Giant cell tumour of the first metacarpal

A 32-year old lady presented to the outpatient department with history of swelling of the right thumb for four months. There was progressive increase in size and pain being aggravated on thumb movement. There was no history of trauma. Examination revealed a tender ill-defined swelling along the first metacarpal bone with pain on firm palpation and during thumb movement. Sensations over the thenar eminence was normal but mobility of the thumb was restricted and painful. X-ray of right hand showed a lytic area in the proximal half of the first metacarpal bone with cortical break on the medial side and extension into the soft tissue. Laboratory tests revealed normal serum calcium, phosphorus and alkaline phosphates level. The diagnosis of giant cell tumor was made. MRI confirmed grade III tumour with soft tissue involvement. Open biopsy was performed which showed expanded lytic greyish bone with haemorrhagic area in the first metacarpal bone. Cortical bone was disrupted in the middle of the tumour on its medial side and tumour tissue was not separable from the surrounding soft tissue. Tumour was diagnosed to be a low -grade giant cell tumour with few mitotic figures and no evidence of necrosis. In consultation with the radiologist, pathologist, oncologist and hand surgeon, reconstruction was planned, as the patient was unwilling for amputation, from the very first consultation. The entire bone was disarticulated and removed along with the soft tissue leaving the long flexor and extensor tendons. Substitution was done by placing a fibular graft with fixation by two K-wires. Wound healing was uneventful

Tuberculous osteomyelitis

Skeletal tuberculosis is known as an osteoarticular disease. It is rare to find a bony involvement sparing the joint. We treated 16 cases between 1991 to 2001. All patients had symptoms varying from 02 to 09 months. Six out of 14 were treated elsewhere as cases of pyogenic osteomyelitis by incision and drainage with non-healing wounds. Diagnosis in early stages is difficult. Conventional radiography may be deceptive in early stages and CT or MRI may be required in the diagnosis of difficult cases. Biopsy is mandatory to confirm the diagnosis. This should be done inform of judicious curettage of the affected tissue, which not only confirms the diagnosis but also aids in early healing due to the evacuation of the necrotic tissue

Congenital dislocation of the knee: a review of four cases

Congenital dislocation of the knee [CDK] is a very rare condition, the incidence not being known with certainty. The etiology is also unknown. We reviewed four patients with severe CDK during the period of 1974-1986. The male/female ratio was 3:1. Three had bilateral and one unilateral dislocation. All were treated initially conservatively. Later three knees were operated upon. All treated knees have full range of movements except one which had secondary infection. The maximum follow up period [one case] is 12 years