Minimizing radiation and incision in minimally invasive percutaneous plate osteosynthesis (MIPPO) of distal tibial fractures.

The traditional approach for plating of distal tibia had many problems. Minimally invasive percutaneous plate osteosynthesis for periarticular fractures are considered ideal these days with the availability of locking compression plate. However, this procedure demands radiation exposure. Indirect reduction, percutaneous plate positioning, and drill guide insertion all may require abundant radiation exposure. Minimizing radiation can still be done at the cost of extended skin incision. But we describe our technique of minimizing radiation and incision in minimally invasive percutaneous plate osteosynthesis in distal tibial fractures.

Calcaneal tuberosity avulsion fracture: an unusual variant.

Calcaneal tuberosity fractures involve the posterosuperior aspect of the calcaneus and may involve the insertion of the Achilles tendon. In this report, we describe an unusual presentation of a calcaneal avulsion fracture involving 2 displaced fragments in a male patient who did not seek treatment for 1 month after the original injury. The larger fragment contained the insertion of the Achilles tendon, and tendon lengthening was required in addition to fixation of the fracture fragments with cannulated lag screws and washers. After reduction and healing, the patient recovered fully without clinical weakness of the triceps surae.

The extremes in orthopaedics! Whom to blame?

Traditional medicines especially the herbal paste is routinely prescribed by the herb sellers. The unsupervised combinations and preparations are easily available in our part of world. The demand and supply of such irrational combination is only based on the principle that anything natural is safe. Drugs and preparations made by the people who lack the scientific knowledge of traditional herbal medicines adversely affect the consumer. We put forward few complications that resulted after herbal paste application in those who already had visited the specialist but opted the easily available unsupervised herbal preparations.

Modified tension band for displaced type 2 lateral end clavicle fractures.

PURPOSE: Displaced type 2 lateral end clavicle fractures have a tendency to delayed union or non-union. Various methods of stabilisation of the displaced lateral end fractures are described. The increasing use of implants to fix such fractures also necessitates extensive dissection for implant retrieval. Adequate reduction and minimal tissue trauma during implant placement and removal would be ideal modalities for fixation of such fractures. METHODS: All displaced type 2 lateral end clavicle fractures fulfilling our inclusion criteria were reduced with a small anterosuperior incision. Anteroposterior drill holes were made in both the fragments and a nonabsorabable polyester suture was passed through. The fracture was reduced and fixed with transacromial smooth Kirshner wires. The suture was tied with the knot superiorly in a figure-eight manner. The arm was supported in an arm pouch for six weeks. The Kirshner wire was routinely removed after six weeks in an out-patient department. Clinico-radiological outcome was studied at six weeks, and monthly intervals thereafter until union. RESULTS: All 16 fractures united. The mean average age of patients was 36.25 years with a SD of 11.35. There was no loss of reduction even after removal of Kirshner wires at six weeks. The mean average time of union was 10.75 weeks with a SD of 3.92. All patients regained near normal range of motion, and the mean average constant score at the end of one year was 98.37 with a SD of 2.87. All patients returned to preinjury level by the one-year follow-up. The range of motion remained the same in those who were followed up in successive years. Skin impingement with bent Kirshner wires were noted in four cases. Kirshner wires backed out in one case before six weeks but there was no loss of reduction. Infection and Kirshner wire breakage were not noted in our series. CONCLUSION: The clinico-radiological outcomes with our modified tension band fixation for displaced type 2 lateral end clavicle fractures were encouraging and comparable with earlier studies.

It is a glomus tumor! Not at all a paronychia.

We report an interesting case of chronic obscure pain over the toe tip. This earlier was misdiagnosed as chronic paronychia and operated twice. Obvious clinical appearance and high index of suspicion rendered it a glomus tumor on histopathology. We cite here a simple technique of advancement of flap for covering scarred defects created due to nail bed excision.