Bi-columnar fixation of displaced distal humeral metaphyseal fractures in children: functional outcome assessment of 100 fractures

Background: Supracondylar fractures of the humerus are one of the commonest fractures encountered around the elbow in children. The treatment of these fractures continues to pose challenges even in this age of advancing orthopedics. These fractures have the propensity to go for malunion with cosmetic deformity. This study was done to evaluate the functional results of surgical management of supracondylar fractures of the humerus in children using closed reduction and percutaneous bi-columnar pinning technique.Methods: 100 patients with Gartlands type II, III and IV supracondylar humerus fractures were operated with closed reduction and pinning using K-wires. Patients were followed up at six weeks, twelve weeks and six months and final evaluation were done using the Mayo elbow performance score (MEPS).Results: In our study, there were 70 males and 30 female patients with mean age of 6.5 years. 85 cases were had fall on outstretched hand as mode of injury and rest following motor vehicle accident. Gartland type II fractures accounted for 10 cases; type III fractures accounts 88 cases and type IV was only 2 cases. Excellent to good results were seen in 80 cases as per the MEPS at 6 months follow-up.Conclusions: From our study, we could conclude that closed reduction and bi- column percutaneous pinning offers a reliable fixation which permits early mobilization and good functional outcome in displaced fractures. Increasing the number of wire will allow early mobilization and prevent stiffness.

An Unusual Presentation of Primary Lymphoma of the Ilium

Primary bone lymphoma involving the pelvic bone is a rare entity. It does not have distinct clinical features or radiological features that are diagnostic. Biopsy is the gold standard investigation. We present a case of primary pelvic lymphoma with initial histopathological features of chronic osteomyelitis. Upon further clinical follow-up, repeat biopsy of the lesion revealed features of B-cell Non-Hodgkin’s lymphoma, thus emphasizing the need for a high index of suspicion and close clinical follow-up. This case is presented for the diagnostic dilemma and the unique feature of lymphomatous lesion mimicking chronic osteomyelitis in its early stages

Case Report A Paradoxical Triad: Scapulothoracic Dissociation with Clavicle and Humeral Shaft Fractures

Scapulothoracic dissociation involves varying degree of discontinuity of the upper extremity from its truncal attachment. An eighteen-year-old male presented to the accident and emergency department following a motor vehicle accident where he was hit by a four wheeler while riding a two wheeler. He had tenderness and deformity over the left clavicle and the left humerus. He was unable to perform active wrist and finger dorsiflexion. A CT subsequently revealed a grade 2 splenic laceration. The splenic laceration was treated conservatively. As his general condition improved, he was gradually weaned off the ventilator and his left upper limb neurology was reassessed. He had isolated radial nerve palsy with an otherwise intact brachial plexus. He underwent internal fixation of the clavicle and the humerus. At 4 months after injury the EMG/NCV report showed signs of renervation of the radial nerve, and the fracture progressed to an uneventful union. This prior unreported triad of scapulothoracic dissociation with ipsilateral clavicular and humeral fractures may represent a parody. An apparent increase in the severity of skeletal injury was associated with a paradoxical decrease in the severity of neurovascular injury. We report this case to create awareness among orthopedic surgeons and emergency physicians about the clinical presentation of such injuries

Case Report Traumatic Floating Clavicle: A Case Report and Literature Review

Bipolar fracture dislocations of the clavicle are rare injuries, usually the result of high-energy direct trauma. Since the original description by Porral in 1831, only a handful of individual case reports and case series by Beckman and Sanders have been reported in the literature. Management of these injuries has remained controversial ranging from nonoperative to aggressive surgery. We report on the case of a young army cadet who had a fracture of the lateral end of the clavicle, with an anterior dislocation of the sternoclavicular joint. Despite being planned for surgery, at the patients request, it was decided to manage the lesion conservatively with graded physiotherapy. At one-year follow-up, he had full pain-free, functional range of movement of the shoulder. This young high demand patient had a good outcome with conservative management, despite going against the current trend towards surgical treatment. We present this case with a review of the literature, highlighting the various management options for this rare lesion

A Paradoxical Triad: Scapulothoracic Dissociation with Clavicle and Humeral Shaft Fractures

Scapulothoracic dissociation involves varying degree of discontinuity of the upper extremity from its truncal attachment. An eighteen-year-old male presented to the accident and emergency department following a motor vehicle accident where he was hit by a four wheeler while riding a two wheeler. He had tenderness and deformity over the left clavicle and the left humerus. He was unable to perform active wrist and finger dorsiflexion. A CT subsequently revealed a grade 2 splenic laceration. The splenic laceration was treated conservatively. As his general condition improved, he was gradually weaned off the ventilator and his left upper limb neurology was reassessed. He had isolated radial nerve palsy with an otherwise intact brachial plexus. He underwent internal fixation of the clavicle and the humerus. At 4 months after injury the EMG/NCV report showed signs of renervation of the radial nerve, and the fracture progressed to an uneventful union. This prior unreported triad of scapulothoracic dissociation with ipsilateral clavicular and humeral fractures may represent a parody. An apparent increase in the severity of skeletal injury was associated with a paradoxical decrease in the severity of neurovascular injury. We report this case to create awareness among orthopedic surgeons and emergency physicians about the clinical presentation of such injuries

Traumatic Floating Clavicle: A Case Report and Literature Review

Bipolar fracture dislocations of the clavicle are rare injuries, usually the result of high-energy direct trauma. Since the original description by Porral in 1831, only a handful of individual case reports and case series by Beckman and Sanders have been reported in the literature. Management of these injuries has remained controversial ranging from nonoperative to aggressive surgery. We report on the case of a young army cadet who had a fracture of the lateral end of the clavicle, with an anterior dislocation of the sternoclavicular joint. Despite being planned for surgery, at the patients request, it was decided to manage the lesion conservatively with graded physiotherapy. At one-year follow-up, he had full pain-free, functional range of movement of the shoulder. This young high demand patient had a good outcome with conservative management, despite going against the current trend towards surgical treatment. We present this case with a review of the literature, highlighting the various management options for this rare lesion

Case Report A Pelvic Pseudotumor in a Nonhemophilic Patient: An Unusual Presentation

Hemophilic pseudotumor is a rare complication of hemophilia, occurring in 1 to 2 percent of individuals with severe factor VIII or factor IX deficiency. A 35-year-old male presented with a swelling in the right lower abdomen for 3 months. There was no history of trauma. Examination revealed a swelling over the right iliac fossa. Right hip showed 30 ∘ flexion deformity. Blood investigations like complete blood count, APTT, PT, bleeding and clotting time, and fibrinogen were all normal. Plain radiograph and MRI showed a lytic lesion in the right iliac wing. Excision biopsy of the swelling showed organized hematoma with a fibrous capsule suggestive of a pseudotumor. Further haematological workup like factors VIII and IX was normal. At 2 years follow-up, there was no recurrence. We report this case of pseudotumour in patient without any bleeding disorder. Such case has not been reported in literature to the best of our knowledge

A Pelvic Pseudotumor in a Nonhemophilic Patient: An Unusual Presentation

Hemophilic pseudotumor is a rare complication of hemophilia, occurring in 1 to 2 percent of individuals with severe factor VIII or factor IX deficiency. A 35-year-old male presented with a swelling in the right lower abdomen for 3 months. There was no history of trauma. Examination revealed a swelling over the right iliac fossa. Right hip showed 30° flexion deformity. Blood investigations like complete blood count, APTT, PT, bleeding and clotting time, and fibrinogen were all normal. Plain radiograph and MRI showed a lytic lesion in the right iliac wing. Excision biopsy of the swelling showed organized hematoma with a fibrous capsule suggestive of a pseudotumor. Further haematological workup like factors VIII and IX was normal. At 2 years follow-up, there was no recurrence. We report this case of pseudotumour in patient without any bleeding disorder. Such case has not been reported in literature to the best of our knowledge