Total hip arthroplasty for childhood fused hip

The conversion of a painless fused hip of a long standing duration to a mobile hip is usually not demanded due to a number of per-operative problems, iatrogenic complications and a high demanding procedure. The conversion is, however, required when a patient develops chronic back pain or a painful pseudoarthrosis of the hip. Conversion due to pseudoarthrosis in a recent fracture through femoral neck of previously fused painless hip has never been reported. We are reporting this unique indication for conversion

Giant cell tumours in hand bones

To describe the clinical features of Giant cell tumour of hand, in terms of aggressiveness, multicentricity and radiological grading at presentation, surgical procedures and final outcome. A case series. Jinnah Postgraduate Medical Centre [JPMC], Karachi, from January 1990 to January 2009. Seven cases of Giant cell tumour of hand bones were diagnosed in last 19 years and included in this study. Patients with infections in hand and procedure performed at other centre were excluded. Clinical and radiographic features were analyzed, definitive operative procedures performed and follow-up of the patient were studied and updated. Two hundred ten cases of Giant cell tumour of bones were seen in last 19 years at JPMC, Karachi; 7 cases were of GCT of hand bones which constitutes around 3.3% of all GCT. Four patients [57%] were male and 3 [43%] female with mean age of 24.28 +/- 5.7 years. Four [57%] cases were in metacarpal and 3 [43%] in phalanges. Average duration of symptoms was 5.78 +/- 3.26 months; all presented with radiological stage 3 lesions. One case of multicentric lesion presented after treatment of primary GCT of distal radius. Excision of the tumour and reconstruction by autogenous graft was performed in 6 cases and ray amputation in one case. No complication or recurrence noted in any case on an average of 4.5 years [ranging from 1.5-8 years] follow-up. Giant cell tumour in hand bones is rare tumour and shows specific clinical and radiographic features with early involvement of entire bone, more aggressive behaviour and multi centricity. The treatment of choice is resection of the tumour with reconstruction or ray amputation

Giant cell tumour of the proximal ulna

The report describes a rare case of giant cell tumour of proximal end of ulna occurring in 22 years old lady. Pain and gradual increase in swelling was noticed for last 7 months. X-ray showing complete absorption of proximal ulna. The tumour was excised en-bloc; reconstruction by fibular graft and fusion of elbow in functional position was performed. Postoperatively neurovascular status was normal. Patient is tumour-free and having stable elbow after 5 years of resection and reconstruction

Traumatic hip dislocations in children

To evaluate clinical features, treatment and relationship to the time period between dislocation, reduction and early complications of traumatic dislocation of hip in children. Case series conducted at Jinnah Post Graduate Medical Centre Karachi from July 2005 to August 2009. Children with traumatic hip dislocation up to fifteen years of age who presented in last four years were included in this study. Their clinical information, etiology, associated injuries, duration, method of reduction and early complications are evaluated through emergency room proforma and indoor record. Follow up of patient was updated in outpatient department. We had eight patients, six boys and two girls. Youngest 2.4 years and eldest was 12 years with mean age of 6.2 +/- 3.8 years. All presented with posterior hip dislocation. Etiology was road traffic accident in two and history of fall in remaining six patients. Average duration of time between dislocation and reduction was 19 hours range 3-72 hours. Dislocated hips were reduced under General Anaesthesia in two patients and under sedation analgesia in six patients. No complications were noted in eight cases with mean 18.75 +/- 13.23 months follows up. Traumatic hip dislocation in children is not rare. Slight trauma causes dislocation in younger age and immediate closed reduction and Immobilization reduces complications

Salmonella spondylitis. A case report

Salmonella infection is common in the tropics, but osteomyelitis of the spine due to salmonella is rare. We are reporting a case of 23 years old house wife, who presented with fever and backache and was subsequently diagnosed to have salmonella spondylitis