Revisiting the Vertical Osteotomy Technique for the Removal of a 20-Year-Old Tibial Intramedullary V-Nail: A Case Report.

Vertical osteotomy is a procedure occasionally used for the removal of intramedullary nails when the nail has become jammed, either due to expansion after initial fixation or the formation of a new bone around the nail. Implant removal of any type is usually performed when it is either recommended by the doctor or in response to the complaints of the patients, like sensations of pain, disorder, and infection associated with the potential complications of the given implant. There are different types of cases, which range from a simple procedure of K-wire removal or more complex procedures like intramedullary nail or plate removal. During the removal of implants, certain unforeseen complications can occur such as excessive bleeding, neurovascular deficit, and some other issues related to implants like breakage of screws or implants while removing it, which might lead to its inability to be removed. We present here a technique of vertical osteotomy that was used for the removal of implants in cases of long-term implant retention, which leads to difficulty in removing it.

An Unusual Complication Encountered During the Extraction of the Femoral Nail: A Case Report.

Orthopedic implant removal is a common surgery performed either due to patient's complaint of pain, dysfunction or infection or on doctor's advice depending on the nature of the implant and its related future problems. The surgery may range from simple k-wire removal to difficult plate or intramedullary nail removal. Many unforeseen complications are experienced during implant removal, and occasionally, it results in failure of removal, fracture, prolonged per-operative bleeding and damage to nerves and vessels. We report here an unusual complication of coiling of a thick k-wire used during implant extraction surgery to prevent sinking of the nail and the difficulties in removing this coil and the nail, along with the precautions to be taken to avoid such difficulties.

Diagnosis and Management of Monostotic Fibrous Dysplasia of the Tibia in an Adolescent Patient: A Case Report.

A rare benign bone condition called monostotic fibrous dysplasia (MFD) is characterized by the growth of fibrous tissue in place of a normal bone. It may lead to deformity in the affected bone, pain, and a pathologic fracture due to bone weakness. Hereunder, a case report of MFD in a 17-year-old male adolescent presenting to the hospital with localized bone pain and swelling in his right tibia is presented. After clinical examination and radiographic imaging, a provisional diagnosis of benign osteolytic lesion was considered. A magnetic resonance imaging (MRI) scan of the leg suggested the possibility of fibrous dysplasia or adamantinoma. The patient was managed with an intralesional curettage of the dysplastic bone and packing the cavity with blocks of a synthetic bone. The excised material was sent for histopathology, which established the diagnosis of fibrous dysplasia.

Zoledronic Acid Supplementation With Excision of a Giant Cell Tumor of the Distal End Radius to Prevent Recurrence: A Case Report.

Giant cell tumors are benign yet locally aggressive neoplasms commonly observed in the distal radius, exhibiting higher recurrence rates compared to other tumor types. This study presents a case involving a 50-year-old farmer who presented with swelling at the distal end of his wrist. The patient underwent treatment involving intralesional curettage and supplementation with zoledronic acid, resulting in a significant reduction in the tumor's potential for recurrence. This approach aims to achieve an optimal balance between functional outcomes and disease management in the majority of cases. While this strategy proves effective in most instances, there may be scenarios where resection becomes imperative due to the severity of the disease, ensuring adequate disease clearance. In such circumstances, judicious decision-making coupled with an appropriate treatment plan is crucial to guarantee a satisfactory outcome, even in the face of challenges.

A Comprehensive Review on Managing Fracture Calcaneum by Surgical and Non-surgical Modalities.

This comprehensive review delves into the multifaceted landscape of calcaneal fractures, thoroughly examining their aetiology, clinical presentation, and diverse management strategies. Encompassing surgical and non-surgical approaches, the review scrutinises critical aspects such as patient compliance, rehabilitation protocols, and long-term follow-up considerations. Surgical modalities, propelled by recent innovations like minimally invasive techniques and advanced fixation materials, are juxtaposed with non-surgical interventions, emphasising the pivotal role of patient education and adherence to optimise outcomes. The synthesis of critical findings underscores the need for individualised care and multidisciplinary collaboration in clinical practice. Moreover, the review outlines recommendations for healthcare practitioners and identifies promising areas for future research, including biomechanical studies and telerehabilitation. This comprehensive exploration aims to contribute to the ongoing evolution of calcaneal fracture management, ultimately enhancing patient care and outcomes in this complex orthopaedic realm.

A Comprehensive Review of Genetic Variations in Collagen-Encoding Genes and Their Implications in Intervertebral Disc Degeneration.

This comprehensive review examines the intricate relationship between genetic variations in collagen-encoding genes and their implications in intervertebral disc degeneration (IVDD). Intervertebral disc degeneration is a prevalent spinal condition characterized by structural and functional changes in intervertebral discs (IVDs), and understanding its genetic underpinnings is crucial for advancing diagnostic and therapeutic strategies. The review begins by exploring the background and importance of collagen in IVDs, emphasizing its role in providing structural integrity. It then delves into the significance of genetic variations within collagen-encoding genes, categorizing and discussing their potential impact on disc health. The methods employed in studying these variations, such as genome-wide association studies (GWASs) and next-generation sequencing (NGS), are also reviewed. The subsequent sections analyze existing literature to establish associations between genetic variations and IVDD, unraveling molecular mechanisms linking genetic factors to disc degeneration. The review concludes with a summary of key findings, implications for future research and clinical practice, and a reflection on the importance of understanding genetic variations in collagen-encoding genes to diagnose and treat IVDD. The insights gleaned from this review contribute to our understanding of IVDD and hold promise for the development of personalized interventions based on individual genetic profiles.

Osteitis Condensans Ilii: A Case Report.

Hyperostosis triangularis ilii, also called osteitis condensans ilii (OCI), is a rare condition, mostly occurring in females, and the etiology is unknown. This disease is a sclerotic disorder associated with iliac fibrosis, a noninflammatory and self-limiting disorder. This condition primarily affects the iliac part of the sacroiliac joints and sometimes the adjoining bones, such as the sacrum, lumbar vertebrae, and iliac bones. It is an incidental finding in many individuals but rarely associated with lower back pain due to sacroiliac joint involvement. It is mainly treated with physical therapy and medications. OCI should be considered a cause of chronic back pain in females not having ankylosing spondylitis or inflammatory arthritis. Herein, a case of osteitis condensans ilii in a 47-year-old female, presenting with the chief complaints of intermittent lower back pain in the midline and on both sacroiliac regions, without any evidence of ankylosing spondylosis and the X-ray of the pelvis and magnetic resonance imaging (MRI) showing features of OCI, is being reported. The case was managed with medications and exercise, and the patient is under regular follow-up.

Spontaneous Osteonecrosis of Knee: A Case Report.

A 49-year-old man with no prior history of trauma, steroid use, or alcohol consumption presented with spontaneously developing progressive left knee discomfort that worsened after intense activity for 1.5 years. Normal x-rays indicated local discomfort along the joint line, and magnetic resonance imaging (MRI) revealed a T1-weighted hypointense line with bone infarcts in the medial and lateral condyle and the lower part of the left femur in addition to diffuse bone edema. Spontaneous osteonecrosis of the knee (SONK) was identified. Initially, he was treated conservatively with painkillers and calcium supplements. Then, the patient showed a significant improvement.

Ilizarov Ring Fixator in the Lower Limb for 2000 Days: A Case Report.

Ring external fixators developed by Gavriil Abramovich Ilizarov from Russia are used to treat the difficult cases of infected non-union, shortening of limbs by bone lengthening, and deformity correction in joints and bones in isolation or in combination. Fixation of the involved bone with the ring is commonly achieved using four rings, each having two Ilizarov wires that are passed along the superior surface of the ring, then across the bone, and exiting out on the opposite side touching the surface of the ring. The case report herein reports a patient who kept the ring fixator on his thigh without any problem for a long period of five and a half years. The case is being reported due to the abnormally long period of ring fixator application without any complications and the excellent result achieved in terms of union and infection control.

A Rare Case of Giant Cell Tumour of the Medial Epicondyle of the Humerus Managed With Curettage and Bone Grafting.

Giant cell tumours (GCTs) of the medial epicondyle of the humerus are rare. These are generally benign tumours but have the potential to be locally aggressive. They can invade the adjacent joint or the surrounding soft tissues or, in rare cases, cause distant metastasis. Locally aggressive GCTs are generally treated with wide resection, curettage, and bone grafting, followed by joint reconstructions. Here we present a case of a 49-year-old female with a history of swelling over the medial epicondyle of the humerus for six months. The patient was diagnosed with a locally aggressive GCT and was managed with wide excision of the tumour followed by sandwich bone grafting. A two-year follow-up of the patient shows no signs of recurrence. The patient is pain-free and has decent elbow function.

Exostosis of Ulna With Developmental Deformity of the Left Forearm: A Rare Case.

This case report presents a rare occurrence of exostosis of the ulna associated with a developmental deformity of the left forearm in a 15-year-old female. The patient reported a history of trauma resulting in a supracondylar humerus fracture managed conservatively eight years prior. The patient presented with a two-year history of pain and swelling over the left forearm. Clinical examination revealed a firm, non-tender, immobile swelling closely associated with the ulna, accompanied by a 20-degree cubitus varus deformity and forearm shortening. Radiographs and computed tomography scans confirmed the presence of a solitary external bony protuberance over the ulna shaft, communicating with the medullary cavity. A preliminary diagnosis of osteochondroma was established based on clinical and imaging findings. The patient underwent extraperiosteal en bloc resection of the lesion under supraclavicular nerve block anesthesia. A histopathological examination confirmed the diagnosis. Postoperative physiotherapy was initiated, and at the one-month follow-up, the patient reported being pain-free. This case highlights the rarity of exostosis of the ulna with associated developmental deformity, emphasizing the importance of a comprehensive diagnostic approach. Early surgical intervention resulted in a successful outcome, underscoring the significance of timely management in improving patient outcomes and quality of life.

A Comprehensive Review of Treatment Strategies for Early Avascular Necrosis.

Avascular necrosis (AVN), characterised by compromised blood supply leading to bone necrosis, poses a significant challenge in orthopaedic and rheumatologic practice. This review comprehensively examines early AVN treatment strategies, including aetiology and risk factors, clinical presentation, conservative and surgical approaches, emerging therapies, and rehabilitation. Key findings underscore the importance of early detection, personalised treatment plans, and a multidisciplinary approach involving orthopaedic specialists, rheumatologists, and physical therapists. The implications for clinical practice emphasise individualised care, staying abreast of emerging therapies, and patient education. Recommendations for future management strategies highlight the need for imaging technology advancements, regenerative therapies integration, and ongoing research into genetic and molecular pathways. As the field continues to evolve, translating research findings into clinical practice holds promise for improving outcomes and enhancing the overall quality of life for individuals affected by AVN.

Pigmented Villonodular Synovitis Presenting at an Atypical Site: A Case Report.

Pigmented villonodular synovitis (PVNS) is an idiopathic villous overgrowth and pigmentation of the synovial membrane of a single joint. It is an uncommon condition characterized by yellow or yellowish-brown colour due to deposits of cholesterol and hemosiderin, excessive secretion of yellowish-brown synovial fluid, and the formation of brownish chocolate synovial tissue. This condition commonly occurs at the knee joint at the age of 20-50 years. Here we present a case of a 75-year-old male with PVNS involving the lower third of the right thigh who came to the surgery department and was eventually referred to the orthopedic department on the basis of investigations performed. It is a case of PVNS at a unique location on the lower third of the right thigh. The swelling was painless initially, but the pain increased over a duration of 10 months. Clinically, the mass was suspected to be bursitis or lipoma with features of mild inflammation in the overlying skin. Magnetic resonance imaging (MRI) suggested a swelling of 100*70*40 mm in dimension with the possibility of PVNS. Ultrasonography (USG) of the mass and fine needle aspiration cytology (FNAC) supported the diagnosis of PVNS. An excisional biopsy of the swelling was submitted. Per-operatively, there were typical features of PVNS. The swelling was situated superficial to the iliotibial band. There was no defect or gap in the iliotibial tract, and the swelling didn't have any continuity to the knee joint. The occurrence of synovial tissue without any attachment to the joint or tendon is rare and hence reported.

Traumatic First Rib Fracture: An Indication of Life-threatening Injuries.

Introduction: First rib fracture is a very uncommon injury due to protection provided to it by clavicle. In isolation, it may be associated with neurovascular injury rarely but as part of poly trauma the first rib fracture may be associated with vascular injury in significant number of cases. There is definite role of computed tomography scan thorax in diagnosis of this fracture which can be missed on X-ray chest. Management includes early diagnosis of associated life-threatening complications and its prompt treatment. Case Report: A case of poly trauma associated with right first rib fracture with subclavian artery thrombosis resulting in gross ischemia of the right upper limb and fractures in the right upper limb and right lower limb long bones is reported. The patient developed signs of ischemia and lung complications 24 h later. Subclavian artery damage was diagnosed on Doppler ultrasound and angiography. The case was managed by surgical repair of subclavian artery damage and stabilization of fractures. Conclusion: The case is reported to highlight association of first rib fracture with life-threatening complication of subclavian artery laceration causing extensive swelling around shoulder, ischemia to the right upper limb, lung damage, and problem of its detection and management.

The Importance of Prompt Management of Morel-Lavallée Lesions.

The Morel-Lavallée lesion (MLL) is a closed soft-tissue injury that is frequently associated with high-intensity trauma. The thigh, hip, and pelvic regions are the most typically affected regions. It is critical to recognize and treat an MLL as soon as possible because it is often neglected or its identification is delayed because of other distracting injuries in a polytrauma patient. Bacterial colonization of these closed soft-tissue wounds can result in an increased risk of perioperative and postoperative infection. Magnetic resonance imaging has recently been used to define and grade these lesions. To reduce the dangers of these situations, clinical suspicion and on-the-spot identification of these lesions are essential. Here, we report an operated case of fracture shaft femur associated with MLLs and discuss the diagnostic and surgical approaches.

Transient Hypertension in a case of Congenital Pseudarthrosis of Tibia treated with Ring Fixator: A Case Report.

Introduction: Congenital pseudarthrosis of tibia is an uncommon condition leading to gradually progressive deformity, shortening of the limb and disability. The condition is notorious for failure of treatment and need of multiple operations. A combination of open reduction, thorough excision of abnormal tissue at the pseudarthrosis site, intramedullary nailing, ring fixator application, and distraction to achieve bone equalization has proved successful. Case Report: A case of congenital pseudarthrosis of the left tibia and fibula associated with neurofibromatosis treated by open reduction, intramedullary nailing, ring fixator application, and distraction at corticotomy to cause compression at the pseudarthrosis site and limb length equalization is being reported due to uncommon occurrence of transient hypertension in the child as a complication of ring fixator. Conclusion: Transient hypertension is a rare complication seen in children after application of ring fixator. Its diagnosis and control require proper perioperative assessment of child regarding blood pressure (BP), monitoring of BP during distraction period and period of application of ring fixator, and its treatment under care of pediatrician.

A Case Report of Giant Cell Tumor of the Flexor Tendon Sheath in Index Finger.

INTRODUCTION: Giant cell tumor of the tendon sheath (GCTTS) is an uncommon benign soft tissue tumor of unknown etiology. It is seen more commonly in hand than ankle and foot. It presents as a painless and palpable swelling. Its diagnosis is mostly established by histopathology after surgical resection, although pre-operative imaging and fine-needle aspiration cytology (FNAC) support its suspicion. Herein, a case of GCT of flexor tendon sheath of the right index finger is reported due to its rarity. CASE REPORT: A 46-year-old female presented with complaints of swelling over the front of the right index finger for 1½years. The swelling was spontaneous, painless, and very slowly progressive. Examination revealed a 2 cm × 1.5 cm firm swelling situated on the palmar aspect of the right index finger over distal part of middle phalanx and proximal part of the distal phalanx. Swelling was well defined, having smooth surface, uniformly firm consistency and could be moved sideways easily. X-ray of the hand showed localized soft tissue shadow in the involved area without any bony involvement. Ultrasonography of the finger showed soft tissue mass. FNAC examination reported the swelling as GCTTS. Excisional biopsy was done. Histopathology showed typical features of GCTTS. CONCLUSION: GCTTS should be kept as a differential diagnosis in soft tissue tumors of hand in adults. FNAC followed by excisional biopsy is diagnostic and curative, but the patient should be followed up for detecting and managing recurrences.

Multiple Brown tumors in a Case of Primary Hyperparathyroidism with Pathological Fracture in Femur.

INTRODUCTION: Pathological fractures in long bones are commonly caused by simple bone cyst or Osteogenesis imperfecta in children and by metastatic tumors from primary carcinoma, multiple myeloma, osteoporosis, and bone tumors in adults. Hyperparathyroidism causing pathological fractures, though a well-known entity, is seen infrequently in clinical practice. The fractures occur in the expansile fibro-cystic bone lesions called as "Brown tumor." The reported case describes a patient with classical features of primary hyperparathyroidism (PHPT) having multiple lytic lesions in pelvis and bilateral femur with pathological fracture. It is being reported due to its rarity. CASE REPORT: A 28-year-old young married lady presented with chronic dull aching pain in both thighs and difficulty in walking for 2 years. Examination revealed tenderness in both thighs, with antalgic gait. X-ray pelvis with both thighs showed multiple lytic lesions of variable size in both femora and pelvis. Blood investigations showed raised levels of serum calcium, with highly raised levels of serum parathyroid hormone (PTH). Contrast-enhanced computerized tomography (CT) scan of neck demonstrated parathyroid adenoma. The patient admitted for prophylactic nailing for right femur, developed a fracture while indoor and was managed by right proximal femoral nailing, followed by parathyroid adenoma excision. Follow-up showed dramatic clinical and radiological improvement with good healing of fracture. Lytic lesions healed gradually and blood parameters returned to normal. The patient remains asymptomatic at 2 years follow-up. CONCLUSION: Advanced case of symptomatic PHPT affecting bones is rare and it should be considered as a differential diagnosis in cases of a solitary and or multiple osteolytic lesions. Serum calcium and PTH level estimation at an early stage prevents missing the diagnosis and progression of disease. Early diagnosis and appropriate treatment help in rapid clinical improvement with almost total reversal of bony changes, thus avoiding devastating complications.