Bipolar fracture of clavicle mimicking fracture dislocation of sternoclavicular joint: A case report.

INTRODUCTION AND IMPORTANCE: Bipolar fractures involving segmental fractures of the lateral and proximal clavicles are exceptionally rare, with only isolated cases documented in the literature. Such fractures may easily be overlooked during the initial presentation. CASE PRESENTATION: We present the case of a 35-year-old male with deformation in the middle segment of the clavicle following a road traffic accident (RTA). On radiography, the injury was initially thought to be a lateral clavicle fracture combined with sternoclavicular joint dislocation but was later changed to a bipolar clavicle fracture intraoperatively. The patient had an uneventful postoperative course with excellent functional outcomes 14 months after surgery. CLINICAL DISCUSSION: A bipolar clavicle fracture is the result of direct trauma to the shoulder region commonly following RTA. Bipolar injuries can be diagnosed based on clinical findings and radiographic evaluation using plain X-rays and aided by computed tomography (CT) scans in doubtful scenarios. With a paucity of guidelines regarding the management of bipolar clavicle fractures most reported cases have been managed operatively with open reduction and internal fixation using locking plates and screws. CONCLUSIONS: Due to its rarity, bipolar clavicle fractures can be easily missed, necessitating a high index of suspicion and detailed evaluation of suspected cases. Appropriate initial and definitive management through operative fixation can lead to optimal outcomes.

Iliac Crest Bone Graft Harvesting: Modified Technique for Reduction of Complications.

Bone graft harvesting is one of the common procedures in orthopaedics surgery, and iliac crest is the gold standard donor site for autologous bone graft. There are a number of complications related with harvesting iliac crest bone graft, "donor site pain" is the commonest one. We modified the conventional surgical technique for autogenous iliac crest bone graft on patients who underwent anterior cervical decompression/corpectomy and fusion surgeries. Among 23 patients, 18 didn't complain more pain at the donor site compared to the neck pain on the first postoperative day and the wound on the iliac crest did not affect their mobilisation. Mean Visual Analog Score was 2.62±1.80, 1.83±1.41, and 1.10±1.20 at the time of suture removal (14 days), at six weeks and three months respectively. At one year of follow-up, no patient complained of donor site pain. Our surgical modification has encouraging results and thus can be advocated for bone graft. Keywords: bone grafting; complications; iliac crest; pain.

Nerve Root Sedimentation Sign among Lumbar Canal Stenosis Patients Visiting the Department of Orthopaedics in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Lumbar canal stenosis is a common cause of back pain and neurogenic claudication in the elderly population. Nerve root sedimentation sign-on Magnetic resonance imaging is a novel sign proposed for the diagnosis of lumbar canal stenosis. There is limited research so far. So, the aim of this study was to find out the prevalence of nerve root sedimentation signs in lumbar canal stenosis among patients visiting the Department of Orthopaedics in a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted from 1 January 2020 to 31 July 2021 in the tertiary care centre, after receiving ethical approval from the Institutional ethical review board (Reference number: 299/(6-11)076/077). The anteroposterior diameter of the dural sac at the most stenotic level and nerve root sedimentation sign in magnetic resonance images were measured in patients with lumbar canal stenosis. Point estimate and 95% Confidence Interval were calculated. Results: Among 40 patients enrolled, 34 (85%) (84.01-85.99, 95% Confidence Interval) patients had positive nerve root sedimentation sign. Out of 34 (85%) cases with positive sedimentation signs, 32 (94.12%) had severe lumbar stenosis and the remaining 2 (5.88%) had moderate lumbar stenosis. Conclusions: The prevalence of nerve root sedimentation signs is similar to the similar studies done in similar settings. Nerve root sedimentation signs on magnetic resonance imaging can be used as an objective sign for the diagnosis of severe lumbar canal stenosis. Keywords: magnetic resonance imaging; prevalence; spinal stenosis.

Primary spinal epidural non-Hodgkin's diffuse large B-cell lymphoma: A case report.

Rare disease like primary spinal epidural diffuse large B-cell lymphoma should be considered as a differential diagnosis in patients presenting with back pain and rapid neurological deterioration in the lower extremities.

Molecular Confirmation of G1138A Mutation in FGFR gene in Achondroplasia.

INTRODUCTION: Achondroplasia is the most common form of skeletal dysplasia of genetic origin in humans which is characterized by disproportionate rhizomelic dwarfism. Heterozygous mutation in the transmembrane domain of the FGFR3 gene (4p16.3) occurs as a de novo mutation in most of the cases. METHODS: DNA was isolated from seven samples, out of which, five had clinical features of Achondroplasia while one was dwarf but did not show symptoms of the disorder and one as negative control. PCR was performed for the region incorporating the hotspot region viz. 1138th nucleotide. PCR amplicon of size 164 bp was obtained from all the samples, and was sequenced. RESULTS: Sequence analysis showed the presence of mutation (G to A transition) in all of the five samples. The five samples that showed the clinical features of Achondroplasia had mutation in the region being analyzed while the single patient who had no clinical manifestations of the disorder despite being dwarf had no such mutation. Among the five patients studied, one patient had a family history of Achondroplasia as observed through pedigree analysis while the remaining four cases were sporadic in nature. CONCLUSIONS: This study further supports that the G1138A mutation is the one of the most common point mutation among Achondroplasia cases. Genetic diagnosis can be useful to identify the disease prenatally and differentiate other life threatening dwarfism for the safety of both mother and fetus.

Irreducible anterior dislocation of the elbow without associated fracture.

Anterior dislocation of the elbow joint is a rare entity and is usually associated with injuries to surrounding bony and soft tissues. Simple dislocation of the joint is managed conservatively. An eight years old girl had traumatic anterior dislocation of the elbow joint with intact distal neurovascular status. X-rays showed no associated bony injury. Close reductions failed. Per operative findings showed no intra-articular fracture and the radial head was button holed into the anterior joint capsule. Reduction was achieved openly and maintained in a posterior slab for four weeks. Active and assisted mobilization started after removal of the slab. At ten month follow-up there was almost full range of movement of the joint.