Ashwini Sharma

Diagnostic significance of radiologic measurements in posterior heel pain.

BACKGROUND Posterior heel pain is a common complaint in both athlete and non-athlete. For diagnosis of etiology certain angles, lines and soft tissue parameters have been developed in the literature to describe the calcaneal prominence and its relationship to Achilles tendon and its bursae. OBJECTIVES A prospective study was undertaken to evaluate the diagnostic values of these angles, lines and soft tissue parameters in posterior heel pain. MATERIALS AND METHODS Seventy-one painful heels in 58 patients (30 males and 28 females, mean+/-S.D. age; 41.4+/-10.82 years) were clinically and radiologically examined. This was compared with 50 heels in 25 control subjects. A lateral weight bearing film of the foot was taken to calculate different angles, lines and soft tissue parameters mentioned in the literature. RESULTS There were 45 Pavlovs parallel pitch line positives and using test of Denis and Huber-Levernieux in only one posterior superior crest extended beyond vertical tangential. There was only one heel with Fowler & Philip angle >75 degrees. There were 10 heels with Steffensen & Evensen angle >65, 5 heels with total angle >90 degrees and 52 heels with Chauveaux-Liet angle >12 degrees. There were 73% true positive for Chauveaux-Liet angle and 63% true positive for parallel pitch line. Among soft tissue parameters ill defined retrocalcaneal recess was present in 61 symptomatic heels, plantar spur in 42 heels, posterior calcaneal step in 33 heels, Achilles tendon calcification in 29 heels, superficial tendo-Achilles bursitis in 58 heels, posterior calcaneal spur in 31 heels and antero posterior diameter of tendo-Achilles more than 9 mm in 68 symptomatic heels. CONCLUSION Parallel pitch lines, Chauveaux-Liet angle, ill-defined retrocalcaneal recess, superficial tendo-Achilles bursa and anteroposterior diameter of Achilles tendon more than 9 mm about 2 cm above insertion are reliable objective diagnostic indicators of bony deformity of calcaneus and soft tissue affection in patients with posterior heel pain. It is the combination of these bony and soft tissue parameters, which enhance the diagnostic certitude.

Treatment of pathologic femoral neck fractures with modified Pauwels' osteotomy

Treatment of pathologic femoral neck fractures secondary to extensive lesions of fibrous dysplasia and simple bone cysts has been controversial. We think that modified Pauwels’ intertrochanteric osteotomy and osteosynthesis can result in sound healing of the lesion and of the fracture, with no recurrence, low complication rates, and good functional results. Seven patients were treated with a uniform approach consisting of biopsy (Stage I) and osteotomy with osteosynthesis (Stage II). Curettage of the lesion and bone grafting were not done. The average followup was 79.28 months (range, 32-142 months). All of the fractures and osteotomy sites healed in means of 14 weeks (range, 12-16 weeks) and 9.1 weeks (range, 8-10 weeks), respectively. All fibrous dysplasia lesions healed radiologically. Grade IV radiographic healing was seen in both patients with simple bone cysts after 35 and 92 months. Using the Musculoskeletal Tumor Society functional evaluation and Toronto Extremity Salvage Score, all the patients had good to excellent results. Complications such as infection, local recurrence, refracture, femoral neck deformity, osteonecrosis of the femoral head, and growth arrest of capital femoral physis were not seen. In addition to biomechanical advantages, the procedure seems to have had a biologic role in healing of the fracture and of the lesion by initiating osteogenesis to replace the defect with new bone. Level of Evidence: Therapeutic study, Level IV (case series-no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

NODULAR FASCIITIS OF THE THUMB: A CASE REPORT

Nodular fasciitis is an uncommon, benign, reactive fibroblastic soft tissue tumour. It is infrequently seen in the hand. A case of nodular fasciitis involving the thumb of a 34-year-old male is reviewed, and its clinicopathologic features are presented. Main significance lies in clinical and pathological recognition of the lesion to avoid over-treatment.

Simultaneous asymmetric bilateral hip dislocation with unilateral fracture of femur—peculiar mode of trauma in a case

Simultaneous anterior and posterior traumatic hip dislocations with unilateral femoral fracture in a 50-year-old man is being reported. He sustained this injury with an unusual mode of trauma, which is being discussed.RésuméUne luxation de hanche bilatérale simultnée, l’une antérieure et l’autre postérieure avec une fracture unilatérale du fémur chez un homme âgé de 50-ans est rapportée. Les lésions sont liées à un traumatisme inhabituel, qui est discuté.

Intrahepatic migration of Kirschner wire from hip: a case report

We report a case of intraabdominal migration of a nonthreaded Kirschner wire in a 2-year-old child, operated for congenital dislocation of the right hip. The hip was openly reduced and fixed with Kirschner wire, incorporated in a hip spica cast. At the 7-week follow-up, the Kirschner wire was found partly embedded in the liver. The wire was removed at laparotomy, and the child was well without complications 3 month later.

Giant cell tumour of the first metatarsal: a case report

The classical giant cell tumour (GCT) is a solitary lesion characterised by benign-appearing osteoclast-like giant cells and stromal cells that originate within the epiphysis of adults. Long tubular bones (75–90%) are frequent sites of involvement and make up 5% of all primary bone tumours. The foot is a rare site for GCT; less than 50 cases of GCT in foot bones have been reported in the literature. It is easy to misdiagnose a lytic lesion in the foot for commoner disorders. We report a case of GCT of the first metatarsal and highlight the importance of early and proper diagnosis.RésuméLa tumeur à cellules géantes classique est une lésion solitaire bénigne caractérisée par la présence d’ostéoclastes géants et de stroma, se développant dens les épiphyses chez l’adulte. Les os longs (75% à 90%) sont le plus souvent concernés et cette localisation représente 5% des tumeurs primitives. Le pied est un siège rare et moins de 50 cas de localisations au pied ont été publiés dans la littérature. Il est facile de méconnaître ce diagnostic deavnt une lésion lytique du pied avec une symptomatologie clinique banale. Nous rapportons un cas de lésion du premier métatarsien et insistons à ce propos sur l’importance du diagnostic précoce.

An unusual penetrating shoulder injury: a case report

AbstractA 32-year-old male sustained penetrating injury of the right shoulder with an angled iron rod in a road side accident. He presented with the rod in situ in his shoulder. Fortunately there was no neurovascular deficit. The metal rod was carefully removed with success, after cutting the rod with hacksaw to avoid neurovascular damage during removal.