Functional outcome of wide resection and autologous avascular proximal fibular graft arthroplasty in distal radius GCT

Background: Giant cell tumor (GCT) of distal radius usually presents in late stages with aggressive progression. Extended curettage alone is usually inadequate and wide resection is the most common surgery performed. Reconstruction of the resulting defect poses significant challenges.Methods: 11 patients with distal radius GCT treated with wide resection and autologous avascular proximal fibular graft arthroplasty were studied retrospectively. One patient was Campanacci grade II and the rest 10 were Campanacci grade III. All patients underwent a standard preoperative workup and underwent a standard procedure. Patients were followed up for a mean period of 33 months (range: 1 year–7 years). Wrist movements were documented and functional outcome was scored using revised musculoskeletal tumor society scoring (MSTS).Results: Of the 11 patients, eight had excellent outcome, two had good outcome and one had satisfactory outcome according to MSTS scoring. Mean dorsiflexion, palmar flexion, supination and pronation was 44 degrees (range 10-80), 34 degrees (range 10-70), 60 degrees (range 20-80), 54 degrees (range 15-70) respectively. The complications encountered were fibulo-ulnar diastasis in 3 patients, fibulo-carpal subluxation in 2 patients, soft tissue recurrence in 1 patient and graft site non-union in 1 patient. Despite fibula-ulnar and fibula-carpal instability functional outcomes were seen to be excellent (4 patients) or good (1 patient).Conclusions: Avascular autologous proximal fibular arthroplasty provides for excellent to good functional outcomes after wide resection in distal radius GCT even if radiological appearances are suboptimal

Effectiveness of Standalone Weight-bearing Radiographs in Guiding the Management of Supination External Rotation Type Isolated Lateral Malleolar Fractures in Indian Population: A Prospective Clinical Study

Aim and objective: To assess the effectiveness of standalone weight-bearing radiographs (WBR) in guiding the management of Supination External Rotation (SER), type of isolated lateral malleolar fractures in Indian population. Materials and methods: In a prospective study involving 19 consecutive patients with SER type of isolated lateral malleolar fractures, stability of the ankle was assessed using both WBR and external rotation stress radiographs. The decision toward conservative or surgical management was made solely on the assessment of ankle stability on WBR alone. Fractures with a medial clear space of <5 mm were deemed stable and managed conservatively (full weight-bearing in cast), while unstable ones were managed surgically (with open reduction and fibular plating). Periodic follow-up was done to assess radiological union and functional outcomes using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Patient's pain score visual analogue scale (VAS) and compliance was assessed during radiographic assessment. Results: Based on WBR alone, 17/19 (89.5%) fractures were found to be stable and treated conservatively, while 2/19 (10.5%) fractures were unstable and managed surgically. The mean AOFAS score in the conservative group [92.9 ± 3.4 (excellent)] and surgical group [91.5 ± 1.5 (excellent)] were comparable at latest follow-up. Complete radiological union was seen at 8.8 ± 1.9 (range, 8-14) weeks in 82% (14/17), while delayed union (union taking place >8 weeks) was seen in three patients in the conservative group. Four patients (21%), who would have been operated had external rotation stress views been used in decision making, were managed conservatively with successful clinical outcome and excellent AOFAS scores. Patient compliance was good with WBR as compared to external rotation stress radiographs. Conclusion: Standalone WBR are feasible, and reliable in detecting injury of the deep deltoid ligament and the consequent instability of the tibiotalar joint, in Weber type B fractures. They are associated with better patient compliance. Clinical significance: Standalone WBR serve as a useful guide in decision making between conservative and surgical treatment, in SER type isolated lateral malleolar fractures

An Unusual Complication in Osteonecrosis of Femoral Head: A Case Report

We report a case of fracture of femoral head occurring in the setting of underlying osteonecrosis following a low-energy trauma in a middle-aged male. Patient also has underlying pelvic pathology from a previous trauma. The possible mechanism of injury is discussed. Extensive literature search reveals that this is the first report of a fracture in an osteonecrotic femoral head

Unstable Fracture Neck of Femur in Young Adults: Management with Cannulated Cancellous Screws Augmented with Medial Buttress Plate

ABSTRACT Objective This study is to evaluate the clinical and radiological outcome of unstable fracture neck of the femur in young adults treated with three cannulated cancellous screws augmented with medial buttress plate. Materials and methods Fifteen patients of less than 60 years were operated from January 2017 to March 2018. Reduction was achieved by closed or open means to Garden's alignment index grade I. Internal fixation was done with three cannulated cancellous screws through mini lateral incision, and medial buttress plating was done through modified Smith–Peterson approach. All patients were mobilized from the immediate postoperative period and allowed toe-touch weight-bearing as tolerated. All patients were followed at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Results Fracture united in 14 of 15 patients. Reduction loss and backing out of cancellous screws occurred in one patient. No cases of avascular necrosis was identified at a mean follow-up of 13.7 months. No significant femoral neck shortening was observed in all united fractures. Conclusion Anatomical reduction by closed or open method; stable fixation with three cannulated cancellous screws augmented with medial buttress plate, increases fracture union rate compared to the historical series using closed reduction and cancellous screw fixation alone. Open reduction and medial antiglide plate fixation do not appear to increase morbidity. How to cite this article Singaravadivelu V, Kartheesan G, Vignesh S. Unstable Fracture Neck of Femur in Young Adults: Management with Cannulated Cancellous Screws Augmented with Medial Buttress Plate. J Orth Joint Surg 2019;1(1):1–4. </jats:sec

Floating Knee Injury Associated with Patellar Tendon Rupture: A Case Report and Review of Literature

Floating knee injuries are frequently associated with other concomitant injuries to the ipsilateral limb or other parts of body of which injury to the ipsilateral knee ligaments carries significance for various reasons. A middle-aged man sustained a floating knee injury following RTA. DCS fixation by bridge plating technique for the distal femur and lateral buttress plating by MIPO technique for proximal tibia were planned and executed under spinal anesthesia with image intensifier. In addition, there were patellar tendon rupture along with avulsion of VMO from the medial border of patella and torn MPFL, which we have missed initially. To the best of our knowledge no similar case has been reported in English literature so far. We have reviewed the literature and proposed a different interpretation of Blake and McBride classification