Novel technique of removal of broken intra-medullary nail from femur with secondary DCS plating

Femoral shaft fractures are one of the commonest fractures of the lower limb which are frequently operated with intramedullary nailing which enables immediate post-operative mobilization of the patient. There could be various causes of nail breakage – some of the notable being weight bearing over the non-union of the femur shaft, or a re-trauma over the operated limb causing both the implant and the nail to be broken. There are various methods of removal of the broken implant the commonest being the use of T-reamer technique. However not always can this be used due to varied intra-operative obstacles in different cases as described in this case below. We have a 35 year old male patient who was brought to us 2 hours after an alleged history of slip and fall following which he had sustained right sided subtrochanteric femur fracture with a broken implant – intramedullary interlock nail. The patient is a previously operated case of right sided femur shaft fracture with interlocking nailing done 15 years back. The patient was operated with – broken implant removal on the right side along with a secondary DCS plating with bone grafting for the subtrochanteric femur fracture. Intra operative period was met with a certain number of challenges and difficulties in view of a 15 year old implant for removal which was successfully with removed with DCS plating done. As is obvious with the above case, it would be quite imperative to say that older the implant, more difficult it becomes for its removal.

Development of DVT in an operated case of cemented bipolar hemiarthroplasty during COVID pandemic: a case report

One of the most common treatment for fracture neck of femur in the elderly is bipolar hemi-arthroplasty which is associated with the patient being mobilized early, lower complication rate, longer implant life. Both uncemented and cemented arthroplasty have been associated with good outcomes, however cemented arthroplasty has higher incidences of DVT due to the thrombogenic potential of cement in addition to the hypercoagulability due to the femoral fracture. Hence, DVT remains a life-threatening complication of arthroplasty, despite the preventive measures owing also to certain genetic and acquired risk factors. We have a 70-year-old female patient, who presented to us with a post traumatic right sided displaced neck of femur with greater trochanter fracture following an alleged history of slip and fall at home who was operated with cemented bipolar hemi-arthroplasty. The patient developed deep vein thrombosis of the operated limb even after adequate mobilization with full weight bearing over the operated limb from post op day 2 and other adequate physiotherapy exercises such as hip/knee ROM exercises and ankle pump exercises. Although, our case report seems to be too far-fetched in terms of correlating this episode of DVT even after adequate mobilization from POD-2 to the ongoing COVID-19 pandemic causing a sub-clinical asymptomatic coronavirus infection causing an increased hypercoagulability of the blood as has been demonstrated by various studies, it does provide substantial evidence which warrants wider multi-centric studies in order to provide a definite correlation of the aforementioned scenario.

Fracture union in extra articular distal tibia fracture after definitive delta frame external fixation in COVID 19 pandemic: a case report

Distal tibia fractures account for 10% of lower limb fractures. Mode of trauma also determines the fate of soft tissue recovery. In low energy fractures soft tissue show better healing whereas fractures due to high energy trauma show high chances of soft tissue complications like poor soft tissue coverage, wound infection and necrosis. We presented a 50 years old male case of extra articular left distal tibia fibula open fracture managed by delta frame external fixator with fibular K wiring used as a definitive management with good fracture healing and range of motion 5 months postoperative. Ankle spanning external fixation is a good modality of surgical management of extra articular compound distal tibia fractures as both temporary and definitive surgical fixation

Case series of orthopaedic complications associated with endocrine disorders presented at tertiary care center and review of literature

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 affected by the endocrine hormones, such as parathyroid hormone, thyroid, glucocorticoids and gonadotropins. Any abnormality in these hormones leads to alteration of bone mineral density. Hyperthyroidism, glucocorticoid excess, hyperparathyroidism, hypogonadism, and acromegaly decrease bone mineral density and aggravate the osteoporotic tendencies and leading to orthopaedic complications. As an orthopaedic practitioner we should be well aware of endocrine disorders affecting bones. Early diagnosis and treatment of these endocrine problems in older patients helps to maintain their skeletal integrity, prevent osteoporotic fracture and orthopaedic complications