Tuberculous Dactylitis in Adult - A Case Report and Review of Literature.

INTRODUCTION: Tubercular dactylitis is an uncommon form of musculoskeletal tuberculosis (TB), especially after the age of 5 years without any risk factors. CASE REPORT: A case of 49-year-old male presented with pain, swelling, and discharging sinus of proximal phalanx of third digit of the right hand with no constitutional symptoms for 2 years, with multiple failed treatment in form of antibiotic therapy. There were no risk factors such as immunodeficiency or any co-morbidities. The plain radiograph was suggestive of increased bone density with mild periosteal reaction; magnetic resonance imaging was suggestive of tubercular osteomyelitis. A biopsy was performed, the gene expert of the sample revealed TB with no drug resistance. The patient was managed with anti-tubercular drugs with complete resolution of clinical and radiological symptoms at 1-year follow-up. CONCLUSION: TB should be considered a differential in patients with chronic soft-tissue or skeletal lesions even in the absence of the usual risk factors because with treatment it still carries a good prognosis.

Functional and radiological outcome in management of compound tibia diaphyseal fracture with AO monolateral fixator versus Limb reconstruction system.

INTRODUCTION: Tibia being the most common fractured long bone represents 36.7% of all long bone fractures in adults with open fracture comprises 23.5% of all tibial shaft fracture. The lack of the muscular covering over anteromedial aspect of the tibia and poor blood supply predispose open tibial fractures to a 10-20 fold increased risk of developing infection than open fracture in any other anatomical areas and a nonunion rate as high as 28% has been reported in the literature. METHODS: We did a prospective study at our institute from 2014-2016 comprising 40 patients with compound tibia diaphyseal fracture managed with AO monolateral external fixator (Group 1) (n = 20) and Limb reconstruction system (Group 2) (n = 20) as primary and definitive tool. Final assessment for bone results and functional results were done using ASAMI (Association of the study and application of the method of Ilizarov) score. RESULTS: In our study bony outcome by ASAMI score shows 6 (30%) patients had Excellent, 5 (25%) patients had Good and 9 (45%) had Poor bony outcome from Group I. In group II, 12 (60%) patients had Excellent, 4 (20%) patients had Good, 2 (10%) patients had Fair, and 2 (10%) had Poor bony outcome. The functional outcome by ASAMI score shows 3 (15%) patients had Excellent, 8 (40%) patients had Good, 5 (25%) patients had Fair, 3 (15%) had Poor bony outcome from Group I. In group II, 9 (45%) patients had Excellent, 7 (35%) patients had Good, 2 (10%) patients had Fair, and 2 (10%) had Poor functional outcome. CONCLUSION: Limb reconstruction system (LRS) offers several advantage over AO monolateral external fixator such as ease of application, versatility, stronger fixation, less fixator related complications, early weight bearing and early bony union for management of compound tibia diaphyseal fracture as primary and definitive tool.