Ashish Anand

Deep vein thrombosis and thromboprophylaxis in arthroscopic anterior cruciate ligament reconstruction

Background: There is no clear evidence in the literature regarding the incidence of deep vein thrombosis (DVT) in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction. Literature also lacks on the recommendations on thromboprophylaxis in patients undergoing elective arthroscopic ACL reconstruction. We conducted a prospective analysis to assess incidence of DVT in patients undergoing arthroscopic ACL reconstruction. Materials and Methods: 120 consecutive patients with MRI proven ACL injury who were operated for arthroscopic ACL reconstruction were enrolled in this prospective study. None of the patients had risk factors (on history) for DVT, and all were below the age of 45 years. All cases were operated upon by a single surgeon and a standard rehabilitation regime was followed. The patients underwent clinical examination and screening (Doppler ultrasonography/venous scan) for any DVT, on the day prior to surgery, day of discharge (Day 3) and at 4 weeks postsurgery. None of the patients received any form of thromboprophylaxis against DVT. Results: One hundred and twelve patients (61 males and 51 females) completed the study. The average age was 31.6 years (range 24-42 years). All patients underwent arthroscopic assisted ACL reconstruction surgery within 3 weeks of the injury. Two patients (males) in the series had Doppler venous scan proven DVT. One patient was asymptomatic but the screening Doppler picked up the DVT on the third postoperative day. The other patient was symptomatic at 12 weeks with pain and swelling in the leg and had ultrasound -proven DVT. Conclusion: In our study the incidence of deep vein thrombosis in patients undergoing arthroscopic ACL reconstruction is 1.78%. We do not recommend routine thromboprophylaxis in patients, who are not high risk candidates for thrombosis and are of less than 45 years, in patients undergoing arthroscopic ACL reconstruction, with early postoperative rehabilitation.

Ipsilateral femoral neck and trochanter fracture

Ipsilateral fractures in the neck and trochanteric region of the femur are very rare and seen in elderly osteoporotic patients. We present a case of a young man who presented with ipsilateral fracture of the femoral neck and a reverse oblique fracture in the trochanteric region following a motor vehicle accident. A possible mechanism, diagnostic challenge, and awareness required for identifying this injury are discussed.Ipsilateral fractures in the neck and trochanteric region of the femur are very rare and seen in elderly osteoporotic patients. We present a case of a young man who presented with ipsilateral fracture of the femoral neck and a reverse oblique fracture in the trochanteric region following a motor vehicle accident. A possible mechanism, diagnostic challenge, and awareness required for identifying this injury are discussed.

Intramuscular cysticercosis: an unusual presentation: report of three cases

The term endemic is a fading entity as many diseases are getting globalized. Cysticercosis was considered a third-world disease but that is fast changing as sporadic case reports have been reported in Western literature. Though presence of cysticercal soft tissue involvement is a pointer for evaluation of central nervous system, we present three different cases of intramuscular cysticercosis in varied locations, without central nervous system involvement, which responded to conservative treatment. We discuss in this report the unusual clinical presentation, the diagnostic difficulties, the image findings, and management of these lesions.

Breakage of bioabsorbable femoral transfix screw after arthroscopic anterior cruciate ligament repair: a report of two cases

The reconstruction of anterior cruciate ligament (ACL) has become the standard of care for a torn ACL in active, young athletes. Various methods, graft options and techniques of reconstruction are published. The use of biotransfix bioabsorbable screw is one of the options of anchoring the graft on the femoral side. We describe the failure of transfix due to breakage in two patients after arthroscopic ACL reconstruction. These patients developed symptoms of screw irritation subcutaneously or skin penetration of the broken, migrated transfix pin. The clinical presentation, diagnosis, the image findings, management and review of literature are presented in this report. To the best of our knowledge, this is the only report from Asia.

Spontaneous reduction in both dislocated head and dissociation of head–neck in a modular total hip arthroplasty

A year after the right total hip replacement for primary osteoarthritis of the hip, a patient presented to the hospital with dislocation of femoral head from the acetabulum and dissociation of the head–neck junction after a trivial rotational movement of the lower limb. While waiting for the surgery, spontaneous reduction in dislocated femoral head into the acetabulum and spontaneous relocation of the femoral neck occurred. This rare phenomenon and the possible mechanism of such dissociation and relocation are discussed in this report. Such relocations provide dramatic pain relief to the patient but they are not therapeutic. Revision surgery was required to correct the underlying problem.

Neglected pediatric Monteggia fracture dislocation with persistent posterior interosseous nerve palsy: a case report

This is a rare case report of persistent PIN palsy following a case of neglected Monteggia fracture dislocation in a 7-year-old boy. The patient had presented with prominence around the elbow and inability to abduct the thumb, extend the thumb at interphalangeal joint, and inability to extend the fingers at the metacarpophalangeal joints. The index procedure of ulnar osteotomy and closed reduction of radial head did not yield satisfactory results; subsequently, patient underwent a second surgery for open reduction of radial and exploration of the PIN with simultaneous sural nerve grafting. To the best of our knowledge, this is the first case from India describing the use of sural nerve as a cable graft for neglected Monteggia fracture dislocation with nerve palsy.