Results of percutaneous release of stenosing tenosynovitis (trigger finger) using hypodermic needle

Background: Stenosing tenosynovitis or trigger finger is a common condition affecting finger function, which can lead to disability in hand function. Treatment in form of conservative can be helpful in early stages, however later stages and chronic triggering needs release of A1 pulley either by open or percutaneous methods. The aim of this study was to find the results of percutaneous release of trigger finger with 18 guage needle.Methods: 43 digits in 36 patients were enrolled for this prospective study in a district level hospital over a 2 year period. Release was done under local anaesthesia using 18 guage needle percutaneously. Follow up was done upto 6 months. Final scoring was done at 6 months using Quinell’s criteria.Results: We had 81.39% (35 out of 43) excellent to good results. 19.61% (8) needed open release. We had no neurovascular injury or infection in our series.Conclusions: Percutaneous release by 18 guage needle is safe and effective treatment for trigger finger without much complication

Isolated cystic tuberculosis of medial cuneiform: a case report

Isolated tuberculosis of foot is a rare entity. Plenty of literature is available on osteoarticular tuberculosis but literature on tuberculosis of foot is limited. Additionally the condition mimics variety of other foot pathologies which can delay diagnosis and add to morbidity. We present a twelve year old boy who presented clinically with swelling, pain and discharging sinus of foot with a cystic lesion in medial cuneiform on radiography. Though histopathology and Ziehl Nielsen staining later on established the diagnosis, but initially it was mistaken as a case of mycotic osteomyelitis. Tuberculosis of foot, though rare, should always be one of the differential diagnoses in a patient presenting with bony lesion on radiography irrespective of absence of constitutional symptoms and negative tests for tuberculosis. If battery of tests fails to establish diagnosis, open biopsy with curettage and histopathology should be considered to work out the final diagnosis

Closed intramedullary nailing of acute femoral shaft fracture: reduction with help of bone levers through a small incision without opening fracture site

Background: Femoral shaft fractures are usually treated with intramedullary nailing. In this study, we report a modified closed surgical technique with reduction with bone levers through a small percutaneous stab incision without opening fracture site for this type of fracture.Methods: From June 2015-January 2017, this technique was used on 43 patients with femoral shaft fractures. Patients were followed up postoperatively for clinical evaluation. The surgical technique involves a mini-percutaneous incision slightly distal to the fracture site, and fracture reduction is performed with bone levers without opening the fracture site.Results: 39 patients were included in final assessment. 29 fractures (74.4%) healed in the first 6 month. 35 (89.7%) fractures were united by one year. 4 (10.3%) patients needed bone grafting. The functional results were considered excellent and good in 36 (92.3%) patients, 3 (7.7%) patients had poor results.Conclusions: The advantages of this procedure include that no fracture site is opened, there is a shorter operation time, less radiation exposure and it is especially suitable for multiple trauma and obese patients.

Pilonidal sinus: excision and primary closure over suction drain and its outcome

Background: Pilonidal sinus is a chronic inflammatory disease predominantly involving Sacrococcygeal region. Despite advances in medical sciences, management of pilonidal disease is still not well defined. Treatment varies from simple techniques to more sophisticated surgeries with their own pros and cons. Methods: This prospective observational study comprised of forty-two patients who underwent the surgery for pilonidal sinus as per the procedure described. This study was carried from 1 May 2019 till 30 November 2022. Median age of the patients was 24.5 years, ranging between 19-32 years. Sinus discharge was the predominant symptom of our study population with 34 patients (80.94%) complaining of same. Results: Mean operative time was 54 minutes with a range of 45-78 minutes. Average hospital stay was 1.8 days though it ranged from 1 to 3 days. Five patients (11.90%) developed seroma while four patients (9.52%) had superficial wound site infection. We had two recurrences (4.76%) over the follow-up period of 1 year. Conclusions: Excision and primary closure of the pilonidal disease is effective with comparable complication rates and shorter time off work. The surgery can be easily performed

Early result of pediatric shaft femur fractures treated by hip spica cast in children upto 10 years of age

Background: Fracture shaft of femur is constitute 1.6% paediatric fractures. Traditionally most femur fractures in children were treated conservatively, however with the coming of new implants, the indications of operating have increased. We believe guidelines based on age are from western literature where children are usually of big frame, our children being of smaller frame, the conservative management by hip spica can be extended to older children.Methods: This study was done to see the results of conservative management of femur fractures in form of hip spica and traction followed by spica in children less than 10 years of age. Patients less than 6 months of age (treated by Pavlik harness), having compound fractures and those with associated injuries were excluded from the studyResults: Follow up was done in OPD after 1,4,6,10,12 weeks with check X-rays taken after spica application and at 6, 10 ,12 weeks and at removal of spica cast. All fractures united with average union time of 7.3weeks. At final follow up of 1 year 23 patients had a limb length difference of more than 1cm. average hospital stay was 13.5 days. We had 4 cast complications in form of skin excoriation and superficial skin ulceration in 2 children and broken spica in 2 children.Conclusions: Traction followed by spica cast is safe and effective method of treating fracture of paediatric femur fractures

Results of traction followed by hip spica cast for closed fracture shaft of femur in children from 2 years upto 10 years of age: experience from a remote centre in North India

Background: Fracture shaft of femur is a common fracture in children, with treatment from conservative in form of skin traction to intramedullary nailing depending on age. Conservative treatment is mostly used upto six years of age, while for children more than 12 years surgery is usually preferred. We extended conservative in form of hip spica cast till 10 years of age. This study evaluates results of skin traction followed by spica cast in children upto 10 years of age.Methods: Study was done in GMC Doda from April 2019 to March 2022. 47 patients were enrolled for study, patients were initially given skin traction to get alignment which was followed by spica cast. Patients were evaluated at 3, 6, 9 and 12 weeks, final follow up was done at 6 months.Results: Out of 47 children, 4 patients were lost to follow up. Average age of children was 5.83 years. Mode of trauma was mostly RTA or fall from height. Average duration of traction was 9.14 days and average stay in hospital was 11.5 days. Average union time was 8.36 weeks. We had significant limb length discrepancy or angulation in 6 (13.9%) of our patients.Conclusions: skin traction followed by spica cast gives good results in fracture shaft femur in children upto 10 years of age

Evaluation of results of three and four-part fracture dislocations of proximal humerus in young adults using philos (proximal humerus internal locking system)

Background: The fractures of proximal humerus constitute about 5% of fractures in adults third in number to fracture colles and hip usually in elderly patients due to a low energy trauma. In young patients the fractures are mostly due to high energy trauma and as such are associate with other soft tissue injuries. A sub group of young patients have a three or four fracture dislocation of shoulder joint. The aim of this study was to find the results of fixation by PHILOS in these young patients.Methods: This study was done in a teritiary referral centre over a period of about 1 year. All patients were operated within three weeks. Open fractures, patients with age more than 50 years were excluded from the study. All patients underwent open reduction and fixation using commercially available PHILOS. A minimum of 6 months follows up was essential for inclusion into the study. Final functional results were evaluated by Constant Murley scoring.Results: 14 patients were included in the study. The average age of patients was 38.42years. All fractures united. We had 71.4% excellent or good results. The complications noted were shoulder stiffness in 3, inadequate post op reduction, rotator cuff insufficiency, head necrosis, secondary osteo arthritis 1 each.Conclusions: Despite the relatively high rate of complications encountered in the management of these complicated high-energy fractures, the PHILOS plating system could be considered an adequate management of these patients

Closed intramedullary nailing of acute femoral shaft fracture: reduction with help of bone levers through a small incision without opening fracture site

Background: Femoral shaft fractures are usually treated with intramedullary nailing. In this study, we report a modified closed surgical technique with reduction with bone levers through a small percutaneous stab incision without opening fracture site for this type of fracture.Methods: From June 2015-January 2017, this technique was used on 43 patients with femoral shaft fractures. Patients were followed up postoperatively for clinical evaluation. The surgical technique involves a mini-percutaneous incision slightly distal to the fracture site, and fracture reduction is performed with bone levers without opening the fracture site.Results: 39 patients were included in final assessment. 29 fractures (74.4%) healed in the first 6 month. 35 (89.7%) fractures were united by one year. 4 (10.3%) patients needed bone grafting. The functional results were considered excellent and good in 36 (92.3%) patients, 3 (7.7%) patients had poor results.Conclusions: The advantages of this procedure include that no fracture site is opened, there is a shorter operation time, less radiation exposure and it is especially suitable for multiple trauma and obese patients.

Gorham′s vanishing bone disease of ribs mimicking metastasis: A case report and review of the literature

Gorham′s disease is a very rare self-limiting osteolytic disorder of the bone of unknown etiology, and can affect any bone of the body. Clinical presentation varies with the location and extent of the lesion. Lesions of the thoracic cage, spine and craniofacial bones are associated with high morbidity. Mortality multitude of treatment options is available, but none is satisfactory. We present a case of Gorham′s disease of the ribs that was initially suspected to be metastasis, but subsequent search for the primary lesion was negative. It was the histopathology of the lesion that leads to the diagnosis of Gorham′s disease. The lesion did not progress, neither did it resolve either due to the natural arrest or due to effect of the bisphosphonate therapy

Giant ′giant cell tumor′ of pelvis

Giant cell tumor (osteoclastoma) of pelvis is rare entity. Most of these have average size of 9.5cm. We here present a massive osteoclastoma involving pubis and periacetabular region to such an extent that surgical excision could not be done. Our surgical intervention was aimed to correct the associated deformity and improve function by debulking the part of tumor responsible for mechanical symptoms and deformity