Step-cut osteotomy in neglected Monteggia fracture dislocation in pediatric and adolescent patients: A retrospective study.

INTRODUCTION: Neglected Monteggia fracture dislocation in children leads to significant restriction of daily activities by causing decreased range of motion at elbow, stiffness, deformity, and neurological compromise. Various treatment strategies have been described in the literature and one of them is ulnar osteotomy combined with reduction of radial head and annular ligament reconstruction. AIM: The aim of this study was to evaluate the results of step-cut osteotomy without the use of bone grafting with reconstruction of annular ligament in the management of neglected Monteggia fracture dislocation in children. MATERIALS AND METHODS: A retrospective study was conducted in six patients with neglected Monteggia fracture dislocation with a mean age of 8.83 years. The median interval between the original injury and the corrective surgery for 6 patients was 4.4 months (range 1-12 months). All children underwent step-cut osteotomy of ulna, open reduction of radial head, and annular ligament reconstruction. Mayo Elbow Performance Index (MEPI) score was used for evaluation. RESULTS: The ulnar osteotomies healed uneventfully without the need for a bone graft. Elbow range of motion improved post-op along with improved elbow functioning as indicated by raised MEPI score. The MEPI score was excellent in 5 cases and fair in 1 case. CONCLUSION: Step-cut osteotomy alone without the use of bone grafting and reinforcement with annular ligament repair is a simple yet effective technique for treating neglected Monteggia fracture dislocation.

Cytological diagnosis of osteoblastoma of the talus: Case report with unusual presentation and diagnostic pitfalls.

Osteoblastoma is a rare bone tumor mostly affecting the young adults and commonly involving the spinal cord and long bones. Talus is the uncommon site of presentation, and if involved, then the neck is more commonly involved than the body of talus. The cytological diagnosis of osteoblastoma is limited, and to the best of our knowledge, its fine-needle aspiration (FNA) in the talus has still not been reported in the literature. The present case of osteoblastoma is, therefore, being reported due to the unusual presentation in elderly male in the body of talus and showing extensive involvement on X-ray. The case was initially diagnosed on FNA cytology excluding the possibility of giant-cell tumor and osteosarcoma. The case also highlights the importance of vigilant observation of subtle cytological features of this rare tumor which may be helpful in avoiding diagnostic pitfalls, especially at an uncommon site and with unusual presentation. An early precise diagnosis by cytology may be followed by appropriate treatment and thus avoiding any further complications.

Primary Nailing in the Open Fractures of the Tibia-Is it worth?

UNLABELLED: Context (Background): The tibial shaft is one of the most common sites of open fractures. The specific methods of skeletal stabilization and soft tissue treatment of open fractures continue to be topics of debate in the orthopaedic traumatology. AIMS: To evaluate the results of the intramedullary nailing in the open fractures of the tibia, especially in the Indian scenario. SETTINGS AND DESIGN: An observational, descriptive study which was done at a tertiary care hospital from 2006 to 2010. MATERIAL AND METHODS: A prospective study was done on thirty cases which had sustained open fractures of t/hable Gustilo and Anderson grades I, II and III, who were operated for primary intramedullary interlocking nail fixation after thorough debridement and closure of their wounds with suturing, lateral skin release, split thickness skin grafting and muscle pedicle flap, where ever necessary. All the patients were followed up for a minimum of two years. STATISTICAL ANALYSIS: Descriptive statistics and Fisher's Exact test were used. RESULTS: Of the total thirty cases, ten were of grade I, seven were of grade II, three were of grade IIIA, seven were of grade IIIB and three were of grade IIIC. Dynamization was done in nine cases. The average time to union was 16.0 weeks in the grade I cases, it was 18.3 weeks in the grade II cases, it was 23.6 weeks in the grade III A cases, it was 28.4 weeks in the grade III B cases and it was 32 weeks in the grade III C cases. The mean time to union was 20.7 weeks. Infection occurred in 3 cases. Delayed unions were observed in 4 cases. A non union occurred in 1 case of type IIIC. A mal union was observed in 1 case of type IIIB. 1 case of grade IIIC had the compartmental syndrome. No case had any implant failure (nail / screw breakage), or deep vein thrombosis. CONCLUSION: We conclude that the unreamed intramedullary nailing in cases of open fractures of the tibia, with an early soft tissue coverage, results in a faster soft tissue and bony healing, an easier soft tissue coverage, a better biomechanical stability and early rehabilitation and infection rates as comparable to those which are seen with other methods.