Functional and radiological outcomes following craniovertebral junction surgery.

Background: Craniovertebral junction (CVJ) pathologies include atlantoaxial instability/deformities resulting in myelopathy, respiratory failure, and even death. Here, we describe the indications, preoperative planning, and intra-operative/postoperative complications following surgical management of CVJ anomalies. Methods: A prospective analysis of 34 patients with CVJ pathology was evaluated between 2015 and 2022. Their various etiologies included atlantoaxial instability, trauma, tuberculosis, Down's syndrome, Morquio syndrome, os odontoideum, and atlantoaxial abnormalities. Clinical outcomes were assessed using the American spinal injury association (ASIA) impairment scale score and Benzel's modified Japanese Orthopedic Association (mJOA) score. Surgical assessments included length of hospital stay, operative time, blood loss, and intraoperative postoperative complications. Radiological parameters included fusion (i.e., implant loosening/implant failure), preoperative/ postoperative atlanto-dens interval (ADI), clivus canal angle (CCA), and space available for cord (SAC). Results: Five patients were managed conservatively, while 29 patients had surgery. Operations included occipitocervical fusion (14 patients), C1-2 fusion (10 patients), C1-2 transarticular screw fixation (four patients), and one patient underwent anterior corpectomy decompression/fusion. Seven patients had vertebral artery anomalies, and 13 patients had atlantoaxial abnormalities. At the final follow-up, atlantoaxial instability (i.e., mean preoperative ADI of 6.6 ± 2.3 mm) was restored to 4.2 ± 0.6 mm, significant cord compression (i.e., with mean SAC of 8.3 ± 2.9 mm) was relieved to 17.2 ± 1.6 mm, and the mean preoperative CCA (i.e., 130.2 ± 15.3) was improved to 143.3 ± 8.3°. There was also a statistically significant improvement in the ASIA scale and mJOA score. Conclusion: Surgical management of CVJ abnormalities requires expertise and meticulous planning to avoid devastating complications such as wound dehiscence and catastrophic vertebral artery injury.

Delayed Presenting Radial Neck Epiphysiolysis Managed with Open Reduction and Internal Fixation with K Wires: A Case Report and Review of Literature.

Introduction: Radial neck fractures in the pediatric age group account for 1% of all fractures in children. A completely displaced fracture with an angle >30° requires operative intervention. Case Report: An 11-year-old boy with Judet IVb radial neck epiphysiolysis 4 weeks old was managed by open reduction and internal fixation with K-wires. Conclusion: Anatomic reduction must be achieved in radial neck fractures to restore their function. Open reduction and internal fixation with K wires must be considered in patients with >30° angle of inclination, neglected fracture, and failure of closed reduction.

Combined Greater and Lesser Tuberosity Fracture of Proximal Humerus with Intact Humeral Head and Shaft - A Case Report.

Introduction: Combined fracture of greater and lesser tuberosity is an extremely rare injury. Such fracture pattern has not been described in the Neer's, AO Muller, and Jakob's classification system. Case Presentation: We report a unique fracture pattern consisting of combined greater and lesser tuberosity of the proximal humerus (PH) with intact humeral head and shaft in a 32-year-old female. Routine radiographs and computed tomography scan with three-dimensional reconstruction were advised for better understanding of the fracture pattern, later managed by open reduction and fixation with PH locking plate. The patient has excellent clinical, radiological, and functional outcome at the end of 2 years follow-up. Conclusion: This is one among the few case reports highlighting this unique variant of PH fracture, not much has been described in the literature about this injury. Anatomic reconstruction of the fractured tuberosities combined with stable construct by PH locking plate facilitates optimum bone healing and aggressive shoulder rehabilitation.

Case Report of Osteopoikilosis: Sparse Cause of Bone Pain and Mimicker of Metastasis on Radiographs.

INTRODUCTION: Osteopoikilosis (OPK) is an extremely rare benign condition with autosomal dominant inheritance characterized by sclerosing bony dysplasia with multiple benign enostoses. It is characterized by symmetrically distributed numerous, small, well-defined, homogenous circular or ovoid radiodensities clustered in epiphysis and metaphysis of long bones in periarticular region, and in some cases diffusely present throughout axial and appendicular skeleton. There is no age and sex predilection; age at the time of diagnosis ranges from 15 to 60 years. It is usually asymptomatic but rarely in 15-20% patients slight juxta-articular pain and joint effusions can be seen. These are incidental radiological findings in most of the cases, also sometimes confused as bony metastasis. There are no specific clinical features; histological features are similar to bony island and it may be associated with connective tissue disorders, synovial osteochondromatosis, and a rare bone condition melorheostosis. CASE REPORT: We present a case of OPK in a 32-year-old male with bilateral hip and shoulder pain, based on the available literature and focus on clinical significance, due to its mimicking capability of other more severe conditions such as bone metastases and an extremely uncommon cause of bone pain. CONCLUSION: OPK is an uncommon hereditary condition involving juxta-articular region of long bones with intricate etiopathogenesis, often discovered incidentally on radiographs. It is characterized by multiple, symmetrical ovoid radiodensities, and in most instances confused with osteoblastic metastasis. This concludes that OPK is a condition that should be kept in mind to avoid misdiagnosis, in particular osteoblastic metastasis and undue distress to both the patients and doctors.

Primary Hypothyroidism Presenting as Slipped Capital Femoral Epiphysis in an Adult Patient : A Case Report and Review of Literature.

Introduction: Slipped capital femoral epiphysis (SCFE) is rare in adults and is often associated with endocrine pathology. Case Report: We report a case of a 21-year-old male presenting with an acute on chronic left hip SCFE who was diagnosed with primary hypothyroidism on the investigation. The patient was treated for hypothyroidism and positional reduction with in-situ fixation was carried out with two cannulated cancellous screws for the SCFE. At the latest follow-up of 30 months, patient remains asymptomatic, euthyroid, with a nearly full range of motion in the hips, significant functional improvement, fused physis on radiographs, and no signs of avascular necrosis. Conclusion: SCFE is a potentially devastating but avoidable complication in children/adults with the endocrine disorder and there may be a possible role for a screening pelvic radiograph in detecting this condition earlier.