Sudhir Kapoor

The Ilizarov method in infected nonunion of fractures.

Thirty patients with infected non-union of long bones were treated with radical resection of the necrotic bone and bone transport or compression/distraction osteosynthesis. Non-union, infection, deformity, bone gap and shortening were all addressed simultaneously using the Ilizarov principles. There were 15 cases with bone loss ranging from 4 to 12 cm (median bone gap of 7 cm), 10 cases of stiff non-union (six of which had an associated deformity) and five cases of mobile non-union. The median time in the Ilizarov frame was 150 days. Median follow up time after frame removal was 23.5 months. Bone grafting at the docking site was only required in three cases (10%). There were three cases of refracture (10%) and three cases of recurrence of infection (10%). The bone result was excellent in 21 patients (70%), good in three (10%), fair in none (0%) and poor in six (20%). The functional results were excellent in eight patients (26.7%), good in 12 (40.0%), fair in three (10%) and poor in seven (23.3%). It is difficult to precisely define the indications for preservation and reconstruction of severe injuries. The surgical team has to take into account the length, disability, complications and cost of treatment. Patients must be aware of the limitations of functional results and the possible difficulty of return to work despite the reconstructive attempt.

Cytological features of chondroblastoma: A case report with review of the literature

Chondroblastoma is an uncommon benign tumor of bone with a characteristic epiphyseal location. This report documents the cytological features on fine‐needle aspiration biopsy (FNAB) of a chondroblastoma which appeared as a lytic lesion, predominantly in the metaphysis of the medial condyle of right femur in a 20‐year‐old male. Smears characteristically revealed hyper‐ to hypocellular lobules comprising small round to polyhedral cells (chondroblasts) embedded in an abundant myxoid stroma. The cytological diagnosis of chondroblastoma was confirmed on histopathology. The radiological appearance and differential diagnosis in this case is discussed. Diagn. Cytopathol. 23:348–350, 2000.

Isolated type IIIA fracture of the coronoid process of ulna

Abstract. A very rare, Regan and Morreys type IIIA fracture of the coronoid process of ulna is presented and discussed with a review of the literature. The operative approach to be used is emphasised. Open reduction and internal fixation render the elbow stable, and a good range of motion can be achieved if such fractures are fixed and mobilised early.

Posttraumatic osteonecrosis and nonunion of distal pole of scaphoid.

Posttraumatic osteonecrosis of distal pole of scaphoid is an extremely rare with only two reported cases so far. We present a case of a 30-year-old male with a 2-year-old posttraumatic osteonecrosis and nonunion of distal pole of scaphoid left wrist. He presented with complaints of pain and restriction of movements. There was no evidence of radiocarpal arthritis. He was managed with open reduction and internal fixation with k-wires, supplemented by a pronator quadratus based muscle pedicle bone graft. The fracture union was achieved at 6 months. After 2 years, he had almost complete range of wrist motion and had returned to his preinjury level of functional activity. His MRI (magnetic resonance imaging) scans showed evidence of revascularization suggesting successful incorporation of bone graft.

Multifocal skeletal TB or disseminated bone TB

requiring catheterization. Two days after re-admission he had a short generalized convulsion, which responded to diazepam (0.3mg/kg). He was neither dehydrated nor fluid overloaded, and his blood pressure was 120/ 90mmHg. He regained consciousness, but remained prostrated with a stiff neck, but without papilloedema. An LP excluded meningitis. He had five further generalized convulsions that required phenytoin. Subsequently, his total leucocyte count dropped to 2.0 10/L (20% neutrophils), plasma sodium dropped to 96mmol/L (urinary sodium 33mmol/L), while the plasma and urine osmolality were 211 and 410mosm/kg, respectively. These levels were confirmed on a repeat sample (Figure 1). Following fluid restriction, the plasma sodium rose to 135mmol/L, and he was able to be discharged 10 days later. The chemotherapy treatment regime was continued and he completed the full course uneventfully with no recurrence of hyponatraemia.

Dysplasia Epiphysealis Hemimelica of Talus Mimicking Posterior Ankle Impingement Syndrome in a Young Male: A Case Report with Review of the Literature

Dysplasia epiphysealis hemimelica is a rare skeletal developmental disorder representing an osteocartilaginous tumor arising from 1 or more epiphyses during childhood. We report a case of a young male who presented with complaints of pain and swelling in the posteromedial aspect of the left ankle with the clinical diagnosis of posterior impingement syndrome. Imaging studies, including radiography, computed tomography, and magnetic resonance imaging, suggested the possibility of localized juxta-articular dysplasia epiphysealis hemimelica arising from the talus. The patient was successfully treated by surgical excision. The postoperative histologic findings were consistent with osteochondroma. This case report emphasizes the possibility of dysplasia epiphysealis hemimelica in the differential diagnosis of impingement syndromes around the ankle. The aim of the present study was to familiarize clinicians with this rare entity, because the number of documented cases has been increasing.