A Rare Case Report of Tuberculous Infection in a Previously Neglected Dysplastic Hip of a Young Woman.

A 14-year-old girl presented with an insidious onset of left hip pain, limp, and intermittent fever for a 3-month duration. Patient had a history of toe walking since childhood which continued into adolescence. On radiographic investigations, she was found to have a dysplastic hip with fluid collection around the hip which was surgically drained. The microbiological investigations proved the presence of Mycobacterium tuberculosis (TB). Accordingly, she was started on anti-TB chemotherapy as per drug sensitivity. TB infection in a previously neglected dysplastic hip is not reported as per our knowledge and poses unique diagnostic and management difficulties.

High tibial osteotomy in a lax knee: A review of current concepts.

The technique of high tibial osteotomy (HTO) was traditionally documented for symptomatic medial tibiofemoral arthrosis associated with coronal plane malalignment in a stable knee., recently, more attention has been given to the treatment of coronal malalignment in lax knees with HTO with or without ligament reconstruction. Patients with overwhelming pain, chronic ligament deficiency and coronal or sagittal deformity are generally easier to treat with HTO as compared to those who have mild pain and a proximal tibial deformity. The instability at the knee joint can be either in the coronal or sagittal plane or in both planes. Younger patients with chronic ACL deficiency, varus malalignment and advanced medial compartment arthritis, who present with pain and slight instability show satisfactory results with HTO. Double-limb weight bearing anteroposterior view radiographs are used to plot mechanical leg axis (from the centre of the femoral head to the centre of the knee), anatomical axis (a line from the centre of the piriformis fossa to the centre of the knee joint and a line through the long axis of tibia) and weight bearing axis (line drawn from the centre of the femoral head to the centre of the ankle joint) and are used to plan HTO. A 3-dimensional pre-operative plan using CT and MRI is recently studied. The decision to perform HTO alone or in combination with ligament reconstruction involves consideration of patient demographics, symptoms and ligaments involved. The most commonly used surgical techniques for high tibial osteotomy include lateral close wedge osteotomy, medial open wedge osteotomy and dome osteotomy. The post-operative rehabilitation depends on the rigidity of fixation.

Bicentric Synchronous Giant cell tumor: A Rare Managed Case Report of Bilateral Fibula Neck Tumor.

INTRODUCTION: Multicentric giant cell tumor (GCT) of bone is an uncommon variant of the typical solitary lesion, with numerous large series reporting an incidence of 0-1.4%. Multifocal lesions also appear to be more locally aggressive than their solitary counterparts and have higher rates of recurrence. Solitary GCT of proximal fibula usually involves fibular head, bicentric synchronous bilateral fibular neck involvement is a rare presentation. CASE PRESENTATION: An otherwise healthy 24-year-old boy presented with a palpable mass in the region of his left proximal fibula and B/L knee pain. He reported pain with activity but no peroneal nerve symptoms. Radiographs of his left knee revealed an expansile lytic lesion at the proximal fibula epimetaphyseal level while the right knee X-ray showed a similar smaller lesion. MRI was done to delineate the accurate extent of the tumor. On the left side, the patient underwent partial fibulectomy (en bloc resection) and chemical cauterization of the edges with 5% phenol. The other side GCT was smaller and the patient was largely asymptomatic, hence was planned for conservative management. CONCLUSION: Multicentric GCT is a known entity and diagnosis should be considered after thorough metabolic workup and after ruling out more common polyostotic skeletal lesions. Selected patients with aggressive (benign) and malignant tumors of the proximal fibula can be treated successfully by resection and with supplementary soft-tissue reconstruction, a good functional outcome can be anticipated.