Charcot’s osteoarthropathy – Lest we forget

Charcot’ osteoarthropathy (COA) is a rare, often misdiagnosed inflammatory debilitating complication of conditions most common being diabetes that needs to be discussed further to prevent associated morbidity. The natural history of the disease sees four stages and requires prompt diagnosis and treatment to ensure the desired outcome. We describe a case series of two cases of diabetes-associated osteoarthropathy and their management. A 72-year-old male with the early COA was managed with a total contact cast for both lower limbs and an 80-year-old male with the early COA with bone marrow edema in the tibia and talus, as well as, subtalar effusion, managed conservatively. The follow-up review documented clinical recovery in the form of a marked reduction in swelling of the lower limbs with the resolution of the functional status of lower limbs. It is the responsibility of every physician to ensure the goals of management which includes immediate offloading and good glycemic control.

Long-Term Outcome of Valgus Osteotomy and Fixation with Double Angled Dynamic Hip Screw for Nonunion Fracture of the Neck of the Femur in Young Adults / Desfecho a longo prazo da osteotomia valgizante e fixação com parafuso dinâmico de quadril de ângulo duplo de fratura não consolidada do colo femoral em adultos jovens

Abstract Objective To evaluate the long-term results of valgus intertrochanteric osteotomy fixed with double angled dynamic hip screw for nonunion fracture of the neck of the femur in young adults. This implant allows more freedom of fixation in the sagittal plane. Very few studies have evaluated the long-term outcome for treatment of nonunion in fractures of the neck of the femur. Methods This is a prospective interventional study that included 20 patients with nonunion of the fracture of the neck of the femur aged < 60 years old without avascular necrosis of the head and significant resorption of the neck of the femur. A lateral closing wedge osteotomy was performed just above the lesser trochanter after inserting the Richard screw across the nonunion site, and it was fixed with a double-angle 120° barrel plate. The outcome was evaluated using union rate and the Harris Hip Score for functional outcome. Results The average postoperative decrease in the Pauwels angle was of 28.9°. A total of 80% of the cases progressed to union within a mean duration of 7.53 months. The mean Harris Hip Score at the final follow-up was 86.45. Conclusion Valgus intertrochanteric osteotomy and fixation with a double angled dynamic hip screw is a reliable and effective method for preservation of head and promoting union in an ununited fractured neck of the femur in young patients.

Resumo Objetivo Avaliar os resultados a longo prazo da osteotomia intertrocantérica valgizante, fixada com parafuso dinâmico de quadril (DHS, na sigla em inglês) de ângulo duplo, em fraturas não consolidadas do colo femoral em adultos jovens. Este implante permite uma liberdade maior de fixação no plano sagital. Muito poucos estudos avaliaram o desfecho do tratamento a longo prazo da fratura não consolidada do colo femoral. Métodos Trata-se de um estudo prospectivo de intervenção que incluiu 20 pacientes com fratura não consolidada do colo femoral com idade < 60 anos, sem necrose avascular da cabeça femoral e significativa reabsorção do colo femoral. Foi realizada uma osteotomia em cunha de fechamento lateral logo acima do trocânter menor após a inserção do parafuso tipo Richard no sítio do retardo da consolidação óssea, sendo fixada com uma placa cilíndrica de ângulo duplo de 120°. O resultado foi avaliado com o uso da taxa de consolidação e da escala Harris Hip Score quanto ao desfecho funcional. Resultados Foi obtida uma redução pós-operatória média de 28,9° do ângulo de Pauwels. Os casos que evoluíram para a consolidação alcançaram 80%, em um período médio de 7,53 meses. A média da escala Harris Hip Score foi de 86,45 no acompanhamento final. Conclusão A osteotomia intertrocantérica valgizante e a fixação com DHS de ângulo duplo é um método confiável e eficaz para a preservação da cabeça do fêmur, promovendo a consolidação de uma fratura não consolidada do colo femoral em pacientes jovens.

Correlation of nipple eczema in pregnancy with atopic dermatitis in Northern India: a study of 100 cases

Abstract Background Nipple eczema is a less common presentation of atopic dermatitis. No studies in the literature have correlated nipple eczema in pregnancy as a manifestation of atopic dermatitis. Objective To evaluate whether nipple eczema presenting in pregnancy is a manifestation of atopic dermatitis. Methods This was a prospective observational study including 100 women who presented with nipple eczema for the first time during pregnancy. The exclusion criteria were any patient with previous history of nipple eczema, those already on oral or topical treatment for atopic dermatitis or nipple eczema, and other disorders mimicking eczema. Patients were divided into two groups ‒ nipple eczema with atopic dermatitis and without atopic dermatitis. Demographic data, clinical features, total leukocyte count, differential leukocyte count, absolute eosinophil counts, and serum IgE levels were compared between the two groups to detect association between nipple eczema in pregnancy and atopic dermatitis. Results Out of 100 patients, 39 were diagnosed with atopic dermatitis, whereas 61 were ruled out to have any features suggestive of atopic dermatitis. There were no statistically significant differences in mean age, mean duration of symptoms, and serum IgE levels. In patients with atopic dermatitis, bilateral symptoms were noted more commonly than in patients without the disease, but this was statistically insignificant. Study limitations Lack of long term follow-up and no large studies in literature to compare results. Conclusion Nipple eczema in pregnancy follows a similar pattern as in other age groups. The clinical profile of patients is similar in cases with and without atopic dermatitis.

Breaking Survival Barriers In Breast Cancer- A Case Of Cns Metastasis

One in every eight women worldwide will be diagnosed to be suffering with breast cancer in their lifetime. It is vital not only to diagnose the disease early but also to refer it to a tertiary care center for the most appropriate or standard anti-cancer treatment without delay. The outcomes of such therapy can be a game changer for the patient. Screening mammography is only having a small reduction in mortality of breast cancer. Here, we present a clinical report of one patient who had Her2 Neu positive disease with early central nervous system (CNS) metastasis and responded extremely well to anti her2 Neu therapy with chemotherapy and has survived over six years now on treatment

Comparative analysis of treatment of basicervical femur fractures in young adults with CCS, DHS, and PFN / Análise comparativa do tratamento de fraturas basocervicais de fêmur com CCS, DHS e PFN em adultos jovens

ABSTRACT Objective: To the best of the authors' knowledge, no studies in the literature have compared the clinical outcome of the three most common implants used to treat basicervical fractures of the femoral neck in young adults, i.e. CCS, DHS, and PFN. The present study attempts to fill the void in the literature and reach a conclusion regarding the usefulness of these implants in these fractures. Methods: This was a prospective interventional study including 90 patients with basicervical fracture of the neck of femur treated randomly with cancellous cannulated lag screws or dynamic hip screw, with a derotation screw or short PFN. Results: Mean time for fracture union was 14.4, 13.9, and 13.5 weeks and union rate was 93.2%, 100%, and 100% in groups 1, 2, and 3, respectively. The mean Harris Hip Score at the final follow up was similar among all the groups, i.e. 79.4, 82.2, and 81.9 in CCS, DHS, and PFN groups, respectively. The highest proportion of good to excellent results was noted in the DHS group, i.e. 83.3%, whereas it was 73.6% and 80% in the CCS and PFN groups, respectively. Conclusion: Multiple cancellous screws do not provide a sufficiently stable construct during fracture healing. PFN, although associated with lesser implant failures than CCS, have a higher incidence of technical errors. DHS provides sufficient stability in well-reduced basicervical fractures in young adults; it is associated with highest fracture union rates and best functional outcome out of the three implants at final follow-up.

RESUMO Objetivo: Tanto quanto é do conhecimento dos autores, nenhum estudo na literatura comparou o resultado clínico dos três implantes mais comumente usados para tratar fraturas basocervicais do colo femoral (CCS, DHS e PFN) em adultos jovens. O presente estudo tenta preencher essa lacuna na literatura e chegar a uma conclusão sobre a utilidade desses implantes nessas fraturas. Métodos: Estudo prospectivo de intervenção, incluiu 90 pacientes com fratura basocervical do colo femoral tratada aleatoriamente com parafuso esponjoso canulado interfragmentário ou parafuso de quadril dinâmico, com um parafuso derrotativo ou um PFN curto. Resultados: O tempo médio para a consolidação de fratura foi de 14,4, 13,9 e 13,5 semanas e a taxa de consolidação foi de 93,2%, 100% e 100% nos grupos 1, 2 e 3, respectivamente. A média do Harris Hip Score no seguimento final foi similar entre todos os grupos: 79,4, 82,2 e 81,9 nos grupos CCS, DHS e PFN, respectivamente. A maior proporção de resultados bons a excelentes foi observada no grupo DHS (83,3%), enquanto que foi de 73,6% e 80% nos grupos CCS e PFN, respectivamente. Conclusão: O uso de vários parafusos esponjosos não fornece uma construção suficientemente estável durante a consolidação da fratura. O PFN, embora associado a falhas de implantes menores do que o CCS, apresenta maior incidência de erros técnicos. O DHS proporciona estabilidade suficiente em fraturas basocervicais bem reduzidas em adultos jovens; seu uso está associado às maiores taxas de consolidação de fraturas e o melhor resultado funcional dentre os três implantes no seguimento final.

Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw: a comparative study / Tratamento de fraturas intertrocantéricas estáveis do fêmur com haste femoral proximal versus parafuso dinâmico de quadril: um estudo comparativo

ABSTRACT Objective: To evaluate and compare the clinical and radiological outcomes of patients with stable intertrochanteric fractures treated with proximal femoral nail vs. dynamic hip screw. Methods: Sixty patients with stable intertrochanteric fractures, aged over 18 years, were randomly divided into the proximal femoral nail and dynamic hip screw groups. Dynamic hip screw with a three-hole side-plate and an anti-rotation screw were used, as well as a modified ultra-short proximal femoral nail for the smaller Asian population. The intra-operative, early and late complications were recorded, and the functional outcome of each group was assessed using the Harris Hip Score. Results: In the dynamic hip screw group, the one-month mean Harris Hip Score was slightly lower than that of the proximal femoral nail group. However, at the three- and six-month monthly follow-ups, the dynamic hip screw group presented higher mean scores than the proximal femoral nail group; at the one-year follow-up, both the groups attained similar scores. Conclusion: Proximal femoral nail provides a significantly shorter surgery with a smaller incision that leads to less wound-related complications. However, the incidence of technical errors was significantly higher in proximal femoral nail when compared with dynamic hip screw as it is a technically more demanding surgery that leads to more implant failures and the consequent re-operations.

RESUMO Objetivo: Avaliar e comparar os resultados clínicos e radiológicos de pacientes com fraturas intertrocantéricas estáveis tratados com hastes femorais proximais vs. parafuso dinâmico de quadril. Métodos: Sessenta pacientes com fraturas intertrocantéricas estáveis, maiores de 18 anos, foram divididos aleatoriamente em dois grupos, um de hastes femorais proximais e outro de parafuso dinâmico de quadril. Um parafuso dinâmico de quadril com placa lateral de três furos e um parafuso antirrotação foram usados, bem como uma hastes femorais proximais ultracurtas, modificadas para a população asiática de menor estatura. As complicações intraoperatórias, precoces e tardias foram registradas; o resultado funcional de cada grupo foi avaliado com o Harris Hip Score. Resultados: No grupo parafuso dinâmico de quadril, o Harris Hip Score foi um pouco menor do que o do grupo hastes femorais proximais. Entretanto, nos seguimentos de três e seis meses, o grupo parafuso dinâmico de quadril apresentou maior média do que o grupo hastes femorais proximais; no seguimento de um ano, ambos os grupos atingiram valores similares. Conclusão: A hastes femorais proximais proporcionam uma cirurgia significativamente mais curta, com uma menor incisão e consequentemente menos complicações relacionadas à ferida. Entretanto, a incidência de erros técnicos foi significativamente maior no grupo hastes femorais proximais quando comparada com o grupo parafuso dinâmico de quadril, visto que essa é uma cirurgia tecnicamente mais exigente, que apresenta mais falhas de implantes e as consequentes reoperações.