Post-Traumatic Radio-ulnar Synostosis Managed by the Excision of the Bone Bridge and Palmaris Longus Encircling Loop over the Ulna: A Case Report.

Introduction: Radioulnar synostosis is an uncommon complication of forearm fractures and presents with varying degrees of restricted forearm movement. The diaphysial distal third synostosis is less common and excision of the synostosis is fraught with risk of re-ossification. Use of inert or biological interposing material has thus been accompanied with the synostosis excision and various methods have been described. There is still no consensus on the ideal treatment method. Case Report: We, hereby, report a case of a long-standing radioulnar synostosis with rotational restriction of movement. Despite the movement restriction, the patient could perform basic activities of daily living and wanted to improve the movements. The presence of diaphyseal radioulnar synostosis was conformed on the radiographs and computerized tomography scan. A volar forearm approach was used and the bony bridge was excised. The ipsilateral native palmaris longus (PL) tendon was extracted from distal wrist crease and with its proximal attachment intact, circumferentially wrapped around the ulnar raw surface as an interposing material. Apart from this, free fat was also placed at the synostosis site. In the long-term follow-up of 10 years, there was no radiological evidence of re-ossification noted. The clinical improvement was not much but the patient was performing activities of daily living with no discomfort. Conclusion: The use of an encircling loop of the native PL tendon, over the raw surface of one of the forearm bones, may be another useful method to decrease the chances of recurrence following the excision of the synostosis.

Subperiosteal Osteoid Osteoma in the Coronoid Fossa Mimicking Early Elbow Arthropathy: A Case Report.

Introduction: The elbow pain and restricted movement is a nagging problem and elbow arthropathies need to be excluded. On rare instances, uncommon etiology like a benign lesion is the culprit and the diagnosis would require judicious clinicoradiological correlation. Osteoid osteoma in the intra- or juxta-articular region is reported in the literature as rare, sporadic report. Case Report: A 23-year-old, Indian male patient presented with a provisional diagnosis of early elbow arthropathy on account of unexplained pain and restricted elbow movement without a history of trauma. He was subjected to appropriate investigations revealing synovial hypertrophy, effusion, and bone edema suggestive of early arthropathy. Additional imaging led to an uncommon definitive diagnosis. An intra-articular osteoid osteoma was found over the medial aspect of the coronoid fossa with a thin rim of cortical rim projecting anteriorly. The lesion was diagnosed and delineated on computerized tomography and an open excision of the lesion and synovectomy was done for histopathological evaluation. Histology confirmed the presence of an osteoid osteoma at an uncommon location. Conclusion: The careful appreciation of radiological images is critical to not miss significant etiology that may mimic non-specific elbow pain. High index of suspicion coupled with appropriate diagnostic imaging results in early diagnosis and appropriate management. Osteoid osteoma should be a differential diagnosis in cases with pain and restricted elbow movement and excision of which results in recovery of painless range of motion.

Primary care level prevalence of osteitis pubis in non-athlete patients in hill region: A short communication and a proposal for simple radiological grading.

Background: Osteitis pubis (OP) is inflammation of pubic symphysis associated with varying degrees of supra-pubic, pelvic, or lower abdominal pain. The condition may be severe in many patients with significant disability and protracted course of recovery. The condition is frequently described in sportspersons or athletes but consensus on classification and treatment guidelines is non-existent due to rarity of the condition. Its presence in non-athletic population is limited to a series of few cases or anecdotal case reports. Our study describes salient features of pattern of this disorder diagnosed on clinico-radiological basis in cases referred from primary care centers to our tertiary care center. Materials and Method: A total of 26 patients (mean age of 36.28 years, 25 females, and 1 male case) with radiological features suggestive of OP were included in the study and relevant demographic details were noted for each. A radiological grading (Grade A to E) for notification was developed and the cases were categorized accordingly. Results: Most of the cases were hard-working women from villages. Pregnancy was the major condition for which they ever consulted a health-care facility. Chronic, but not disabling, supra-pubic pain was the chief complaint in most cases. In some cases, the primary presentation was for some other disorder like low back pain in two, hip pain in six cases, adjacent fracture in three, and old lumbar osteoporotic compression fracture in one case. Other notable associated disorders included polio, ankylosing spondylitis, femoroacetabular impingement, and hip dysplasia. Conservative management was done in all cases except one with associated fracture. Good clinical outcome was noted in all but one case. Grade A cases were maximum (7) followed by grade B (6), grade D (4), and grade C (3). Only one case of grade E was noted with almost ankylosed symphysis. Conclusion: This article highlights acknowledgment and knowledge of OP in primary care settings and its anticipation even in normal population for a better understanding of prevalence and radiological presentation.

Colloidal silver-based nanogel as nonocclusive dressing for multiple superficial pellet wounds.

A good dressing is mandatory to an uncomplicated wound healing, especially when foreign particles contaminate the wound. Various forms of dressing preparations are available for use and differ in chemical composition and efficacy. Silver has been a known agent with good antimicrobial and healing properties and recent times has seen an upsurge in various silver-based dressing supplements. We describe our report of use and efficacy of a silver nanoparticle- based gel dressing in the healing of multiple superficial firearm pellet wounds.