Hoffa fracture: analysis of factors affecting the final outcome after treatment with partially threaded screws

Background: Coronal fractures of the femoral condyles are rare injuries.Methods: This retrospective case series included patients with coronal fractures of the femoral condyles managed operatively. The surgeries were performed by authors NJ, RL and VB. A total of 11 patients with Hoffa fracture were operated between May 2011 and July 2012.Results: We report the outcome of open reduction and internal fixation using partially threaded screws in 11 patients with Hoffa fracture. There were 10 male and 1 female patient operated at a mean age of 37 years. The average duration of follow up was 15.6 months. Fractures in all the patients united with a mean 115.450 range of flexion at knee at final review. The final outcome had a poor correlation with the shear angle of the fracture but fracture comminution and open nature of injury had a negative effect on the final outcome achieved. The number of screws used and the type of rehabilitation followed post operatively also had no bearing on the final range of motion achieved.Conclusions: Partially threaded screws offer consistently good results in coronal fractures of the femoral condyles and the outcome is dictated only by perioperative factors like comminution and open nature of injury

En bloc excision and autogenous fibular reconstruction for aggressive giant cell tumor of distal radius: a report of 12 cases and review of literature

<p>Abstract</p> <p>Introduction</p> <p>Giant cell tumor (GCT) of distal radius follows a comparatively aggressive behaviour. Wide excision is the management of choice, but this creates a defect at the distal end of radius. The preffered modalities for reconstruction of such a defect include vascularized/non-vascularized bone graft, osteoarticular allografts and custom-made prosthesis. We here present our experience with wide resection and non-vascularised autogenous fibula grafting for GCT of distal radius.</p> <p>Materials and methods</p> <p>Twelve patients with a mean age of 34.7 years (21-43 years) with Campanacci Grade II/III GCT of distal radius were managed with wide excision of tumor and reconstruction with ipsilateral nonvascularised fibula, fixed with small fragment plate to the remnant of the radius. Primary autogenous iliac crest grafting was done at the fibuloradial junction in all the patients.</p> <p>Results</p> <p>Mean follow up period was 5.8 years (8.2-3.7 years). Average time for union at fibuloradial junction was 33 weeks (14-69 weeks). Mean grip strength of involved side was 71% (42-86%). The average range of movements were 52° forearm supination, 37° forearm pronation, 42° of wrist palmerflexion and 31° of wrist dorsiflexion with combined movements of 162°. Overall revised musculoskeletal tumor society (MSTS) score averaged 91.38% (76.67-93.33%) with five excellent, four good and three satisfactory results. There were no cases with graft related complications or deep infections, 3 cases with wrist subluxation, 2 cases with non union (which subsequently united with bone grafting) and 1 case of tumor recurrence.</p> <p>Conclusion</p> <p>Although complication rate is high, autogenous non-vascularised fibular autograft reconstruction of distal radius can be considered as a reasonable option after en bloc excision of Grade II/III GCT.</p

Tuberculosis of the foot: An osteolytic variety

Background: Foot involvement in osteoarticular tuberculosis is uncommon and isolated bony involvement of foot bones with an osteolytic defect is even more rare; diagnostic and therapeutic delays can occur, worsening the prognosis. We present a retrospective series of osteolytic variety of foot tuberculosis. Materials and Methods: We present 24 osteolytic variety of foot tuberculosis (Eleven calcaneus, four cuboid, two cunieforms, one talus, three metatarsals, three phalanges) out of 92 foot TB cases collected over last 20 years. There were 16 adults and eight children. Tissue diagnosis was established in 23 of 24 cases based on PCR AFB staining, culture, and histopathology. Surgical intervention was reserved for patients with either a juxtaarticular focus threatening to involve a joint or an impending collapse of a midfoot bone with cystic destruction. Results: Fifteen cases had an osteolytic lesion on the radiographs resembling a space-occupying lesion, five had patchy osteolysis, while four showed coke like sequestra; one patient had a lesion in two bones. Antitubercular chemotherapy after biopsy was sufficient to heal the lesion in 19 cases, while in five cases surgical debridement needed to be done. The lesions healed eventually. At an average followup of 8.3 years, (range 2-15 years) there were no recurrences and all patients were free from pain, with no restriction of movements. Six patients complained of occasional pain during walking on uneven ground. Conclusion: When tuberculous pathology is limited to the bone, the prognosis is better than in articular disease, as there is less deformity, and hence, less residual pain and disability

Tuberculosis of the elbow: A clinicoradiological analysis

Background: The incidence of Tuberculosis (TB) of elbow is 2-5% of all skeletal locations. Most reports of TB elbow have focused attention on the diagnosis. The management options and classification has been missing. We present a retrospective clinicoradiological analysis of 38 cases (40 elbows) of TB of elbow joint. Materials and Methods: The patients presented with pain, swelling and loss of motion. Two cases had bilateral involvement. The average delay between onset of symptoms and presentation was 8 months. The elbows were classified according to modified Martini′s radiological classification, which distinguishes between osseous lesions close to joint line (e.g. coronoid, condyles) and lesions away from the joint line (e.g. epicondyles, olecranon). We modified the classification to subdivide into para-articular bony lesions that had invaded the joint and those that were threatening to invade joint. All patients received antitubercular chemotherapy and immobilization in above-elbow plaster slab for 4-8 weeks. Twenty patients underwent surgical interventions (synovectomy, intraarticular debridement). Results: The average followup period was 5.3 years (range 1.5-14.2 years). The range of movement at final followup averaged 107° for stage 2, 90° for stage 3A, 47° for stage 3B and 32° for stage 4. Range of supination and pronation was less satisfactory as compared to flexion and extension and all elbows with bony involvement had less than 90° arc of supination and pronation. Conclusion: Surgical intervention could appreciably alter the outcome especially in patients with extra-articular involvement close to the joint. We have classified this subgroup separately

A large osteosarcoma of distal humerus in a 13-year-old child - Case report

Background: Massive skeletal tumours are rare and usually have a poor prognosis. Delayed presentation alters management and reduces survival, and is challenging to manage. Case report: A 13-year-old girl presented to our OPD with a 35cm X 35cm swelling over her left arm, which had been increasing in size for the past one year and an inability to use her left hand for the last three months. The patient had been bedridden for the past eight months and had stopped schooling. The distal vascularity of the limb was intact. However, there was a left radial nerve palsy. Radiographs revealed a sclerotic swelling with peripheral calcifications, which had destroyed the shaft of the humerus. The biopsy concluded the swelling to be a chondroblastic osteosarcoma. Neoadjuvant chemotherapy was given, and a forequarter amputation was performed. The patient was discharged on the fifth postoperative day and received adjuvant chemotherapy. Currently patient has resumed her daily activities and schooling, with no signs of recurrence. Conclusion: The gigantic size of such a tumour constitutes a rare presentation and calls for analysis and audit of the loopholes in our healthcare setup that might have led to this. Proper patient education and counselling regarding the disease and management options are essential. The size of the tumour isn't indicative of the presence or absence of metastasis, and a radical surgery such as an amputation may also drastically improve the quality of life of such patients

Flexible intramedullary nailing in paediatric femoral fractures. A report of 73 cases

Abstract Background Flexible intramedullary nailing has emerged as an accepted procedure for paediatric femoral fractures. Present indications include all patients with femoral shaft fractures and open physis. Despite its excellent reported results, orthopaedic surgeons remain divided in opinion regarding its usefulness and the best material used for nails. We thus undertook a retrospective study of paediatric femoral fractures treated with titanium or stainless steel flexible nails at our institute with a minimum of 5 years follow up. Material and methods We included 73 femoral shaft fractures in 69 patients treated with retrograde flexible intramedullary nailing with a minimum follow up of 5 years. Final limb length discrepancy and any angular or rotational deformities were determined. Results Mean age at final follow up was 15.5 years (10-21 years). Mean follow up was 7.16 years (5.0-8.6 years). Titanium and stainless steel nails were used in 43 and 30 cases respectively. There were 51 midshaft, 17 proximal, and 5 distal fractures. All fractures united at an average of 11 weeks but asymptomatic malalignment and LLD were seen in 19% and 58% fractures respectively. LLD ranged from -3 cm to 1.5 cm. Other complications included superficial infection(2), proximal migration of nail(3), irritation at nail insertion site(5) and penetration of femoral neck with nail tip(1). There were 59 excellent, 10 satisfactory and 4 poor results. Conclusion Flexible intramedullary nailing is reliable and safe for treating paediatric femoral shaft fractures. It is relatively free of serious complications despite asymptomatic malalignment and LLD in significant percentage of fractures.</p