Alok Sud

Open reduction for late-presenting posterior dislocation of the elbow

Purpose. To evaluate results of open reduction for late-presenting (more than 3 weeks) posterior dislocation of the elbow in 10 patients. Method. Elbow stiffness was the main indication for surgery. The mean age of the patients was 34 (range, 13–65) years; the mean time since injury was 4 (range, 2–6) months. All patients had non-functional elbow movement for any activity of daily living. Three patients had associated fractures around the elbow joint. Results. At a mean follow-up of 19 (range, 11–28) months, 8 patients regained a functional range of movement for activities of daily living and maintained a median arc of flexion of 100 degrees and a supination-pronation arc of 140 degrees. According to the Mayo Elbow Performance Index, the results of 5 patients were excellent, 3 were good, and 2 were poor. Complications included pin site infection (n=2), ulnar neuritis (n=1), and delayed wound healing (n=1). Conclusion. In patients with late-presenting, unreduced elbow dislocation occurring up to 6 months earlier, open reduction is effective in restoring the joint to a painless, stable and functional state.

Evaluation of Ponseti method in neglected clubfoot

Background: Gentle passive manipulation and casting by the Ponseti method have become the preferred method of treatment of clubfoot presenting at an early age. However, very few studies are available in literature on the use of Ponseti method in older children. We conducted this study to find the efficacy of Ponseti method in treating neglected clubfoot, which is a major disabler of children in developing countries. Materials and Methods: 41 clubfeet in 30 patients, presenting after the walking age were evaluated to determine whether the Ponseti method is effective in treating neglected clubfoot. This is a prospective study. Pirani and Dimeglio scoring were done for all the feet before each casting to monitor the correction of deformity. Quantitative variables were expressed as mean ± standard deviation and compared between preoperative and postoperative followup using the paired t-test. Also, the relation between the Pirani and Dimeglio score, and age at presentation with the number of casts required was evaluated using Pearsons correlation coefficient. No improvement in Dimeglio or Ponseti score after 3 successive cast was regarded as failure of conservative management in our study. Results: The mean age at presentation was 3.02 years (range 1.1 - 10.3 years). The mean followup was 2.6 years (range 2–3.9 years). The mean number of casts applied to achieve final correction were 12.8 casts (range 8 - 18 casts). The mean time of immobilization in cast was 3.6 months. The mean Dimeglio score before treatment was 15.9 and after treatment were 2.07. The mean Pirani score was 5.41 before treatment and 0.12 after treatment. All feet (100%) achieved painless plantigrade feet without any extensive soft tissue surgery. 7 feet (17%) recurred in our average followup of 2.6 years. Conclusions: Painless, supple, plantigrade, and cosmetically acceptable feet were achieved in neglected clubfeet without any extensive surgery. A fair trial of conservative Ponseti method should be tried before resorting to extensive soft tissue procedure.

Is surgery always indicated in rachitic coronal knee deformities? Our experience in 198 knees:

Introduction: Defective mineralization of osteoid matrix prior to physeal closure causes rickets. Poor calcification of the cartilage matrix in the zone of provisional calcification causes flattened skull, rachitic rosary, bowed legs, coxa vara and brittle bones. The recent literature has seen an increase in the incidence of the disease in both developing and developed nations. We evaluated behaviour of lower limb deformities due to nutritional rickets in 117 patients. Materials and methods: A prospective study was conducted from January 2009 to December 2011 for clinical and radiological evaluation of knee deformities in nutritional rickets. A total of 117 patients with 198 coronal plane knee deformities between 2 years and 12 years age of rickets were enrolled in this study. Results: In our study, there were 65 genu varum and 133 genu valgum deformities. Seven genu varum (10.7%) and 37 genu valgum (28%) deformities were regarded as failure. Fifty eight genu varum got corrected completely obtaining an average of 5° of valgum in an average of 6.3 months. The average rate of spontaneous correction was 1.9° a month. Ninety six valgum got corrected obtaining an average of 4.7 valgum in an average of 13.3 months. The average rate of spontaneous correction was 0.92° a month. Conclusion: Most of the rachitic deformities get corrected with age. Genu varum is having better chances and a faster rate of correction as compared with genu valgum. Early surgery may be indicated in late presenting cases. We believe varum above 4 years and 18° of valgum above 9 years usually do not correct and may require surgical intervention.

Pediatric cervical disc calcification simulating tubercular spondylitis - A case report.

Calcification of intervertebral disc in children is rare. It mostly affect lower cervical region and present with acute neck pain, torticolis, restriction of range of motion. Neurological deficit or dyspahagia are rare features. The presence of fever, leukocytosis and elevated erythrocyte sedimentation rate, gives impression of tuberculosis or other infections. This differentiation is important as the management of pediatric disc calcification is mostly conservative and prognosis is good.

Femoral shortening in the congenital dislocation of the knee joint: results of mid-term follow-up.

Femoral shortening has an advantage of gaining reduction in severe grades of congenital dislocation of the knee joint without release or lengthening of the quadriceps tendon, thereby reducing the incidence of extensor lag. We report our mid-term functional results in six patients (10 knees) with grade III congenital dislocation of the knee joint who were treated with femoral shortening. At an average follow-up of 4.1 years, the mean active range of motion was −0.5 to 107° and none of the patients had extensor lag. The results in arthrogryposis multiplex congenita were noteworthy for the absence of extensor weakness, postoperative deformity, or recurrence.

Unusual multicentric angiomyolipoma of knee joint and soft tissue foot

To report unusual occurrence of angiomyolipoma at intraarticular location with another lesion in the same side foot. A 12-year-old girl was referred to us after initial inconclusive work-up done elsewhere for swelling of left knee joint. There was a 15 × 12 cm swelling in the knee joint partially encasing patella while also a similar hourglass shaped swelling measuring 9 × 4 cm was noted in the same side foot. After clinical and radiological evaluation an excision biopsy was planned for both sites. The specimen sent for histopathological evaluation revealed angiomyolipoma with identical characteristics in the two locations and was HMB45 immunostain negative. Patient was evaluated for possibility of tuberous sclerosis but there was no contributory evidence. Angiomyolipoma is typically a solitary renal tumor with rare occurrence at musculoskeletal sites. Multicentric variety is still infrequent. Intraarticular occurrence of angiomyolipoma presents a diagnostic challenge not only in terms of unfamiliarity but also unusual presentation with absence of characteristic immunostaining and multicentricity requiring careful exclusion of other lesions that may require a more radical approach for treatment.

EXTRA-ARTICULAR OSTEOCHONDROMA IN THE TIBIALIS ANTERIOR TENDON — CASE REPORT

Extra skeletal osteochondroma is a rare soft tissue tumor. We report a case of extra skeletal osteochondroma in the tendon sheath of tibialis anterior tendon near the left ankle joint in a 7 year old child. The diagnosis of soft tissue osteochondroma should be considered when a well defined bony mass is located in the soft tissue. It must be differentiated from other causes of soft tissue calcification as myositis ossificans, synovial (osteo) chondromatosis, tumor calcinosis; synovial sarcoma, extra skeletal osteosarcoma & other causes of heterotopic ossification.

EXPANSILE LYTIC LESION IN MEDIAL END CLAVICLE IN AN ADOLESCENT GIRL: A CASE REPORT

Clavicle has a number of peculiar features in the human skeleton. It is the only long bone lying horizontally and the first bone to begin ossification, among other features. It is also a peculiar and unusual site for an expansile lytic lesion which, if present, would raise multiple diagnostic possibilities. We present this unusual case of an expansile lytic lesion in the medial end of clavicle in an adolescent girl and the possible differential diagnoses.