Divesh Gulati

Autogenous non-vascularized fibula for treatment of giant cell tumor of distal end radius

AbstractIntroductionGiant cell tumor of distal end of radius is treated by wide resection and intralesional procedures with former having better results. The various modalities for the defect created are vascularized/non-vascularized bone graft, osteoarticular allografts and custom-made prosthesis. We report outcome of wide resection and non-vascularized fibular grafting in biopsy-proven giant cell tumors.Patients and methodsNine patients with mean age of 40 years with Campanacci grade II giant cell tumor of distal radius were managed with radical excision of the tumor and reconstruction with ipsilateral free fibular graft.ResultsMean follow-up time was 56 months. One patient developed recurrence and was treated by amputation. All other patients showed a good union at fibular graft–radius junction. In wrist, average range of motion achieved at last follow-up was 40° of dorsiflexion, 30° of palmar flexion, 45° each of supination and pronation. Major complications encountered included graft fracture (2), wrist subluxation (2), tourniquet palsy (1), aseptic graft resorption (1) and tumor recurrence (1).ConclusionReconstruction after wide excision by non-vascularized fibular graft is a viable alternative for giant cell tumors of the lower end of radius though it is a challenging procedure and may be accompanied by major complications.

Rubber band syndrome--high accuracy of clinical diagnosis.

Background Rubber band syndrome is a rare condition seen in younger children in communities where rubber bands are worn around the wrist for decorative purposes. When the band is worn for a long duration, it burrows through the skin and soft tissues resulting in distal edema, loss of function, and even damage to the neurovascular structures. Recognition of this syndrome at the earliest can prevent catastrophic events. Methods We report 3 cases of rubber band syndrome. Three children presented with a discharging sinus at the wrist. There was a linear circumferential scar at the wrist in all cases. Plain radiographs showed a circumferential constriction in the soft tissue shadow in all the cases. There was a history of a band tied around the wrist, which had been forgotten by the parents and eventually became embedded in the soft tissues of the wrist. Results Surgical removal of the buried rubber band was successful in all the cases. Postoperative follow-up over a mean period of 13 months have shown a surprisingly good outcome of hand function in all our patients. Conclusions The cardinal features of a linear constricting scar around the wrist in the presence of a discharging sinus should always alert the clinician to the possibility of a forgotten band around the wrist, which might have burrowed into the soft tissues over a period of time. A radiograph of the affected wrist shows a soft tissue constriction at the wrist. A high index of clinical suspicion and the uniformity of symptoms and clinico-radiologic signs enabled us to make a clinical diagnosis of a constriction band (rubber band syndrome), which was proved after a surgical exploration. Study Design Case series. Level of Evidence-—Level IV.

Dilemma in stress fractures.

We read with interest the article by Fottner et al. [3], concerning stress fractures presenting as tumours, where the authors described pain as the first symptom as well as the index finding for their inclusion criteria. But it is worth mentioning that atypical presentations of stress fractures are known and pain may be preceded by swelling/fullness or other signs of inflammation [1, 5]. The article emphasises the detection of a fracture line either on MRI or CT to differentiate between a tumourous condition and a stress fracture. Cortical abnormalities or fatigue lines only appear in advanced stages of stress fractures (Fredericson’s MR imaging classification of osseous stress injury; grade 4) and are not present in early grades 1–3 [4], where the diagnosis is primarily clinical. Moreover, as the authors have themselves mentioned, pathological fractures in tumour lesions do occur and in such cases the diagnostic dilemma deepens. Correlation to the clinical setting, sequential radiographs, and a careful study of the fracture characteristics (fracture line continuous with the cortex, extending into the intramedullary space, orientated perpendicular to the cortex and the major weight-bearing trabeculae [2]) help avoid this pitfall.

Subtrochanteric periosteal chondroma: A case report and tumor overview

We report a rare case of subtrochanteric periosteal chondroma in a 16 years boy. The purpose of this presentation is to stress the importance of a proper clinico-radiological and histopathological diagnosis of this lesion. Awareness of the features of this lesion helps to prevent overtreatment of this benign condition, since its differentiation with malignant lesions may be extremely difficult, even at histology; and since conservative surgery with complete excision of the lesion leads to permanent cure.