Manish Kumar Varshney

Treatment of aneurysmal bone cysts with percutaneous sclerotherapy using polidocanol: A REVIEW OF 72 CASES WITH LONG-TERM FOLLOW-UP

Aneurysmal bone cyst is a rare tumour-like lesion which develops during growth. Our aim was to determine the efficacy of the administration of percutaneous intralesional 3% polidocanol (hydroxypolyaethoxydodecan) as sclerotherapy. Between July 1997 and December 2004 we treated 72 patients (46 males, 26 females) with a histologically-proven diagnosis of aneurysmal bone cyst, at various skeletal sites using this method. The sclerotherapy was performed under fluoroscopic guidance and general anaesthesia or sedation and local anaesthesia. The mean follow-up period was 34 months (26.5 to 80). The patients were evaluated using the Enneking system for functional assessment and all the lesions were radiologically quantified into four grades. The mean age of patients was 15.6 years (3 to 38) and the mean number of injections was three (1 to 5). Ten patients were cured by a single injection. The mean reduction in size of the lesion (radiological healing) was found to be 76.6% (61.9% to 93.2%) with a mean clinical response of 84.5% (73.4% to 100%). Recurrence was seen in two patients (2.8%) within two years of treatment and both were treated successfully by further sclerotherapy. Percutaneous sclerotherapy with polidocanol is a safe alternative to conventional surgery for the treatment of an aneurysmal bone cyst. It can be used at surgically-inaccessible sites and treatment can be performed on an out-patient basis.

Dextrose prolotherapy for recalcitrant coccygodynia

Purpose. To present the results of dextrose prolotherapy undertaken for chronic non-responding coccygodynia in 37 patients. Methods. 14 men and 23 women (mean age, 36 years) with chronic coccygodynia not responding to conservative treatment for more than 6 months were included. 27 of them had received local steroid injections. A visual analogue score (VAS) was recorded for all patients before and after injection of 8 ml of 25% dextrose and 2 ml of 2% lignocaine into the coccyx. In 8 patients with a VAS of more than 4 after the second injection, a third injection was given 4 weeks later. Results. The mean VAS before prolotherapy was 8.5. It was 3.4 after the first injection and 2.5 after the second injection. Minimal or no improvement was noted in 7 patients; the remaining 30 patients had good pain relief. Conclusion. Dextrose prolothearpy is an effective treatment option in patients with chronic, recalcitrant coccygodynia and should be used before undergoing coccygectomy. Randomised studies are needed to compare prolotherapy with local steroid injections or coccygectomies.

Locking Compression Plate in Long Standing Clavicular Nonunions With Poor Bone Stock

BACKGROUND Aim of our study was to evaluate the use of Locking Compression Plate (LCP) in patients with long standing nonunions of the clavicle with osteoporotic bones. MATERIAL AND METHODS There were a total of 11 patients. Surgery was performed for painful nonunion with shoulder dysfunction. Average time since injury was 6.9 months (3-39 months). Nonunions were stabilized by a 3.5-mm LCP, applied on the antero-inferior surface of the clavicular shaft. A six-hole LCP was used in eight cases. In three patients seven-hole LCP and in one patient eight-hole LCP was used. The fixation was supplemented by autogenous cancellous bone graft (except in hypertrophic nonunions). Patients were followed for a mean of 2.8 (1-3) years. RESULTS The average time of radiologic union was 5.3 months (3-9 months). Union was achieved in all patients. Subjective clinical assessment was performed using the Disabilities of the Arm, Shoulder, and Hand functional score (DASH). The mean DASH score preoperatively was 42 (25-52) and postoperatively was 24 (11-34). Superficial infection and features of reflex sympathetic dystrophy were seen in one patient each. CONCLUSION Long standing clavicular nonunion with osteopenic bone is a difficult problem to treat. Our study shows that LCPs can be an improved implant option with good fracture healing.

Tuberculosis of the sternum: a clinical study.

A series of 14 patients suffering from tuberculosis of the sternum with a mean follow-up of 2.8 years (2 to 3.6) is presented. All were treated with antitubercular therapy: ten with primary therapy, two needed second-line therapy, and two required surgery (debridement). All showed complete healing and no evidence of recurrence at the last follow-up. MRI was useful in making the diagnosis at an early stage because atypical presentations resulting from HIV have become more common. Early adequate treatment with multidrug antitubercular therapy avoided the need for surgery in 12 of our 14 patients.

Calcaneal osteomyelitis caused by exophiala jeanselmei in an immunocompetent child. A case report.

Fungal osteomyelitis of the calcaneus is very rare and has been reported in immunocompromised children1,2. We present the case of an eight-year-old immunocompetent child with fungal osteomyelitis of the calcaneus from the fungus Exophiala jeanselmei, which has been reported to be a very rare cause of mycetoma pedis. To our knowledge, isolated involvement of the calcaneus with fungal osteomyelitis has not been reported previously. The family of our patient was informed that data concerning the case would be submitted for publication. Fig. 1 Clinical photograph showing multiple sinuses and granulation tissue involving the left heel. An eight-year-old boy presented with a six-month history of pain, swelling, and multiple discharging sinuses over the heel of the left foot. There was no history of trauma or skin puncture, but there had been intermittent discharge of black-colored granules from the sinuses along with an associated occasional low-grade fever. There were no systemic or constitutional symptoms otherwise. He had received treatment in the form of local dressings and broad-spectrum antibiotics from his primary care physician, but these treatments had had no appreciable effect. Fig. 2 Radiograph of the left heel, showing the honeycomb appearance of the extensive loculated lytic areas of destruction within the body of the calcaneus. Clinical examination of the left heel revealed discharging sinuses with black, soft, …

Isolated tuberculosis of the coccyx

Vertebral disease constitutes approximately 50% of all skeletal tuberculosis. We describe a patient who developed a discharging sinus at the tip of the coccyx. Extensive examination revealed isolated tuberculosis of the coccyx. Although rare, the condition should be suspected in patients presenting with a chronic sinus in the sacrococcygeal area and a lytic lesion in the coccyx on CT or MRI, particularly in the developing world.

Kimura disease of extremity: Unusual manifestation in a long bone

Kimuras disease is a rare, chronic inflammatory disorder, presenting usually as head and neck swellings and regional cervical lymphadenopathy. The disease is more often described from oriental literature but the osseous manifestations and involvement of extremity are rare and unidentified in literature. We present an unusual case of long bone periosteal reaction in a patient of Kimuras disease of extremity. This potentially innocuous disorder must be kept in mind as a radiological differential of periosteal reaction.

Isolated tuberculosis of the vastus lateralis muscle: a case report.

Tuberculosis is 1 of the most deadly diseases in the world. With an increase in the incidence of HIV worldwide, tubercular infections at unusual sites are being reported. Skeletal muscle tuberculosis without bony involvement is an extremely rare presentation of tuberculosis. A case of isolated tuberculosis of the vastus lateralis muscle without any evident primary focus in a 30-y-old immunocompetent female is presented.

Plate augmentation leaving the nail in situ and bone grafting for nonunion of femoral shaft fractures

We read with interest the article “Plate augmentation leaving the nail in situ and bone grafting for non-union of femoral shaft fractures” by Y. S. Choi and K. S. Kim. Intern orthop 2005:29: 287–290. Femoral nailing being the standard treatment for fractures of the shaft of the femur, this article evokes great interest in the minds of all orthopaedic surgeons regarding the treatment options available for non-union especially in difficult cases. However, after reading the article in detail, some questions regarding the patient selection and treatment options were raised in our mind. Achieving 100% success rate in union would encourage surgeons if “objective” criteria for preoperatively determining ‘continuous motion’ at the fracture could be laid out, as the selection seems more presumptive than objective. The definition of non-union chosen is too broad, especially patient no. 8 and to some extent, patient 9 (Table 1) may not be deemed to be having non-union by orthopaedic community at large. Bone grafting is a standard procedure for atrophic non-unions. Ueng et al. [1] has done bone grafting in ‘all’ atrophic non-union cases of intramedullary nailing. Furthermore, in cases of Winquest–Hansen type I–II with fractures in middle third (five patients, Table 1), dynamisation could have been a better option, if not tried earlier. We feel that this article would be more informative if the cases of non-union requiring “more” stability than that provided by intramedullary nailing, can be better targeted and defined preoperatively for their effective management.

Computed Tomography–Guided Radiofrequency Ablation of Osteoid Osteomas

Purpose. To report on 14 patients with osteoid osteomas treated by computed tomography–guided radiofrequency ablation. Methods. Nine males and 5 females aged 13 to 45 (mean, 25) years with osteoid osteomas were included. The proximal tibia was the commonest site involved. A bipolar 18-gauge radiofrequency probe with a 9-mm active tip was used. A 4.5-mm hollow drill was introduced into the nidus. Energy application was started at 2 W and increased to a maximum of 5 W. Heat was applied for 4 to 6 minutes at 90 degrees Celsius. Results. 12 (86%) of the 14 patients had prompt pain relief; the remaining 2 underwent a repeat ablation. After a mean follow-up period of 19 (range, 9–25) months, no patient had pain recurrence. Conclusion. Radiofrequency ablation is a minimally invasive and cost-effective treatment for osteoid osteomas.