolic bone diseases. Bilateral involvement of femoral neck in a healthy, non-athletic young adult is an extremely rare entity. We report one such case of a 36-year-old male who presented with bilateral groin pain for last three months. He had a history of excessive running prior to the onset of pain. The investigations confirmed bilateral stress fracture of the femoral neck, and the patient was operated with dynamic hip screw (DHS) on both sides. He returned to his routine activities in six months and at latest follow-up after two years; he is asymptomatic and has full function at both hips. This report highlights a rare cause of bilateral groin pain in a young adult, which requires early diagnosis and treatment to prevent complications.

Massive Gouty Tophi Presenting as Pseudotumor of the Elbow: A Rare Presentation.

Gout is a systemic metabolic disorder characterized by hyperuricemia and deposition of monosodium urate crystals in joints and other extra-articular tissues. Poorly controlled cases progress to chronic gout with tophi, which can sometimes assume massive sizes. We report one such case of a 39-year-old male with poorly controlled polyarticular tophaceous gout presenting with a massive swelling of the left elbow simulating a soft tissue tumor. Subsequent investigations confirmed it to be a massive tophus which was then surgically excised, as the mass was not responding to the medical management. At the latest follow-up after two years, the patient has full function of the elbow and gout is well controlled with medications.

Evaluation of results of open distal femur fractures with primary fixation and antibiotic impregnated collagen.

PURPOSE: Distal femoral fracture is one of the most common lower limb injuries and accounts for less than 1% of all fractures. Open fracture takes 5%-10% of the all distal femoral fractures, which is at an increased risk of complications. There were limited studies which documented the outcomes of such cases. The present study aims to evaluate the outcome and complications in these fractures using primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement. METHODS: This is a prospective study conducted in a tertiary care orthopaedic hospital in northern India. Thirty patients of open distal femoral fractures were managed by primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement. They were followed for minimum of six months. Patients were followed up monthly for first four months, at six months and one year after surgery. Clinical and radiological signs of healing, any complications, time to union, and functional outcome were assessed. RESULTS: The mean age of patients was 44.33 years (range 20-82 years) with male predominance of 66.7%. According to Gustilo-Anderson classification, there were 5, 15 and 10 patients with open grade I, II and IIIA distal femoral fractures respectively. According to orthopaedic trauma association (OTA) classification, majority of patients in our study were of C3 type. The mean time to bony union was 5.6 months (range 4-9 months). Average postoperative knee range of motion (ROM) at the latest follow-up was 98° (range 70°-120°). Lysholm knee scoring scale showed excellent score in 11 patients, good in 9 patients, fair and poor in 5 patients each; however, there was no significant correlation with fracture pattern types (p < 0.05). Knee stiffness was the major complications encountered in the study. The knee ROM was <90° in 5 patients and 90°-120° in rest of the patients, while 1 patient had extensor lag of 10°. One patient had implant failure and lost to follow-up; 3 patients had deep infection. CONCLUSION: An approach of primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to early aggressive debridement in open distal femur fractures shows significant results in terms of functional and radiological outcomes with minimal complications.

A recurred subungual glomus tumour of the thumb.

Glomus tumours are rare benign neoplasms arising from the glomus body, accounting for 1-5% of all soft-tissue tumours of the hand. The diagnosis of glomus tumour is frequently delayed, varying from 3 to 15 years. We present a case of a recurred glomus tumour of the thumb where symptoms persisted for a period of 6 years after an attempted surgical excision. The patient presented with classical symptoms of localised tenderness, cold sensitivity and excruciating pain on touch. Findings on radiograph, ultrasonography and contrast-enhanced MRI further supported the diagnosis. Complete surgical excision, the only recommended treatment, resulted in complete symptomatic relief to the patient. This case report highlights the importance of meticulous complete excision and clinical awareness of the disease among primary care physicians.