Sequential Imaging Characteristics and Potential Role of F18 Fluorodeoxyglucose Positron Emission Tomography/CT in the Evaluation of Treatment Response in Cases of Spinal Tuberculosis Without Neurological Involvement: Results From a Pilot Study.

Purpose In this non-randomized study, we prospectively studied the sequential imaging properties of fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and evaluated the role of FDG PET as a non-invasive imaging modality for identifying non-responders during anti-tubercular treatment (ATT) of spinal tuberculosis (TB). Methods Before starting anti-tubercular treatment, 25 patients with clinically and radiological suspected; pathologically confirmed spinal TB had a pretreatment contrast-enhanced whole-body FDG PET scan, followed by scans at six, 12, and 18 months. The maximum standardized uptake value (SUVmax) was computed, and the mean change in SUVmax was compared. The mean change in SUVmax was correlated with the clinicoradiological improvement.  Result In cases of spinal tuberculosis, the FDG PET scan can help identify extra-spinal and non-contagious involvement. In our 25 cases of spinal TB, the baseline peak SUVmax of lesions ranged from 6.3 to 28.5 (mean 14.8). Despite treatment, the condition progressed in two patients, and they had neurological deficits; in both cases, the SUVmax levels increased. The fall in SUVmax during the treatment course was statistically significant (p-value <0.05) and correlated well with the clinical improvement. Conclusion The inflammatory cells show increased uptake of F18 FDG, so uptake of radioactive tracer localizes and quantifies the disease activity; thus, FDG PET/CT holds a promising role as a sensitive non-invasive modality for the detection, staging, assessing disease activity, and monitoring therapy and deciding end point treatment in spinal TB.

Music as an aid to Allay Anxiety in Patients Undergoing Orthopedic Surgeries under Spinal Anesthesia.

Introduction: Patients undergoing surgery are anxious owing to the surgery, anesthesia, and unfamiliar environment of the operation theater. This anxiety can hamper the health and recovery of the patients. Among various nonpharmacologic modalities available, music can be used as a coping strategy to change uncomfortable conditions to the pleasant ones. Aims: To evaluate the role of music on perioperative anxiety, hemodynamic parameters, and patient satisfaction in patients undergoing orthopedic surgeries under spinal anesthesia. Settings and design: Tertiary care hospital, randomized control trial. Materials and methods: : The study was conducted after approval by Hospital Ethical Committee on 70 adult patients of either gender scheduled to undergo lower limb surgeries under spinal anesthesia. In group M (n = 35), patients listened to standard relaxation music, and in group C (n = 35), patients listened to standard operation theater noise tape through noise canceling headphones. The intraoperative hemodynamic parameters were recorded. Perioperative anxiety was assessed using visual analog scale for anxiety. Sedation score was observed using observer's assessment of alertness/sedation scale. Patient's satisfaction was also assessed in both the groups. Statistical analysis: Student t test, Chi-squared test, and paired sample t test. Results: : In group M, heart rate was lower when compared with group C. The difference was statistically significant at 10 minutes of assessment (P = 0.003) and statistically highly significant (P < 0.001) for rest of the time period. Statistically significant lower respiratory rate was there in group M when compared with group C (P = 0.05). Patients were more satisfied in the music group when compared with control group. Conclusion: The potential of music therapy can be used to allay patient anxiety, stabilize hemodynamics, and improve patient satisfaction.

Validation and Cross-Cultural Adaptation of the Hindi Version of the Oxford Knee Score in Patients With Knee Osteoarthritis.

INTRODUCTION: Cases of knee osteoarthritis are on the rise in India with an increasingly ageing population. A large number among them shall undergo total knee replacement, so there is a requirement for validated patient-reported outcome measures in the Hindi language. Oxford Knee Score (OKS) is one of the most commonly used patient-reported outcome measure scoring systems. The current study was designed to test and validate cross-cultural adaptation and translate the Hindi version of the Oxford Knee Score (OKS-H).  Material and Methods: The OKS-H was formulated as per recommendations for cross-cultural adaptation and translation. The OKS was tested on 162 patients with knee osteoarthritis who underwent a total knee replacement. Reliability of the OKS-H was tested using the intraclass correlation coefficient (ICC) and internal consistency was assessed using Cronbach's alpha. The construct validity was assessed using OKS-H, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short Form Survey (SF-36) questionnaire.  Results: The translation was performed with no major difficulty. The OKS was completed by 158 (97.5%) and 157 (96.9%) patients at test and retest, respectively, after one week. With an ICC of 0.87, OKS had shown good reliability. The construct validity obtained against the WOMAC and SF-36 scores was strong (ICC between 0.49 to 0.86). CONCLUSION: The translated OKS-H is a reliable and valid instrument for patient-reported outcome measures in cases of knee osteoarthritis opting for total knee arthroplasty.

Comparison Between Vancomycin and Gentamicin for Intraoperative Presoaking of Hamstring Graft in Primary Anterior Cruciate Ligament Reconstruction.

Introduction Postoperative infection is an uncommon complication with grave consequences following anterior cruciate ligament reconstruction (ACLR). Presoaking of the hamstring graft with antibiotics results in a lower rate of infection. The purpose of the current study was to compare the efficacy of two commonly used antibiotics, vancomycin and gentamicin, in reducing infection rates following anterior cruciate ligament reconstruction. Methods The retrospective study included a total of 578 patients who underwent arthroscopic anterior cruciate ligament reconstruction between June 2015 and October 2021. The timeline was categorized as the period between June 2015 to October 2018 (Vancomycin presoaking of hamstring graft) and November 2018 to October 2021 (Gentamicin presoaking of hamstring graft). All patients were examined for the development of infection, causative organism, and treatment received. Patients with intravenous drug abuse, alcoholism, steroid use, revision cases, and a prior history of infection in the knee were excluded from the study. Fisher's exact test was used for comparison of categorical data, and Poisson regression analysis was carried out to calculate incidence rate ratios after adjusting for confounding variables. Results Presoaking of hamstring grafts with vancomycin was carried out in 224 patients, and gentamicin was used in 354 patients. In total, three patients in the vancomycin and four patients in the gentamicin groups developed an intraarticular infection, and the difference in infection rate between the two groups was not statistically significant (p=0.919). Coagulase-negative Staphylococcus aureus was isolated in four cases, Enterobacter cloacae in one, and no organism was seen in two cases. The groups were comparable in terms of age (p=0.563), smoking (p=0.84), sex (p=0.359), and operative time (p=0.09). Conclusion Presoaking of hamstring autografts with gentamicin intraoperatively is a good alternative to vancomycin in the prevention of infection following arthroscopic anterior cruciate ligament reconstruction.

Outcome Analysis of En bloc Resection and Reconstruction by Non-vascularized Proximal Fibular Autograft in Giant Cell Tumor of Distal Radius supplemented with Brachytherapy.

Introduction: Giant cell tumors of the bone are aggressive and potentially malignant lesions. Juxtaarticular giant cell tumors of the lower end radius are common and is a challenge for reconstruction after tumor excision. Several reconstructive procedures like vascularized and non-vascularized fibular graft, osteoarticular allograft, ceramic prosthesis, and megapros thesis are in use for substitution of the defect in the distal radius following resection. Here, we have analyzed the results of aggressive benign Giant cell tumor of the distal radius treated by en bloc excision and reconstruction using autogenous non-vascularized fibular graft along with brachytherapy. Material and Methods: Eleven patients with either Campanacci Grade II or III histologically proven giant cell tumors of lower end radius were treated with en bloc excision and reconstruction with ipsilateral non-vascularized proximal fibular autograft. Host graft junction was fixed with low contact dynamic compression plate (LC-DCP) in all cases. Fixation of the head of the fibula with carpal bones and distal end of the ulna, if not resected, using K-wires at graft host junction was done. Brachytherapy was given in all 11 cases. Routine radiographs and clinical assessments regarding pain, instability, recurrence, hand grip strength, and functional status were done using Mayo modified wrist score at regular intervals. Result: The follow-up ranged from 12 to 15 months. At last follow-up, the average combined range of motion was 76.1%. The average union time was 19 weeks. Out of 11 patients, two patients had good results, five patients had fair results, and four patient had poor results. There was no case of graft fracture, metastasis, death, local recurrence, or significant donor site morbidity. Conclusion: En bloc resection of giant cell tumors of the lower end radius is a widely accepted method. Reconstruction with non-vascularized fibular graft and internal fixation with LC-DCP along with brachytherapy minimizes the problem and gives satisfactory functional results with no recurrence.

Correlation between Chondromalacia Patella and Patellofemoral Factors in Middle-Age Population: A Clinical, Functional, and Radiological Analysis.

Background Despite higher incidence of patellofemoral pain (PFP) and consequently morbidity, the understanding about PF factors leading to PF arthritis is way lacking. Material and Methods A prospective study of first 80 patients who were diagnosed with chondromalacia patella (CMP) on magnetic resonance imaging (MRI) divided into early and late CMP groups were evaluated clinically, radiologically, and in terms of functional outcome. Results : Quadriceps angle, Clark's test, and Insall-Salvati ratio results were nonsignificant despite greater values were observed in late CMP group, whereas trochlear morphology results (sulcus angle: 153:138 degrees and sulcus depth 3.9:5.4 mm) and clinical scores were significant in late CMP group (Kujala's score: 61:78, whereas PF pain score: 43:25). Type-C patellar morphology was found in greater number in late CMP cohort. Conclusion Trochlear and patellar morphologies along with clinical scores play a key role in understanding of the CMP.

A Rare Case of Aneurysmal Bone Cyst - Navicular Bone Treated by Intralesional Sclerotherapy Agent Polidocanol.

INTRODUCTION: Aneurysmal bone cyst (ABC) is an intraosseous arteriovenous malformation, usually treated by surgical excision but with higher recurrence rates. The occurrence of this lesion in navicular bone is a rare entity. Repetitive sclerotherapy using 3% polidocanol is a minimally invasive, safer method of treatment for ABCs. METHODS: A patient of ABC of the navicular bone precisely diagnosed through X-ray, MRI, and biopsy was given periodic injections of 4 ml of 3% polidocanol under aseptic precautions from April 2018 to July 2018. A total of four injections given at an interval of 1 month. RESULTS: Regular follow-up done for 1 year. At the end of all the four injections, the lesion healed completely with a relief in presenting symptoms. No complications were reported. At 3 months post-therapy, the patient was able to walk without pain. After 1 year of follow-up, the patient was symptom-free with no signs of recurrence. CONCLUSION: Surgical resection/curettage has higher chances of recurrence; therefore, usage of intralesional sclerotherapy agent polidocanol should be considered the treatment of choice in the lesions smaller than 5 cm.

Comparing pattern of musculoskeletal injuries prior to and during COVID-19 lockdown: A time-trend case study from a tertiary level Trauma Center of Northern India.

BACKGROUND AND AIMS: In the COVID-19 times, Indian sub-continent is struggling to contain the epidemic and trying to strengthen the existing health infrastructure, the national level lockdown has raised concerns about the pattern of injuries whether it has remained the same or has changed over this period. This is the first study to compare injury pattern during the two months lockdown period with the data of corresponding months from years 2016-2020. Also we compared the age- and sex-wise distribution patterns of these injuries for the above mentioned period. METHODS: This retrospective cross sectional study was conducted by the Department of Orthopaedics in Guru Gobind Singh Medical College and Hospital (GGSMCH) in Faridkot, Punjab. Secondary data for patient's age and sex, mode of injury, and site of injury was collected through record review for the period of two months (24th March to 24th May) for five consecutive years of 2016-2020. Descriptive analysis and Chi-square test was used to see the association between age and sex with mode and type of injury. RESULTS: The five year injury trends reflected that the proportion of injuries in 2016 was 16.5% (n = 48) of the total musculoskeletal injuries (n = 291) which rose to 23.4% (n = 68) in 2020. Majority of the patients were males (80%), and belonged to adult age group (69.4%) followed by elderly (17.2%), adolescents (8.6%) and children (4.8%). The proportion of road traffic accidents out of all injuries significantly reduced during the lock down period of two months in 2020 (p = 0.001). On the contrary, the proportion of injuries due to falls as well as unspecified assault increased significantly in 2020 as compared to previous years. CONCLUSIONS: The proportion of musculoskeletal injuries have increased from 2016-2020. Unspecified assault and all types of falls pushed the road traffic accidents to third position during the lockdown period in 2020 as compared to previous four years. Injury surveillance needs to be integrated in routine hospital system for precise information and for more efficient functioning.

Seropositivity Load in Orthopedic Surgery at Tertiary Care Hospitals in North India - An Observational Study.

BACKGROUND: Exposure to blood and blood-borne viruses is major concern for orthopedic surgeons and operation theater staff because of constant exposure to sharp instruments and bodily fluids. The objective of this study was to assess the burden of seropositive patients in the orthopedic department of tertiary care hospitals in North India. MATERIALS AND METHODS: This retrospective study was carried out in author's institute on indoor patients admitted from January 2015 to December 2017. A total of 8914 patients were included in the study and relevant clinical data were collected for seropositivity of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) in patients admitted in the orthopedic emergency department. These patients were routinely tested for seropositivity before undergoing various surgical procedures. RESULTS: A total of 8914 patients included in the study, out of which 7193 (80.7%) were male and 1721 (19.3%) were female. Out of total patients, 262 (2.9%) were found to be seropositive. Out of these patients, 31 (11.8%) were found to be positive for HIV, 190 (72.5%) for HCV, and 41(15.7%) for HBV. About 35.90% of patients with highest prevalence of seropositivity were truck drivers. CONCLUSION: HIV, HBsAg, and HCV are common in this region with HCV infection being the major concern in Punjab. Screening for viral markers will help in adequate pre-operative planning, timely precautions, and immediate post-exposure prophylaxis in case of contact with blood or body fluids of seropositive patients.

Wound healing of open fractures: comparison of vaccum assisted dressing versus traditonal dressing.

PURPOSE: For permanent wound coverage of compound fractures, the wound surface should have 100% granulation tissue without any discharge or necrotic slough. Negative pressure wound therapy (NPWT) is a well known modality in the management of open fractures, and post-operative wound problems. This study was conducted to compare the outcome of NPWT and traditional dressing in wound healing of open fractures. MATERIAL AND METHODS: A prospective study of 100 cases was conducted to compare the wound healing outcomes of open fracture following vacuum assisted closure (VAC) dressing (50 cases) and traditional wound dressing (50 cases). Patients included in the study underwent initial debridement to remove necrotic slough and tissue when indicated. Foam dressings were used to cover the wounds using aseptic conditions in the VAC group. Dressings were changed daily for patients in traditional dressing group using hydrogen peroxide, normal saline and povidone iodine in a sequential manner and every 3-4 days in the VAC dressing group. Patients were evaluated clinically for appearance of granulation tissue, duration of hospital stay and reduction in wound surface area using appropriate statistical methods. RESULT: There was a significant difference between the rate of wound healing in the group NPWT/VAC group compared to the traditional wound dressings group in terms of appearance of granulation tissue, reduction in wound surface area and duration of hospital stay. CONCLUSION: Vacuum assisted dressing is more effective than traditional wound dressing in wound healing of open fractures.

Traumatic Anterior Hip Dislocation in Elderly Male: An Atypical Case Report.

INTRODUCTION: Anterior dislocation of the hip joint is a rare presentation accounting for around 15% of all hip dislocations. Obturator (inferior) type traumatic anterior hip dislocation in adult is rare of all types of hip dislocation. Here, we described a case with same description. It can occur as a result of a high-energy trauma in circumstances such as a motor vehicle accident or a fall from a significant height. A delay in relocation of more than 6 h has been associated with a high risk of avascular necrosis of the femoral head. CASE REPORT: We reported the case of a 70-year-old man who suffered an anterior dislocation of his hip joint who was brought to the emergency room with a history of fall from the bicycle hit by a motorcyclist from his back. After examined clinically and radiologically, the patient was diagnosed with obturator type of anterior right hip dislocation. Closed reduction under short general anesthesia was planned. CONCLUSION: Inferior hip dislocations are very rarely seen injuries with severe high-energy trauma. The reduction must be done as soon as possible because it involves the functional prognosis of the hip by the risk of necrosis of the femoral head and subsequent osteoarthritis requiring long-term monitoring.

Correlation of acromial morphology in association with rotator cuff tear: a retrospective study.

PURPOSE: There have been many studies that have attempted to correlate radiographic acromial characteristics with rotator cuff tears, but the results have not been conclusive. Rotator cuff tears (RCT) are the common aetiology of shoulder pain. We assessed the association of rotator cuff tears with commonly used radiographic parameters of acromial morphology and their different radiographic characteristics. MATERIAL AND METHODS: From a retrospective study of 98 patients, we characterised acromial type and measured acromial thickness (AT), critical shoulder angle (CSA), lateral acromial angle (LAA), acromiohumeral distance (AHD), and acromion index (AI) on a 1.5T MRI, from 68 patients with partial or full-thickness supraspinatus tendon tears and 30 controls without tears. RESULTS: Out the 68 patients with rotator cuff tear, supraspinatus was the most commonly affected tendon, with 86% (59) cases showing abnormalities. The average age of the patients was 45.11 ± 21.45 years with male dominance (80%). Partial tears of rotator cuff were more common than complete tears. Forty-eight cases showed partial tears in supraspinatus as compared to 11 cases of complete tears. The acromial type did not show any correlation with any particular cuff lesion. The AT and AI of controls were significantly smaller than cuff-tear patients. The LAA of cuff-tear patients was significantly different from that of control patients. The impingement patients demonstrated a significantly greater acromial thickness, larger CSA, decreased AHD, and decreased LAA than their control counterparts. CONCLUSIONS: A higher prevalence of rotator cuff tears and impingement associated with low lateral acromial angle, larger CSA and decreased AHD was observed. AT and AI have a direct correlation with rotator cuff tear.

Spinal Tuberculosis - Directly Observed Treatment and Short Course or Daily Anti Tubercular Therapy -Are We Over Treating?

STUDY DESIGN: Prospective randomised control trial. PURPOSE: To compare the effectiveness of Directly Observed Treatment and Short Course (DOTS) and Daily Anti Tubercular Therapy (ATT) in spinal tuberculosis with no neurological deficit. OVERVIEW OF LITERATURE: Spinal tuberculosis is rampant in India with a major cause of morbidity and mortality. There is a lot of conflict regarding management with anti tubercular drugs, the regimen to be followed and the duration the drugs needed for complete cure. MATERIAL AND METHODS: This prospective study was conducted during the period of 2006 to 2009. Thirty cases of spinal tuberculosis were randomly divided equally into two groups of fifteen each and treated with DOTS and Daily ATT and compared at the end of follow up on clinical, radiological and Erythrocyte Sedimentation Rate values (ESR). RESULTS: Pain score on Visual Analogue Scale (VAS) exhibits that mean pain score was 5.93+_1.54 at start and 0.64+_1.01 at the end of follow up with 89.39% change with DOTS therapy whereas mean pain score was 7.08 +_1.61at start of therapy and 0.69+_0.95 at end of follow up with 91.73% change in patients treated with Daily ATT with p value >0.05 (not significant). The radiological recovery in patients with DOTS and Daily ATT have similar results after 1.5 years with p value > 0.05 showing that the radiological recovery by both treatment modalities are comparable. Mean change in ESR scores in DOTS therapy patients and patients on daily ATT were 74.57+_9.34% and 75.69+_9.38% change with p value >0.05 which was not significant. CONCLUSION: DOTS therapy is an effective means of management of spinal tuberculosis cases with no neurological involvement, however its efficacy in patients with neurological deficit is further to be evaluated.

Ipsilateral Radial Head Dislocation And Proximal One-Third Radial Shaft Fracture In An Adult: A Case Report.

INTRODUCTION: Dislocation of the radial head in adults is quite uncommon. A simultaneous dislocation of the radial head with a fracture of ipsilateral shaft radius without any other associated injury is even rare. CASE PRESENTATION: We are reporting a case of a young adult male who was operated for proximal one-third radial shaft fracture at some peripheral centre by Open Reduction and Internal Fixation (ORIF), but came to our centre on the fourth post-operative day with complaints of painful restricted movements of the elbow joint. On careful look at the postoperative x-ray, radial head was found to be dislocated. Radial head dislocation was reduced under general anesthesia and at 2 years follow up, patient fracture has fully united having good functional outcome. CONCLUSION: Traumatic dislocation of radial head with ipsilateral fracture shaft radius is a rare injury in adults and it is very important to timely diagnose it and manage it appropriately in order to give good functional outcome to the patient.

Resistant Non-union of Humerus After Intramedullary Nailing Treated with Locking Compression Plate with Bone Grafting With Nail in Situ and Shoulder Spica: A Case Report.

INTRODUCTION: Humerus non-union is a challenging situation for the surgeon and devastating and morbid situation for the patient. Surgical approach to the humerus is demanding because of the complex neurovascular anatomy and especially when previous surgeries have been attempted. CASE REPORT: We report a case of a young adult male who sustained a compound fracture of humerus shaft treated with intramedullary nailing followed by subsequent bone grafting and eventually landed up in non-union and was treated at our center by locking compression plate application with nail in situ with iliac crest autogenous bone graft followed by shoulder spica application. CONCLUSION: Although humerus nailing is a valid therapeutic option for humeral shaft fractures, compression plating is considered the gold standard and non-union secondary to failed interlocking nailing is a challenging situation.

Role of Computed Tomography (CT) in Localisation and Characterisation of Suprahyoid Neck Masses.

BACKGROUND: Suprahyoid neck lesions are difficult to assess only by means of clinical inspection and therefore imaging techniques are required to precisely evaluate suprahyoid neck spaces. The aim of this study was to evaluate the distinctive role of computed tomography in the assessment of anatomical source and pathological type of masses involving the suprahyoid neck spaces. MATERIAL/METHODS: Sixty patients presenting with suprahyoid neck masses underwent computed tomography of the neck. The CT findings were correlated with histopathological findings and a final diagnosis was made. RESULTS: Overall, male preponderance was seen except in the case of parotid space lesions where female predominance was seen. The most common aetiology was squamous cell carcinoma and the majority of cases (30%) were seen in patients aged 41-50 years. The majority of lesions were found in the pharyngeal mucosal space (n=16) with squamous cell carcinoma being the most common pathology. In the parotid space, pleomorphic adenoma and in the prestyloid parapharyngeal space, squamous cell carcinoma were the most common lesions, respectively. In the retropharyngeal space, an equal incidence of malignant and inflammatory aetiologies was seen. Abscesses were the most common lesions in the prevertebral space. The pleomorphic adenoma was the most common benign tumour and was also the second most common tumour in the suprahyoid neck spaces. CT had an excellent correlation with histopathological findings with sensitivity of 96.4%, specificity of 100%, positive predictive value of 100% and a negative predictive value of 91.67%. CONCLUSIONS: Computed tomography definitely has a major role to play in the evaluation of suprahyoid neck masses as it has an excellent correlation with post-operative histopathological diagnosis.

Neglected hip dislocation: an unusual presentation, its management and review of the literature.

Neglected traumatic posterior hip dislocation is not an uncommon condition seen in developing countries. Its treatment is fraught with great difficulties and controversies. Here we present a 31-year-old female patient presented to our hospital 2 years after sustaining an accident. She had gone through multiple treatments for her dislocated hip without any success. After arrival to our hospital, patient managed by constrained total hip replacement (THR). Her Harris hip score improved from 48 (preoperative) to 81 (postoperative). On follow-up she had a good range of movement of the hip with no pain, deformity and limb length discrepancy. Constrained THR provides promising results in neglected hip dislocation.

Giant-cell tumour of proximal radius in a 50-year-old female with wrist drop: a rare case report.

Giant-cell tumour is a locally aggressive tumour of long bones of epiphyseal region commonly occurring in adults aged 20-40 years. Most common location is distal femur, proximal tibia, and distal radius. Different treatment options being used are curettage with bone graft or bone cement, resection with arthrodesis, reconstruction, radiation, and chemotherapy. We are reporting a case of giant-cell tumour of right proximal radius in a 50-year-old female with posterior interosseous nerve palsy. It is very rare, and only four cases have been reported in the literature. It was treated by wide margin resection with fibular grafting, titanium elastic nail system along with cancellous bone graft reconstruction.

Giant cell tumour of clavicle: Occurrence of a common tumour in a rare location.

INTRODUCTION: The clavicle is rare site of bone tumours. Majority of the tumours of clavicle are malignant and are often misdiagnosed due to low index of suspicion. The oncological patterns of clavicle resemble that of flat bones. CASE PRESENTATION: A 60year old man presented to our centre with pain and swelling over lateral end of left clavicle. After thorough investigation a provisional diagnosis of giant cell tumor was made which was treated with partial claviculectomy. At one year follow up, there was no shoulder disability or any incidence of recurrence. CONCLUSION: Since majority of clavicular tumors are malignant so any selling occurring in this area should be seen with high index of suspicion and should be investigated thoroughly.

Loose body as an obstacle for posterolateral arthroscopic portal formation in the knee joint.

In this report, we present a case with difficult arthroscopic posterolateral portal formation due to loose body located in posterior compartment. These loose bodies are responsible for pain, decreased range of motion and cartilage damage in the knee joint. By making the posterior trans-septal portal prior, posterolateral portal could be made without difficulty completing the planned arthroscopic procedure.