Aneurysmal Bone Cyst Of Pubic Ramus: A Rare Entity.

INTRODUCTION: Aneurysmal bone cyst is an expansile, lytic, multiloculated, fluid filled cavities which usually occurs in the metaphysis of the long bones. ABC of the pubic ramus is a rare entity.. CASE REPORT: We present a case of a 21 year old male who presented with a swelling of the right inguinal region which was gradually progressive. Radiologically, there was a lytic expansile lesion of the superior pubic ramus. A contrast computed tomography revealed multiloculated cystic cavities and histopathology confirmed the diagnosis of ABC. Surgical excision of the complete tumor by anterior approach was done. Till date (2 years since surgery) patient has no recurrence. CONCLUSION: ABC of pubic ramus is a rare entity and other differentials should always be kept in mind with confirmation of diagnosis by histopathology. Treatment with surgical curettage and bone grafting the defect is curative in selective cases but in this case due to size and location excision is the choice of treatment.

Antegrade interlocking nailing versus dynamic compression plating for humeral shaft fractures.

PURPOSE: To compare antegrade interlocking nailing with dynamic compression plating for humeral shaft fractures in terms of functional outcomes, union and complication rates. METHODS: 34 men and 22 women aged >18 years with fresh humeral shaft fractures (up to grade IIIa) with or without neurological deficits underwent either antegrade interlocking nailing (n=31) or dynamic compression plating (n=25). Functional outcome of the upper limbs (according to the American Shoulder and Elbow Surgeons [ASES] score), pain, rates of union, and complications in the 2 groups were compared. RESULTS: Respectively in the nailing and plating groups, mean operating times were 65 and 112 minutes (p<0.001), mean blood loss volumes were 20 and 232 ml (p<0.001), mean ASES scores were 31.4 and 29.0 (p=0.448), complication rates were 20% (6/31) and 24% (6/25) [p=0.900], non-union rates were 13% (4/31) and 8% (2/25) [p=0.625], and delayed union rates were 7% (2/31) and 4% (1/25) [p=0.787]. CONCLUSION: Both techniques were appropriate for treating humeral shaft fractures.

Intramedullary nailing supplemented with Poller screws for proximal tibial fractures.

PURPOSE: To evaluate outcome of intramedullary nailing supplemented with Poller screws for proximal tibial fractures using small diameter nails. METHODS: 50 men and 20 women (75 fractures) aged 18 to 65 (mean, 33) years underwent intramedullary nailing supplemented with Poller screws for acutely displaced fractures (n=60) or for delayed union (n=10) or mal-union (n=5) of the proximal metadiaphyseal tibia. 88% of the fractures were caused by road traffic accidents. 54 cases had closed fractures and 21 had grade I or II compound fractures. Clinical and radiological outcome was evaluated. RESULTS: In 69 cases, healing occurred after a mean of 4.2 (range, 3-9) months. In 5 cases, there was non-union, which was resolved by bone grafting. One case was mal-united. 63 patients recovered a full range of knee motion (0º-130º), and the remaining 7 attained flexion of 0º to 90º. According to the knee rating scale of the Hospital for Special Surgery, outcome was excellent in 50 patients, good in 14, poor in 3, and failed in 3 at month 12, and remained so after a mean follow-up of 30.8 months. Postoperatively, 74 cases had <5º of varus or valgus malalignment, and only one developed varus of +7º. 65 cases exhibited no deformity, 7 had a deformity of <3º, and 3 had a deformity of 4º to 9º. CONCLUSION: Poller screws help maintain fixation of intramedullary nailing and alignment of fractures.

Antegrade interlocking nailing for distal femoral fractures.

PURPOSE: To assess outcomes of antegrade interlocking nailing for supracondylar or intercondylar fractures of the distal femur. METHODS: Records of 10 women and 20 men aged 20 to 70 (mean, 48.7) years who underwent antegrade interlocking nailing for distal femoral fractures were reviewed. 23 patients had closed fractures and 7 had open fractures; 6 had associated fractures of the forearm or tibia. According to the AO/ASIF system, fractures were classified as types A1 (n=13), A2 (n=6), A3 (n=3), and C1 (n=8). The affected leg was put in an extension shoe for traction, and reduction was achieved with the help of percutaneous lag screws. The nail was inserted from the tip of the greater trochanter and centred in both anteroposterior and lateral planes. The nail was modified to have 3 screw slots in the mediolateral plane and one screw slot in the anteroposterior plane distally for stability in multiple directions. Postoperatively early mobilisation and partial weight bearing were allowed. Patients were assessed using the modified knee-rating scale of the Hospital for Special Surgery. RESULTS: The mean time to bone union was 13.1 (range, 10-18) weeks. The mean follow-up period was 18.8 (range, 11-30) months. Three patients were lost to follow-up; outcomes in the remaining patients were excellent in 20 and good in 7. The mean range of knee flexion was 106 (range, 90-120) degrees. One patient developed a flexion deformity of 10 degrees. All patients attained full quadriceps strength. No patient had ligamentous instability, nerve injuries, superficial or deep infections, or implant failure. Three patients had malunion, which was located in the meta-diaphyseal segment and not in the intraarticular segment. Hence, there was no functional problem or shortening. The mechanical axis was not deviated. CONCLUSION: Antegrade interlocking nailing achieved good-to-excellent outcomes for distal femoral fractures.