Morphometry of distal end radius in the Indian population: A radiological study.

INTRODUCTION: The morphometry of distal end radius (DER) comprises the four necessary parameters: radial inclination, palmer tilt, radial height, and ulnar variance. The unblemished intellect about the morphometry is urged for the management of fracture of DER. The goal of our study was to determine the values of morphometric parameters of the DER from the adult Indian. MATERIALS AND METHODS: It was a single hospital- based observational cross-sectional, prospective study. Radial inclination, radial height, and ulnar variance were measured on posteroanterior view, and the measurement of palmer tilt was accomplished on the lateral view. All the statistical analysis was done by Microsoft XL 2007 (data add in function were installed for data analysis). T-test was used for comparing the means of the parameters. RESULTS: Two hundred and forty two (n = 242) X-rays were included in this study to analyze. The mean value (n = 242) of radial inclination was 23.27°± (standard deviation [SD]) 7.42° (range: 11.3-42.1°), palmer tilt 10.07° ± (SD) 5.28° (range: 1-16.9°), radial height 11.31 mm ± (SD) 4.9 mm (range: 7.1-30.4 mm), and ulnar variance 0.66 mm ± (SD) 2.46 mm (range: -2.4 to +4.1). CONCLUSION: This study may provide an inauguratory plinth to prosecute the further analytical research in the Indian population. Moreover, the data may also be used as a reference data for the anatomical alignment while treating the injuries of the DER in the Indian population.

Reverse V osteotomy and treatment of cubitus varus deformity - Results and experience.

INTRODUCTION: Cubitus varus is a most common repercussion of malunited supracondylar fracture of humerus in paediatric age group. Initially, valgus osteotomies were in trend, but due to higher rate of complications, these procedures are not in trends today, as they were earlier. Here, we are sharing our experience and results of reverse V osteotomy done for cubitus varus. MATERIAL AND METHOD: Reverse V osteotomy was done on 20 patients of cubitus varus (due to malunited supracondylar fracture of humerus). After correcting the deformity, cross K-wires and wiring (from lateral side) or Y-shaped plate was used for internal fixation. Y-shaped plate was used in older (in 20% cases) and K-wire was used for internal fixation in younger patients. All the patients underwent follow-up by clinical-radiological means and the analysis of functional outcome was done by the criteria of Oppenheim et al. RESULTS: Based on the Oppenheim's criteria, our results were 90% excellent and 10% good, among the 20 cases. CONCLUSION: We concluded in this study that reverse V osteotomy provides inherent stability and its stable behaviour further strengthened by internal fixation. It is a safe technique for correcting cubitus varus with aesthetic satisfaction.

Isolated plexiform neurofibroma of arm with unusual presentation - a rare case report.

Plexiform neurofibroma (PNF) arises as a diffuse mass from nerve trunk and leads to overgrowth of cutis and subcutis structure. This is a case report of 20-year-old male, presented to our hospital with a giant ulcerated swelling over his left arm. Differential diagnosis of sarcoma, neurofibroma, hemangioma and angiolipoma was made but biopsy confirmed the diagnosis of plexiform neurofibroma. Isolated PNF with ulceration of overlying skin over arm is a rare presentation and here we are presenting it as a perusal of rare entity.

Results of triple muscle (sartorius, tensor fascia latae and part of gluteus medius) pedicle bone grafting in neglected femoral neck fracture in physiologically active patients.

BACKGROUND: Femoral neck fractures are notorious for complications like avascular necrosis and nonunion. In developing countries, various factors such as illiteracy, low socioeconomic status, ignorance are responsible for the delay in surgery. Neglected fracture neck femur always poses a formidable challenge. The purpose of this study was to evaluate the results of triple muscle pedicle bone grafting using sartorius, tensor fasciae latae and part of gluteus medius in neglected femoral neck fracture. MATERIALS AND METHODS: This is a retrospective study with medical record of 50 patients, who were operated by open reduction, internal fixation along with muscle pedicle bone grafting by the anterior approach. After open reduction, two to three cancellous screws (6.5 mm) were used for internal fixation in all cases. A bony chunk of the whole anterior superior iliac spine of 1 cm thickness, 1 cm width and 4.5 cm length, taken from the iliac crest comprised of muscle pedicle of sartorius, tensor fascia latae and part of gluteus medius. Then the graft with all three muscles mobilized and put in the trough made over the anterior or anterosuperior aspect of the femoral head. The graft was fixed with one or two 4.5 mm self-tapping cortical screw in anterior to posterior direction. RESULTS: 14 patients were lost to followup. The results were based on 36 patients. We observed that in our series, there was union in 34, out of 36 (94.4%) patients. All patients were within the age group of 15-51 years (average 38 years) with displaced neglected femoral neck fracture of ≥30 days. Mean time taken for full clinicoradiological union was 14 weeks (range-10-24 weeks). CONCLUSION: Triple muscle pedicle bone grafting gives satisfactory results for neglected femoral neck fracture in physiologically active patients.

Midshaft Clavicular Fracture and Titanium Elastic Intra-medullary Nail.

INTRODUCTION: Clavicular injury is common in active and younger age group with male preponderance (male-female ratio is 2:1). Purpose of this study was to analyze the outcome of surgically treated displaced fracture midshaft clavicular fracture using Intra-medullary fixation by titanium elastic nail. MATERIALS AND METHODS: We present a series of cases of midshaft clavicular fracture who were subjected to Intra medullary fixation with the average nail diameter of 2.5 to 3 mm titanium elastic nail system by the closed/open reduction method under Image intensifier control. RESULTS: Average time taken for full clinical and radiological union was nine weeks (with minimum six weeks to maximum eleven weeks). Time taken for fully functional recovery (time of functional disability) was 35±7 days in all patients except in two cases of floating shoulder and one case of poly-traumatic patient in which it was 50 days. Follow-up period ranged between 9 months and 24 months with an average of 18 months. Average Constant-Murley-Score after assessment of shoulder function was 96.8. CONCLUSION: Titanium elastic intra-medullary nailing is a promising surgery with excellent functional outcome, safer percutaneous method with less invasive nature and rapid healing tendency with fewer complications in contrast to plate osteosynthesis.

Non-Traumatic Fracture Of Pedunculated Osteochondroma - A case report and brief review of literature.

INTRODUCTION: Non-traumatic fracture of pedunculated osteochondroma is a known, but rare complication. Treatment protocols for such complication are debatable, however, surgical intervene have been advocated. CASE REPORT: 14 years old male presented with pain and redness around the knee with no history of injury. Radiograph showed fracture of solitary osteochondroma of femur. Excision was done through posterolateral approach and confirmed with histopathology. Patient returned to activities at 2 weeks post surgery. CONCLUSION: Atraumatic fractures may occur due to strong muscular contractions in cases of pedunculated osteochondroma. Surgical excision gives prompt relief from symtoms.