Fracture of an aberrant os styloideum: a unique case report.

Several accessory bones can be found around the wrist, which may pose a diagnostic challenge. Hereby, we report a unique case of a traumatic fracture of an aberrant os styloideum in a 66-year-old male. The patient presented with a swollen dominant right hand and a hematoma on its anterior and posterior aspects, as a result of a fall on an outstretched hand. The diagnosis was based on a CT scan, which showed a fractured accessory bone between the distal portion of the capitate bone and the base of the third metacarpus. Due to its typical location, the ossicle was identified as os styloideum. The patient was treated conservatively and the symptoms subsided on a short forearm cast after 2 weeks. At a 12-month follow-up, no other episodes were declared. Strong anatomical knowledge and sharing of such cases is essential for proper diagnosis and treatment of this very rare condition.

EFFECT OF LOCALLY DELIVERED BISPHOSPHONATES ON ALVEOLAR BONE: A SYSTEMATIC REVIEW AND META-ANALYSIS.

OBJECTIVE: To assess the effect of locally applied bisphosphonate drugs on alveolar bone defects caused by periodontitis and marginal bone level after placement of dental implants. MATERIALS AND METHODS: Three electronic databases (PubMed/MEDLINE, Web of Science, and Scopus) were searched from January 2010 until May 2020 for randomized controlled clinical trials reporting the effect of locally delivered bisphosphonates on alveolar bone. The risk of bias was assessed and quantitative synthesis was conducted with both fixed and random-effects meta-analyses by using RevMan version 5.3. Subgroup and sensitivity analyses were performed whenever required. RESULTS: Among the included studies, the effect of locally delivered bisphosphonates on alveolar bone regeneration in periodontitis was measured by 15 studies and on marginal bone level after installation of dental implants by three studies. Bisphosphonates showed significantly higher intrabony defect depth reduction than placebo/control in vertical bone defects treated with non-surgical approach (MD = 1.69mm; 95% CI, 1.32-2.05; P < 0.00001; I²=93%) or surgical approach (MD = 0.70mm; 95% CI, 0.23-1.16; P = 0.003; I²â€¯= 78%) and in class II furcation defects treated with non-surgical approach (MD = 1.61mm; 95% CI, 1.15-2.07; P < 0.00001; I²â€¯= 99%) or surgical approach (MD = 0.24mm; 95% CI, 0.05-0.42; P = 0.01; I²â€¯= 62%). Clinical attachment loss increased by 1.39mm (95% CI, 0.92-1.85; P < 0.01; I²=93%) and 1mm (95% CI, 0.75-1.26; P < 0.001; I²â€¯= 0%) in vertical bone defects after non-surgical and surgical treatments, respectively, and by 1.95mm (95% CI, 1.37-2.53; P < 0.00001; I²â€¯= 96%) and 0.84mm (95% CI, 0.58-1.10; P < 0.01, I²â€¯= 47%) after non-surgical and surgical treatment in class II furcation defects, respectively. Lesser marginal bone loss during pre-loading (MD = -0.18 mm; 95% CI, -0.24- -0.12; P<0.00001; I²=0%) and 1-year post-loading (MD = -0.33 mm; 95% CI, -0.59-0.07; P = 0.01; I²â€¯= 0%) periods was observed when bisphosphonate coated dental implants were used. CONCLUSION: Locally delivered bisphosphonates induce bone regeneration in periodontal defects and decrease the rate of marginal bone loss after dental implant therapy.

Posterior Interosseous Nerve Injury After a Fracture of Ulna and Radius: A Case Report.

The aim of this study is present a case of isolated injury to the branch of posterior interosseous nerve. A 27-year-old gentleman was presented with an inability to extend the ulnar three fingers of his left hand after sustaining closed fractures of the left ulna and radius after a motorbicycle accident. The patient recovered partially over the course of 3 months but continues to be functionally compromised by the persistent radial deviation of his left wrist and incomplete mobility of the ulnar 3 fingers upon extension. On second exploration, we found the denervated muscles supplied by the recurrent branch of posterior interosseous nerve. Tendon transfer was performed with good clinical outcome at 12 months. This is a rare case of isolated injury to branch of posterior interosseous nerve. This generates the suspicion of possibility of PIN or its branch injury even in closed fractures of the forearm. In addition, this highlights the importance of interval generation during the fracture fixation to prevent the possibility of iatrogenic injury to branches of PIN.

Outcomes for late presenting lateral condyle fractures of the humerus in children: A case series.

BACKGROUND: Fractures of lateral condyle of humerus are very common in children. While the management of acute displaced and rotated lateral condyle fracture of humerus with early open reduction and internal fixation yields good results, the results of late treatment are less clear. We conducted this study to analyse the results of operative treatment of late presenting fractures and see if it is dependent on the patient's age, fracture type, or the time until treatment. MATERIALS & METHODS: A retrospective study of 40 patients with a symptomatic lateral condyle fracture beyond 3 weeks, who underwent open reduction and internal fixation between January 2002 and December 2011, was conducted. Fractures were described as per Jakob's classification. Patients radiographs were evaluated, and clinical evaluation was done with Mayo elbow scoring and Dhillon scoring system as well as range of motion. RESULTS: Thirty-nine fractures united with average time of 7.8 weeks except one who had previous surgery done for the fracture and developed avascular necrosis. The average Mayo score was 93 and average Dhillon score was 7.6. The average improvement in the arc of motion was 40.32° (77.3-117.6°). Younger age and shorter time to operation had a statistically significant but weak effect on outcomes. CONCLUSIONS: Functional outcomes of fractures managed surgically revealed good results, even in the fractures presenting more than 12 weeks after injury. Families with children presenting late should be offered ORIF to improve function and decrease symptoms.

Outline of Hand and Wrist Injuries Presenting to an Emergency of a Tertiary Care Centre in Nepal.

BACKGROUND: Hand and wrist injuries are getting commoner with increasing incidence of injuries and accidents. This study aims to identify the prevalence and pattern of hand and wrist injuries presenting to the emergency department of a tertiary care center of Nepal. METHODS: The study was conducted through review of electronic data of the patient in the emergency department database for the period of 1 Nov 2005 till 31 Oct 2015.Data was extracted in Microsoft Excel 2007 andanalyzed to measure incidence and pattern of the hand and wrist injuries. RESULTS: There were2899 number of patients with hand and wrist injuries during the period. Most were males (80%) and commonest age group was 20-29 years. Majority of the injuries were due to road traffic accident (n=786, 27.11%), fall injury (n=696, 24.09%), cut injury with sharps (n=404, 13.94%) and machinery injury (n=319, 11%). The commonest presenting injuries were hand fractures (n=1820, 62.8%) followed by distal radius fracture (n=613, 21.1%), crush injury of hand (n=409, 14.1%), and cut injury (n= 406, 14%). Almost half, 48.84 % cases were discharged from the emergency department with preliminary or definitive management. CONCLUSIONS: Hand and wrist injuries constitute a substantial number of casesseen and managed in the emergency department.Therefore, public health measures should be taken to reduce RTI, fall injury and occupational accidents. Andit is of paramount importance that emergency care giver attends these injuries properly and timely and establishes a good referral system as and when necessary.