Yugal Karkhur

Radiological evaluation of pelvic inlet and outlet radiographic view in Indian population

Background Pelvic fractures represent one of the most challenging clinical problems in which an urgent multidisciplinary approach is required. The early management in a suspected pelvic fracture starts with the good radiological evaluation. The standard radiographic view includes the anteroposterior, inlet and outlet views. The inlet and outlet views are taken with 45° tilt from anteroposterior plane. However, recent studies have shown that there is significant individual variation within the population and these values should be redefined. Material and Methods This is a retrospective study carried out in a tertiary care teaching institute. Total 110 patients (including 42 female and 68 male patients) of age older than 18 years, who had a routine pelvic Computed Tomography (CT) scan performed for any indications unrelated to pelvic pathologies were included. Statistical analysis Mean and standard deviation were calculated. For each angle measured, the effect of age was determined and a comparison was made between male and female patients, p value <0.05 is considered significant. Results The mean angle of caudal tilt for the ideal screening inlet view was 33° +/-8 (16.3-31.3) and the mean angle of cephalic tilt for the ideal screening outlet view was 56° +/-9 (51.6-81.8). Conclusion This study re-evaluated the optimal inlet and outlet angles in Indians and demonstrated that the mean angles needed to create an ideal pelvic inlet and outlet views are 33° and 56° respectively.

Concomitant Posterolateral Elbow Dislocation with Ipsilateral Comminuted Intra-articular Distal Radius Fracture: A Rare Orthopaedic Scenario

Fracture dislocations are common around the elbow joint. However, closed fracture of the distal radius with ipsilateral elbow dislocation is an uncommon injury pattern. We discuss the case of a middle-aged woman presenting with posterolateral elbow dislocation with concomitant ipsilateral closed intra-articular fracture of the distal radius. It was treated with closed reduction for the elbow dislocation first followed by closed reduction for the distal radius fracture. Even with conservative management, the patient had a good functional outcome at one year. The importance and incidence of such a rare injury pattern and the possible mechanism of injury has been discussed.

Total hip replacement in tuberculosis of hip: A systematic review

Total hip replacement (THR) in patients with tuberculous arthritis of the hip is controversial. The timing of surgery, type of prosthesis, reactivation of the disease, high complication rates and the long-term survival of the reconstruction are the major conc erns. There is little information regarding this concern in the literature. We conducted a systematic review of published studies on Total Hip Replacement in patients with Tuberculosis of the hip. A search of Pubmed and Google Scholar database articles published between January 2000 and July 2017 was performed. Thirteen articles were identified, comprising 226 patients. The mean follow-up was 5.48 years. Antituberculosis treatment was given for atleast 2 weeks pre-operatively and continued post-operatively for between six and 18 months after THR. Three patients had reactivation of infection. At the final follow-up, the mean Harris hip score was 89.98. Total Hip Replacement in tuberculosis of hip is safe and efficient way to save the joint function. The most important factors to achieve success include the accurate diagnosis, efficient pre- and postoperative anti-tuberculosis therapy, thorough debridement, two stage procedure for patients with sinus(es).

Unusual presentation of chondroblastoma mimicking Trevor's disease

Chondroblastoma is a benign bone tumor, represents 1%–2% of all primary bone tumors, typically seen in patients 10–25-year-old and more common in males. It occurs most frequently in the distal femur, proximal tibia, and proximal humerus. Soft tissue extension is extremely rare. Adjacent joints may develop effusions, but the tumor mass protruding into the joint has never been seen in case of chondroblastoma. We report a rare case of intra-articular chondroblastoma arising from proximal tibia in a 16-year-old boy and growing into the knee joint mimicking an intra-articular osteochondroma.

Pathological Fracture of Femoral Neck Leading to a Diagnosis of Wilson's Disease: A Case Report and Review of Literature

Wilsons disease (WD) is a rare inherited disorder of copper metabolism. It chiefly has hepatic, neurological and ophthalmic manifestations. Although osteoporosis, rickets and early arthritis are common features of WD, they are under-recognized. Musculoskeletal manifestations very rarely lead to diagnosis of the disease. Here we present a case of a 12-year-old girl who presented with a 3-month-old pathological fracture of neck of femur. WD was diagnosed on investigating the cause of the pathological fracture, which was managed by performing a conventional McMurrays intertrochanteric osteotomy. At 6 months follow up, fracture had united and patient was able to ambulate with support. WD can be a rare cause of pathological fracture. A high index of suspicion must be maintained in patients of pathological fracture presenting with associated neuropsychiatric or hepatic manifestations.

Astragalus Tuberculosis: A Case Report and Review of the Literature

Osteo-articular tuberculosis continues to be a major global pandemic, with its greatest impact in the third-world countries. Among osteo-articular tuberculosis, plantar localisation, particularly isolated involvement of the talus is an extremely rare event. We discuss the case of a 20-year-old male diagnosed with isolated tuberculosis of right talus without the radiological involvement of the distal tibia, fibula or calcaneum. The diagnosis was made with the help of magnetic resonance imaging and confirmed through core biopsy of the talus. He was treated with multi-drug antitubercular chemotherapy and ankle immobilization with protected weight bearing with good results.

Isolated tubercular osteomyelitis of acromion: A case report and review of literature

Tuberculosis is an infectious disease of public health interest, infecting one-third of the world population. Up to 3% of all Tubercular cases have musculoskeletal involvement with less than 1% involving the scapular. To the best of our knowledge, we present the third case of acromion involvement in reported literature. An adolescent female with complains of shoulder pain with no restriction of movements, no local symptoms, no fever, no history of tuberculosis was being treated on analgesics for three months at a primary health centre. With a provisional diagnosis of Chondroblastoma, surgical exploration was done, but pus was drained. It was realized in retrospect that tuberculosis needs to be considered as a differential diagnosis for any undefined bony pain, however uncommon the site of involvement may be, especially in Indian subcontinent.