Introduction: Giant cell tumour (GCT) is a benign osteolytic, locally aggressive lesion. Seen in ... more Introduction: Giant cell tumour (GCT) is a benign osteolytic, locally aggressive lesion. Seen in young adults at the epiphysis. The most common site is long bones (85-90%). GCT of the metatarsal in elderly patients is very rare. Case Report: A 60-year-old male came with complaints of pain and swelling over right foot dorsal aspect since for the last past one 1 year. There was no history of trauma. X-ray foot showed an osteolytic lesion in the right third metatarsal with thinning of the cortex. MRI and fine-needle aspiration cytology confirmed the diagnosis of GCT. The patient was managed by excision with the 3rd ray amputation. At present, 1.5 years follow-up, the patient is having no pain, difficulty in walking and no evidence of clinical and radiological recurrence . Conclusion: Giant cell tumours could also present at uncommon sites, and they should be considered in the differential diagnosis of lytic lesions of the metatarsals. Excision with ray amputation of the involved metata...
Tubercular dactylitis or spina ventosa is the tubercular infection of phalanges, metacarpals and ... more Tubercular dactylitis or spina ventosa is the tubercular infection of phalanges, metacarpals and metatarsals termed after cystic swelling of short tubular bones by tubercular infection. Here we presented two rare cases of spina ventosa in a 10 years old female and a 16 years old male patients. In both cases there was swelling of digits with stiffness. The radiographs were suggestive of chronic osteolytic infection with cortical destruction and diffuse sclerosis. We managed them with adequate surgical debridement, splintage and anti-tubercular therapy with good functional recovery. Spina ventosa or tubercular dactylitis is a rare condition and is often missed on diagnosis due to vague non-specific presentation, unavailability of rapid diagnostic tests and can be confused with other mimicking diseases. Any swelling over small tubular bones of hand or feet should raise the suspicion of spina ventosa, especially in endemic countries for tuberculosis. In neglected chronic infections, sur...
Introduction: Post-operative spinal wound infection increases the morbidity of the patient and th... more Introduction: Post-operative spinal wound infection increases the morbidity of the patient and the cost of healthcare. Despite the development of prophylactic antibiotics and advances in surgical technique and post-operative care, wound infection continues to compromise patient outcome after spinal surgery. This kind of infection places the patient at risk for pseudoarthrosis, adverse neurologic sequelae, chronic pain, deformity, and even death. In spite of all preventive measures, the SSI following spinal surgeries are 1% among operated spinal instrumentation. Case Series: Here, we present a series of three patients who presented to us with post-operative surgical site infection (SSI) in spine surgery in the form of wound, discharge, and other complaints. Out of all, two of them were operated with debridement and skin closure followed by broad spectrum IV antibiotics and one of them managed with vacuum-assisted closure dressing and high antibiotics sensitive to organisms found in w...
Introduction: Finger dislocations account for 5% of upper extremity injuries. Metacarpophalangeal... more Introduction: Finger dislocations account for 5% of upper extremity injuries. Metacarpophalangeal (MCP) joint/Kaplan dislocations post-trauma are of rare occurrence. An MCP joint dislocation is considered simple when it can be managed by closed reduction and considered complex when open reduction is necessary. Case Report: Here, we present a rare case of dorsal Kaplan dislocation of left second MCP joint in an 11 years old male child, which was managed by open dorsal approach with stable reducion and good functional outcome. Conclusion: We experienced closed reduction should not be tried in cases of complex dorsal dislocations. The dorsal approach of complex MCP dislocation is found to be safe and simple even in hands of inexperienced surgeons which may or may not need division of deep transverse ligament.
Introduction: Chondroblastoma is a rare benign, epiphyseal bone tumor that typically affects the ... more Introduction: Chondroblastoma is a rare benign, epiphyseal bone tumor that typically affects the second decade of life and represents approximately 1% of all bone tumors. Radiologically it manifest as a lytic tomour lesion in the epiphysis of long bones. Case report: We present a case of 19 year-old male who presented with recurrent symptoms of pain and swelling in right shoulder associated with restricted shoulder mobility. Preoperative radiological imaging showed large lytic epiphyseal lesion arising from upper end of humerus interspersed with areas of calcification. MRI was done which reveal significant findings of chondroblastoma which guided in the planning of treatment. Conclusion: Chondroblastomas are typically benign, but rarely it can progress locally or metastatise. Recurrence is also noted even after surgical resection which may suggest inadequate curettage. Early diagnosis and aggressive primary management prevents further surgeries and recurrences.
Introduction: Osteomyelitis is the infection of bone that is characterized by progressive inflamm... more Introduction: Osteomyelitis is the infection of bone that is characterized by progressive inflammatory destruction with appositioning of new bone. Pelvic osteomyelitis is often an unusual condition but accounts for approximately 1% to 11% cases of haematogenous osteomyelitis (2). The most common location is the ilium due its larger size and abundant blood supply and hematopoetic marrow. The average age of onset tends to be between 7 and 14 years, with a slight male preponderance (2). Mechanism of spread of iliac osteomyelitis can be hematogenous, contiguous or direct inoculation due surgical contamination or open fractures. Case report: Here is a 21 year old female health care worker student presented with pain in right Iliac region and difficulty in walking and inability to bear weight since last 18 months. She is a case of Chronic Osteomyelitis where Debridement was performed previously and now Patient also had recurred complaints of on and off Discharge from the site of previous ...
International Journal of Research in Orthopaedics, Apr 25, 2022
Chronic non-bacterial osteomyelitis (CNO) is a rare disorder characterized by focal aseptic infla... more Chronic non-bacterial osteomyelitis (CNO) is a rare disorder characterized by focal aseptic inflammation with a selflimiting, relapsing course of disease with female predominance and usually observed in paediatric age groups diagnosed by clinical, radiological and histopathological findings after ruling out all other differentials. We reported this rare case found in a 7 year old female with a history of greenstick fracture of distal ulna 3 years ago with flaring up of pain and swelling since trivial trauma to left wrist 1 month ago. We emphasize on the relevant data and findings to reach the conclusive diagnosis and treatment of the disease. CNO can present as benign unifocal non-relapsing to more severe form of multifocal relapsing inflammatory lesions involving metaphysis of long bones, vertebrae, clavicle and mandible. Diagnosis is made after excluding infection, malignancy, auto-immune and metabolic disorders. Treatment is mainly empirical to reduce pain and inflammation through NSAIDs, corticosteroids, bisphosphonates and sometimes TNF alpha inhibitors as no proper guidelines are available.
Surgical site infection is the most deleterious complication for any surgery and it's quite a... more Surgical site infection is the most deleterious complication for any surgery and it's quite a daunting task for the surgeon to manage such post op events which also takes a great toll on patients' health physically as well as financially. Here we are presenting one such case report of early SSI effectively managed with antibiotic cement beads incorporation locally. We report a 65 year old male patient case of left sided comminuted distal femur fracture who was managed operatively with open reduction and internal fixation with 8 holes distal femur plate. Patient developed early SSI and was managed with debridement and antibiotic cement beads which was removed 6 weeks later. Here, we bring to the fore relevant findings to conclude the advantages of antibiotic cement beads for infected surgical wounds. In our case, early intervention resulted in full recovery of the patient from surgical site infection, early rehabilitation of joint mobility, decreased hospital stay and expense...
Background: Inter-trochanteric fracture is one of the most common fractures in elderly population... more Background: Inter-trochanteric fracture is one of the most common fractures in elderly population around the world due to global rise of osteoporosis, which is generally due to a simple slip and fall in the house hold[1]. It is growing to be a disease burden for orthopedics of our era to manage. With its rise Understanding the important factors in management of IT fracture like stability, reduction, role of posterior-medial wall support, intact lateral wall configuration, will help in choosing implant for better outcome ,thus helping to achieve better post operative results[2]. Hence, understanding the role of posteriomedial wall support in IT fracture reduction in terms of positive, neutral(anatomic) or negative beak and its impact on the post operative fracture stability and early ambulation is of great importance. We conducted a retrospective comparative study in our institution to study the outcome of these configuration and its effect post operatively. Methods: A retrospective ...
Endocrine glands affecting skeletal system are parathyroid glands, adrenal glands, pituitary glan... more Endocrine glands affecting skeletal system are parathyroid glands, adrenal glands, pituitary gland, thyroid and gonads. If any abnormality occurs in these glands, they cause structural and functional impairment of the skeletal system. Early diagnosis and treatment of these endocrine problems and ruling out musculoskeletal involvement helps to maintain skeletal integrity and prevent osteoporotic fractures and chronic bone pathologies. Here we present a case series of 4 patients who came to us with chronic bone pathologies or post-traumatic fractures associated with endocrine abnormalities; such as parathyroid adenoma (hyperparathyroidism), Cushing’s syndrome and thyroid adenocarcinoma. One patient with osteoporotic and pathological fracture was managed operatively and sent for management of endocrine pathology and other three patients after evaluating cause for the bone pathology were referred for primary management of endocrine disease. Osteoclasts and osteoblasts of the bone are a...
Introduction: Giant cell tumour (GCT) is a benign osteolytic, locally aggressive lesion. Seen in ... more Introduction: Giant cell tumour (GCT) is a benign osteolytic, locally aggressive lesion. Seen in young adults at the epiphysis. The most common site is long bones (85-90%). GCT of the metatarsal in elderly patients is very rare. Case Report: A 60-year-old male came with complaints of pain and swelling over right foot dorsal aspect since for the last past one 1 year. There was no history of trauma. X-ray foot showed an osteolytic lesion in the right third metatarsal with thinning of the cortex. MRI and fine-needle aspiration cytology confirmed the diagnosis of GCT. The patient was managed by excision with the 3rd ray amputation. At present, 1.5 years follow-up, the patient is having no pain, difficulty in walking and no evidence of clinical and radiological recurrence . Conclusion: Giant cell tumours could also present at uncommon sites, and they should be considered in the differential diagnosis of lytic lesions of the metatarsals. Excision with ray amputation of the involved metata...
Tubercular dactylitis or spina ventosa is the tubercular infection of phalanges, metacarpals and ... more Tubercular dactylitis or spina ventosa is the tubercular infection of phalanges, metacarpals and metatarsals termed after cystic swelling of short tubular bones by tubercular infection. Here we presented two rare cases of spina ventosa in a 10 years old female and a 16 years old male patients. In both cases there was swelling of digits with stiffness. The radiographs were suggestive of chronic osteolytic infection with cortical destruction and diffuse sclerosis. We managed them with adequate surgical debridement, splintage and anti-tubercular therapy with good functional recovery. Spina ventosa or tubercular dactylitis is a rare condition and is often missed on diagnosis due to vague non-specific presentation, unavailability of rapid diagnostic tests and can be confused with other mimicking diseases. Any swelling over small tubular bones of hand or feet should raise the suspicion of spina ventosa, especially in endemic countries for tuberculosis. In neglected chronic infections, sur...
Introduction: Post-operative spinal wound infection increases the morbidity of the patient and th... more Introduction: Post-operative spinal wound infection increases the morbidity of the patient and the cost of healthcare. Despite the development of prophylactic antibiotics and advances in surgical technique and post-operative care, wound infection continues to compromise patient outcome after spinal surgery. This kind of infection places the patient at risk for pseudoarthrosis, adverse neurologic sequelae, chronic pain, deformity, and even death. In spite of all preventive measures, the SSI following spinal surgeries are 1% among operated spinal instrumentation. Case Series: Here, we present a series of three patients who presented to us with post-operative surgical site infection (SSI) in spine surgery in the form of wound, discharge, and other complaints. Out of all, two of them were operated with debridement and skin closure followed by broad spectrum IV antibiotics and one of them managed with vacuum-assisted closure dressing and high antibiotics sensitive to organisms found in w...
Introduction: Finger dislocations account for 5% of upper extremity injuries. Metacarpophalangeal... more Introduction: Finger dislocations account for 5% of upper extremity injuries. Metacarpophalangeal (MCP) joint/Kaplan dislocations post-trauma are of rare occurrence. An MCP joint dislocation is considered simple when it can be managed by closed reduction and considered complex when open reduction is necessary. Case Report: Here, we present a rare case of dorsal Kaplan dislocation of left second MCP joint in an 11 years old male child, which was managed by open dorsal approach with stable reducion and good functional outcome. Conclusion: We experienced closed reduction should not be tried in cases of complex dorsal dislocations. The dorsal approach of complex MCP dislocation is found to be safe and simple even in hands of inexperienced surgeons which may or may not need division of deep transverse ligament.
Introduction: Chondroblastoma is a rare benign, epiphyseal bone tumor that typically affects the ... more Introduction: Chondroblastoma is a rare benign, epiphyseal bone tumor that typically affects the second decade of life and represents approximately 1% of all bone tumors. Radiologically it manifest as a lytic tomour lesion in the epiphysis of long bones. Case report: We present a case of 19 year-old male who presented with recurrent symptoms of pain and swelling in right shoulder associated with restricted shoulder mobility. Preoperative radiological imaging showed large lytic epiphyseal lesion arising from upper end of humerus interspersed with areas of calcification. MRI was done which reveal significant findings of chondroblastoma which guided in the planning of treatment. Conclusion: Chondroblastomas are typically benign, but rarely it can progress locally or metastatise. Recurrence is also noted even after surgical resection which may suggest inadequate curettage. Early diagnosis and aggressive primary management prevents further surgeries and recurrences.
Introduction: Osteomyelitis is the infection of bone that is characterized by progressive inflamm... more Introduction: Osteomyelitis is the infection of bone that is characterized by progressive inflammatory destruction with appositioning of new bone. Pelvic osteomyelitis is often an unusual condition but accounts for approximately 1% to 11% cases of haematogenous osteomyelitis (2). The most common location is the ilium due its larger size and abundant blood supply and hematopoetic marrow. The average age of onset tends to be between 7 and 14 years, with a slight male preponderance (2). Mechanism of spread of iliac osteomyelitis can be hematogenous, contiguous or direct inoculation due surgical contamination or open fractures. Case report: Here is a 21 year old female health care worker student presented with pain in right Iliac region and difficulty in walking and inability to bear weight since last 18 months. She is a case of Chronic Osteomyelitis where Debridement was performed previously and now Patient also had recurred complaints of on and off Discharge from the site of previous ...
International Journal of Research in Orthopaedics, Apr 25, 2022
Chronic non-bacterial osteomyelitis (CNO) is a rare disorder characterized by focal aseptic infla... more Chronic non-bacterial osteomyelitis (CNO) is a rare disorder characterized by focal aseptic inflammation with a selflimiting, relapsing course of disease with female predominance and usually observed in paediatric age groups diagnosed by clinical, radiological and histopathological findings after ruling out all other differentials. We reported this rare case found in a 7 year old female with a history of greenstick fracture of distal ulna 3 years ago with flaring up of pain and swelling since trivial trauma to left wrist 1 month ago. We emphasize on the relevant data and findings to reach the conclusive diagnosis and treatment of the disease. CNO can present as benign unifocal non-relapsing to more severe form of multifocal relapsing inflammatory lesions involving metaphysis of long bones, vertebrae, clavicle and mandible. Diagnosis is made after excluding infection, malignancy, auto-immune and metabolic disorders. Treatment is mainly empirical to reduce pain and inflammation through NSAIDs, corticosteroids, bisphosphonates and sometimes TNF alpha inhibitors as no proper guidelines are available.
Surgical site infection is the most deleterious complication for any surgery and it's quite a... more Surgical site infection is the most deleterious complication for any surgery and it's quite a daunting task for the surgeon to manage such post op events which also takes a great toll on patients' health physically as well as financially. Here we are presenting one such case report of early SSI effectively managed with antibiotic cement beads incorporation locally. We report a 65 year old male patient case of left sided comminuted distal femur fracture who was managed operatively with open reduction and internal fixation with 8 holes distal femur plate. Patient developed early SSI and was managed with debridement and antibiotic cement beads which was removed 6 weeks later. Here, we bring to the fore relevant findings to conclude the advantages of antibiotic cement beads for infected surgical wounds. In our case, early intervention resulted in full recovery of the patient from surgical site infection, early rehabilitation of joint mobility, decreased hospital stay and expense...
Background: Inter-trochanteric fracture is one of the most common fractures in elderly population... more Background: Inter-trochanteric fracture is one of the most common fractures in elderly population around the world due to global rise of osteoporosis, which is generally due to a simple slip and fall in the house hold[1]. It is growing to be a disease burden for orthopedics of our era to manage. With its rise Understanding the important factors in management of IT fracture like stability, reduction, role of posterior-medial wall support, intact lateral wall configuration, will help in choosing implant for better outcome ,thus helping to achieve better post operative results[2]. Hence, understanding the role of posteriomedial wall support in IT fracture reduction in terms of positive, neutral(anatomic) or negative beak and its impact on the post operative fracture stability and early ambulation is of great importance. We conducted a retrospective comparative study in our institution to study the outcome of these configuration and its effect post operatively. Methods: A retrospective ...
Endocrine glands affecting skeletal system are parathyroid glands, adrenal glands, pituitary glan... more Endocrine glands affecting skeletal system are parathyroid glands, adrenal glands, pituitary gland, thyroid and gonads. If any abnormality occurs in these glands, they cause structural and functional impairment of the skeletal system. Early diagnosis and treatment of these endocrine problems and ruling out musculoskeletal involvement helps to maintain skeletal integrity and prevent osteoporotic fractures and chronic bone pathologies. Here we present a case series of 4 patients who came to us with chronic bone pathologies or post-traumatic fractures associated with endocrine abnormalities; such as parathyroid adenoma (hyperparathyroidism), Cushing’s syndrome and thyroid adenocarcinoma. One patient with osteoporotic and pathological fracture was managed operatively and sent for management of endocrine pathology and other three patients after evaluating cause for the bone pathology were referred for primary management of endocrine disease. Osteoclasts and osteoblasts of the bone are a...
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