Management of Grade Three Open Distal Humerus Intra-articular Fracture Using the BB Joshi External Fixator: A Case Study and Review of Outcomes.

Distal humeral intra-articular fractures often result in functional impairment if treated conservatively. These fractures are particularly challenging due to osteoporosis and severe comminution. A 32-year-old female with a grade three open distal humerus intra-articular fracture presented with a 5 cm x 5 cm open wound on her right elbow. The patient underwent open reduction and internal fixation (ORIF) using the BB Joshi external fixator and a local flap for skin coverage, achieving stable fixation and early mobilization. The patient regained a near-normal range of movements and adequate skin coverage of the wound at follow-up. Compared to traditional ORIF, it showed lower infection rates and comparable union rates, leading to better functional outcomes when compared with the studies reported earlier. The BB Joshi external fixator effectively treats grade three open distal humerus intra-articular fractures, minimizing complications and promoting functional recovery.

Mini Fragment Locking Compression Plate Fixation of a Rare Case of Displaced Medial End Clavicle Fracture.

Clavicle fractures at the medial end are very rare. Even in cases where there is severe displacement, such fractures have usually been managed nonoperatively. Yet, there are many patients who remain symptomatic over a year following injury, and the non-union rate is also high. Operative intervention for displaced clavicle fractures of the medial end has been more common in the past decade. The possibility of iatrogenic injury due to the near proximity of critical vascular structures continues to be a concern. This case report describes the management of a rare displaced medial end clavicle fracture in a young male. The patient is a 28-year-old male who came with a week-old displaced medial end left clavicle fracture. On examination, tenting of skin was seen over the medial end clavicle region. CT angiography of the left upper limb was performed to check the vascular structures in relation to the fracture, as there remain concerns about the close proximity of underlying vascular structures and the potential for iatrogenic damage. A vascular surgeon was kept on standby during the surgery. The patient was taken up for surgery after a pre-anesthetic checkup and open reduction and internal fixation was done with a 2.4-mm system mini fragment locking compression plate over the anterior surface of the clavicle. The surgery was uneventful, and the patient had a good clinical and radiological outcome postoperatively.

Prospective Research Comparing Different Trochanteric Fracture Fixation Techniques.

Aim Evaluation and comparison of various methods of trochanteric fracture fixation. Methods This study was conducted prospectively at the Orthopaedics Department of Dr. D Y Patil Medical College and Research Centre. The study spanned 18 months and involved 100 patients treated in the outpatient and the emergency department. Patients who fulfilled that specific criteria were selected for this study and the appropriate surgical intervention for each group was determined through radiological examination. Results Of the 100 patients, 55 (55%) were male and 45 (45%) females. Patients in our collection ranged from 20 to 90 years old. Proximal Femoral Nail (PFN), Dynamic Hip Screw (DHS ), and Proximal Femoral Locking Compression Plate (PFLCP ) groups averaged 56, 58, and 64 years old, respectively. The most common cause of intertrochanteric fracture was domestic falls (60%), followed by road traffic accidents (35%). The Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification rated 40 individuals (40%) as stable and 60 as unstable. Most patients in our study had unstable A3 fractures. PFN patients had 16 A3 fractures. In DHS, 32 patients suffered A3 fractures. Twelve PFLCP patients suffered A3 fractures. The smallest group had A1 fractures. Six PFN patients suffered A1 fractures. Two DHS patients had A1 fractures. Two PFLCP patients suffered A1 fractures. PFN group mean scores improved significantly after one and three months in this study. At six months, the PFN group had a significant mean score improvement. Conclusion PFN results ranged from satisfactory to excellent, offering numerous advantages over other methods such as DHS and PFLCP. The benefits of PFN include a shorter lever arm, fracture site compression, and enhanced rotational stability, which contribute to a lower chance of mechanical failure. Additionally, patients treated with PFN typically experience shorter hospital stays, earlier mobilization, less blood loss, shorter surgery times, faster rehabilitation, and quicker bone healing, making PFN a highly effective treatment option for certain fractures.

Inferior Pole of the Patella Fracture Fixed by Percutaneous Approach: A Case Report.

Fractures of the inferior pole of the patella are rare but challenging orthopedic injuries. This case study presents the management of such a fracture using a percutaneous approach. A 70-year-old female patient presented with significant knee pain and swelling following a fall. Radiographic examination revealed a displaced fracture of the inferior pole of the patella along with an ipsilateral tibial plateau fracture. Surgical intervention was deemed necessary due to the extent of displacement and the potential for compromised knee function. A percutaneous technique was employed for fracture reduction and fixation using cannulated screws under fluoroscopic guidance. Postoperative rehabilitation focused on early mobilization and strengthening exercises. At a six-week follow-up, the patient demonstrated satisfactory clinical outcomes with restoration of knee function and minimal residual symptoms. This case highlights the efficacy of percutaneous fixation in managing inferior pole patellar fractures, offering a minimally invasive approach with favorable functional outcomes.

Outcomes of Femoral Neck System in Treating Intra-capsular Neck of Femur Fractures in a Young Adult: A Case Report.

The introduction of the Femoral Neck System (FNS) represents a promising alternative to traditional cancellous cannulated (CC) screw fixation for managing intra-capsular neck of femur (ICNF) fractures. This case report aims to validate its safety and report the outcomes in a young patient. The findings demonstrate that the FNS possesses excellent biomechanical properties and provides significantly greater overall construct stability bearing in mind, that it was used in a Pauwels Classification Grade 3 ICNF fracture.

Flexor Digitorum Profundus Avulsion With Distal Interphalangeal Joint Dorsal Dislocation: A Case Report.

An irreducible closed dorsal dislocation of the distal interphalangeal (DIP) joint of the finger is a rare injury, often caused by factors such as the interposition of the volar plate, entrapment of the flexor digitorum profundus (FDP) tendon behind the head of the middle phalanx, or the buttonholing of the middle phalanx head through the volar plate or flexor tendon. This case report presents a rare instance of FDP avulsion combined with dorsal dislocation of the DIP joint in a 42-year-old male who sustained trauma to his right middle finger during a workplace accident. Clinical examination and imaging confirmed FDP avulsion along with dorsal dislocation of the DIP joint. Urgent surgical intervention was performed, successfully reducing and repairing the FDP tendon and stabilizing the DIP joint. Subsequent follow-up showed satisfactory functional outcomes. This case highlights the importance of prompt diagnosis and appropriate surgical management in treating complex finger injuries.

Fixation of Paediatric Proximal Humerus Fractures Using Percutaneous Pinning: A Case Report.

A 12-year-old male came to our Emergency Department with chief complaints of pain and inability to move the right shoulder for one day following a fall while playing. The range of motion of the right shoulder was restricted and painful in all directions. Initial radiographs revealed a transverse, displaced proximal humerus fracture at the head-shaft junction. The patient was managed by closed reduction internal fixation with percutaneous K-wiring (Kirschner wires). The K-wires were removed after four weeks, and the shoulder was mobilized. The patient had a near-normal and pain-free range of motion at three months of follow-up. Percutaneous K-wiring remains a viable option for the treatment of paediatric proximal humerus fractures, and good post-operative rehabilitation can help restore near-normal function, as demonstrated in this report.

A Glomus Tumor Presenting on the Ventromedial Aspect of the Little Finger Causing Bony Erosion: A Rare Case From India.

Glomus tumors are rare neoplasms originating from the glomus body that predominantly manifest in the subungual region of the digits and are distinguished by severe pain and a heightened sensitivity to cold. Bony erosion associated with glomus tumors is a rare phenomenon. Here, we present a unique case of a glomus tumor situated on the ventromedial aspect of the little finger, leading to notable bony erosion. A 42-year-old female from India presented with a chief complaint of severe and localized pain in the ventromedial region of her right little finger, exacerbated by exposure to cold temperatures. Radiological investigations demonstrated focal bone erosion at the site of the tumor. Surgical excision of the lesion was performed. A fish-mouth incision was made on the ventromedial aspect of the little finger, which was extended to the tip of the finger. The nail bed was kept intact. The tumor was excised using small forceps. The patient experienced complete resolution of symptoms postoperatively and reported no recurrence during the follow-up period. This case report highlights the exceptional presentation of a glomus tumor causing bony erosion on the ventromedial aspect of the little finger, a manifestation rarely encountered in clinical practice. Furthermore, this case contributes to the limited body of literature on this combination of uncommon clinical entities, shedding light on its diagnosis and management.

A Study Evaluating the Functional Outcomes of Mason Type III and IV Radial Head Fractures Treated With a Radial Head Prosthesis.

Objective This research aimed to assess the functional result of type III and IV radial head fractures that were treated using a radial head prosthesis. Methods A retrospective investigation was conducted on 70 patients with type III and IV radial head and neck fractures, as classified by Mason. The patients were hospitalized and received treatment at the Orthopaedics Department, where they had radial head prosthesis surgery for three years. Results Among the total of 70 cases, 42 (60%) cases were below the age of 40, while 28 (47%) cases were over 40 years. The average age was 36.4 years. The maximum age recorded was 54 years, while the lowest age recorded was 30 years. The female population outnumbered the male population. The majority of instances (42, 60%) were attributed to falls, while the remaining cases were caused by road traffic accidents (RTAs). Out of the total 70 instances, 52 cases (74.28%) exhibited right-side dominance, whereas 18 cases (25.72%) exhibited left-side dominance. Within our case study group, 56 (80%) cases fell under modified Mason's classification type Ill, totaling 56 instances. The remaining 20% of the cases, amounting to 11 cases, were classified as modified Mason's classification type IV. Among the 70 patients, 55 cases (78.58%) did not have any ligamentous damage, whereas seven (10%) cases had lateral ulnar collateral ligament (LUCL) injury and eight (11%) cases had medial collateral ligament (MCL) injury. The P value for flexion, extension, pronation, and supination was shown to be very significant. Out of the total, 47 (67%) instances had an MEPI score (Mayo Elbow Performance Index) of more than 90, indicating exceptional performance. In addition, 16 cases (22.85%) had an MEPI score ranging from 75 to 89, which is considered a good result. Lastly, seven cases (10%) had an MEPI score ranging from 60 to 74, indicating a fair result. Conclusion The use of a radial head prosthesis is considered a viable option for managing severe and irreparable fractures of the radial head. Effective outcomes hinge on meticulous preoperative planning, skilled intraoperative techniques, and intensive postoperative rehabilitation. These elements collectively contribute to achieving consistent and favorable results in patients undergoing this surgical intervention.

Bilateral Humerus Midshaft Fracture Associated With Birth Trauma: A Case Report.

Bilateral humerus fractures as a result of birth trauma are a rare occurrence in neonatal care, necessitating special consideration due to their potential long-term implications. Birth-related injuries involving neonatal skeletal structures, especially fractures of the humerus, require special attention and a comprehensive approach to diagnosis and management. Here, we present the case of a newborn female child who experienced bilateral humerus fractures due to birth trauma. The subsequent management involved the application of splints to immobilize the affected arms, a standard practice in the treatment of fractures.

A Case of Chronic Rupture of Achilles Tendon Managed Using a Combination of Multiple Surgical Techniques.

Achilles tendon rupture is a common injury that occurs due to sudden dorsiflexion of the plantar-flexed foot. Both acute and chronic ruptures are frequently misdiagnosed and mistreated. Acute Achilles tendon rupture commonly occurs in middle-aged individuals (30-40 years). Although several operative procedures are available for Achilles tendon repair, the management of choice remains controversial and debatable. A 27-year-old male came to our clinic complaining of pain over the left ankle for the last five months. History revealed trauma caused by a heavy metal object five months ago. Physical examination revealed tenderness and swelling over the left heel. Ankle plantar flexion was restricted, and painful and squeeze test was positive. Magnetic resonance imaging was suggestive of a tear of the Achilles tendon in the left ankle. Surgical management was done with multiple techniques which included flexor hallucis longus tendon graft augmentation, end-to-end suturing (Krackow technique), V-Y plasty, and bioabsorbable suture anchor. Although complications such as scar stiffness and wound gaping are common in such cases, the postoperative outcome was excellent in our case according to the American Orthopedic Foot and Ankle Score.

A Rare Case of Destruction of the First Metatarsophalangeal Joint in a Patient With Gout.

Gout is a crystal deposition disorder caused due to the deposition of monosodium urate crystals in joints and other tissues secondary to hyperuricemia. Podagra is the term for gout of the first metatarsophalangeal joint. In our case report, a 30-year-old male patient came to our OPD with complaints of swelling over the first metatarsophalangeal joint for one year, which was insidious in onset, localized, and had a sudden increase in size over the past three months. The patient also complained of an inability to properly wear his shoe. A plain radiograph was done, which was suggestive of an expansile lesion with the destruction of the first metatarsophalangeal joint and the erosion of the joint surface extending to the head of the first metatarsal and the proximal phalanx of the great toe. Lab investigations revealed a serum uric acid level of 10.2 mg/dl and an acid phosphatase level of 8.92 U/L. Excision of the lesion was done and a frozen section biopsy was sent intra-operatively which confirmed the presence of monosodium urate crystals. A fibular strut graft was taken to fill the defect using a square nail passing through the first metatarsophalangeal joint and a Kirschner wire was added to the interphalangeal joint to maintain the stability of the reduction. The foot was immobilized for six weeks following which the Kirschner wire was removed and range-of-motion exercises started. There was no residual deformity, and the patient responded well to the treatment.

A Rare Case of Bilateral Hip Tumoral Calcinosis With Intertrochanteric Fracture Treated by Closed Reduction Internal Fixation (CRIF) Using a Proximal Femoral Nail.

Tumoral calcinosis, also referred to as Teutschländer disease is a rare familial disorder characterized by painless, periarticular lumps or masses. Large amorphous calcific concentrations that surround the joints are the defining feature. These lesions have fibrous septa that divide them into lobules and may often show fluid/calcium levels (milk of calcium/suspended hydroxyapatite crystals). In our case report, a 24-year-old male came to the outpatient department (OPD) with complaints of pain over the right hip for two days and swelling over both hips for six years. He was apparently well two days prior to the hospital visit, when he met with a road traffic accident, falling off his bike. A plain radiograph of the pelvis and bilateral hip joints along with cross-table lateral views were done, which depicted a typical appearance of amorphous and multilobulated ("cloud-like") calcifications located in a periarticular distribution in both hips along with an intertrochanteric fracture in the right hip. A CT scan, done for better delineation of the calcific masses and fracture pattern, showed no obvious erosion or osseous destruction by the adjacent soft-tissue masses. Laboratory investigations revealed a serum calcium level of 8.8 mg/dl and a serum phosphorous level of 6.0 mg/dl.  The patient was taken up for surgery after routine pre-operative investigations and a pre-anaesthesia check-up. Closed reduction internal fixation (CRIF) was done using a proximal femoral nail (PFN). A biopsy of the soft-tissue masses was sent for histopathology, which was suggestive of lobules of calcific material surrounded by histiocytic giant cells. The patient responded well to the treatment with no residual discharge from the incision site, and his treatment was continued with phosphate binders as prescribed by the endocrinologist.