ABSTRACT
Aim and objectives: To know the diagnostic yield of pleuroscopy (medical thoracoscopy) in cases of pleural effusions which remain undiagnosed after routine initial investigations. To notice the different gross pleuroscopic findings during the procedure. To observe various histopathological reports of pleural biopsy taken through medical thoracoscopy. To know the various complications of pleuroscopy in patients undergoing this procedure. Materials and methods: A total of 56 patients having undiagnosed pleural effusion were taken for study after informed written consent. All patients underwent medical thoracoscopy. The clinical, demographic, and radiological profile of patients was recorded. Gross pleuroscopic findings and histopathological reports of the pleural biopsy were noted. All patients were observed for any complications that occurred during or after the procedure. Result: Diagnostic yield of thoracoscopy in the present study was 91.07% (malignant pleural effusion 75% and tuberculous pleuritis 12.5%). Adenocarcinoma was the commonest malignancy in 60.71% of patients amongst malignant pleural effusion in the present study. Very few complications were recorded. The most common postprocedure complication was subcutaneous emphysema (12.5%) followed by pneumothorax (10.78%). Conclusion: Thoracoscopy gives excellent diagnostic yield in undiagnosed pleural effusion without major complications, and should be utilized wherever feasible.
ABSTRACT
Tuberculous dactylitis (TD) is an uncommon presentation. It is also known as spina ventosa. Mycobacterium tuberculosis is the causative agent responsible for Tuberculosis. We here present a case of a young adolescent female presenting with complaints of pain and swelling in middle finger region for the last seven month. She was diagnosed as case of tubercular dactylitis and was managed surgically along with anti-tubercular chemotherapy.
ABSTRACT
Gap Nonunion of patella fractures are rare conditions whose treatment is challenging for surgeons. Strict protocol for such fracture gap nonunion of patella is not well documented in the literature. The decision in treatment of these conditions is based on many factors such as functional demands of the patient, factors leading to nonunion, and presence of an intact extensor mechanism of the knee. We present a case of neglected gap nonunion of a transverse fracture of patella treated at 5 months after injury with a two stage reconstruction procedure.
ABSTRACT
Background: The non-union of bones is a multifactorial phenomenon. In this study, it was emphasized to evaluate the efficacy and safety of bone morphogenetic protein-2 (BMP-2) as a bone-stimulating agent in the treatment of non-unions. Methods: Fifteen patients [5 males, mean age 51.06 years (range: 21—75)] with sixteen non-unions were treated with BMP-2. There were eleven femoral non-union, three humerus, one ulna, one distal fibula non-union. The mean follow-up was 22.06 months. Results: Both clinical and radiological union occurred in 15 (93.75%) non unions cases. Radiological union achieved within a mean time of 15.75 weeks. The remaining one show incomplete union with recalcitrant formation was asymptomatic and having good pain free range of movement, declines further intervention. No complications or adverse effects from the use of BMP-2 were encountered. Conclusion: In this study, it was observed that BMP-2 is a powerful adjunct and one of the safe armamentarium for the surgeon to handle difficult and challenging clinical conditions.
ABSTRACT
Post-partum pubic symphysis diastasis is termed as abnormally wide gap between the two pubic bones following vaginal delivery. It is a rare and under diagnosed condition following acute pelvic pain. We are presenting a case of post partum pubic diastasis, in a 31 year old female with complain of pain, tenderness over pubic area and unable to walk. Patient was diagnosed with x-ray and MRI and treated surgically.
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Hallux varus is relatively uncommon and few cases have been reported in the orthopedic literature. In this article, we report the case of a 63 years old, female patient with severe hallux varus deformity, associated with deformity of other toes. Here we describe the case report of hallux varus managed by surgical intervention at our tertiary care hospital in Mumbai, India.
ABSTRACT
Isolated tuberculosis of cuneiform is rare in literature. Diagnosis of tuberculosis of cuneiform remains a dilemma because of its rarity in the lower limb. Chance of misdiagnosis and delay in diagnosis may add to morbidity. Presumptive diagnosis can be made on the basis of X-ray, MRI, histopathology of the pathological tissue, which reveals granulomatous inflammation with or without caseation. Here we are reporting a case of 15 year old girl with swelling and pain over a mid foot diagnosed as tuberculosis of cuneiform on subsequent X-ray, MRI and biopsy.
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Macrodystrophia lipomatosa is a rare presentation and only few cases are reported in scientific literature. We report a case of Macrodystrophia lipomatosa in a 7 year young girl from a tertiary care hospital Mumbai. Case presentation: A 7 year old female was presented to outpatient department with progressive enlargement of right lower limb with increase in size of right great toe since birth. On clinical examination there was non tender fluctuant soft tissue swelling with good functional limb. Scannogram showed reduction of the medial compartment of right knee joint and the right lower limb length was slightly longer compared to the left side with presence of soft tissue swelling on medial distal thigh and knee region. MRI showed un-encapsulated subcutaneous fatty tissue involving the entire right lower limb along its medial aspect up to the great toe with fatty infiltration of the vastus medialis muscle suggestive of macrodystrophia lipomatosa. Arterial and venous colour Doppler study of right lower limb was normal. Conclusion: Macrodystrophia lipomatosa is a rare congenital, non hereditary condition with localized macrodactyly and proliferation of mesenchymal element and marked increase in fibroadipose tissue. X-ray and MRI are investigation of choice. Doppler study shows normal vascularity.
ABSTRACT
Ulnar nerve compression at guyon’s canal is rare and very few cases have been reported in literature. It can be missed due to its rarity. Symptoms vary from pain and paresthesia to wasting and significant loss of muscle strength, with significant deformities of the hand. The diagnosis is made by detailed history and examination, electromyography, nerve conduction velocity test, ultrasound and magnetic resonance imaging. Early decompression of nerve is treatment of choice. Here we are presenting a case of compression of ulnar nerve in guyon’s canal due to ganglionic cyst.
ABSTRACT
Tuberculosis of clavicle is one of the rarely reported pathology of skeletal tuberculosis in the literature. It is difficult to diagnose because other conditions of clavicle also presents with same confusing picture, which can lead to delay in proper diagnosis and treatment. Our case is a young adolescent female presenting with complaints of mild pain and swelling in mid clavicular region for the last six month. She was diagnosed as case of mid clavicular tuberculosis and she was managed with anti-tubercular chemotherapy.
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Background: A retrospective study was conducted in the department of orthopaedic surgery in a tertiary care hospital of western Maharashtra. Methods: Data of all the patients with fracture of distal end radius with or without ulna fracture who were admitted in our centre over a period of 4 years were recorded from case files, casuality admission register and operative records. A total of 204 patients were included in our study and mode of treatment was compared among the various available treatment modality such as cast/slab; percutation fixation with k-wire, external fixation & plate osteosynthesis. Results: Out of the total number of cases (n=204) for fracture distal end radius, nearly 10% case were managed with cast (n=21), 22% with percutaneous fixation with k-wire (n=45), 23.5% with external fixature (n=48), 19% with both external fixator and k-wire (n=38) and 25% with plate osteosynthesis (n=52). Hence when we assess the modality of treatment of distal end radius year wise from 2011 to 2014, the incidence of surgery by plate osteosynthesis has increased over a span of period. Conclusion: Retrospective study conducted at our tertiary care hospital concludes that incidence of plating for distal end radius fracture has increased over a period of time as compared to cast, percutaneous k -wire fixation and external fixator.
ABSTRACT
Bioabsorbable materials are more commonly used now days in orthopaedic surgeries. Bioabsorbable implants for fracture fixation, and meniscal repair. These implants provide the advantages of gradual load transfer to the healing tissue, reduced need for implant removal, and radiolucency, which facilitates postoperative radiographic evaluation and no hinderance in second surgery. These also carries disadvantages like, more expensive, having less strength than metals, tissue reactions including mild fluid accumulation, painful erythematous fluctuating papule, sterile sinus tract formation, osteolysis, synovitis, and hypertrophic fibrous encapsulation. We advocate more researches to be carried out for the best suitability of these materials in orthopaedic surgeries.