Open Displaced Fracture of Acromion with Associated Complete Supraspinatus Tear: A Rare Case Report.

Introduction: Isolated acromion fractures are rare and in that too, orthopaedicians rarely come across open acromial fractures. Hence literature regarding their management, outcome and any associated complications is obscure. In an extensive search for literature related to our case we found very few articles. We hereby report a case of Gustilo IIIA open acromial fracture with associated supraspinatus, deltoid and capsular injury managed with tension band wiring (TBW) and soft tissue repair with 6 month follow up. Case Report: A 21-year-old male was admitted in our hospital for wound of right shoulder with pain and inability to move this arm with a history of direct trauma with sharp object 3 days back. On examination, a wound 15 cm in length on the superior aspect of the right shoulder with its depth extending up to the glenohumeral joint was noted. The glenohumeral joint was exposed with a Gustilo Anderson type IIIA acromion fracture and injury of supraspinatus and capsule with no associated vascular or neurological injury. Wound was thoroughly irrigated and was used to approach the fracture site for repair. Capsule of shoulder was carefully closed with absorbable suture followed by suturing of supraspinatus with non-absorbable suture. Our initial plan to fix the acromial fracture to spinous process of scapula with 2 4 mm cannulated cancellous screw placed orthogonal to fracture site was modified intraoperative due to screw cut out and we went ahead with TBW with 1 screw and 1 Kirschner wire to prevent further fragmentation of the fragment. Wound was healing and healthy. Patient was started on a passive pendular exercises after 4 weeks and active exercises at 6 weeks. Six months postoperatively patient had complete range of shoulder rotation with forward flexion of 80° and abduction possible till 45°. Patient was able to do most of his activities of daily living barring overhead activities. Conclusion: As there are very limited cases of this sort of injury, this case report will cast a light on management options and outcomes of such injuries. We received fair results in our study with good healing and painless functional shoulder joint. However, long term and multi centric studies are required for further information pertaining to such scenarios.

Multifocal Tuberculous Spondylitis and Extensive Extraspinal Tubercular Osteomyelitis without Immunocompromise: Case Report and Literature Review.

Multifocal extensive spinal and extraspinal tuberculosis is very rare. So far, fewer than 10 cases have been reported. We hereby report two such cases to highlight their rarity, the diagnostic and therapeutic challenges they presented, and the overall prognosis of the condition. The two patients (a 19-year-old woman and another 20-year-old woman) had multifocal extensive tuberculosis involving spine and appendicular skeleton with neurological deficit. Both patients presented with back and neck pain and gradual neurological deficit. The insidious onset and malignancy-like spread pattern mimicked neoplasm. After thorough investigations with magnetic resonance imaging, positron emission tomography scan, and biopsy, antitubercular drug therapy was started, and debridement and fixation were done for significant thoracic and cervical vertebral lesions, respectively. Both patients showed excellent neurological recovery after the procedure. Early surgical treatment of the cases with large abscesses helped provide decompression and stabilization and prevented neurological deterioration and deformity. In patients with noncontiguous spinal tuberculosis, high percentage of surgical treatment may be required due to the aggressive behavior of the disease.

A Case Report of Closed Reduction of Anterior Transolecranon Fracture Dislocation of Elbow in a Pediatric Patient.

Introduction: Anterior transolecranon fracture dislocation of the elbow is rarely found in pediatric patients, with very few cases reported till now, and very less literature available on its management. Case Report: We hereby present a rare case of trauma to the left elbow in a 9-year-old female child who sustained anterior transolecranon dislocation without neurovascular deficit. Such fracture dislocations are managed usually by surgical methods with or without osteosynthesis. However, we present a report of closed reduction of the condition with good clinical outcomes. Conclusion: Closed reduction can be a safe method of treatment of anterior dislocation of the elbow if no neurovascular deficit is present. This case report aims to highlight this possible treatment method which in itself is unusual for this uncommon pediatric injury.

Management of Pelvic Fractures and Hip Dislocation in Pregnancy: A Case Report and Review of Literature.

Introduction: Trauma is the leading non-obstetric cause of maternal mortality during pregnancy and pelvic fractures are challenging to manage in such cases due to the effect of trauma on the gravid uterus and altered maternal physiology. About 8-16% of pregnant females can have fatal outcome after trauma, with pelvic fractures contributing majorly to the same, and also can have severe fetomaternal complications. There are only two cases reported till date of hip dislocation in pregnancy, with very little literature available on its outcome. Case Report: We, hereby, present a case of a 40-year-old pregnant female hit by a moving car with the right superior and inferior pubic rami fracture and left anterior hip dislocation. Closed reduction of the left hip was done under anesthesia and pubic rami fractures were managed conservatively. On follow-up after 3 months, the fracture was completely healed and the patient had a normal vaginal delivery. We have also reviewed management protocols for such cases. Aggressive maternal resuscitation is important for both maternal and fetal survival. Pelvic fractures should not be left unreduced in such cases to prevent mechanical dystocia and can have a good outcome with both closed and open reduction and fixation techniques. Conclusion: Pelvic fractures in pregnancy should be treated by careful maternal resuscitation and timely intervention. The majority of such patients can deliver vaginally if the fracture heals before delivery.

A Rare Cause of Ankle Pain - Chondrosarcoma of the Talus: A Case Report and Literature Review.

Introduction: Chondrosarcoma of the talus is one of the rare causes of ankle pain. Often this pain is neglected by the patients. Hence, the presentation is late. A rare occurrence, lack of clinical familiarity, and resemblance to enchondroma make the diagnosis of chondrosarcoma difficult. Case Report: We present a case of chondrosarcoma of talus in a 42-year-old female, which is an uncommon site of occurrence. In the presence of non-classical radiologic and histologic findings, the patient was treated with below-knee amputation. At present, the patient is disease-free and walking with a prosthesis. Conclusion: Talus is an infrequent site for chondrosarcoma. When affected, it presents as vague ankle pain. A patient can be underdiagnosed as there are no clear radiological and histological guidelines to differentiate between benign and low-grade cartilaginous tumors such as enchondroma and low-grade chondrosarcoma. Histologically proven benign lesions must be followed for a long time in suspicion of malignancy. The treatment of chondrosarcoma of the talus can vary from local wide excision to below-knee amputation, depending on the grade of malignancy.

A prospective, randomized, double-blind, multicentre, parallel-group, active controlled study to compare efficacy and safety of biosimilar adalimumab (Exemptia; ZRC-3197) and adalimumab (Humira) in patients with rheumatoid arthritis.

AIM: In this study, efficacy, tolerability and safety of biosimilar adalimumab (Exemptia; Zydus Cadila) was compared with reference adalimumab (Humira; AbbVie) in patients with moderate to severe rheumatoid arthritis (RA). METHOD: In this multicentre, prospective, randomized, double-blind, active controlled parallel arm study, 120 patients with moderate to severe RA were given 40 mg of either test adalimumab (Exemptia) or reference adalimumab (Humira) by subcutaneous route every other week for 12 weeks. The primary endpoint was proportion of responders in two tretament groups by American College of Rheumatology 20 (ACR20) at week 12. The secondary endpoints were change in Disease Activity Score of 28 joints - C-reactive protein (DAS28-CRP) and proportion of patients with an ACR50 and ACR70 response in two treatment groups at week 12. Safety outcomes were also assessed. RESULTS: After 12 weeks, patients treated every other week with test adalimumab (Zydus Cadila) had statistically similar response rates as compared to reference adalimumab (AbbVie): ACR20 (82% vs. 79.2%; P > 0.7); ACR50 (46%, vs. 43.4%; P > 0.7); ACR70 (14% vs. 15.1%; P > 0.8). The change in DAS28-CRP score was -2.1 ± 1.09 and -2.1 ± 1.21, in test and reference products, respectively. It was statistically significant compared to baseline, but not significantly different between the two products. Three serious adverse events and no death was reported during the study. Both adalimumab preparations were safe and well tolerated in this study. CONCLUSION: The results demonstrated biosimilarity with respect to efficacy, tolerability and safety of test adalimumab (Exemptia) and reference adalimumab (Humira) in patients with moderate to severe RA.