Fat emboli-Related diffuse alveolar haemorrhage (FEDAH) an acronym to remember-Case series.

Fat embolism syndrome (FES) is a rare but potentially fatal complication of trauma or orthopaedic surgery, which presents predominantly with pulmonary symptoms. The rapid worsening respiratory failure in a previously normal orthopaedic surgery or trauma patients usually get evaluated for pulmonary embolism, fat-embolism-related acute respiratory distress or transfusion related acute lung injury. Orthopaedic surgeons and clinicians need to be aware of related entity termed 'Fat Embolism related Diffuse Alveolar Haemorrhage' (FEDAH). The clinical presentation in an orthopaedic surgery of trauma patient with FEDAH are haemoptysis, worsening type 1 respiratory failure and oxygen requirement, drop in haemoglobin levels with chest x-ray/computed tomography suggestive of Diffuse alveolar haemorrhage (DAH). Early bronchoscopy and bronchoalveolar lavage (BAL) confirmation of DAH, presence of BAL haemosiderophages and lipid-laden macrophages are the pointers in the early diagnosis of FEDAH. It needs a high clinical suspicion and interdepartmental collaborative measures. Timely referral from orthopaedic surgeons, early bronchoscopy and treatment with steroids is key in diagnosis and management.

Modified Woodward's procedure confers functional improvement in Sprengel's deformity.

Modified Woodward's procedure improves shoulder movement and cosmesis. There is a paucity of literature reporting objective assessment of functional outcomes. We report cosmetic and functional outcomes in Sprengel's deformity treated with modified Woodward's procedure. Children aged 12 years and under, who underwent Modified Woodward's procedure from January 2006 to December 2014 were included in the prospective study. Improvement in Cavendish grade, Rigault scale, and shoulder movements was noted. Pediatric outcomes data collection instrument (PODCI) and simple shoulder test (SST) scores were assigned at the final follow-up. Statistical analysis was conducted with paired T-test and Wilcoxon signed-rank tests. Fourteen patients (one bilateral) with a mean follow-up of 4.5 years (1-8 years) were analyzed. The mean age at surgery was 5.7 years (3-12 years). Ten (71%) patients had omovertebral bars. Six patients had Klippel-Feil syndrome including one with cervical hemivertebrae with anterior chest wall deficiency. Cavendish grade and Rigault scale improved significantly (P < 0.05). Mean shoulder abduction and forward flexion improved by 37.3° (P < 0.001) and 38.7° (P < 0.001), respectively. The mean normative PODCI score was 24.07 (reported normative score ranges from -146 to 53) and the SST score was 9.64 (reported score ranges from 0 to 12). SST scores demonstrated a moderate correlation with shoulder function. Patients without associated anomalies had better cosmetic (P = 0.057) and functional (P = 0.029) improvement. Modified Woodward's procedure improved cosmesis and provided near-normal functional outcomes in children irrespective of age and sex. Better improvement was noted in children without anomalies.

Osteoblastoma of the coracoid process: an unusual location.

Bone tumours arising from the coracoid process of the scapula are very rare. We present a case of a 19-year-old man with left shoulder pain for 1 year, with associated infraclavicular swelling for 8 months. Examination revealed a tender, bony, hard swelling measuring 3×4 cm. Imaging revealed an expansile osteolytic lesion arising from the coracoid process with loss of corticomedullary differentiation. MRI showed altered signal in the adjacent soft tissues. The patient underwent en bloc resection of the lesion. Histology was suggestive of osteoblastoma. At the end of 2 years follow-up, the patient had no pain or recurrence of the lesion. We present this case for its rare location and have briefly discussed the difficulties in diagnosis of this condition.

Isolated Tubercular Osteomyelitis of Scapula - A Report of Two Cases and Review of Literature.

INTRODUCTION: Isolated tuberculosis of the scapula is rare. The presentation mimics the tumors of scapula. Hence it is important to know the clinical presentation and when to suspect tubercular osteomyelitis of scapula. Few cases have been described before. We have analyzed all reports with isolated scapular tuberculosis so far and described the varied presentations. CASE REPORT: We report two cases of isolated scapular tuberculosis. One patient underwent aspiration and was started on antituberculous drugs (ATT) and the other underwent debridement, drainage of abscess and then was started on ATT. Both had excellent outcomes at the end of one year follow up. We reviewed previous published literature of isolated scapular tuberculosis. The most common presentation of scapular tuberculosis is as follows: age less than 30 years and there is no difference with respect to gender. Swelling and pain are the commonest symptoms. Lytic areas with surrounding sclerosis is the commonest radiological finding. Body of the scapula is affected most commonly. Prognosis is excellent with adequate treatment. CONCLUSION: To conclude, clinicians should have high index of suspicion for diagnosing this condition as it mimics tumors. Pain and swelling is the most common presentation of scapular tuberculosis. Radiography shows lytic lesion with marginal sclerosis. The prognosis is excellent with appropriate treatment.

Amphotericin B cement beads: A good adjunctive treatment for musculoskeletal mucormycosis.

Mucormycosis is one among the aggressive, invasive fungal infections usually seen in immunocompromised patients. Mucormycosis osteomyelitis is very rare. We present a patient with acute myeloid leukemia who complained of pain over the right proximal thigh. Plain radiograph revealed ill defined osteolytic lesion of proximal femur. MRI showed altered signal in proximal femur with focal collection and cortical breach. Biopsy and tissue culture diagnosed mucormycosis both histologically and microbiologically. He was treated with aggressive debridement, skeletal stabilization, and amphotericin antifungal cement beads. He recovered with no residual pain, minimal limb shortening, and no clinical or radiological evidence of recurrence at 3 years followup. The high index of suspicion, early diagnosis, aggressive surgical debridement, and adequate antifungal therapy play a significant role in the treatment of musculoskeletal mucormycosis.