Neglected Anterior Dislocation of Hip Managed with Total Hip Arthroplasty Using Dual Approach: A Case Report and Review of Literature.

Introduction: Traumatic hip dislocations frequently result from road traffic accidents and are prevalent in developing nations. Untreated dislocations either due to ignorance or lack of proper treatment become more challenging to manage and have an increased likelihood of developing avascular necrosis (AVN). Over time, closed methods of reduction become impractical, and if the waiting period surpasses 3 months, open reduction likewise becomes unworkable. Anterior dislocations are less common than posterior dislocations, accounting for a frequency of 7-13% of all hip dislocations. Neglected anterior hip dislocations are extremely rare, and therefore, there is a paucity of information about the management of these dislocations and associated injuries. The available treatment options for these particular situations are total hip arthroplasty (THA), Girdlestone surgery, or hip arthrodesis. Case Report: We describe the case of a 49-year-old male who presented to our hospital with a neglected anterior dislocation of the hip. The patient disclosed a history of hip trauma 8 months ago, initially receiving conservative management. However, due to persistent pain and functional limitations, he sought further medical attention. A physical examination, radiographic evaluation, and computed tomography (CT) scan confirmed the diagnosis. The patient underwent THA using dual anterior and posterior approaches, followed by a comprehensive rehabilitation program. Conclusion: Anterior dislocation of the hip is a relatively rare condition, and its neglected presentation is even rarer. This case highlights the importance of prompt diagnosis and early intervention in neglected anterior hip dislocations to minimize complications and optimize patient outcomes.

Combined articular and ligament reconstructions in neglected fracture-dislocation of the knee.

Background: The management of neglected traumatic knee dislocations is challenging and is commonly associated with suboptimal outcomes. In this article we present two cases of neglected knee dislocations in two young trauma victims who presented late due to restrictions during the COVID-19 pandemic. Methods: Two young patients presented at our center with neglected knee fracture-dislocations after eight weeks and six months of trauma. Comprehensive evaluation was performed using radiographs, computed tomography scans, and magnetic resonance imaging. Surgical intervention included open reduction and internal fixation of the mal-aligned intra-articular fracture fragments. Additionally, articular congruency was restored and repair or reconstruction of the posterior cruciate ligament, anterior cruciate ligament, and meniscus was conducted using suitable tendinous autografts and implants. Following surgery, the knees were immobilized for six weeks, followed by aggressive physical therapy. Results: After three months of surgical intervention, fracture union and joint stability were achieved. At the >36-month follow-up appointments, both patients were pain-free at rest with a stable knee joint, achieving ≥90 degrees of knee flexion and without extensor deficits. Concurrent with radiographic evidence of osteoarthritic changes in the knee joint, there was mild pain (VAS 2) after prolonged knee movement activities and walking for long distances (>1 km). Conclusion: Open reduction and internal fixation, along with simultaneous menisco-ligamentous reconstructions in neglected fracture-dislocations of the knee result in satisfactory clinical outcomes. This approach proves to be an effective joint preservation procedure in young patients, even in delayed and neglected conditions.

Knee Arthrodesis Using Dual-Plate Construct is Following Failed Distal Femur Megaprosthesis-A Case Report.

Introduction: Knee arthrodesis following failed total knee arthroplasty is a viable limb salvage option, and this procedure is reserved for failed two-stage revision surgery in severe comorbid patients with irreparable extensor mechanism disruption, severe instability, and extensive soft tissue loss. Knee arthrodesis using a dual-plate construct has been scarcely reported. We report a case of knee arthrodesis using a dual-plate construct in a male in his 20s who presented to us with a broken distal femur megaprosthesis. Case Report: An anterior midline incision was given. The cement mantle and broken prosthetic components were removed. The bone surfaces were freshened up and fixed using two orthogonal locking plates. After 4 months, there was a solid fusion in the knee, and the patient started walking independently with a short limb gait. The patient was advised limb lengthening for a shortening of 3 cm, but he denied it and managed with a shoe raise. After 4 years, he was pain free, and radiographs revealed a solid knee fusion. The patient was fully satisfied with the procedure, and he resumed manual work. Conclusion: This case report revealed that knee arthrodesis using a dual-plate construct is an economically viable salvage option for failed distal femur megaprosthesis.

Reconstruction of the extensor mechanism using polypropylene mesh in a displaced pathological fracture of the patella affected by giant cell tumour.

A man in his 30s came to our clinic with a year-long history of progressive pain and swelling in his knee. Diagnostic imaging revealed a displaced patellar fracture with an osteolytic, septated lesion and thinned expanded cortex in both fracture fragments. A core needle biopsy confirmed the diagnosis of giant cell tumour. Treatment involved wide excision of the tumour and the use of polypropylene mesh and a peroneal longus tendon autograft to reconstruct the extensor mechanism of the knee joint. One year postoperatively, the patient experienced no pain, demonstrated full range of motion and showed no signs of functional impairment or local tumour recurrence. This case highlights that reconstruction of the extensor mechanism of the knee after tumour excision with synthetic mesh is an affordable, user-friendly and widely accessible method. It can address large defects effectively while minimising the risks of disease transmission and graft lengthening, resulting in satisfactory outcomes.

Does indirect decompression by oblique lateral interbody fusion produce similar clinical and radiological outcomes to direct decompression by open transforaminal lumbar interbody fusion.

Objectives: Open transforaminal lumbar interbody fusion (O-TLIF) remains the most popular and widely practiced lumbar fusion method even today, providing direct decompression. Oblique lateral interbody fusion (OLIF) is a novel retroperitoneal approach that allows placement of a large interbody cage which provides an indirect neural decompression, and screws can be placed minimal invasively or through the Wiltse OLIF (W-OLIF) approach. We aim to find out the short-term efficacy of W-OLIF to O-TLIF in terms of radiological and clinical outcomes in patients of lumbar degenerative diseases. Materials and Methods: Fifty-two patients were divided equally into two groups (group O-TLIF and group W-OLIF). Several parameters were measured, such as the spinal cord cross-sectional area (SC-CSA), foraminal cross-sectional area (F-CSA), disc height (DH), foraminal height (FH), Schizas grade for stenosis, and Meyerding's grading for olisthesis. Functional scores were measured using the visual analog scale (VAS) for low back pain (LBP) and lower limbs, Oswestry Disability Index. All parameters were repeat measured at 3 months follow-up. Statistical analysis was done using SPSS software. Results: Both groups were similar in composition preoperatively. There was significant improvement in all clinical and radiological parameters post-surgery in either group. However, at 3 months, The DH, FH, FSA, and VAS (LBP) were better in the W-OLIF group than in O-TLIF. Procedure-related complications were seen in both groups (15% in the O-TLIF group and 19% in the W-TLIF group), but only one patient in O-TLIF required revision due to cage migration. Conclusion: Similar improvement occurs in most of the clinical and radiological parameters in the W-OLIF group compared to the O-TLIF group. Few radiological parameters such as the DH, FH, and F-CSA and the VAS (LBP) correction are superior in the W-OLIF group in the short-term follow-up. We conclude that indirect decompression by W-OLIF provides equivalent, if not better, results than the traditional O-TLIF lumbar fusion.

Correlation between Vertebral Marrow Fat Fraction in MRI Using DIXON Technique and BMD in DXA in Patients of Suspected Osteoporosis.

Aim Osteoporosis is a common metabolic bone disease accounting for low back pain (LBP). It is diagnosed by dual-energy X-ray absorptiometry (DXA). Magnetic resonance imaging (MRI), a routine investigation for LBP, is also sensitive to detect fat fraction (FF) of the vertebral body that increases with increasing age. This study aimed to correlate vertebral marrow FF using MRI and bone mineral density (BMD). Material and Methods Patients presenting with low backache and suspected osteoporosis were included. All patients underwent an MRI of lumbosacral spine and DXA. Patients were categorized into an osteoporotic and a nonosteoporotic group based on the T-score obtained from DXA. "T-scores" of < -2.5 on BMD were considered as osteoporotic spine. T-score of > -2.5 was considered as nonosteoporotic. The FF obtained from the DIXON sequence of MRI was correlated between the two groups. Result Thirty-one patients were included with a mean age of 54.26 ± 11.6 years. Sixteen patients were osteoporotic based on the defined criteria in the methods. The mean vertebral marrow FF was significantly higher in the osteoporotic patients (64.98 ± 8.8%) compared with the nonosteoporotic (45.18 ± 13.2%) ( p = 0.001). The mean FF of the vertebra having fracture (69.19 ± 7.73%) was significantly higher than that of patients without fracture (57.96 ± 5.75%) ( p = 0.03). Taking a cutoff value of vertebral marrow FF of 54.85, the sensitivity and specificity of diagnosing osteoporosis were 93 and 80%, respectively, with a confidence interval of 95%. The area under the curve was 0.925. Conclusion Increased vertebral marrow FF is noted in the osteoporotic spine. FF has an inverse correlation with the T-score obtained from BMD. MRI with FF measurement can provide indirect evidence of osteoporosis, which can be done under one roof, especially in young patients where we need to avoid ionizing radiation.

Concurrent replacement of four major joints in a woman with advanced rheumatoid arthritis.

We report a case of a woman in her mid-40s with advanced rheumatoid arthritis (RA), with bilateral hip and knee joint involvement, who underwent a one-stage quadruple joint arthroplasty during a single session of anaesthesia. Chronic RA had severely incapacitated her, necessitating this uncommon surgical intervention. The surgical approach involved sequential bilateral total hip and knee replacements, which were completed within 180 min with a cumulative blood loss of 950 mL. The patient showed significant improvement with rapid mobilisation and regained joint function postoperatively. At 8 months post-surgery, the patient resumed her daily activities, showcasing the potential benefits and positive outcomes of quadruple joint arthroplasty in selected RA patients. This case, only the second documented globally, highlights the complexities and possibilities surrounding a single-stage quadruple joint arthroplasty in advanced RA.

Primary Aneurysmal Bone Cyst in the Iliac Bone: A Case Report.

Introduction: Aneurysmal bone cysts (ABCs) are non-neoplastic expansile, vascular, osteolytic benign tumors in the long bone, spine, and sternum. The location in the pelvis is sparse. Case Report: A 12-year-old female presented with pain in her left pelvis for 6 months. On radiological examination, we found an expansile balloting lytic lesion involving almost the whole ilium and sparing the hip joint. There were multiple fluid levels seen on magnetic resonance imaging. The initial biopsy suggested ABC. Curettage and bone grafting were done along with electrocauterization and chemical cauterization. At 1-year follow-up, she is doing well without any complaints. Conclusion: This case report demonstrates a rare ABC of the ilium that was managed with curettage and bone grafting.