A rare case of extensive neurogenic heterotopic ossification: a case report.

INTRODUCTION: Neurogenic Heterotopic ossification (NHO) is a potential sequalae and a detrimental complication following neurological insult. It is characterized by formation of localized gradually progressive, peri-articular lamellar bone formation in extra-skeletal tissues. We would like to report a rare case of heterotopic ossification involving all 4 limbs, in which we tried to restore joint mobility to improve his functional status so that he could perform his daily tasks. CASE PRESENTATION: We present a case of a 33-year-old bed ridden male, diagnosed with NHO involving all 4 limbs (bilateral hip, right knee, right shoulder, left elbow). The patient had a crippled posture, significant pain and impaired range of motion hampering movement of all four limbs which prevented him from lying down supine, sitting, walking and performing activities of daily living. After three surgeries, the patient achieved wheelchair mobilization and upright posture with the assistance of calipers. CONCLUSION: The management of NHO requires a multidisciplinary approach involving orthopaedic surgeons, neurologists & rehabilitation specialists. Prognosis of NHO depends on factors such as extent of ossification, underlying neurological condition & patients overall health.

Unusual Mechanism of Injury during a Wedding Tradition Leading to a Metacarpal Shaft Fracture - A Case Report.

Introduction: "Joota Chori" is a traditional Indian wedding ritual which involves playful competition between the bride's and the groom's friends, with the aim of hiding and retrieving the groom's shoes. Case Report: We describe a rare case scenario wherein an orthopedic surgeon sustained a metacarpal shaft fracture while gripping the shoe and engaging in a tussle with the groom's friends. Despite feeling a sudden snap and experiencing pain, the surgeon held onto the shoe. The subsequent diagnosis revealed a 4th metacarpal long oblique shaft fracture. Conclusion: This case highlights the uncommon mechanism of injury involving forceful hyperextension of the MCP joint and the potential risks associated with physically intense wedding rituals. It also emphasizes the importance of adequate first aid resources and medical attention at wedding venues to promptly address musculoskeletal injuries.

Intraosseous Retrieval of Broken Guide Wire while Fixing Proximal Femur Fractures - A Report of 2 Cases and Review of Literature.

Introduction: Hardware breakage during surgery is a known risk that may result in serious complications. Drill bits and guide wires are particularly prone to breakage, and if not promptly recognized and removed, can cause damage to intrapelvic structures, or may lead to hip arthritis later. Herein, we present two cases in which broken guide wire fragments were safely retrieved through the same incision, resulting in good outcomes and reduced morbidity. Case Report: In the first case, a broken guide wire piece that had been pushed into the hip joint during intertrochanteric fracture surgery was retrieved using disc forceps after reaming over the same guide tract. In the second case, the broken tip of a partially withdrawn guide wire was removed from a transcervical femur fracture using a cannulated drill bit. Conclusion: Our approach highlights the importance of attempting retrieval of broken hardware through the same tract using unconventional instruments, such as disc forceps, before resorting to more invasive methods, such as arthrotomy or separate incisions. These cases demonstrate the feasibility of this approach and its potential to reduce morbidity associated with hardware retrieval.

Intraprosthetic Dislocation of Dual Mobility Total Hip Arthroplasty: A Case Report and Review of Literature.

Introduction: First introduced in Europe in the 1970s, dual mobility total hip arthroplasty (DM-THA) has gained popularity over years due to the reduced dislocation rates compared to standard THA. However, intraprosthetic dislocation (IPD), a rare complication where the femoral head separates from the polyethylene (PE) liner, remains a potential complication. Case Report: A 67-year-old female presented with a transcervical neck of femur fracture. She was managed with a DM-THA. She dislocated her THA on post-operative day 18. Closed reduction was performed for the same under general anesthesia. However, she again dislocated her hip 2 days later. CT scan was done and an IPD was diagnosed. The PE liner was revised and the patient had a good outcome at 1 year follow-up. Conclusion: When a DM-THA dislocates, it is important to consider the possibility of IPD which is a rare but unique complication associated with these systems. The recommended treatment for IPD is open reduction and replacement of the PE liner.

Femoral Head Fracture Without Associated Hip Dislocation.

We present a rare case of femoral head indentation fracture without associated hip dislocation in an elderly female secondary to a low-energy trauma. She was managed with primary total hip arthroplasty and achieved an excellent functional outcome. We have proposed the mechanism of injury and discussed shortcomings in the present classification systems. A review of literature of such cases is presented along with the rationale for our management decision and the various other treatment modalities available for the surgeon.

Outcome Analysis of Anterior Reconstruction with Rib Grafts in Tuberculosis of the Thoracic Spine.

INTRODUCTION: Tricortical iliac bone is the gold standard as an autograft for the reconstruction of the anterior column in tuberculosis (TB) of the thoracic spine. However, the quantity of graft needed is significant. It creates a considerable defect in the pelvic bone, causing graft site complications, including pain, pelvic instability, fractured ilium, herniated muscle, or abdominal contents. To prevent these donor site morbidities, ribs that were removed during the versatile approach were used for anterior reconstruction. The aim of this study was to assess the clinical and radiological results of the reconstruction of the anterior column of the spine with the help of an excised rib during the versatile approach. SUBJECTS AND METHODS: This retrospective study was undertaken at a tertiary care center with a study duration of 14 years. Between January 2004 and December 2016, 52 patients with thoracic Koch's spine had anterior column reconstructed with multiple rib grafts. A single surgeon performed all operations. Indications for the surgery in these patients were the presence of neurologic deficit (49 patients) and vertebral column instability (3 patients). The preoperative kyphosis angle and visual analog scale (VAS) score were compared with postoperative values using a paired t-test. RESULTS: All patients underwent a minimum follow-up of 18 months and were evaluated clinicoradiologically. Good bony fusion with neurological recovery was achieved in all cases. The VAS score for back pain improved significantly postsurgery. There was one case of graft buckling treated conservatively. DISCUSSION: Appropriate anterior reconstruction forms the cornerstone of successful surgical management of spinal TB. The "Versatile approach" used offers anterior and posterior access in the lateral position. In these patients, we obviated the need for iliac crest graft using multiple segments of the rib for anterior column reconstruction. This meticulous rib grafting technique gives good functional outcome in terms of solid bony fusion. CONCLUSION: Meticulous rib grafting technique gives 360° bony fusion and good functional outcome in surgery for thoracic spinal TB. It has the advantage of avoiding the complications associated with a tricortical iliac crest graft.

Bilateral Transcervical Femur Neck Fracture in a Case of Pseudohypoparathyroidism: A Rare Case Report and Review of Literature.

INTRODUCTION: Pseudohypoparathyroidism (PHP) is an uncommon metabolic bone disorder characterized by biochemical hypocalcemia, hyperphosphatemia and raised parathyroid hormone (PTH), and target tissue unresponsiveness to the biological actions of PTH. In addition, many patients with PHP exhibit a distinctive constellation of developmental and skeletal defects. CASE REPORT: An 11-year-old girl was brought to emergency pediatric department for the assessment of fever with generalized tonic-clonic seizure (GTCS) with inability to walk. She had hypocalcemia and hyperphosphatemia. The diagnosis of PHP was made and was started on Vitamin D3 and oral calcium. Physical examination revealed no dysmorphic features. Biochemical investigations revealed normal complete blood count, liver and renal functions, and arterial blood gas. However, serum PTH was high with slightly decreased Vitamin D3. CONCLUSION: As per our knowledge, this is the first reported case in literature of bilateral pathological transcervical neck femur fracture in a case of PHP following episode of GTCS. Multidisciplinary team approach with the involvement of pediatrician, endocrinologist, and orthopedic surgeon and devising a plan after thorough workup keeping in mind the infrequent presentations of hypoparathyroidism and adequate pre-operative optimization helps provide appropriate management of this rare presentation. This case report was prepared following the CARE guidelines.

Intraoperative Diagnosis of a Rare Case of Arthropathy - A Case Report and Review of Literature.

INTRODUCTION: Alkaptonuria is a rare metabolic disorder of autosomal recessive pattern of inheritance caused due to homogentisic acid oxidase enzyme deficiency. As a result, polymers of homogentisic acid get deposited in excessive amounts in the connective tissues, leading to brownish-black pigmentation termed as ochronosis. As the disease progresses, chronic inflammation results in arthritis of large weight-bearing joints. CASE REPORT: A 70-year-old female patient presented with complaints of being non-ambulatory since the past 10 days. She gave a history of difficulty in walking for the past 10-15 years associated with pain in the right hip which did not respond to analgesics and physiotherapy. The radiological assessment revealed severe joint destruction of the right hip. The patient underwent a total hip arthroplasty. A provisional diagnosis of ochronosis was made intraoperatively which was later confirmed on histopathological examination of the tissue. CONCLUSION: At present, there is still no known effective medical treatment to halt alkaptonuria entirely. Ochronotic arthropathy is usually managed conservatively. However, for severely involved hip joints, arthroplasty can provide extremely good results.