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BACKGROUND: Treatment for osteoporosis can have catastrophic side effects, including the uncommon fracture known as an atypical femur fracture (AFF), which is related to the long-term usage of antiresorptive agents. Bisphosphonate therapy may lead to significant and chronic suppression of bone turnover, impairing the bone's remodelling property and finally leading to incomplete or complete atypical femur fracture. AFF was defined by the American Society for Bone and Mineral Research (ASBMR) Task Force in 2010 and is far less prevalent than proximal femur (hip) fracture, with an incidence of 2 to 78 per 100,000 patients per year following two to eight years of bisphosphonate therapy, respectively. Due to the rarity of the fracture, it is still not clear what the functional and radiological outcome will be after surgery. AIM: To identify the functional and radiological outcomes of surgical fixation of atypical femur fractures. METHODS: The study was conducted in a tertiary healthcare centre after scientific and ethical clearance from the competent authority. Between January 2018 and December 2021, individuals who were diagnosed with an atypical subtrochanteric femoral fracture associated with the use of bisphosphonates and treated surgically were retrospectively evaluated. The study's inclusion and exclusion criteria were used to include 20 patients. The features of an atypical subtrochanteric fracture were congruent with the radiographic findings. Most of the patients were treated with internal fixation with intramedullary osteosynthesis in standard with or without plate osteosynthesis. They were then followed up for a year to look at the functional and radiological outcomes. RESULTS: All of the 20 patients who were included had an atypical subtrochanteric fracture, with 15 of them being female and 5 of them being male. The patients' mean age at surgery was 65.12 (range 49 to 82) years, and their average history of bisphosphonate use was 3 (range 2.5 to 5) years. All patients were treated surgically. We found that five months was the mean period for bone union (p = 0.990). Within six months, bone union was achieved in 11 patients (55 %) (p = 0.884). Five patients (about 25%) had implant failure and non-union, requiring two to three revision surgeries. At three, six, and nine months, the mean visual analogue score (VAS) was 4.14, 3.12, and 1.85, respectively. The modified Hip Harris Score had a mean of 72.66 and 15 patients (about 75% of them) could walk normally again after a fracture. The mean of the modified HHS was 72.66, and the VAS at three, six, and nine months was 4.14, 3.12, and 1.85, respectively. CONCLUSION: AFFs are rare fractures that must be treated effectively, and most of them require surgery. Successful treatment of AFF is possible by the use of intramedullary fixation, which enhances axial stability, serves as an internal splint, and lessens the likelihood of implant failure. A good functional and radiological prognosis can come from a stable fixation and a fracture that has been reduced anatomically.
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Introduction: Osteofibrous dysplasia is a fibro-osseous benign lesion of childhood and infancy that are commonly seen in the anterior shin of the tibia. Osteofibrous dysplasia in the clavicle is rare and in this study, we reported a case of osteofibrous dysplasia arising in the midshaft of the clavicle. Case Report: An 11-year boy presented with complaints of pain and swelling over his left clavicle and was unable to do overhead abduction following a fall while playing 2 years back. Initially, the patient was diagnosed with a left clavicle fracture and was treated conservatively. The pain subsided after 3 months. The patient had re-injury after 6 months, following which pain and swelling of the left clavicle were gradually progressive. On examination, there was a diffuse swelling extending from the medial end to the lateral end of the left clavicle, which was tender, and bony-hard in consistency. The range of movements of the left shoulder was painful and terminally limited. A percutaneous core-needle biopsy was done, suggestive of a benign fibro-osseous lesion. An open biopsy was done from the tumor-normal bone junction, and caseous materials were found inside the medullary canal, the microscopic finding shows fibroblastic proliferation and osteoblastic proliferation laying down the woven bone. We treated the case with intravenous pamidronate injection in 6 months intervals for 2 years. The patient improved symptomatically achieving a full range of movements of the affected shoulder with good radiological consideration of the lesion. Conclusion: Osteofibrous dysplasia is uncommonly seen in the clavicle, and if it is seen, it may mimic osteomyelitis clinically. It should be differentiated from other lesions by radiological, histopathological, and immunohistochemistry findings.
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OBJECTIVE: To determine the relationship between Posterior Tibial slope in terms of medial and lateral in Anterior cruciate ligament deficient patients. METHODS: Magnetic resonance images (MRI) of the knee of 100 ACL injured patients and 100 ACL intact patients were studied. Their medial and lateral posterior tibial slopes were measured using MRI. Of 200 subjects, 100 (Male- 63, Female- 37) were controls, other 100 (Male - 68, Female-32) were ACL injured cases. Using DIACOM viewer software,the slopes of both medial and lateral slopes were measured. Range of Variation, mean value and standard deviation of medial tibial plateau slope (MTS), lateral tibia plateau slope (LTS) of controls and ACL injured patients were measured. The data collected were entered into Microsoft excel worksheet and analysed using statistical package for social sciences, Version 15.0 (SPSS Inc. Chicago, IL, USA). Distribution of data was confirmed using Shapiro's Wilk Test and appropriate parametric statistics were applied. For all analysis p value < 0.05 was set to be significant. RESULTS: In control (ACL uninjured) population mean MTS was 5.95° with SD 3.09°, mean LTS was 6.08° with SD 3.48°. In ACL injured population mean MTS 6.41° with SD 2.66°, mean LTS was 8.12° with SD 3.65°. So ACL injured population had MTS steeper than control population with no statistical significance (p value < 0.27) and LTS was steeper than control population with statistical significance (p value < 0.001),where as there were comparable results between male and females. CONCLUSION: Our current results indicate that lateral PTS is a risk factor for patients with primary ACL tears as compared with ligament-intact controls. Therefore,PTS should be considered as independent modifiable risk factors in ACL injury.
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AIM AND OBJECTIVES: The aim is to know the augmented new bone formation in postsurgical bony defects in the maxillofacial region when filled with plasma-enriched demineralized freeze-dried bone allograft (DFDBA). MATERIALS AND METHODS: The study group included 45 patients, selected randomly, and divided in three equated groups. In Group I (control) patients, the wound was closed primarily without incorporating any graft in the bony defect. In Group II, the defect was filled with DFDBA alone and in Group III with DFDBA enriched with platelet-rich plasma (PRP). The said graft material was procured from the (to be discarded) femur head, treated to get rid of its antigenicity, made suitable to be incorporated as a graft material, sterilized by gamma irradiation and then implanted into the jaw defects. RESULTS: The results were evaluated and interpreted both clinically and radiographically by studying the changes post 1 week, 1 month, 3 months, and 6 months, respectively. Bone density was evaluated using computed tomography scan in addition to standard conventional radiographs. Evidence of trabecular formation and calcification were noted down. Measurements were recorded by taking note of Hounsfield units. Statistically, one-way ANOVA test followed by least significant difference post hoc test was done. Final results showed that the patients in the Group III had more bone density at the grafted site when compared to the Group II and I patients. These findings were significant. CONCLUSION: PRP-enriched DFDBA is a superior grafting material in terms of other grafting materials available. It possesses both osteoconductive and osteoinductive properties and elicits the least immunological response, thereby making it one of the best effective combinations of grafting material to be used in oral and maxillofacial reconstructive purposes.
