Chronic Unreduced Anterior Shoulder Dislocation Managed by Latarjet Procedure: A Prospective Study.

The shoulder joint is the most common joint to undergo dislocation, with the anterior subtype being the most common. The most accepted definition of chronic dislocation is a shoulder joint that has remained dislocated for a minimum of three weeks. Due to rare presentation, there is a lack of consensus among surgeons regarding the optimal management option of chronic shoulder dislocation. The goal of this prospective study was to assess the efficacy of open reduction with Latarjet procedure in the management of chronic unreduced shoulder dislocation. A total of seven patients were included in this study. Five patients were males and two were females. The study was conducted in a single tertiary care centre between July 2015 and May 2018. All patients were managed by open reduction with the Latarjet procedure. The capsulolabral structures were repaired in all the cases. The post-operative functional outcome was assessed by shoulder range, Rowe score, and the University of California, Los Angeles (UCLA) score at regular intervals for a period of one year. There was a significant improvement in terms of pain relief and functional status of the patients. The patients were satisfied as they could do their daily routine activities without pain at a one-year follow-up. Early post-operative rehabilitation and physiotherapy are key to improving the functional range.

Parathyroid Adenoma with a Pathological Fracture: A Rare Case Report.

Introduction: Primary hyperparathyroidism may mimic osteoporosis and lead to pathological fractures. Case Report: We report a case of 35-year-old female who sustained left distal tibia-fibula fracture after a trivial fall, later diagnosed to have left inferior parathyroid adenoma. The fracture was managed conservatively and left inferior parathyroidectomy for the adenoma. At 4 years follow-up, there are no clinical or biochemical signs of recurrence. Conclusion: Pathological fracture in a case of parathyroid adenoma is extremely rare and requires a multidisciplinary approach for optimal outcome. A combination of clinical, biological, radiological, and biochemical markers with a high index of suspicion in an isolated bone fracture is required to diagnose parathyroid adenoma.

Comparative Analysis of Clavicular Hook Plate Versus Distal Radius Volar Plate With Coracoclavicular Augmentation for Neer's Type 2b Lateral Clavicle Fractures: A Prospective Study.

Background Clavicle fractures are common injuries in the adult population. The commonest site of fracture in the clavicle is the mid-shaft followed by the lateral end fracture. The anatomy and biomechanics of the lateral end clavicle make it prone to be unstable. Conservative management usually fails due to the deforming forces. Aim Our study evaluates pain relief, functional outcome, and the union rate in unstable lateral end clavicle fracture fixed by two different modalities of operative management, namely clavicular hook plate fixation and distal radius volar plate fixation. Materials and method A total of 60 patients with the unstable lateral end of clavicle fracture were evaluated in this study at a single tertiary care center between August 2015 and September 2021. Half of the patients (30 patients) were managed by open reduction and internal fixation with clavicular hook plate. The remaining half (30 patients) underwent open reduction and internal fixation by distal radius volar plate supplemented with coracoclavicular fixation. All patients were followed up for a mean duration of 20 months. The functional outcome was assessed at regular intervals by Constant score and Disability of the Arm, Shoulder and the Hand (DASH) score for a period of one year. Result There was significant pain relief and improvement in the functional status of patients. The pain relief was significant in the group managed by distal radius volar plate. The decrease in DASH score and increase in Constant score suggests better functional outcomes in these patients. Conclusion Our study highlights the fact that the distal radius volar plate is an excellent alternative to the hook plate in the treatment of unstable lateral third clavicle fractures. The decrease in pain and improved functional outcome stresses the fact that the volar locking plate is the recent most advancement in the fracture fixation of Neer's type ll fractures. The distal radius volar plate is the recent internal fixation technique to manage unstable lateral end clavicle fractures.

Clinicoradiological outcome of percutaneous intralesional polidocanol in Aneurysmal Bone Cysts: A prospective study of 43 patients in a single tertiary care centre.

Objective: The study reports the efficacy of sequential instillations of intralesional percutaneous polidocanol in the treatment of skeletal ABC. The study also analyses the pain relief, recurrence, radiological outcome and complications after percutaneous sclerotherapy. Materials and methods: A total of 43 patients with ABC were managed by fluoroscopy assisted percutaneous intralesional sclerotherapy with 3% Injection Polidocanol under suitable anaesthesia. The pain relief was assessed by Visual Analog Scale (VAS) and the progressive healing of the lesion by Rastogi Classification. Patients were evaluated clinico-radiologically, pre-operatively and at monthly interval for the first three months and then at 6 months, one year and two years follow up. Result: The VAS score decreased significantly at six months follow up and was zero (No pain) at one year follow up. Out of 43 patients, 37 patients had Degree I (excellent) residual lesion and 6 patients had degree II (good) lesion at one year follow-up as per Rastogi classification. The lesions resolved completely by two-year follow-up with all 43 patients having Degree (excellent) I resolution. Conclusion: Our study highlights the efficacy of percutaneous intralesional polidocanol in the treatment of ABC's. The procedure is safe, simple and effective with excellent outcome. Sclerotherapy is highly beneficial for deep lesions which are difficult to assess and for comorbid patients who are medically unfit for surgery. Our study strongly advocates the use of sclerotherapy as the first line treatment for ABC, considering its clinical and radiological efficacy.

Extensive Synovial Chondromatosis of the Knee Managed by open radical synovectomy: A Case Report with review of literature.

Introduction: Synovial chondromatosis of the knee is an unusual, rare, benign metaplastic neoplasm of the synovium, characterized by the formation of focal cartilaginous nodules in the synovium. It predominantly involves the anterior compartment of knee and extensive, disseminated involvement is rarely reported. Diagnosis is usually established with clinicoradiological imaging and confirmed by histology. The paucity of literature on the management of synovial chondromatosis puts an orthopedician in dilemma regarding the optimal surgical intervention. Case Report: We report a case of 50-year-old male who presented with severe pain and swelling in his left knee associated with functional incapacitation. Magnetic resonance imaging demonstrated diffuse proliferation of synovium with mild effusion displaying multiple, disseminated calcific nodules. We managed the case by open removal of loose bodies and radical synovectomy through combined anterior and posterior approach. At 4 years follow-up, there are no clinical or radiological signs of recurrence. Conclusion: Extensive involvement of the knee with calcific nodules is extremely rare. Treatment is controversial which usually includes removal of loose bodies combined with an open or arthroscopic synovectomy. Our case report recommends single stage, open retrieval of loose bodies combined with radical synovectomy to decrease the incidence of recurrence in extensive synovial chondromatosis. To the best of our knowledge, disseminated synovial chondromatosis of the knee, managed by open, combined approach, has been reported only once in the literature.