Radiologists should use the hip-knee-ankle angle rather than the mechanical axis deviation to describe knee alignment.

OBJECTIVE: Preoperative and postoperative coronal knee alignment is an important predictor of total knee arthroplasty (TKA) failure. Radiologists often report the mechanical axis deviation (MAD) rather than hip-knee-ankle angle (HKAA) to describe coronal knee alignment. The aim of this study is to evaluate (i) how well the MAD predicts the HKAA; (ii) if patient height and sex affect the performance of the MAD; and (iii) if the MAD could be measured faster than the HKAA. MATERIALS AND METHODS: Two hundred patients undergoing hip-to-ankle radiographs for TKA planning were retrospectively reviewed. The MAD and HKAA were measured using previously published methods by the Visage picture archiving and communication systems (PACS) tools. Receiver operator characteristic (ROC) curves were used to evaluate the performance of the MAD to predict HKAA by gender and height. The performance of a linear model was used to predict HKAA from MAD in a prospectively collected cohort of 40 patients. Paired t tests were used for the comparison of time measurement in MAD and HKAA in this cohort. RESULTS: MAD strongly correlated with HKAA (r = 0.99, p < 0.001); however, the performance of MAD differed by height (p = 0.005) and sex (p < 0.001). There was no significant difference in the time taken to measure HKAA versus MAD (p > 0.05). CONCLUSION: HKAA should be used instead of the MAD because it is more clinically relevant and takes the same amount of time to be measured.

Bilateral Clavicle Fractures Treated With Screw Intramedullary Flexible Nail.

Clavicle fractures have been known to be common injuries with a reported incidence of 2.4-4% amongst all fractures, however the incidence of bilateral clavicle fractures is rare. A thorough search of all English language journals revealed that bilateral clavicle fractures comprised 0.43% of all clavicle fractures, with an overall incidence of between 0.011-0.017%. Though the surgical intervention of clavicle fractures uses many implants, never has been screw intramedullary flexible nail been used in a bilateral clavicle fracture. We report a case of a 32-year-old male who presented with bilateral clavicle fracture and was treated successfully.

Kaplan's Lesion: A Case Report On The Complex Dislocation Of The Index Finger In A Weightlifter.

Background: Complex Dislocation of the metacarpophalangeal joint of the hand is a rare and unusual injury. These are also called as Kaplan's Lesion. They are divided into complex/irreducible and simple/reducible dislocation. Two approaches exist regarding their surgical intervention. We present a case of a 36-year-old weightlifter who presented to us with this uncommon entity and who was successfully treated with a dorsal approach. This case is presented to highlight the occurrence of this dislocation along with a brief discussion on its etiopathogenesis and management.

Giant Cell Tumour Of The Occipital Bone In A 13-Year Old Male.

Giant Cell Tumours (GCT) are usually found at the extremities of the long bones and their presence in the skull being less than 1%. In the skull, sphenoidal bone and temporal bone are the commonest sites. There have been very few reports of GCTs of the occipital bone. Total excision surgery is the ideal treatment of choice. If surgery poses a problem, then adjuvant radiotherapy can be administered too. We present a case of 13-year-old male child who was diagnosed with GCT of the occipital bone. He was successfully operated and is symptom free 6 months post his surgery till now.

Segmental Fracture Of The Clavicle - Unconventional Fracture Pattern Of A Conventionally Fractured Bone: A Case Report With Review Of Literature.

Though clavicle fractures are routinely seen in clinical practice, rarely do we encounter segmental fractures. This unusual pattern of fracture in clavicle has been seldom reported previously. We present a case of segmental fracture of the left clavicle fracture in a 64-year-old who was treated successfully. A detailed literature review has been presented too.

What is diversity?

This article introduces the topic of diversity in this minisymposium by defining the terminology as well as providing descriptions of the positive impact of diversity. We aimed not only to examine the proven effects of diversity, but also to understand the barriers present so we can effectively mitigate these at the individual, institutional and systemic levels.

Anterior Dislocation of the Sternoclavicular Joint - A Case Report.

Dislocation of joints in the human body is a common occurrence, with the upper limb being commonly involved in most dislocations. Despite the common occurrence of upper limb dislocations, sternoclavicular dislocation is rare, comprising just 1% of all dislocations seen. This is attributed to a combination of restricted range of movements and strong ligaments around it. A thorough search of literature revealed a handful of cases of sternoclavicular dislocation. We report a case of a 35-year-old firefighter who presented to us an hour after his injury. He was diagnosed with anterior dislocation of the left sternoclavicular joint and was successfully managed by the closed reduction maneuver. We present this case to highlight the rarity of this unusual dislocation and also shed light on its etiopathogenesis and current management trends.

An Unusual Case Of Ipsilateral Shoulder And Elbow Dislocation.

A 34 years old male, labourer by occupation was brought to our trauma centre in an inebriated state with a history of fall from a height of approximately 10 feet. He complained of pain in the right elbow. A complete examination of the affected upper limb revealed an ipsilateral anterior shoulder dislocation and a posterior elbow dislocation with no other concomitant injuries. Both the dislocations were reduced conservatively and the patient was successfully managed. The patient is absolutely fine now, 6 months post his dislocation and has resumed back to his work. This case has been presented to highlight the rare and unusual nature of the injury, since ipsilateral dislocation of shoulder and elbow occur infrequently.

An Uncommon Case of Primary Leptomeningeal Melanoma in a 66-Year-Old White Caucasian Male.

Primary melanocytic tumors of the central nervous system (CNS) arise from leptomeningeal melanocytes and possess a variable degree of aggressiveness. They have been classified into melanomatosis, melanocytoma, malignant melanoma, and diffuse melanocytosis. Melanocytic lesions of the CNS include both benign (leptomeningeal melanocytosis, melanocytoma) and malignant (leptomeningeal melanomatosis, melanoma) pathologies and the extent of anatomical site involvement dictates their clinical features. Primary CNS melanoma accounts for approximately 1% of all melanoma cases with a peak incidence in the fourth decade. Though the most common location of occurrence is in the lumbar region, our patient presented with a thoracolumbar lesion. We present a case of a 66-year-old white Caucasian male who presented with complaints of headache for six months and was thoroughly evaluated leading to a rare diagnosis of primary leptomeningeal melanoma.

Ponseti Technique for the Management of Congenital Talipes Equinovarus in a Rural Set-Up in India: Experience of 356 Patients.

Congenital talipes equinovarus (CTEV), also known as clubfoot, is a complex congenital deformity of the foot that, left untreated, can limit a person's mobility by making it difficult and painful to walk. Worldwide, 80% of children born with clubfoot are in low- and middle-income countries. The management of clubfoot has a long history. Non-operative management did not become popular, as an increasing number of orthopaedists started leaning towards surgical treatment. The late Dr. Ignacio Ponseti developed a method of clubfoot correction that successfully realigns clubfoot in infants without extensive and major surgery. The aim of the study was to assess the functional outcome of CTEV management by the Ponseti technique, to study the severity of CTEV deformity using the Pirani score, and to evaluate the cost-effectiveness of the technique. A total of 356 cases with 402 feet with CTEV were treated by the Ponseti method. The average age of the children and the number of casts applied before full correction were 4.03 months and 6.91, respectively. There was a good functional outcome in 95.45% of cases (score > 30) at the last follow up. The management of CTEV by the Ponseti technique provides a good functional and cosmetic outcome. In a developing country like India, this technique is a safe, easy, economical method of clubfoot management.

Double trouble!!! An unusual presentation of cervical cord herniation and medial end clavicle non-union in a single patient.

Non-union of medial end clavicle is rare. Though traditionally they have been treated with conservative methods, surgery at initial presentation should be considered in these patients since conservative treatment can lead to non-union. Herniation of spinal cord, though rare, is seen in the thoracic region but can also occur in the cervical region post-traumatically as seen in our patient.

Intraosseous ganglion cyst of the distal tibia: a rare entity in a rarer location.

Intraosseous ganglion cysts are rare entities, even rarer in the subchondral region of the distal tibia. A 20-year-old male presented to us with complaints of pain and limp in the right ankle joint, which was diagnosed as an intraosseous ganglion cyst of the right distal tibia and was successfully treated with curettage and bone cement with no recurrence seen even after a year.

An Unusual Case of Giant Cell Tumor of the Distal Tibia.

INTRODUCTION: Giant cell tumors are common in proximal tibia and distal end radius and have a low tendency to recur. They have been treated successfully with excision and cementing or sandwich bone grafting without recurrence. Here, we present a rare case of giant cell tumor (GCT) of the distal tibia treated successfully with no recurrence at the end of 2 years. CASE REPORT: A 28-year-old female presented with complaints of pain and restricted movement of the right ankle joint since 1 month. There was no history of trauma. On examination, tenderness on the anterior aspect of the right ankle joint with restricted range of motion was found. X-rays revealed a well-defined expansile predominantly lytic lesion in the distal epi-metaphyseal region of the right tibia with minimal periosteal reaction seen along the medial margin. Magnetic resonance imaging revealed an ill-defined expansile lesion involving the epi-metaphyseal end of the lower end of tibia causing cortical breach and having extra-osseous tissue component with the abnormal signal in flexor and extensor group of muscles with the possibility of GCT. Surgery by excision, curettage, and cementation was performed to fill the defect. Histopathology of the tissue showed multinucleated giant cells with a uniform vesicular nucleus and mononuclear cells which were spindle shaped with uniform vesicular nucleus suggestive of GCT. CONCLUSION: The patient at 2-year follow-up is doing well, walking without any pain, comfortably and with a full range of motion of the ankle joint with no signs of recurrence.