Is Anterior Cervical Discectomy and Fusion Sufficient for Neglected Unstable Hangman's Fracture? A Retrospective Case Series of Five Patients.

Introduction: This study investigates the outcomes of treating neglected unstable Hangman's fractures through a single-stage Anterior Cervical Discectomy and Fusion (ACDF) procedure with tricortical iliac crest bone grafts. Methods: Five patients with neglected unstable Hangman's fractures, treated at our institution between March 2012 and March 2017, underwent C2-C3 ACDF. Functional outcomes were assessed using the Visual Analog Scale (VAS) score and Neck Disability Index (NDI), and neurological evaluation was done using the American Spinal Injury Association (ASIA) grading system. The radiological assessment included serial plain radiographs and a computed tomography scan at a 12-month follow-up. Results: Postoperatively, C2-C3 angulation improved significantly, decreasing from 15° to 4.4°, and sagittal translation improved from 4.2 mm to 2 mm. The VAS score improved from 6.4 to 1.4 at 24 months postsurgery. Concurrently, NDI decreased from 70.4% to 14.8%. Fusion occurred in an average of 5.6 months. Neurologically, one patient improved from ASIA grade D to grade E, while the other four retained their grade E status. Conclusions: A single-stage ACDF with autologous iliac crest bone grafts is an effective surgical option for neglected type II/IIA Hangman's fractures, yielding satisfactory functional and radiological outcomes. This technique significantly corrects anterior translation and angulation, even in neglected cases, with the aid of intraoperative skull traction and plate reduction.

Subacute Bacterial Infection Mimicking a Slipped Capital Femoral Epiphysis in an Obese Adolescent Male - A Case Report and Review of Literature.

Introduction: Atypical and subacute presentations of pediatric bacterial septic arthritis are difficult to diagnose due to lack of systemic manifestations and inadequate laboratory data. Furthermore, they may mimic certain well-documented pediatric disorders to confound the diagnosis and management. Case Report: The authors present a case of an adolescent obese male with features suggestive of a slipped capital femoral epiphysis (SCFE). Further investigations revealed bacterial septic arthritis which may have contributed to the slip. He was treated with an initial debridement followed by a definitive pelvic support osteotomy (PSO) with a compensatory distal femoral varus osteotomy. At 12 months, he had a satisfactory clinical and radiological outcome. Conclusion: Clinicians should have a high degree of suspicion for infection in patients presenting with atypical clinical or radiological signs of SCFE. A thorough investigation in such cases is a must, to aid in correct management. PSO is an effective salvage procedure in adolescents with septic hip sequelae.

Broad Arm Sling vs Figure of 8 Bandage: The Better Choice in Conservative Management of Middle Third Clavicle Fractures in Indian Population.

Background: A prospective randomised trial was conducted to compare the results of conservative management of middle-third clavicular fracture using the figure of 8 bandage and broad-arm sling. Methods: 296 patients with middle-third clavicle fracture were included in the study conducted between March 2017 and January 2020. 152 patients were managed with figure of 8 bandage and 144 patients were managed with a broad arm sling. Results were evaluated based on clinical, radiological and functional outcomes. Visual analogue scale (VAS) for pain was used to evaluate the clinical outcomes, whereas radiological outcomes were assessed with non-union, malunion, clavicle shortening and time to union. Disability of Arm, Shoulder and Hand score (DASH), Constant score and Nottingham Clavicle Score were used to assess functional outcomes. Results: The broad arm sling group showed a significantly better VAS score in the first 4 weeks. DASH score was significantly superior in the broad arm sling group in the initial 4 weeks, but with similar outcome thereafter. Constant scores showed a good outcome for both groups at the final follow-up, whereas the Nottingham Clavicle Score was significantly superior in the broad arm sling group at the 2 year follow-up. A satisfactory outcome was achieved with respect to the radiological parameters, without any significant difference between the 2 groups. Incidence of malunion was significantly higher in figure of 8 bandage group. Conclusions: Broad-arm sling proves to be a better modality of management for middle-third clavicular fractures in terms of ease of application, pain relief, incidence of malunion, and functional outcomes.

Extraction of Broken Tibial Interlock Nail with a Retrograde Hooked Guide Wire: A Novel Surgical Technique.

INTRODUCTION: Removal of a distal piece of a broken nail often possesses a technical challenge. Several methods have been described in the past to extract a distal piece by using specialized instruments like such as hooks, olive wires, and talwalkar radial square nail etc. It is difficult to extract a distal piece from a proximal incision site and often fracture or the nonunion site has to be opened. In this article, we describe a novel technique to extract a distal piece of broken intramedullary tibia nail by retrograde manner using a guide wire with a "'U"' shaped bend at its distal end to hook the tip of a distal piece of broken nail and help in extraction. CASE REPORT: A 43- year-s old male presented with complain of pain in left leg since 3 months. Patient had sustained left- sided compound Grade 2 tibia shaft fracture in a road traffic accident 4 years back. He was operated with tibia interlock nail followed by skin grafting for wound coverage in a different facility. On clinical examination: There was tenderness around distal tibia, no swelling, no coronal or sagittal plane fracture mobility, and no crepitus or loss of transmitted movements which suggested fracture union clinically. Radiographs confirmed complete union of tibia shaft fracture with hypertrophic nonunion of distal fibula with broken intramedullary nail IMN at the level of proximal most screw hole of distal locking holes with both distal locking screws broken. As fracture was united, we planned for removal of broken nail without opening fracture site. For extraction for distal tibial broken nail part, we used this new Retrograde Hooked Guide Wire technique. CONCLUSION: It is a simple, cost effective, minimally invasive procedure with minimal blood loss and decrease time of surgery that can be used before attempting more invasive extraction methods and hence should be included in standard procedures for extraction.

Cervical corpectomy in delayed presentation of irreducible cervical dislocation: experience with eight cases.

OBJECTIVE: To describe a single-staged procedure for the management of neglected subaxial cervical spine injuries. METHODS: Between January 2012 and December 2014, 12 patients presented to us with healed cervical sub axial dislocations. The deformities could not be reduced using skull traction. Eight were operated with anterior cervical corpectomy. American spinal injury Association (ASIA) grade, Neck Disability index (NDI), and Visual analog scale (VAS) score were recorded throughout the patient course and CT was done at 12 months for assessment of fusion. RESULTS: Four patients improved from ASIA C to ASIA D, two patients improved from ASIA B to ASIA E, one patient improved from ASIA D to ASIA E and one patient remained static at ASIA B. All patients except one showed evidence of fusion on CT scan at 12 months. NDI improved from preoperative range (18-32, mean 25) to postoperative range (8-16 mean, 11.25), VAS from preoperative range (3-6, mean 4.25) to postoperative range (1-3, mean 1.75). CONCLUSIONS: Single-stage in situ fixation does not disrupt ongoing natural healing and has good clinical and radiological outcomes.

Solitary Osteochondroma of Posterior Elements of the Spine: A Rare Case Report.

INTRODUCTION: Osteochondromas are the most common benign tumors of the bone accounting for 35% to 40% of all benign bone tumors. They present in two distinct clinical forms - solitary osteochondroma and multiple osteochondromas. Solitary osteochondroma accounts for 85% of all osteochondroma and is commonly seen in childhood and adolescence. They more frequently affect the appendicular skeleton and are rarely found in spine. Biopsy and imaging help in diagnosis and en bloc resection is the treatment of choice in symptomatic patients. CASE REPORT: We present a case of a 6-year-old girl who presented with swelling over back for 4 years. Radiological evaluation and biopsy were done and the patient was diagnosed with osteochondroma of the left lamina and spinous process of dorsal 12th vertebral body which was managed with extraperiosteal en bloc excision. CONCLUSION: Osteochondroma of the lamina and spinous process of vertebrae is rare and can be effectively treated by extraperiosteal en bloc resection and has a good post-operative outcome.

Scapholunate Dissociation with Ulnar Impaction: A Case with Review of Literature.

INTRODUCTION: Scapholunate dissociation and ulnar impaction syndrome are common causes of wrist pain but often missed on initial clinical and radiological evaluation; hence, diagnosis is delayed. Management is challenging as there is diversity in surgical option. There is not a single case in literature described for both scapholunate dissociation and ulnar impaction syndrome treated in one setting. We are presenting a case of both ulnar impaction syndrome and scapholunate dissociation treated surgically in one setting with good functional outcome. CASE REPORT: A 30-year-old male with chronic scapholunate dissociation and ulnar impaction syndrome treated with modified Brunelli technique for scapholunate dissociation and extra-articular ulnar shortening osteotomy for ulnar impaction syndrome in one setting with good functional outcome. CONCLUSION: In cases with scapholunate dissociation and ulnar impaction syndrome, treatment should be directed toward both. When done with careful pre-operative evaluation and planning in one setting, can yield favorable results.