A Case Report of Tuberculosis of Isolated Radial Head A Rare Location with Diagnostic Dilemma.

INTRODUCTION: Tuberculosis (TB) of isolated radial head is scantily reported in the literature. Nonspecific symptoms and difficulty in interpreting initial screening radiographs often lead to misdiagnosis. CASE REPORT: We present a case of 42-year-old male elsewhere diagnosed as pyogenic arthritis of left elbow and treated by incisional drainage and broad-spectrum antibiotics, who presented to us 6 months later with multiple non-healing actively discharging sinuses. The repeat radiographs and Magnetic Resonance Imaging (MRI) were reported as chronic osteomyelitis of proximal radius without the involvement of humerus and ulna. The excision of radial head along with sinus tracts was done for clearance of disease and excised tissues, on being subjected to Cartridge Based Nucleic Acid Amplification Test (CB-NAAT), culture and histopathological examination, the diagnosis of TB was established. CONCLUSION: The diagnosis of TB of the elbow is generally delayed & mismanagement may occur. Therefore, not only biopsy is essential to demonstrate the presence of mycobacterium TB by CB-NAAT (Cartridge Based Nucleic Acid Amplification Test) method and in culture but also the presence of tuberculoma in histopathology is essential to establish the diagnosis so that early appropriate treatment can be instituted.

A case report on partial scapulectomy with glenoid preservation for Chondromyxoid fibroma of scapula.

Chondromyxoid fibroma is a benign bone tumour accounting for less than 1% of all primary bone tumours. It usually affects the metaphyseal region of long bones in the first or second decade of life. It rarely occurs in scapula. We present a case of 29 year old female with biopsy proven Chondromyxoid fibroma of left scapula. She underwent wide marginal excision by partial scapulectomy with preservation of glenoid. Post operatively she has stable shoulder joint with normal range of movement & no recurrence on regular follow up.

Giant cell tumour of bone: an analysis of 139 Indian patients.

BACKGROUND: Giant cell tumour of bone (GCT) is a benign but locally aggressive lesion. We analysed a series of GCTs of bone to determine whether there was any variation in the incidence and distribution in an Indian population compared to other populations reported in the literature, as well as treatment options applicable in developing countries, and we report the results here. METHODS: A total of 139 patients with histologically proven GCT of bone were treated in our referral centre. Of these, 124 cases had a follow-up of more than 2 years (mean 8.3 years). Demographically, 72 were male, 67 were female, and they had a mean age of 29 years (range 15-59 years). The majority of the cases were of Campanacci grade III (n = 72, 51.1%). A total of 157 oncological procedures were performed. RESULTS: Incidence of GCT of bone was found to be 20.3% (n = 139/685) among all primary bone tumours. The distal radial involvement amounted to 22.7% (n = 28). There were 14 recurrences (11.1%) and 3 re-recurrences. Functional outcome was evaluated using the MSTS-93 scoring system. Average rating was 89.6% (avg. score 26.9) for upper extremities and 84% (avg. score 25.2) for lower extremities. CONCLUSIONS: The incidence of GCT of bone was found to be high in our population, with surprisingly high involvement of the distal radius. Nonvascularised autogenous fibular graft was found to be an effective option for reconstruction. The Indian population, like their South East Asian neighbours, has a higher incidence of GCT compared to Western populations described in the literature.

Resection-reconstruction arthroplasty for giant cell tumor of distal radius.

BACKGROUND: Giant cell tumor (GCT) of the distal radius poses problems for reconstruction after resection. Several reconstructive procedures like vascularized and non-vascularized fibular graft, osteo-articular allograft, ceramic prosthesis and megaprosthesis are in use for substitution of the defect in the distal radius following resection. Most authors advocate wrist arthrodesis following resection of distal radius and non vascularized fibular graft. Here we have analyzed the results of aggressive benign GCTs of the distal radius treated by resection and reconstruction arthroplasty using autogenous non-vascularized fibular graft. MATERIALS AND METHODS: Twenty-four cases of giant cell tumor of the distal radius (mean age 32 years, mean follow-up 6.6 years) treated by en-bloc resection and reconstruction arthroplasty using autogenous non-vascularized ipsilateral fibular graft with a minimum followup of two years have been included in this retrospective study. Nineteen cases were of Campanacci grade III and five were of Grade II recurrence. The mean resected length of the radius was 9.5 (8-12) cm. Routine radiographs and clinical assessments regarding pain, instability, recurrence, hand grip strength and functional status were done at regular intervals and functional results were assessed using (musculoskeletal tumor society) MSTS-87 scoring. RESULTS: Early radiological union at host-graft junction was achieved at mean 12.5 weeks, (range 12-14 weeks) and solid incorporation with callus formation was observed in mean 29 weeks (range 28-32 weeks) in all the cases. Satisfactory range of motion (mean 63%, range 52-78%) of the wrist was achieved in 18 cases. Grip strength compared to the contralateral hand was found to be 67% (range 58-74%). Functional results were excellent in six cases (25%), good in 14 cases (58.3%) and four (16.7%) cases had fair results. Soft tissue recurrence was seen in one patient. The most commonly encountered complication was fibulo-carpal subluxation (10 cases, 41.7%). CONCLUSION: Resection of the distal radius and reconstruction arthroplasty with non-vascularized proximal fibular graft is useful in preserving the functional movement and stability of the wrist as well as achieving satisfactory range of movement and grip strength.