Mathew Varghese

Tibialis anterior tendon rupture in gout--case report and literature review.

BACKGROUND A case report in which spontaneous rupture of the tibialis anterior tendon occurred secondary to a gouty tophaceous deposit within the tendon. The injury occurs in middle-aged and elderly patients after displacement of the foot in plantar flexion and eversion. The treatment of the rupture is discussed. METHOD An appropriate clinical examination, including an exact history taking, leads to the right diagnosis of tibialis anterior tendon rupture in gout. The rupture can occur through abnormal tendons or may occur in any portion of the tendon, but causes little disability if diagnosed promptly. RESULTS Repair of the tibialis anterior tendon was done by non-absorbable suture. The leg was immobilized in a plaster cast, and daily active assisted exercises were started at the end of 3 weeks. Patient retained full function, power, and range of motion in foot and ankle at the end of 6 months. CONCLUSIONS Closed rupture of the anterior tibial tendon is uncommon in gout, with few cases being reported previously. This report adds to the list of pathological conditions that should be considered in closed spontaneous rupture of the tibialis anterior tendon. Early repair does improve the likelihood of a good result. The problem of the contributory effect of atresia, degenerative changes, or both, has not yet been solved. Primary operative suture, preferably with non-absorbable suture is the treatment of choice for acute ruptures and for patients with high activity levels. Recovery is prompt with little, if any, measurable permanent disability.

To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures

Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union. Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties. Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity after femoral neck fracture are 87%, 88% and 87%, respectively. Type A or Type B curve pattern is a positive factor to successful osteosynthesis with p value <0.0001 (Chi-square test). This is a statistically significant value. From this finding it can be suggested that the reliability of dynamic curves A and B in predicting maintained vascularity of femoral head is high. This investigation can be used to predict the vascularity of femoral head after intracapsular femoral neck fractures. There was a good correlation between the outcomes of fractures and dynamic MRI curves done within 48 h of injury. This signifies the role of dynamic MRI in predicting the vascularity of femoral head as early as 48 h. A treatment algorithm can be suggested on the basis of dynamic MRI curves. The fractures with Type C dynamic curve should be considered as fractures with poor vascularity of femoral head and measures to enhance the vascularity of femoral head along with rigid internal fixation should be undertaken to promote revascularization process and better healing of fractures. Patients with these fractures should be on longer non-weight bearing ambulation than other patients. To conclude, the dynamic MRI seems to be reliable, non-invasive, sensitive, specific and accurate method of assessing the femoral head vascularity after intracapsular femoral neck fractures as early as 48 h of injury and to predict the outcome of fractures and may be used as a guideline for management of intracapsular femoral neck fractures.

Ewing’s Sarcoma of the Distal Phalanx of the Little Finger:

Ewings tumor in the hand is extraordinarily rare. Lesions in the hand are prone to metastasize, but have an excellent prognosis with respect to survival rate and morbidity. Primary radiotherapy or amputation with chemotherapy is the therapeutic regimen for distal extremities lesions. The differential diagnosis includes pulp abscess, glomus tumor, osteomyelitis, tuberculosis, benign tumors, and tumorous conditions in the hand. Clinical findings, radiographs and excisional biopsy are essential to confirm the diagnosis. We report a case of Ewings tumor of distal phalanx of the right fifth digit.

Tibial chondroblastic osteosarcoma--case report.

Osteosarcoma is a bone tumour that can occur in any bone. It most commonly occurs in the long bones of the extremities near the metaphyseal growth plates. The most common sites are femur (42%), tibia (19%), and humerus (10%). Other locations include the skull or jaw (8%) and pelvis (8%). A number of variants of osteosarcoma include conventional types (i.e., osteoblastic, chondroblastic, fibroblastic types) and telangiectatic, multifocal, parosteal, and periosteal types. We present a 10-year-old boy with Tibial Chondroblastic Osteosarcoma. The clinical features, diagnosis and management are discussed.

Rare presentation of Ewing's sarcoma: a case report and literature review.

Ewings sarcoma rarely occurs in the bones of the hand and feet. The clinical presentations represent a degree of overlap among various benign and infective etiologies. The diagnosis was confirmed by gold standard biopsy. We present a case of Ewings tumor in a 13-year-old girl and discuss its rare presentation, and also offer a literature review.

Bilateral congenital absence of patella

Absence of patella as an isolated anomaly is extremely rare. It is usually absent as part of a syndrome, most commonly hereditary arthro-onchyo-dysplasia (Nail Patella Syndrome). We present a case of congenital bilateral absence of patella in a nine-year-old boy with no associated anomalies.

Rare combination of cervical spine tumours.

Osteoid osteoma, osteoblastoma, and haemangioma should be included in the differential diagnosis of any young patient with pain in the back or the neck, painful scoliosis, or radicular or referred-type pain into the lower limb or the shoulder. Osteoid osteoma and haemangioma may occur in the same cervical spine and both have a significant importance in the prognosis, management and possible complications. Early diagnosis with a bone scan and computed tomography scan, leading to prompt treatment, decreases the average duration of symptoms by two thirds. Early diagnosis and treatment of symptomatic vertebral haemangiomas is essential to prevent permanent and irreversible neurologic deficit.