Naiyer Asif

Fixation using cannulated screws and fibular strut grafts for fresh femoral neck fractures with posterior comminution

Purpose. To evaluate the use of fibular grafting for fresh femoral neck fractures with posterior comminution. Methods. 18 women and 15 men aged 20 to 60 years underwent osteosynthesis and fibular strut grafting supplemented with 7.0-mm cannulated hip screws for Garden grades III (n=21) and IV (n=12) femoral neck fractures associated with posterior comminution. All fractures were reduced by closed methods, and no hip was aspirated. Clinical and radiological outcomes were evaluated. Results. The mean delay in presentation after injury was 3.2 (range, 1–12) days. The mean delay in operation was 8.8 (range, 5–21) days. The mean follow-up period was 2 (range, 1–4) years. According to the Harris hip score, outcome was good to excellent in 20 patients, fair in 7, and poor in 6. 27 of the 33 patients achieved bone union after a mean of 4.7 (range, 4.2–7) months. In 5 patients, the bone was united with a mean of 10° of varus collapse and a mean of 1 cm of shortening. Six patients had nonunion. Other complications included screw migration in the joint space (n=1), graft migration into the joint space (n=3), and screw pullout (n=5). No patient had avascular necrosis of the femoral head. Conclusion. Osteosynthesis and fibular grafting for freshly displaced femoral neck fractures with posterior comminution is an inexpensive and technically less demanding procedure for retaining a stable, painless, mobile, and functional hip.

Metastasis from scapular Ewing's sarcoma presenting as sutural diastasis: An unusual presentation

Ewing’s sarcoma is a malignant non-osteogenic primary tumor of the bone. It is one of the most common primary malignant tumors of bone. Peak incidence is noticed in second decade of life with male preponderance of 1.6:1. It occurs most frequently in long bones and flat bones of pelvic girdles. In 30% cases, Ewing’s sarcoma is multicentric in origin. In 14-50%, multiple metastases are present at the time of diagnosis. CNS spread is rare and isolated CNS involvement is not seen. Skull metastasis of Ewing’s sarcoma is not rare compared to primary Ewing’s sarcoma of the skull, but the actual frequency is unknown. We wish to report a case of “Primary Ewing’s sarcoma of scapula with metastasis to Skull Vault in a Child resulting in sutural diastasis” diagnosed by clinicoradiological examination and confirmed by histopathology.

Femoral artery pseudoaneurysm following trivial trauma: a rare case scenario

Pseudoaneurysm (PSA) formation in femoral artery is rare; the most common cause being arterial catheterization or penetrating trauma. Though the overall incidence of femoral artery pseudoaneurysm (FAP) following catheterization procedures is low, due to increase in number of invasive cardiovascular procedures, FAP is presented as a frequent problem. FAP can present a new thrill or bruit, pulsatile hematoma, or marked pain or tenderness. We have described a rare case report of a patient who developed a femoral artery pseudoaneurysm (FAP) following trivial trauma. In our knowledge, this is the first case report of trivial trauma leading to FAP formation. Doppler flow imaging is the mainstay of diagnosis. However, in certain cases, computed tomographic angiography is needed to plan treatment. Therapeutic options for femoral pseudoaneurysm range from observation, ultrasound-guided compression repair (UGCR), ultrasound-guided thrombin injection (UGTI), coil embolization, and endovascular repair using stent grafts to open surgical repair.

Functional outcome of cemented bipolar prosthesis in unstable trochanteric fractures in elderly

Background Hip arthroplasty in unstable trochanteric fracture warrants quick recovery with little risk of mechanical failure, avoids the risk associated with internal fixation, and enables the patient to maintain a good level of function immediately after surgery. Aim The aim of this study is to evaluate the clinical and functional outcomes of cemented bipolar prosthesis in unstable intertrochanteric fractures in the elderly. Patients and methods Twenty-four patients with unstable type of intertrochanteric fracture according to Association Osteosynthesis Classification were treated with hemiarthroplasty (cemented bipolar prosthesis) and reconstruction of trochanter. The average age of the patients was 79 years. We evaluated postoperative complications, mortality rate, functional outcome using the Harris hip score, time to return to preinjury level of activity, and radiological signs of healing and loosening or migration of implant. The range of period of follow-up was 2–5 years (mean: 3.5 years). Results Mobilization and full weight-bearing was started immediately within 1 week of surgery. The dislocation rate in our study was zero. Deep infection and loosening of the implant was not observed in any of the cases. The mean Harris hip score improved progressively with time of follow-up. The mean score was 45.30 on the third day. The final average Harris hip score at the last follow-up was 81.90. Limb length discrepancy was observed in seven patients and average shortening was 1.3 cm (range: 0.5–1.8 cm). Conclusion Hip arthroplasty in mobile and psychologically stable elderly patients with unstable intertrochanteric fracture is a valuable treatment option.

Inadvertent injection of potassium chloride instead of sodium chloride during treatment of chronic low back ache with epidural injection leading to paraplegia

Epidural injection of steroid is given for back pain resistant to other conservative management. Normal saline (NS) is used as diluent in 80 mg methylprednisolone and a local anesthetic. Due to a similar looking ampoule of NS and potassium chloride (KCl), there is a probability of accidental use of KCl instead of NS. We present a case of a 50 year old male patient having low back ache refractory to other conservative treatments. Epidural injection of steroid was given, but accidently KCl was mixed with methylprednisolone instead of NS. He developed severe cramps in the lower limbs, pruritus, and sweating, and finally paraplegia. Electrocardiography and blood showed features suggestive of hyperkalemia. He was given calcium gluconate and potassium chelating agent along with supportive measures. The patient recovered within 8 h. It is concluded that calcium gluconate and potassium chelating agent can be used if accidentally KCl is injected in epidural space.

Lipoma arborescens: is it the cause or effect?

Lipoma arborescens is benign villous lipomatous proliferation of the synovium. The fronds-like masses are non-neoplastic fatty deposits on the synovium. The word arborescens is a Latin term meaning ′tree-forming′ or ′tree-like′. This article presents two cases of young adults who presented with pain and swelling around knee joint and were diagnosed on the basis of characteristic MRI findings, and hence signifies the role of MRI in diagnosing the cause of inflammatory synovitis in young patients. In addition, MRI helped in deciding the management of these patients. There was significant symptomatic improvement seen on follow-up, which further helps to strengthen the hypothesis that underlying lipoma arborescens could be a rare underlying cause for undiagnosed inflammatory synovitis in young adults.

Minimally Invasive Percutaneous Plate Osteosynthesis (Mippo) in DistalTibial Fractures â A Prospective Study from Developing Nation

Background: The management of distal tibial fractures can be challenging because of scarcity of soft tissues, their subcutaneous nature and poor vascularity. Consequently, operative treatment can lead to complications. The surgical treatment of fractures has evolved a great deal since the development of the original “open reduction and internal fixation” technique by the AO group. A mechanically stable fracture-bridging osteosynthesis can be obtained without significant dissection and surgical trauma to the bone and surrounding soft tissues by minimally invasive percutaneous plate osteosynthesis (MIPPO). This technique utilizes indirect reduction and internal fixation with locking compression plates. Our aim was to observe the outcome of the distal tibial fracture fixation (extra-articular and intra-articular) with locking compression plate (LCP) using MIPPO technique. Material and Methods: 26 consecutive patients were prospectively underwent minimally invasive percutaneous plate osteosynthesis for distal tibial fractures between January 2010 and December 2011. Patients were aged between 20 to 65 years with seventeen males and nine females. Both open and closed AO types 43A, 43B and 43C fractures were included. Patients were managed with LCP using MIPPO technique. Postoperative regimen consisted of knee and ankle bending exercises starting on 1st postoperative day. Non weight bearing ambulation started on 3rd post-operative day, progressing to partial weight bearing at 6 to 8 weeks. Full weight bearing ambulation was allowed after clinico radiological union at 12 to 14 weeks. Observation and Results: RTA was the commonest cause of injury. All fractures healed with good functional outcome. Mean union time was 4.5 months (range 3.5–8 months). Mean follow-up was 14.3 months. For all fractures acceptable active range of ankle movement was achieved. Mean AOFAS score was 88. There were 2 cases of superficial infection, treated successfully with antibiotics. No deep infection, wound dehiscence and hardware failure was noted. Conclusion: MIPPO is a well-documented technique that offers biological advantages and appears to be a reasonable treatment option for complex unstable distal tibial or pilon fractures that are not suited for intramedullary nailing. The literature is full of studies from developed nations, but studies from developing nations are lacking. Nevertheless small numbers of patients were involved in our study to draw any definitive conclusions, but our encouraging results will motivate the trauma surgeons from the developing nations to use MIPPO technique in managing distal tibial fractures, in an endeavor to reduce morbidity and associated complications, especially of the soft tissues.

Siblings with multiple soft tissue calcifications

Answers on p 543. Two brothers aged 10 years and 18 years presented with multiple soft tissue calcareous swellings around the elbows, arms, knees, and forearms, which had been present for the last three years. Both were in good general health and there was no history of trauma. On examination, the younger …