Sushil Rangdal

Functional outcome of ankle fracture patients treated with biodegradable implants.

BACKGROUND Biodegradable devices have been developed to overcome the disadvantages of metallic implants especially the need for their subsequent removal, though they have their own drawbacks like poor mechanical properties and tissue reactions. Aim of this prospective study was to access the outcome of bimalleolar fractures fixed with biodegradable plates and screws. METHODS A prospective study was conducted between July 2006 and November 2008 comprising of sixteen patients with unilateral bimalleolar fractures. Fibula fractures were fixed with biodegradable plates and medial malleoli with screws. Patients were followed at two weeks, six weeks, three months, six months, twelve months and eighteen months. Final evaluation was done using Olerud Molander ankle score. RESULTS Six patients had excellent results; four patients had good results and six patients had fair performance. No patient in this series had a poor outcome. One patient had both pain and swelling at 14 weeks postoperatively which settled down with debridement and antibiotics. None of the patients needed implant removal. CONCLUSION Biodegradable plates and screws when used to fix bimalleolar fracture along with restricted weight bearing, provide satisfactory fracture healing, good functional results and reduce the need of implant removal.

Giant cell tumor of distal phalanx of great toe. A case report

Giant cell tumors are locally aggressive benign osseous neoplasms of unknown origin. They mostly occur after skeletal maturity in 3rd or 4th decade and commonly involve long bones although occasional occurrence at other sites has been reported. It is rare to see these tumors involving the phalangeal bone of foot. We report a case of giant cell tumor involving the distal phalanx of great toe in a 27 year old female who presented with swelling of great toe of right foot. Radiography showed an expansile lesion in distal phalanx of great toe. En bloc resection of phalanx was done. Biopsy showed giant cell tumor and regular follow up of this patient for two years showed no recurrence of tumor. Giant cell tumor at such a location is unusually aggressive and needs regular follow up to detect local recurrence.

Glenoid fossa fractures: Outcome of operative and nonoperative treatment.

Background: Glenoid fossa fractures are rare injuries having a prevalence of 0.1%. These fractures may be managed operatively if substantially displaced. However, several fractures of glenoid fossa are managed nonoperatively, even if displaced, due to high incidence of associated injuries which may render patient unfit to undergo major orthopaedic surgery. There is a relative paucity of articles reporting on outcome of treatment of glenoid fossa fractures. We present our experience of treating these injuries over past decade with operative and nonoperative methods. Materials and Methods: 21 patients of glenoid fossa fractures were included in this series with 14 males and 7 females. Patients with displacement of >5 mm who were fit to undergo surgery within 3 weeks of injury were operated using a posterior Judets approach. Overall 8 patients with displaced fractures were operated (Group A) while 9 patients with displaced fractures (Group B) and 4 patients with undisplaced fractures (Group C) were managed nonoperatively. Results: The mean age and followup period in this series was 29 years and 7.3 years respectively. In group A, average constant score was 87.25. The least constant score was observed for group B (58.55) while group C had an average constant score of 86. Brachial plexus injury and fracture-dislocations had poorer outcome. Conclusion: Operative treatment for displaced glenoid fractures is a viable option at centers equipped to handle critically ill patients and subset of patients with fracture-dislocation as opposed to fracture alone should always be treated operatively due to persistent loss of function.

Chondromyxoid fibroma of the clavicle extending to the adjacent joint: a case report.

Chondromyxoid fibroma is a rare benign bone tumour usually involving bones of the lower extremity in young adults. We present a case of chondromyxoid fibroma of the left clavicle extending to the adjacent joint in a 84-year-old man. The tumour had breached the hyaline cartilage of acromioclavicular joint. The tumour was excised en bloc, and the humeral head was curetted and grafted with autogenous cancellous bone. Postoperatively, the patient had an uneventful recovery and regained excellent function of the left shoulder without any pain or stiffness. At the 18-month follow-up, there was no sign of recurrence.

True congenital dislocation of shoulder: A case report and review of the literature.

The dislocation of a shoulder joint in infancy is extremely rare and is usually the result of traumatic birth injuries, a sequel to brachial plexus injury, or a true congenital dislocation of shoulder. With more advanced obstetric care, the incidence of first two types has drastically decreased. We report a case of true congenital dislocation of shoulder, second of its kind, in a child who was delivered by cesarean section thereby negating any influence of trauma. We report the case because of its rarity, and review the available literature on this topic. We also discuss the management options when encountered with such a rare case scenario.

Late presentation of congenital dislocation of the knee: a case report.

Congenital dislocation of the knee is a rare disorder. Late presentation of congenital dislocation of the knee at an older age is a therapeutic challenge. A 12-year-old girl presented to us with congenital dislocation of the knee and with complaints of limp, short limb, and pain on weight bearing. Two-stage surgery was performed with quadricepsplasty followed by gradual distraction in the first stage and repeat quadricepsplasty, anterior capsular release, and open reduction in the second stage. The result was fair to good with a stable and painless knee on walking.