Complex Proximal Humeral Fracture Fixation with PHILOS Plate using Minimal Invasive Percutaneous Plate Osteosynthesis (MIPPO) Technique: A Series of 30 Patients

@#plate osteosynthesis depends on the quality of the bone,design of the fixation devices and intra-operative soft tissuedissection. This study evaluates the functional outcome ofminimally invasive percutaneous plate osteosynthesis usinglocking compression plate in proximal humerus fracturetreatment. MaterialsandMethods:The study was conducted on 30patients with complex proximal humerus fractures treated byminimally invasive percutaneous plate osteosynthesis usinglocking compression plate (PHILOS). There were 21 malesand 9 females. The average age of our study group was 58.8years. All the patients were evaluated at six weeks, threemonths, four months, six months and 12 months followingsurgery. Results:All patients had fracture union at an average of 13.2weeks. The mean DASH score at the follow-up was 8.69 (2.5to 17.16), the average range of flexion was 143.83 degrees(100 to 170 degrees) and abduction was 121.49 degrees (90to 160 degrees). We had superficial infection in three patientswhich resolved with a short course of antibiotics. There wasexcellent outcome in 26 patients, good and fair in twopatients each. Conclusion:Proximal humerus fractures treated withminimally invasive percutaneous plate osteosynthesis usinglocking compression plate with minimal soft tissuedissection, provides good functional outcome and earlyreturn of shoulder function.

Endoprosthetic Reconstruction of distal Humerus following Resection of distal Humeral Giant Cell Tumours in Six Patients in Rural India

Giant cell tumour is a commonly occurring benign bone tumour in the Indian population. The common sites of involvement in descending order of frequency are distal femur, proximal tibia, distal radius and proximal humerus. The less commonly occurring sites are distal humerus, pelvis and proximal femur. We present six cases of giant cell tumour involving the distal humerus in rural India. After obtaining a tissue diagnosis by Trucut biopsy and classifying using Enneking's classification, we proceeded to perform wide resection followed by endoprosthetic reconstruction using custom mega prosthesis. We present here six patients (M: F: 2: 4) who were managed by us between 2008-2014. They presented to us with pain around the elbow and restriction in range of movements. They were each noted radiographically to have a lytic lesion involving the distal humerus with the likely diagnosis of giant cell tumour. Closed biopsy was done in all of them to obtain a definitive diagnosis. All patients underwent wide resection and reconstruction using distal humerus custom prosthesis. All patients were followed up at 6, 12, 18 and 24 weeks and thereafter six monthly until the last review. They were assessed using the DASH scoring system. All patients were well with no evidence of recurrence with good to fair functional outcome. We conclude that careful pre-operative planning with meticulous soft tissue dissection and good implant metallurgy and design, these tumours can be treated with good long term functional results.

Monilethrix.

Monilethrix is rare hereditary disorder which is in herited as autosomal dominant trit. We report two siblings with a combination of monilethrix and leukonychia.