Atin Jaiswal

Rupture of the triceps tendon – A case series

Triceps rupture is the least common among all tendon injuries. The usual mechanism of injury is a fall on an outstretched hand, although direct contact injuries have also been reported to cause this injury. The diagnosis of acute triceps tendon rupture may be missed, which can result in prolonged disability and delayed operative management. We presented three cases of acute triceps tendon rupture each at different site showing the spectrum of injury to the muscle and mechanism of injury and management were also discussed.

Evaluation of osteosynthesis with dual fibular bone grafting for neglected femoral neck fractures

BACKGROUND Femoral neck fractures in young adults is an unsolved problem and neglected femoral neck fractures presents more challenge to the orthopaedics surgeon if femoral head salvage is attempted. We reviewed the operative results of neglected femoral neck fractures in young adults with fixation with dual fibular bone grafting Purpose of study was evaluation of epidemiological, clinical, functional, rehabilitative outcome and complications in such patients. METHODS Twentyeight patients in age group 18-50 years were operated having fracture neck femur by dual fibular bone grafting in the Department of Orthopaedics, S.N. Medical College, Agra in (May 2005-February 2008) and divided into two groups. Group A: comprised of 8 patients treated by dual fibular bone grafting alone and Group B: comprised of 18 patients treated by dual fibular bone grafting with single cancellous hip screw. RESULTS All the patients of the present series were having neglected intracapsular fracture, neck femur which were treated by dual fibular bone grafting with or without cancellous hip screw fixation. Majority of the patients had good to fair result according to Larson method with average time of union 16 weeks. All patients had useful range of movement at hip. Satisfactory union was achieved in all patients except two. CONCLUSION Double bone grafting is a simple and cost effective modality of treatment for late femoral neck fracture with good results. It is a stable and biological method of fixation with preservation of natural femoral head with fewer complications.

Neglected foreign body in contralateral limb in a traumatic transfemoral amputee---radiographs can be misleading.

Missed or neglected foreign bodies are not infrequent in surgical practice. This case report highlights the fact that thorough clinical examination and detailed evaluation of trauma patients are very necessary so that any associated injuries or foreign bodies will not be missed and any unforeseen clinical or medico‐legal complications can be prevented. We present a case of a 35‐year‐old male patient who had traumatic transfemoral amputation of the right lower limb with a clean laceration (size 2 cmx1 cm) over the medial aspect of the left thigh. Radiographs suggested a single radioopaque foreign body which proved misleading, as during surgical removal multiple radiolucent and radiopaque foreign bodies were discovered. Postoperative ultrasound was performed and showed no retained foreign bodies. A secondary closure of the right thigh amputation was done and patient was discharged. At the last follow‐up, 9 months after injury, the patient had no complaints, and both the amputation stump and the wound over the left thigh were healthy. Thus in the cases of retained foreign bodies, in addition to thorough clinical examination and radiography, ultrasonograpy should be supplemented. And if required, use of CT scan as well as MRI should be also considered.

Boomerang proximal tibial osteotomy for the treatment of severe varus gonarthrosis

Purpose The purpose of the study was to review the results of modified infratubercle displacement osteotomy in patients with severe varus gonarthrosis and to determine the factors influencing outcomes.

Compound posterior cruciate ligament and popliteal artery injury due to dog bite: A case report

Injuries due to dog bites are a common occurrence and are mostly trivial. Severe dog bite injuries requiring hospitalization and complex reconstructive procedures are more common in children. We present the case of a five year old child with popliteal artery thrombosis and compound Posterior Cruciate ligament injury due to a dog bite. The child was managed by immediate thrombectomy, meticulous debridement and knee spanning external fixation followed by Skin Grafting. At one year post surgery range of motion was 10–110°, with no distal neurovascular deficit and no sign of instability.

Triple modified French osteotomy: a possible answer to cubitus varus deformity. A technical note.

BACKGROUND Cubitus varus is the most common delayed complication of pediatric supracondylar humerus fractures. We developed a new technique, the triple modified French osteotomy, that we believe may be the answer to this common but yet unsolved deformity. MATERIALS AND METHODS Ten patients aged between 6 and 12 years with post-traumatic cubitus varus deformity were operated on with the triple modified French technique. A varus angle of more than 10° measured on the radiograph was an indication for surgery. RESULTS The radiologic union at the osteotomy site took place in a mean period of 5.5 weeks (range, 4.5-7 weeks). The average correction achieved by the osteotomy was 27°. There were no cases with complications of radial or ulnar nerve palsy or joint stiffness. CONCLUSION The triple modified lateral closing wedge French osteotomy is a simple and cosmetically effective method of treating cubitus varus deformity in children. It may obviate the need for more complex procedures; at the same time, it also addresses the potential drawbacks of a simple closing wedge osteotomy.

Letter to the Editor Surgical Technique: Hemilaminectomy and Unilateral Lateral Mass Fixation for Cervical Ossification of the Posterior Longitudinal Ligament

To the editor, We read the article by Liu et al. [2] with great interest. Liu and colleagues studied a new surgical technique for multilevel continuous/mixed cervical ossification of posterior longitudinal ligament (OPLL) without fixed kyphosis by multilevel hemilaminectomy with unilateral lateral mass fixation with good results. However, we have some concerns. As described by the authors, there are various options for cervical OPLL depending on its type, associated deformity, and number of vertebrae involved. A posterior approach is based on the concept of indirect decompression by increasing space available for the spinal cord through laminectomy or various type of laminoplasty without directly addressing the ossified lesion. Liu and colleagues stated that the occupying rates were a significant factor for poor results. Occupying rate is defined as the thickness of OPLL divided by the AP diameter of bony spinal canal on the axial CT image. Hemilaminectomy alone will not decompress enough to provide good results [1]. Lateral mass screw fixation is based on the biomechanical principle of “neutralization.” It provides stress shielding, and minimizes torsional bending, shearing, and axial loading [3]. Unilateral mass fixation will result in unequal axial loading, and it will not prevent torsional bending and shearing forces. Unilateral mass fixation will lead to implant failure and deformity of the spine.

Retrospective analysis of open reduction and internal fixation of coronal plane fractures of the capitellum and trochlea using the anterolateral approach

Introduction: Coronal plane distal humeral injuries are relatively rare. Numerous classification systems have been proposed as the complexity of these fractures has been realized. We in the present series of ten patients describe the surgical technique of Open Reduction and Internal Fixation of Coronal plane fractures of the distal humerus with headless compression screws performed using the anterolateral approach. Material and method: It was a retrospective study, the data collected from March 2010 to 2015 was analysed and the final outcome was assessed using the DASH score. Out of a total of 13 patients with distal humerus coronal plane fractures, 10 patients were available for follow up. The X-rays and CT scans were reviewed and the fractures were classified according to Dubberley and Bryan and Morrey classification. Radiographic were evaluated for presence of union or nonunion, avascular necrosis, joint line step-off (none/1-mm/>1-mm), hardware failure and instability. Results: The average age was 41 years. The average DASH score in our study was around 24. The time to union ranged between 8–12 weeks with the average time being around 10 weeks. One patient had post traumatic Arthritis radiologically classified as Broberg and Morrey Type 2 and one patient had Heterotrophic ossification Brooker Grade 1. Conclusion: Open reduction and internal fixation of coronal shear fractures of capitellum and trochlea using headless screw compression via the antero-lateral approach is a reliable treatment modality and results in stable fixation with restoration of a functional arc of motion. Level of evidence: IV

Percutaneous elevation of depressed lunate fossa: A surgical technique

Die-punch fractures or impaction fractures of distal radius articular surface are difficult to treat and hard to achieve satisfactory reduction. We present a unique, percutaneous and minimally invasive technique to elevate the depressed lunate fossa and maintain the reduction of the elevated fragment with no need of grafting in such fractures. This technique is simple, reproducible and can be executed with simple instrumentations. We think it deserves a variety of implications in the treatment of distal radius fractures.