ABSTRACT
Introduction: Osteoarthritis is now understood to be an aberrant remodeling of the joint organ caused by wear-and-tear mechanism and by a variety of inflammatory mediators. Subchondral cysts have been one of the important radiological features of knee osteoarthritis that is not well understood. We report a case of large subchondral lytic lesion which was initially thought to be a giant cell tumor and later was identified as subchondral cyst. Case Report: A 50-year-old man presented to the outpatient department with complaints of intermittent pain and swelling over the left knee associated with difficulty in performing his daily activities Patient had undergone cerclage wiring for fracture left patella fracture 8 years back following which pain started. Radiographs showed extensive degenerative change at the knee with a large, multilocular lytic lesion in the proximal tibia. Magnetic resonance imaging showed similar features with an additional lesion in the distal femur. Core needle biopsy and histopathological examination of both lesions showed fibrocollageous tissue with bone fragments and lymphocytes. Patient was treated conservatively with analgesics and physiotherapy. He had good relief of pain and is on regular follow-up till date. Discussion: Osteoarthritis knee is the most prevalent and leading cause of pain and disability worldwide. Subchondral cysts are strongly associated with osteoarthritis. Articular cartilage damage in osteoarthritis exposes the subarticular bone to injury, particularly in the weight-bearing joints. Large cysts are a well-recognized feature of other disorders such as simple bone cyst, aneurysmal bone cyst, giant cell tumor, and osteomyelitis. As these cases are rarely reported the treatment options are not standardized. Studies had shown similar cases treated both conservatively and surgically. The occurrence of the pathological fracture in these cases is high so prophylactic surgical fixation of massive geodes is advised. We decided to treat our case conservatively with analgesics and physiotherapy. The patient has good relief of pain at present and is on regular follow-up. He has been counseled that he may need a total knee replacement in the future if pain increases in severity. Conclusion: In the presence of osteolytic lesion showing very large cyst with cortical expansion and septations in radiographs with adjacent joint arthritis, the diagnosis of subchondral cyst/Geode should be strongly considered.
ABSTRACT
Introduction: Lisfranc injury is relatively rare and is commonly missed at the initial presentation as these injuries are easily misdiagnosed as a foot sprain. We report a case of chronic foot pain following an injury which was later diagnosed to be a neglected 6 weeks old complex Lisfranc fracture dislocation. Case Report: A 53-year-old man presented with chronic foot pain and swelling which was diagnosed to be a neglected 6-week-old homolateral type of Lisfranc injury (type A Hard castle and Meyerson). We treated him with open reduction and internal fixation (ORIF) with plates and screws and achieved excellent functional outcome at 6-month follow-up period. Discussion: Lisfranc injuries are frequently undetected with estimates ranging from 20% to 80%. Anteroposterior, lateral, and medial oblique views of the foot should be included in the radiological workup following a thorough physical examination. Our case will aid the deficient literature and guide the young surgeons in management of such cases. Conclusion: Given the history and nature of the injury, it can be easily missed by a beginner and the clinician must keep a high index of suspicion when treating these injuries in emergency department. To prevent the many complications linked to this kind of injury, it requires a correct diagnosis and timely treatment in the form of closed/open reduction and fixation. Delayed presentation of such cases can be treated with ORIF and good functional outcome can be achieved.
ABSTRACT
Introduction: Isolated displaced fourth and fifth metacarpal base fracture without a carpometacarpal joint subluxation or carpal bone fracture by a punch injury is extremely rare. The site of the fracture in the metacarpal is determined by the type and direction of punch. These fractures usually occur as a result of misdirected blow or wrong punch on a hard surface with a clenched fist. To best of our knowledge, there are only few published case reports. The difficulties in management and biomechanics of such fractures with 10 months follow-up are discussed in this case report. Case Report: A 37-year-old male right hand dominant person presented with pain and swelling of the right hand after punching a wall. The difficulties in reduction and fixation of such fracture, the functional and radiological outcome of minimally open Kirschner wires fixation of this type of fracture with 10-month follow-up and the fracture biomechanics has been discussed in this case report. Conclusion: Clenched fist injury not always means a boxer fracture. This kind of rare fracture is also a possibility and should kept as a differential diagnosis. These fractures are easily misinterpreted by a beginner. Meticulous reduction techniques and fixation will yield better results.
ABSTRACT
Introduction: Patient presented with persistent shoulder pain 8 months following an injury which was diagnosed to be an old non-united missed acromion fracture. The difficulties in diagnosing such fracture, the functional and radiological outcome of surgical fixation of this type of missed acromion fracture with 6-month follow-up has been discussed in this case report. Case Report: We report a case of 48-year-old male who presented to us with chronic shoulder pain following an injury which was later diagnosed to be a missed non-united acromion fracture. Conclusion: Acromion fractures are commonly missed. Non-united acromion fractures can cause significant chronic post-traumatic shoulder pain. Reduction and internal fixation can alleviate the pain with a good functional result.
