Deepak Mittal

Conjoint bicondylar Hoffa fracture in a child: a rare variant treated by minimally invasive approach

A case of conjoint Hoffa-type fracture in a child is presented. Hoffa fracture, i.e., coronal slice fracture of the condyles of the femur, is rare in adults and even rarer in the pediatric population. To date, no case of conjoint bicondylar Hoffa fracture has been reported in the literature. The presented case was successfully treated by arthroscopically assisted internal fixation.

Tuberculous extensor tenosynovitis of the wrist with extensor pollicis longus rupture: a case report

IntroductionThe tendon sheaths constitute an uncommon target of extra-articular tuberculosis.Case presentationWe present a rare case of tuberculous tenosynovitis of the wrist involving the extensor tendon with rupture of the extensor pollicis longus tendon in a 55-year-old Indian man.ConclusionPrompt surgical debridement and tissue diagnosis are essential for the diagnosis and treatment of this type of infection. With an accurate and timely diagnosis, appropriate surgery and antituberculous treatment may eradicate these infections and prevent complications.

Melioidosis: A review of orthopedic manifestations, clinical features,diagnosis and management

Melioidosis is an infectious disease caused by gram-negative soil-dwelling bacillus Burkholderia pseudomallei. Musculoskeletal melioidosis mimics other infections both clinically and radiologically. An extensive literature review has been performed over musculoskeletal melioidosis through various search engines such as Pubmed, Embase, Medscape, Altavista and Google. Diagnosis requires a high index of clinical suspicion and is dependent on microbiological confirmation. Prompt treatment with long-term combination antibiotics in high dosages and surgical drainage of abscesses improves survival.

Recurrent shoulder dislocations secondary to coracoid process fracture: a case report

Coracoid process fracture is easily missed in recurrent anterior shoulder dislocation. We report one such case in a 48-year-old man. Radiology revealed the Bankart lesion and the Hill-Sachs lesion only; the coracoid process fracture was discovered intra-operatively. The anatomy of the shoulder was restored by fixing the fragment to its scapular remnant with a 4-mm cannulated cancellous screw. The tip and the proximal fragment were reamed before inserting the screw. This fragment was routed with attached short head of biceps and coracobrachialis through the lower one third of the subscapularis, before homing it and fixing it to the proximal coracoid fragment. This extra-articular repair resulted in less stiffness than any intra-articular procedure. At the 2-year follow-up, the patient had had no further shoulder dislocation.

Successfully treated synchronous double malignancy of the breast and esophagus: a case report

IntroductionThe incidence of multiple primary cancers is reported to be between 0.3% and 4.3%. The second primary lesion is identified either simultaneously with the primary lesion (synchronous) or after a period of time (metachronous). Few cases of metastasis of breast carcinoma to the esophagus and vice versa have been reported in the past.Case presentationWe report an extremely rare case of a 55-year-old Indian woman who had carcinomas in both the esophagus and the breast simultaneously. She was treated successfully using combined modalities of surgery, chemotherapy and radiation therapy.ConclusionCases of synchronous double malignancies can be treated by dealing with the malignancy in the two sites as independent carcinomas. We have to take into consideration the total dose of radiation to a critical organ as well as the effect of the total dose of toxic chemotherapeutic drugs on our patient.

Intramedullary Bone Fragment Obstructing Passage of Reaming Guide Wire With Iatrogenic Fractured Tibia

Reamed interlocking intramedullary fixation is the treatment of choice for displaced tibial shaft fractures in adults. In most cases it can be performed without difficulty; however, technical difficulties may be encountered during nailing in some cases. This article describes a case of closed nailing for a tibial shaft fracture in which intramedullary guide wire was obstructed by a small intramedullary bone fragment in the distal fracture segment. Forceful reaming and insertion of the nail led to a break in the cortex of the distal fragment and bending of guide wire. Finally, open reduction and intramedullary nailing was performed to retrieve the guide wire and intramedullary bone fragment and fix the tibia.A comminuted fracture with multiple close fragments in proximity to the fracture site should be preoperatively scrutinized to look for intramedullary bone fragment or a fragment that could be pushed in the intramedullary canal during the intramedullary nailing. The surgeon can then anticipate the potential operative difficulty that may be encountered during closed nailing of such a fracture; and the patient can be counseled, as open nailing is a safer and viable option. Finally it is pertinent that even if this fracture type is overlooked, catastrophe can be avoided by properly following all the steps of intramedullary nailing.

Two stage procedure for neglected transscaphoid perilunate dislocation.

We report a two-staged surgical procedure for neglected 3 month old volar transscaphoid, transcapitate perilunate fracture dislocation wrist in an 18 year old right handed male student. The lunate with proximal scaphoid and proximal capitate maintained its articulation with distal end radius while the rest of carpal bones had dislocated volarly. In the first stage, bilateral uniplanar wrist distractor was applied with the aim of stretching soft tissue. In the next stage open reduction and internal fixation was done by a combined volar and dorsal approach augmented by pronator quadratus flap. At 3 years followup the patient was pain free and had a full range of supination pronation of the forearms and radial and ulnar deviation of wrist with 10° dorsiflexion deficit.

Intrapelvic migration of hip lag screw of proximal femoral nail-sequele to a paradoxical reverse Z effect and their critical analysis

A 40-year-male treated with hip screw for unstable inter trochanteric fracture femur, had an implant failure after an aggressive therapy session .The Dynamic Condylar Screw was removed and fracture was fixed with Proximal Femoral Nail. The nail also failed to achieve its goal of fracture union, as a result of a unique type of reverse Z effect, in contradiction to expected Z effect resulting in intrapelvic migration of proximal hip lag screw of the proximal femoral nail.

Tardy Palsy of Descending Branch of Posterior Interosseous Nerve: Sequela to Plate Osteosynthesis of Forearm Bones

We report a case of tardy paralysis of the descending branch of the posterior interosseous nerve as a consequence of plate osteosynthesis for fracture of both bone forearms. The patient had been operated on 23 years earlier and palsy occurred after a gap of 19 years. The most probable antecedent cause of the palsy was the use of a high-profile implant. The patient was treated by removal of the plate and tendon transfer.

Randomised comparison of pretensioning using cyclical loading and on tendon board for arthroscopic anterior cruciate ligament reconstruction using hamstring autograft

OBJECTIVE Pretensioning is usually done using two methods - manual cyclical loading and using tensioner with a tendon board. Both the methods are being used with little knowledge about the superiority of either method. This study was done with the objective of trying to find out the better method. METHODS A total of 50 patients were selected for the above mentioned study who were randomised into each of the two groups using chit system - In group A patients, cyclical loading was done by twenty times full flexion -extension movements but in group B patients, the graft was placed on a tensioner with 15 pounds tension for 10 minutes. All patients were operated by the same surgeon. The patients were put on a strict rehabilitation protocol. Patients were allowed to bear weight as tolerated. Patients returned for follow up at 6 weeks, 3 months, 6 months and 12 months. At each visit patients were followed with Lysholms Score and ROLIMETER reading. RESULTS The ROLIMETER reading and Lysholms score were seen to improve from preoperative to postoperative period and improved further over time with the progress of the rehabilitation protocol in both the groups. When compared to each other Group A i.e. patients pretensioned with cyclical loading had better Lysholm scores and ROLIMETER readings with the difference being statistically significant at all time periods except at 1 year when the difference between the ROLIMETER readings in the two groups were no more significant, though the difference of the Lysholms score was still found to be statistically significant. CONCLUSION It was concluded in this study that cyclical loading is a better method of pretensioning in ACL reconstruction than tensioner on tendon board with 15 pounds of tension for 10 minutes.