Ankle spanning external fixator with limited internal fixation for distal tibial extra-articular fractures

Background: Fractures of the distal tibia are among the most difficult fractures to treat. The short distal segment presents difficulty in choosing the appropriate fixation method. The greatest challenge lies in the relatively tight soft tissue around the ankle. As a result, it has been a recent interest in treating these fractures with external fixation and limited internal fixation. The external stable fixation methods used are tubular or ring fixators, with or without immobilising the ankle. This minimally invasive nature of the surgery can avoid catastrophic wound complications like dehiscence, implant exposure and infection.Methods: 18 patients with extra-articular distal tibial fractures (AO Type 43A) were treated with the technique of ankle spanning external fixation. Lag screws or K-wires were supplemented for limited internal fixation when required. Fibula was stabilised in all cases. Intra- articular and Compound fractures were excluded. In addition to union at fracture site, ankle pain and motion was noted in each follow-up.Results: The mean follow-up was 25 months. Of the 18 patients included all but one fractures united with an average healing time of 16 to 18 weeks. Ankle pain and motion was graded according to Mazur modified by Teeny and Wiss clinical scoring system. 15 of them had excellent or good results, 2 had fair results. One patient had poor result. Five pin tract infections occurred. 17 patients had no evidence of osteoarthritis after completing follow up of at least 2 years.Conclusions: Distal tibial fractures are complex injuries, not only regarding the bony component, but also in terms of the management of the soft tissue problem. Ankle Spanning External Fixator with Limited Internal fixation is a relatively simple and cost-effective method for treating these fractures, achieving union and also maintaining ankle function

Correlation of Ahlback grading and knee society score in patients with moderate to severe osteoarthritis of the knee

Background: Knee osteoarthritis (OA) is a most common rheumatological disorder that causes functional limitation and disability. The most common problem in knee OA are joint pain and stiffness. It will lead to decreased quality of life and it have a serious economic burden on any country due to effect of disability and treatment.Methods: A correlational study was conducted to find out correlation between Ahlback grading and knee society score (KSS) on a sample of 100 moderate to severe knee OA patients and 142 OA knees. Data was collected at orthopedics OPD, for a period of 3 months by purposive sampling.Results: On evaluation, mean age of the participants was 60.19±1.01. Out of 100 patients, 42 patients had bilateral knee OA, therefore total 142 knees included in the analysis. More than half (51%) participants were overweight. Only 34% subjects had compliament to physiotherapy. Around 76% subjects taking analgesics and massage therapy to reduce knee pain. Maximum 82.4% subjects had a poor knee condition in KSS and mean score is 49.07±1.06. Ahlback grading in X-ray had negative correlation -0.610 with KSS. Hence it is evaluated, both the scales have approximately same result as it is analyzed that both scales are moderately correlated. There is significant association of age, occupation and physiotherapy with Ahlback grading followed with KSS significant associated with BMI, occupation and physiotherapy.Conclusions: The study concluded that there is a moderate correlation found between Ahlback X-ray grading and knee society scoring. X-ray and knee society scoring (clinical evaluation) both are essential for effective treatment of OA

Villous adenoma of the renal pelvis: a common entity at an uncommon location

Villous adenoma is uncommonly seen in the urogenital tract and is even more rarely seen in the upper urinary tract and renal pelvis. Like colorectal adenomas, these neoplasms can transform into adenocarcinoma. The preoperative diagnosis is challenging due to their frequent association with hydronephrosis. Herein, we present the case of a villous adenoma of the renal pelvis in a 62-year-old man presenting with recurrent urinary tract infection. The computed tomography scan showed marked hydronephrosis but no suspicious mass in the right kidney. A laparoscopic right nephrectomy was performed. Gross examination revealed a dilated renal pelvis with an irregular exophytic lesion in the renal pelvis’s upper surface. The histopathological examination showed slender, elongated villi with thin fibrovascular cores, consistent with villous adenoma morphology. Isolated villous adenomas have a favorable prognosis. However, the pathologist should undertake a search for an invasive component

Renal angiomyolipoma with epithelial cyst

Angiomyolipoma with epithelial cysts (AMLEC) is a recently described entity and is an uncommon subtype of kidney angiomyolipomas. AMLEC is a benign entity but usually masquerades a renal cell carcinoma on imaging examination. AMLEC has a distinct histological and immunohistochemical staining pattern, which helps in the pathological diagnosis. We present a rare case of AMLEC in a 26-year-old female, which was provisionally diagnosed as renal cell carcinoma on radiology. We also summarize the differential diagnosis of this rare variant, its characteristic features, and a review of the literature

Cervical Thymic Cyst with parathyroid tissue – a diagnostic conundrum

Cervical thymic cysts are relatively rare benign cystic lesions that tend to be diagnosed clinically as branchial cysts, which usually present as painless, enlarging neck masses. They can occur anywhere along the normal path of descent of thymic primordia from the angle of the mandible to the sternal notch, with mediastinal extension observed in approximately 50% of cases. They are usually seen in the first decade of life on the left side with a male predominance. Here we report a case of a 15-year-old boy who presented to the hospital with left-sided neck swelling for about 2 months. The neck’s contrast-enhanced computed tomography (CECT) revealed a large, well-defined cystic swelling in the left neck region, showing peripheral enhancement, seen from the submandibular region to the superior mediastinum extending into the retrosternal region. Direct fine needle aspiration (FNA) was done, which showed a benign lesion with inflammatory and cystic characteristics, leading to the possibility of a branchial cyst. The cyst was completely excised surgically. Histopathology showed a thymic cyst with parathyroid tissue. The presence of thymic tissue with Hassall’s corpuscles is essential for the diagnosis. Knowledge of the clinical presentation, cyto-histological findings, and differential diagnosis of cystic cervical lesions in the pediatric population is important to diagnose this rare entity. Hence, though uncommon, when one comes across a cystic cervical region mass in children, a diagnosis of cervical thymic cyst should be kept in mind. Nonetheless, a definitive diagnosis depends on imaging findings as well as intraoperative findings and histopathological examination

Quality of life and self-reported disability in patients with osteoarthritis: Cross-sectional descriptive study

BACKGROUND: Osteoarthritis (OA) is a chronic disease in which the cartilage in the joints deteriorates and the bones rub against each other, causing pain, stiffness, and restricted range of motion. This is an age-related condition that affects initially isolated joints or joints on one aspect of the body. The aim of the study is to identify quality of life and self-reported disability in patients with osteoarthritis. MATERIALS AND METHODS: A cross-sectional descriptive study was conducted in Orthopedic O.P.D. of tertiary care hospital. Study was conducted on 150 samples with convenience sampling at orthopedic O.P.D. Data were collected with standardized tools SF-36 with domains physical functioning (PF), role physical (RP), vitality (VT), mental health (MH), role emotional (RE), social functioning (SF), bodily pain (BP) general health (GH), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaires with domains pain, stiffness, and functional disability. Descriptive statistics and inferential statistics were used for data analysis such as mean, frequency, percentage, standard deviation, and Chi-square test. RESULTS: Out of 150 samples, 103 were females, 114 were Hindu, and 131 were married. Highest mean score in RE domain of SF-36 was 60 with SD 38.43 indicating that patients had low impact on quality of life, whereas lowest mean score was 35.33 with SD 32.67 indicating that patients had severe impact in RP domain. In WOMAC index, patients had highest pain in climbing stairs, stiffness during morning, and functional difficulty during doing heavy domestic work, whereas lowest pain in resting, stiffness in evening, and functional difficulty during lying in bed. CONCLUSION: Patients with OA had poorer quality of life in domains PF, RP, VT, BP, and GH. Patients with osteoarthritis showed highest self-reported disability in terms of pain in climbing stairs, stiffness during morning, and functional difficulties in doing heavy domestic duties

Circulating thrombopoietin levels in normal healthy blood donors and in aplastic anemia patients in relation to disease severity

Background: Thrombopoietin (TPO) is the key hematopoietic growth factor regulating the production of platelets from bone marrow megakaryocytes and maintaining platelet hemostasis. This study was done to find any relationship between the levels of thrombopoietin and the severity of disease in patients with aplastic anemia. Materials and Methods: Serum samples were collected from 52 patients with a confirmed diagnosis of aplastic anemia and 45 normal healthy blood donors of both sexes over a period of 2 years, and TPO was estimated by using commercially available TPO-specific-enzyme-linked immunosorbent assay. Results: The median TPO level of 1190 pg/ml (range 625-7651 pg/ml) in aplastic anemia patients was significantly higher than the median TPO level of 121.1 pg/ml (81.25-237.7 pg/ml) in normal healthy blood donors (P = 0.000). No significant difference was observed in TPO levels of male and female patients (P = 0.453). The median TPO concentrations observed in very severe aplastic anemia, severe aplastic anemia, and nonsevere aplastic anemia were 2765 pg/ml (range 625-6451 pg/ml), 1190 pg/ml (range 672.1-7651 pg/ml), and 1111.5 pg/ml (range 761.1-2289.2 pg/ml), respectively. TPO in patients of very severe aplastic anemia was significantly higher than patients of nonsevere aplastic anemia (P = 0.043), with no significant relation among rest of the groups. Discussion: TPO levels in aplastic anemia patients were significantly higher than in healthy blood donors; however, in aplastic anemia patients TPO levels were significantly higher only in patients with very severe disease