Congenital Pseudoarthrosis of Tibia With Anterolateral Bowing Treated With Ilizarov Ring Fixator: A Case Report.

Congenital pseudarthrosis of the tibia (CPT) is a rare, dysplastic condition that is characterized by a "false joint" in the tibia, leading to potential disability. We present a rare case report of a 12-year-old male from India with a history of neurofibromatosis type 1 (NF1) and anterolateral bowing of the tibia since birth. He sustained a tibial fracture during play. X-ray evaluation confirmed the fracture, and a clinical diagnosis of CPT was established. The treatment involved corticotomy for deformity correction and stabilization using Ilizarov's ring fixation. The procedure was successful, with post-operative radiological evaluations showing significant improvement in the center of rotation of angulation (CORA) from 60° pre-operatively to 25° post-operatively. The patient was discharged with an external fixator and after seven months, transitioned to full weight-bearing ambulation with a specialized brace. The Ilizarov procedure proved to be a safe and effective treatment for CPT, offering benefits such as limb lengthening and ankle stabilization.

Study of Clinical Results and Functional Outcome of Patients With Distal Femur Fracture Treated With Dual Plating.

Introduction Distal femur fracture has been routinely fixed with a single lateral locking plate. This method of fixation in intra-articular distal femur fractures has proved to give a higher outcome of varus collapse as well as higher rates of mal-union due to inadequate fixation of the medial aspect of the distal femur. To address this drawback of single lateral plating, the use of medial assisted plating (MAP) has been introduced recently, which was proposed to give better stability to the medial fragments. This Is a prospective case series of 50 patients with distal femur fractures treated with dual plating. Materials and methods Fifty cases of patients with distal femur fractures were treated with dual plating between August 2020 and September 2022. Patients were followed up postoperatively till the third month, when patients were assessed clinically and radiologically. Range of motion of the knee, postoperative fracture displacement, limb shortening, and signs of union and infection were checked. Neer's scoring and Kolmet's scoring were used to grade the outcome for the patients.  Results The mean age of the patients was 39. Only 12% of the cases were open fractures. Eighty-four percent of the cases did not have fixed flexion deformity (FFD) and only 4% had FFD of 15 degrees; 72% of the cases achieved flexion of the knee beyond 120 degrees. Eighty-four percent of patients had normal walking ability by the 12th week postoperatively; 16% of the cases had a postoperative displacement of more than 1.6 cm, with the maximum being 2.5 cm.  Conclusion From the study, we have concluded that outcomes were better for fractures of distal femur when treated with dual fixation, probably due to superior fixation and earlier postoperative mobilization.

Non-Union of Isolated Medial Condyle of Femur Hoffa Fracture: Case Report.

Isolated non-united Hoffa fracture of the femur is a rare finding. They are often missed due to the nature of the fracture and when not assessed appropriately. This is a case report of a 40-year-old male who encountered a high-velocity trauma; the fracture was probably missed on plain radiographs following the trauma. The patient presented to us eight months following the trauma with complaints of pain and decreased range of motion of his right knee (10 to 80 degrees of flexion) and the patient was unable to bear weight on the affected limb. On evaluation, the patient was found to have a non-united Hoffa fracture involving the medial condyle. The patient was treated with freshening of fracture followed by rigid fixation with cancellous screws and reconstruction plate. Postoperatively by week six, the patient achieved full range of motion and was able to walk without assistance with evidence of union on plain radiographs.

Clinical and Radiological Outcome of Dual Plating for Proximal Humerus Fractures.

Introduction Proximal humerus fractures account for approximately 4%-5% of all fractures. It accounts for approximately 45% of all humeral fractures. Proximal humerus fractures which are mostly stable or minimally displaced fractures are usually managed non-operatively with good outcomes. Displaced or unstable fractures may require reduction and stabilization. For proximal humerus fractures, conservative treatments often result in stiffness and malunion of the shoulder. In comminuted proximal humerus fractures the use of a proximal humeral internal locking system (PHILOS) only does not provide the required stable fixation which usually leads to complications such as varus collapse, malunion, anterior-posterior angulation, screw cutout, metal failure and nonunion and thus open reduction and internal fixation with dual plating are recommended for proximal humerus fractures. Material and methods The Institutional Ethics Committee of Dr. D. Y. Patil Vidyapeeth in Pune approved this prospective study. We included a sample size of 52 patients and conducted a study on these patients who were admitted under the Orthopedics department at Dr. D. Y. Patil Medical College and Hospital, Pune. Results In this study, 52 patients were treated with dual plating for proximal humerus fracture, an additional plate is used along with PHILOS. In our study, the majority of the study population belonged to > 50 years (34.6%), followed by 41-50 years (26.9%), 31-40 years (23.1%), and 21-30 years (15.4%). The mean age of the patient was 53.7 years including 33 male and 19 female patients. The majority of the patient in the study included was with RTA 40 patients and 12 patients with a history of falls from height. The fracture was classified using Neers classification, Neer type 2 fracture (23.1%), Neer type 3 fracture (46.2%), and Neer type 4 fracture (30.7%). In the current study, the mean DASH score at Baseline was 58.88±6.29, at three months was 36.23±5.05 and at six months was 31.85±4.16. The mean DASH score decreased significantly from baseline to three months to 6 months. As per the Paavolainen method, it was good among 40 (76.9%) and fair among 10 (19.2%), and poor among two (3.8%) cases. Out of 52 patients, we found varus collapse in immediate postop x-ray in two patient and screw protrusion in the glenohumeral joint in one patient. Conclusion Satisfactory clinical and radiological outcomes were noted. This dual mechanism prevents varus displacement of the proximal fragment, and as a result, it provides a good functional outcome with dual plates in proximal humerus fractures.