Clinical Outcome of Neer Type II Lateral End Clavicle Fractures With Coracoclavicular Ligament Disruption Treated With Pre-Contoured Locking Plate and Endobutton.

Introduction Many surgical techniques have been described for the treatment of Neer type II lateral end clavicle fractures like open reduction and internal fixation with hook plate, tension band wiring, coracoclavicular screw fixation, and distal clavicle locking plate. However, most of these operative procedures are associated with high perioperative complications ranging from hardware prominence, hardware failure, screw and plate pull-out, and infection. As the lateral end clavicle fractures has both vertical and horizontal stress forces, any technique counteracting both the forces should result in a better clinical outcome. Therefore, this study was conducted to assess the functional and radiological outcome of type II lateral end clavicle fracture treated using pre-contoured locking plate along with coracoclavicular reconstruction with endobutton and fiberwire. Methods Thirty-two consecutive patients with Neer type II fractures of the lateral end of clavicle were treated surgically using pre-contoured locking plate and coracoclavicular reconstruction with endobutton and fiberwire between May 2014 and December 2016. Clinical outcome was assessed using the University of California Los Angeles (UCLA) shoulder score and Constant Murley score. The coracoclavicular distance was also recorded. These were compared to the unaffected side at one-year follow-up. Results The bony union was achieved in all cases. There were no major complications in any of the patients. All the patients were able to return to their preinjury level of activity. The UCLA score, the Constant Murley score, and coracoclavicular distance did not vary significantly at a one-year interval when compared to the normal shoulder. Conclusion Open reduction and internal fixation of Neer type II lateral end clavicle fractures using pre-contoured locking distal clavicle plate along with coracoclavicular reconstruction with endobutton and No. 2 fiberwire provide an excellent functional and radiological outcome.

Posterior interosseous nerve entrapment due to bilobed parosteal lipoma.

Entrapment of posterior interosseous nerve (PIN) can be due to fracture dislocation of elbow, fibrous arcade of Frohse, neoplasms (lipoma, schwannoma), ganglion cysts and rheumatoid synovitis. Parosteal lipomas are extremely rare. These tumors grow slowly and as they grow, they can compress a nearby nerve producing sensory and motor disturbances. Till date less than 50 cases of PIN entrapment due to parosteal lipoma have been reported in literature. However, to the best of our knowledge, none was bilobed. A 54-year-old female patient presented with progressive weakness of the right-hand extensors including thumb for the last 5 months with no sensory loss. Clinico-radiological findings and electophysiological studies revealed parosteal lipoma causing entrapment of PIN. Surgical excision of the lesion was done through posterior approach. The excised mass was sent for histopathological examination which confirmed the diagnosis of lipoma. Appreciable recovery was first noticed at 3 months and complete recovery was seen at 7 months. No recurrence was seen until 2 years of follow up. Urgent surgical excision is necessary to prevent entrapment of this nerve and facilitate early functional and neurological recovery.

Doxycycline sclerodesis as a treatment option for persistent Morel-Lavallée lesions.

INTRODUCTION: Morel-Lavallée lesion is a rare cause of subcutaneous swelling, caused by post-traumatic shearing of the hypodermis from the underlying fascia. Treatment of such lesions is still not well established. OBJECTIVE: To evaluate the results of conservative treatment for these lesions using doxycycline induced sclerodesis followed by elastic compression bandaging. PATIENTS AND METHODS: We treated 16 Morel-Lavallée lesions between May 2005 and December 2008. These lesions developed in 13 male and 3 female patients (mean age 41 years; range 10-74 years) due to various modes of trauma. The lesion involved the thigh region in 13 patients with trochanteric region, gluteal, lower back, and lower abdominal wall being other regions involved. An area of palpable fluctuance was the most consistent examination finding. Treatment was effected by fluid aspiration, doxycycline instillation, and compressive elastic bandaging. Healing was defined as the loss of fluctuation with complete absence of fluid on ultrasonography. RESULTS: The average duration of the persistence of the lesion was 13 months (range, 6-23 months). Most of the lesions had been aspirated previously multiple number of times, average being 3.44 times (range, 1-6 times). All lesions were aspirated and found to be negative on culture. The mean follow up period was 50.44 months (range, 31-74 months). 11 patients showed complete resolution of fluid collection at 4 weeks with another 4 patients resolving at 8 weeks follow up. The lesion persisted in one patient at 12 weeks due to non-compliance to compressive elastic bandaging which subsequently resolved on repeating the procedure. All the lesions healed without any infections or necrosis. No recurrences were detected during the follow up period. A persistent non-fluctuant contour deformity, decreased skin mobility over the site of lesion, and feeling of tightness were the most common problems faced on long term follow up. CONCLUSION: Closed degloving injuries can be managed satisfactorily with doxycycline induced obliteration of the cavity with early healing time without recurrences.

Distal tibial aneurysmal bone cyst treatment by using a proximal fibular autologous bone graft: a case report.

A case of an aneurysmal bone cyst that involved the distal tibia and medial malleolus with erosion of the medial cortex in a 22-year-old woman is presented. The patient was surgically treated by curettage and bone grafting along with reconstruction of the distal tibia by using ipsilateral proximal fibula. At the 2-year follow-up, the patient had full, painless range of motion and complete incorporation of the fibular graft. The authors discuss the different treatment options for benign tumors of the distal tibia and the advantages of using proximal fibula as an autologous bone graft in the reconstruction of medial malleolus.