Kaplan's Lesion: A Case Report On The Complex Dislocation Of The Index Finger In A Weightlifter.

Background: Complex Dislocation of the metacarpophalangeal joint of the hand is a rare and unusual injury. These are also called as Kaplan's Lesion. They are divided into complex/irreducible and simple/reducible dislocation. Two approaches exist regarding their surgical intervention. We present a case of a 36-year-old weightlifter who presented to us with this uncommon entity and who was successfully treated with a dorsal approach. This case is presented to highlight the occurrence of this dislocation along with a brief discussion on its etiopathogenesis and management.

Segmental Fracture Of The Clavicle - Unconventional Fracture Pattern Of A Conventionally Fractured Bone: A Case Report With Review Of Literature.

Though clavicle fractures are routinely seen in clinical practice, rarely do we encounter segmental fractures. This unusual pattern of fracture in clavicle has been seldom reported previously. We present a case of segmental fracture of the left clavicle fracture in a 64-year-old who was treated successfully. A detailed literature review has been presented too.

Comparison of anterior cruciate ligament volume after anatomic double-bundle anterior cruciate ligament reconstruction.

BACKGROUD: To determine whether anatomic double-bundle anterior cruciate ligament reconstruction (DB-ACLR) can restore the native ACL volume, and whether the volume change after reconstruction affects clinical outcomes and re-rupture rates following the contemporary techniques. METHODS: Eighty patients undergoing anatomic DB-ACLR using transportal or outside-in technique were prospectively evaluated with magnetic resonance imaging (MRI) before and after surgery. The ACL volumes were determined from 3-D models constructed by applying reverse engineering software. In all participants, measured reconstructed ACL volume were compared with the ACL on the opposite uninjured side. Participants were divided into two groups according to the volume of reconstructed graft; larger volume than native ACL of contra-lateral side (Group 1) or smaller (Group 2). RESULTS: The mean ACL volume on the reconstructed side (1726.5mm3, 982.1 - 2733.8) was significantly smaller than that on the uninjured opposite side (1857.6mm3, 958.2 - 2871.5) (P<0.001). A total of 31 patients in Group 1 and 49 in Group 2 showed no significant difference of improvement in the clinical outcome scales at the postoperative two-year follow-up (Lysholm knee score, P=0.830, Tegner activity score, P=0.848). Four patients with ACL re-rupture during the two-year follow-up after reconstruction had smaller reconstructed ACL volumes than native ligament on the opposite site. CONCLUSION: Anatomic DB-ACLR technique restored the graft volume rather smaller than the volume of the native ACL. Based on the volumetric consideration, graft reconstructed by anatomic DB-ACLR might have increased probability of re-rupture due to its smaller volume related to native ACL on the contralateral side.

Mucoid Degeneration of Posterior Cruciate Ligament with Secondary Impingement of Anterior Cruciate Ligament: A Rare Case Report.

INTRODUCTION: Mucoid degeneration of cruciate ligament is well known entity, but symptomatic lesions are rare. It is even rarer to find a symptomatic posterior cruciate ligament mucoid degeneration than anterior cruciate ligament. CASE REPORT: A 65-years-old female presented to our hospital complaining of pain in right knee joint on terminal extension since 6 months. On clinical examination, there was a flexion deformity of 5 degree and a further flexion of 150 degree with mild pain exacerbated by extension. MRI of the right knee joint showed a diffusely thickened posterior cruciate ligament (PCL) with increased intra ligamentous signal intensity on T2-weighted images. The arthroscopic findings of grossly thickened PCL with a yellowish hue are characteristic and the PCL was filled with a yellowish substance. We excised the yellowish substance from the PCL as precisely as possible not to damage the remaining PCL fiber (Limited Debulking). We did notchplasty of lateral wall and roof to accommodate the Anterior Cruciate Ligament and avoid impingement. CONCLUSION: Posterior cruciate ligament may enlarge significantly and may push the Anterior Cruciate Ligament in the notch and may lead to the anterior cruciate ligament (ACL) impingement symptoms. Partial Debulking of Posterior Cruciate Ligament and notchplasty is effective treatment with immediate postoperative pain relief and good functional results.

Scapulothoracic dissociation: a rare variant: a case report.

ABSTRACT: Scapulothoracic dissociation is a rare injury involving separation of scapula from the thorax along with the upper extremity. Majority of the patients have concomitant neurovascular injury and the prognosis is uniformly poor in such cases. We present a case of scapulothoracic dissociation with comminuted fracture of scapula and acromioclavicular joint disruption without neurovascular deficit. There were associated avulsion fractures of the spinous processes of vertebrae (T3-T5). Such presentation is rare in an already rare scapulothoracic dissociation injury. A discussion regarding the probable mechanism of injury, management and prognosis is presented. KEY WORDS: scapulothoracic dissociation, scapula fracture, brachial plexus injury, vascular injury.

An Unusual Variant of Pipkin's Fracture Dislocation of Hip: A Case Report.

INTRODUCTION: Injuries of the hip joint from pure hip dislocations to fracture dislocations have been described and classified by various authors. These descriptions do not include fracture dislocation of hip associated with fracture of the greater trochanter. CASE REPORT: We report an unusual case of fracture dislocation of hip in which posterior dislocation of hip was associated with fracture of acetabulum, femoral head, femoral neck, greater trochanter and ipsilateral shaft of tibia. The fracture dislocation was managed with open reduction and internal fixation. Such fracture dislocation has not been reported in literature to the best of our knowledge. CONCLUSION: We believe that fracture dislocations associate with fractures of greater trochanter should be included in current classification systems of fracture dislocations of hip.