Giant Cell Tumor of Distal Ulna - A Rare Case Report.

Introduction: Among the benign primary bone tumors, Giant cell tumor (GCT) accounts for about 3% to -5%. It is a locally aggressive tumor with maximum incidence between 20 to and 40 years of age. The sites where GCT is most commonly seen are distal femur, and proximal tibia followed by distal end radius. Distal end of ulna is a rare site with an incidence of only 0.45% to -3.2%. Case Report: We report a case of a 32- year- old male with (GCT) giant cell tumor of the left distal ulna. We managed the patient with en bloc resection of distal ulna along with reconstruction of distal radio ulnar joint (DRUJ) and triangular fibro cartilage complex (TFCC) using proximal fibula graft and palmaris longus graft. DRUJ was stabiliszed with a k- wire. Conclusion: After 1 year of follow- up, patient showed good results in terms of range of movements of the wrist joint with no evidence of recurrence.

Concomitant ipsilateral acetabular and femoral fractures - an appraisal of outcomes and complications in 34 patients.

Concomitant ipsilateral femoral and acetabular fractures are complex injuries which result from high-velocity trauma. Surgical treatment is the accepted management of such injuries. The objectives of this study were to evaluate the outcomes and study the complications in patients treated for concomitant ipsilateral acetabular and femoral fractures (type 'B' floating hip injuries). This retrospective study was conducted at a tertiary care teaching hospital on patients operated for type B floating hip injuries, who had completed a minimum of one-year follow-up after the surgery and whose complete records were available. Those with floating hip injuries with pelvic fractures were excluded. All patients were operated on the femoral side first, followed by the acetabular side. 34 patients were included ; most of them were young males. A road traffic accident was the most common mode, with a dashboard injury being the most common mechanism of injury. No association between the type of acetabular and femoral fractures was found. The clinical (measured with Harris hip score) and radiological (Matta's method) outcomes at the latest follow-up were excellent or good in >60% cases and had a significant association with the quality of reduction on the post-operative radiographs. Complications were seen in 12 out of the 34 patients. Type B floating hips injuries can be managed well with acceptable short-term results by following a femur first strategy. However, patients must be informed of the possible complications and the probabilities of poorer outcomes when compared to isolated acetabular or femoral fractures.

Clinical experience with arthroscopic suture pull technique in isolated PCL avulsion injuries.

OBJECTIVE: to assess twenty two cases of isolated PCL avulsion fractures from tibial insertion, arthroscopically treated with suture pull technique, and to evaluate achieved clinical outcomes in terms of radiographic laxometry (objective) and Lysholm scale (subjective). MATERIAL AND METHOD: Study includes 22 cases operated between April 2014 and March 2017. Patients less than 18 years old, presentation after 3 weeks of injury, concomitant injury in the same limb, with open wounds or with comminuted avulsed fragment were excluded from the study. All cases were MRI proven. All arthroscopic suture fixation technique was used in all cases. Follow up was done at 3 weeks, 6 weeks, 3 months, 6 months and 12 months. Mean follow up was one year. Subjective complaints, Knee flexion, Lysholm score and stress radiographs were noted. RESULTS: Average Lysholm score was 96.3. Seventeen patients had excellent results and Five had good results based on Lysholm scores. In two patients, grade 2 laxity (5-10 mm) was present on stress radiographs but there were no clinical complaints. All patients achieved osseous union and had no functional limitation. Three Patients developed arthrofibrosis initially but gained functional range later. CONCLUSION: Arthroscopic suture fixation method for PCL avulsion fracture from tibia is a good and safe method of choice for fixation.

Influence of three different fixation methods on femoral tunnel widening in ACL reconstructed patients evaluated using computed tomography (CT) scan.

PURPOSE: To evaluate femoral tunnel widening in young and active patients undergoing ACL reconstruction with quadrupled hamstring graft with fixation on tibial side performed with a Bioscrew while femoral fixation performed with either a Tight rope Reverse Threaded (RT) or Transfix or another Bioscrew using CT scan. MATERIAL AND METHOD: A total of 100 consecutive patients underwent single-bundle ACL reconstruction from January 2008 to March 2012. Eighty-six out of these were available with us till the final follow-up. Only 20-40-year-old males with unilateral ACL rupture less than a year old, diagnosed clinically and confirmed radiologically by magnetic resonance imaging, were selected for the study. All patients were evaluated clinically as well as radiologically at follow-up of 2 weeks, 1 month, 3 months, 6 months, 1 year and every 6 months thereafter. CT scans were performed at 2 weeks, 6 months, and 1 year postoperatively. The data acquired at the second week were considered as baseline data and were used for comparison with the data acquired at 6 months and 1 year. RESULTS: The dilatation at the aperture was significantly more in the Tight rope RT group as compared to the other two groups (p value 0.019 and 0.021 for sagittal and coronal images, respectively). CONCLUSION: There is no significant difference between the three different fixation modes in context of tunnel enlargement except with Tight rope RT device which leads to statistically significant dilatation at aperture. Future studies with longer follow-up are required to evaluate its clinical implications.

Clinical experience with management of Hoffa fractures using headless compression screw and headed screw.

PURPOSE: to analyze the radiological and functional outcomes of patients after surgical treatment of coronal plane fractures of femoral condyle using headless compression screw and cannulated cancellous (CC) screws (headed screws). MATERIAL AND METHOD: In this prospective study 30 cases were included, out of which 15 were treated with headed screws and other 15 were treated with headless screws. Active knee mobilization exercises were started from the third postoperative day. Initially, patients were kept non-weight bearing; partial weight bearing was started at 10 weeks and progressed to full weight bearing as tolerated. Follow-up visits conducted at 2, 4 and 12 weeks, thereafter at 6 and 12 months. The long term final results were rated using Neer's rating system. RESULTS: Results were graded as excellent (score > 85), Satisfactory (score 71-85), Unsatisfactory (score 56-70), and Failure (score < 55). In CC screw group the outcome was good in 10 cases (66.66%) and poor in 5 cases (33.33%) whereas in headless group outcome was good in 13 cases (86.66%) and poor in 2 (13.33%). CONCLUSION: fixation of Hoffa fracture with headless compression screw in comparison to CC screw (Headed Screw) have no significant difference in terms of functional outcome like range of motion but complications and implant failure is significantly higher in cases fixed with CC screw than in headless screw. So we conclude that overall outcome is better in study group fixed with headless compression screw as compared to cases fixed with CC Screw.

Clinical experience with woven and parallel hamstring-tendon anterior cruciate ligament reconstruction.

PURPOSE: The purpose of this study was to determine the effect of the weave technique for hamstring graft preparation on the diameter of the prepared graft, functional outcome, and need for harvesting of semitendinosus and gracilis (ST + G) or semitendinosus alone (ST). MATERIALS AND METHODS: This retrospective study evaluated 340 patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction from January 2013 to December 2015. Our protocol for graft preparation is that the graft length must be a minimum of 8 cm and the diameter must be between 7 and 10 mm. The parallel-graft preparation technique was used in 189 patient and the weave technique was used in 151 patients. Outcome was measured by using stress radiographs and International Knee Documentation Committee (IKDC) 2000 score. RESULTS: In the parallel-graft preparation group, ST + G was used in 99 patients and ST was used in 90 patients. In the weave-graft preparation group, ST + G was used in 38 patients and ST alone was sufficient in 113 patients. The need for G harvest was less in the weave-technique group (p < 0.0001). There was no statistically significant difference at 2 years of follow-up in stress laxiometry, IKDC 2000 scores and rerupture rates between the two groups. CONCLUSION: The weave technique helps to reduce the need for G harvest without compromising functional outcome. Level of evidence IV.