The Efficacy of WALANT Technique in the Management of Distal End Radius Fracture - A Case Series.

Introduction: To improve hemostasis and visibility, a tourniquet was used throughout the majority of hand and wrist procedures, despite the fact that patient experience unnecessary and excruciating pain from the tourniquet. The more current method known as wide-awake local anesthesia without tourniquet (WALANT) enables intraoperative function evaluation while the patient is completely conscious. Materials and Methods: Individuals with displaced distal radius fractures that required surgery and isolated, non-concomitant injuries requiring spinal or general anesthesia were considered for WALANT technique. In our study, five patients underwent dorsal plate fixation and five patients underwent volar plate fixation. Patients receiving dorsal plate fixation required definite dorsal buttress to prevent radiocarpal dislocation. Conclusion: The WALANT technique is a simple, reliable, and effective anesthetic method for internal fixation and open reduction of distal radius fractures. Since a tourniquet is not necessary, the patient is protected from the discomfort and risks associated with one.

Giant Cell Tumor of Talus: A Case Report.

Introduction: Giant cell tumor of bone most commonly involves ends of the long bones in a skeletally mature patient. Giant cell tumor of the bones of the hand and feet is very rare, so is the giant cell tumor of talus. Case Report: We are reporting a case of giant cell tumor of talus in a 17-year-old female who presented with a history of pain and swelling around left ankle since 10 months. Radiographs of the ankle showed lytic expansile lesion involving whole of talus. Talectomy followed by calcaneo-tibial fusion was done as intralesional curettage was not feasible in this patient. Histopathology confirmed the diagnosis of giant cell tumor. There was no evidence of recurrence even at 9 years follow-up and the patient was able to carry out her daily activities without much discomfort. Conclusion: Giant cell tumor is most commonly encountered around the knee or distal radius. Involvement of foot bones especially talus is extremely uncommon. In early presentation, extended intralesional curettage with bone grafting and, in late, talectomy with tibiocalcaneal fusion are the treatment options.

Neglected Locked Patellar Dislocation in an Adult Female: Report of a Rare Case.

INTRODUCTION: Dislocation of patella is a very common injury which usually reduces spontaneously or can be reduced easily using gentle manipulation. Irreducible patellar dislocations are rare and usually result due to either rotation of patella along the horizontal or vertical axis or due to bony impaction. Neglected locked patellar dislocations are extremely rare injuries presenting additional challenges. CASE REPORT: We are reporting a case of a 24-year female who presented to us 4 months after suffering a knee injury for which she received native treatment initially. On presentation, patient was able to walk with a limp and some discomfort but was unable to squat or sit cross-legged. Clinical examination revealed a patellar dislocation which was irreducible. On open reduction, the patella was found to be locked in the lateral gutter with rotation along its vertical axis and with an osteochondral fracture of its medial margin. There were a lot of fibrotic adhesions which required extensive release, following which the patella could be derotated and reduced into the trochlear groove. The medial retinaculum was repaired using transosseous sutures. Postoperatively, the patient developed wound edge necrosis which was managed with debridement and secondary suturing. At 1-year follow-up patient had almost full knee range of motion without any signs of patellar pain or instability and was able to squat and sit cross-legged. CONCLUSION: Unlike acute irreducible patellar dislocations which can be managed easily with open reduction, a neglected dislocation necessitates wider surgical exposure and a lot of soft tissue releases, which may jeopardize vascularity of the soft tissues leading to wound healing problems. Release of all adhesions while taking care to prevent further chondral injury, adequate lateral retinacular release, derotation of patella to relocate it into trochlear groove, and meticulous medial retinacular repair is essential for a successful outcome.

Complex Variant of Paediatric Conjoint Bicondylar Hoffa Fracture: A Rare Entity.

Isolated, closed, conjoint bicondylar Hoffa fracture in a child is extremely rare with only three cases reported in literature till date. We report a complex variant of this very rare injury. An 11-year-old male child reported 2-week post-trauma with history of fall from a tree and injury to his right knee. Radiographs revealed a coronal plane fracture of the distal femur. The patient was operated using the swashbuckler approach, which revealed a sagittal split of the lateral femoral condyle along with a conjoint bicondylar Hoffa fracture. Fixation was done using multiple lag screws and fracture went on to uneventful union. Patient was followed up for 3 years and except for limb shortening of around 1.5 cm secondary to premature physeal closure as a consequence of the injury, he had excellent outcome with full range of motion at the knee, without any deformity.

Thrombosis of the Superficial Femoral Artery following Fixation of Intertrochanteric Fracture of the Femur using a Dynamic Hip Screw.

INTRODUCTION: Vascular injuries in orthopedic surgery are relatively rare but potentially limb and life threatening. They are most commonly encountered in knee and hip arthroplasty but also have been reported in trauma surgeries. Pertrochanteric fractures of proximal femur are among the most common fractures encountered in elderly osteoporotic patients. Positioning on fracture table, traction, and reduction maneuvers employed during fixation of these fractures, place the vessels at risk by bringing them closer to the bone. Iatrogenic vascular injuries can occur if adequate care is not taken during instrumentation for fracture fixation. CASE REPORT: We are reporting a case of 62 years female who underwent fixation of an intertrochanteric fracture of femur using a dynamic hip screw (DHS) and subsequently started developing ischemic changes in the operated lower limb on the 3rd post-operative day. Angiography revealed thrombosis of the superficial femoral artery at the level of the third screw of the DHS and the patient ultimately landed up with an amputation. CONCLUSION: Operating surgeon should be aware of the risk of iatrogenic vascular injury during fixation of pertrochanteric fractures. Good surgical technique and simple precautionary measures can minimize the risk of this devastating complication.