Pott's disease in a young child.

A 16-month-old emaciated, immunized child presented with low-grade fever and progressive kyphosis with a right sided para-vertebral abscess for 9 months. During this period of illness the child had marked loss of appetite and progressive weight loss. There was history of contact with sputum smear positive father. A gibbus was present at thoraco-lumbar region with a cold abscess at the right side of the gibbus and signs of upper motor neuron lesion were found on lower limb examination. Diagnosis was supported by relevant investigations including MRI of dorsolumbar spine and treatment was started beforehand with anti-tubercular drugs. The paravertebral abscess was drained several times and antibiotics were used depending upon the results of microbiological study. At the same time the patient was advised to wear a modified chest brace for immobilization and the management for severe malnutrition was also started accordingly. There was significant clinical improvement observed within one month of starting treatment.

Perosteal osteosarcoma of clavicle-treated by limb salvaging surgery (total cleidectomy).

Osteosarcoma of clavicle is extremely rare. Improved survival in patients with osteosarcomas has been associated with recent advances in imaging techniques, histopathological methods, surgery and chemotherapy. In most cases the diagnosis can be made with confidence on the x-ray appearance. Other imaging studies like- radioisotope scans may show up-skip lesions, computed tomography (CT) and magnetic resonance imaging (MRI) show the extend of the tumour. Incisional biopsy or excisional biopsy is carried out after careful clinical study and proper investigations. A 30 years old cultivator with a late case of primary osteosarcoma of clavicle was treated with pre-operative and post-operative chemotherapy and was managed with surgical excision of tumor with limb sparing. The patient was clinically disease free for about 08 (eight) months. Then the patient developed recurrences and died 11 (eleven) months after operation.

Evaluation of 68 cases of chest injuries.

During the period of January, 2003 to December 2004 a descriptive cross-sectional study was done to evaluate the variations in clinical pictures of chest injury, rural and urban distribution, weapons used commonly and finally the result of existing treatment facilities in a general surgical unit of a tertiary level hospital. Total number of patient was 68. All patients of chest injury with or without extra-thoracic other injuries admitted in this period was included non-randomly. Diagnosis was based on history, clinical examination and relevant investigation like radiography and ultrasonography. Penetrating injury predominates over blunt injury in this study. Associated extra thoracic injury was present in a good number of cases. Most of the weapons were made locally and were used in household purposes. Homicidal injury predominates over accidental and incidence is more in rural than in urban areas. Most of the cases were treated by general supportive measures with or without intercostal tube thoracostomy. The outcome of treatment was satisfactory. Only one patient developed empyema thoracis and two patients died.

A case of brittle bone disease.

Brittle bone disease--synonym, osteogenesis imperfecta is a rare genetic disorder of collagen synthesis associated with broad spectrum of musculoskeletal problem, where bones break easily. Recently we got a case of OI, whose name is Babu, 3 days old, full term bay with uneventful home delivery. The baby had multiple fractures in all the extremities with deformities with blue sclera with bilateral inguinal hernia. Other systems were found normal. On 10th day of life he was operated for inguinal hernia with satisfactory postoperative recovery and subsequently he was referred to the orthopedic department for further management.

Post operative diagnosis of osteopetrosis.

Osteopetrosis is a rare hereditary disease that was first described by a German Albert Schonberg in 1904. At least five types of osteopetrosis have been described. Among them osteopetrosis congenita (autosomal recessive) and osteopetrosis tarda (autosomal dominant) are most common. Here we are reporting a case of osteopetrosis tarda, who is a female of fifty years of age presented with fracture femur. Preoperatively there was no suspicion of osteopetrosis.She was only suspected while introducing an IM Nail during her fracture reduction. Diagnosis of osteopetrosis was confirmed post operatively by histopathology of medullary cavity of her femur.

Treatment of non union of humerus using G. A. Ilizarov technique.

The management of the non union of humerus is one of the most challenging problems that the surgeon confronts in his practice. The procedures traditionally used are: I.M. Nailing, interlocking, plating, transplantation of allograft. In our series, 36 cases with non union has been treated by G.A. Ilizarov technique. The age range were: 21-62 years with an average of 32 years. The initial treatment were done by DCP, rush nails & plates with screw fixation. The duration of treatment ranged from 5-11 months (average 8 months). With the application of Ilizarov fixator a good range of elbow & shoulder motion were achieved. The average follow up period was 5 years with a range of 1-8 years. Union was achieved in all the 36 cases.