Allograft Impaction and Supplementary Plating for the Management of Epi-Metaphyseal Enchondroma: A Rare Case Report.

Introduction: Enchondroma is a common bone tumor; however, its location in the proximal epi-metaphyseal region of the tibia is a rare finding. Its management is complicated by the weight-bearing nature of the site and despite an array of available treatment modalities in the literature, there is no fixed consensus. Case Report: Through this case, we report a 60-year-old female who was evaluated for bilateral knee osteoarthritis. On plain radiography, a lytic lesion was noted which on CT guided biopsy was confirmed to be an enchondroma of the right proximal tibia. The patient underwent extensive curettage, allograft impaction, and supplementary fixation by a poly ethyl ether ketone plate. Following a period of immobilization, she was able to walk full weight-bearing after 3 weeks of the surgery and carry out her daily activities at 2 months. At 1 year postoperatively, the patient achieved excellent clinical, radiological, and functional outcomes without any complications. Conclusion: Management of an enchondroma in weight-bearing regions of long bones can pose multiple challenges. Timely diagnosis and management by thorough curettage, uncompromised allograft impaction, and supplementary fixation by a PEEK plate give excellent short-term and long-term results.

Management of a Displaced Pathological Fracture in the Proximal Humerus of a Patient with Autism Spectrum Disorder: A Rare Case Report.

Introduction: Pathological fractures in pediatric age group are most commonly secondary to bone tumors. Management of such cases in patients with autism spectrum disorder (ASD) is complicated by the prevalence of low bone mineral density (BMD) in these patients. Case Report: Through this case, we report a 13-year-old male diagnosed with autism spectrum disease, who was brought by his parents with a history of trivial trauma and gross deformity of the left humerus. On plain radiography, a displaced fracture in the foreground of a lytic, cystic lesion was noted which on magnetic resonance imaging was confirmed to be metadiaphyseal unicameral bone cyst. The patient underwent extensive curettage, allograft impaction, and definitive fixation by a locking compression plate. Following a relatively extended period of immobilization, he was started on range of motion exercises followed by strengthening. He was able to return to his pre-operative activity levels at 14 weeks postoperatively. At 1-year postoperatively, the patient achieved excellent clinical and radiological outcomes, without any signs of failure, complications, or signs of recurrence. Conclusion: Management of pathological fractures in pediatric patients with ASD can be challenging due to the associated low BMD and potential non-compliance from the patient's end. Such cases are best treated with open curettage, allograft impaction, and definitive fixation by locking compression plate, even if present in a non-weight bearing bone.

Pseudoaneurysm of the Lateral Genicular Artery Following Unicompartmental knee Arthroplasty: A Rare Case Report.

Introduction: Unicondylar knee replacement is a minimally invasive technique of surface replacement of the knee joint. Very little literature is available regarding vascular complications in patients who undergo this procedure due to their extremely rare nature. Case Report: This first-of-its-kind report describes a case of pseudoaneurysm of the lateral genicular artery of the right knee in a hypertensive, 65-year-old man, following a single sitting bilateral unicompartmental knee replacement (UKR). With no involvement of the lateral compartment in UKR, we suspect an underlying mechanical element as the cause of the pseudoaneurysm. Patient presented with swelling and pain in the right knee for the first time at 8-month postoperatively, and after aspiration of the hemarthrosis, had two events of recurrence with increasing frequency. Dynamic magnetic resonance angiography confirmed the diagnosis and the patient underwent angiography-guided embolization of the lateral genicular artery using polyvinyl alcohol particles, with no recurrence in over a year since then. Conclusion: Pseudoaneurysm of the lateral genicular artery is a possible cause of recurrent hemarthrosis even after unicondylar knee replacement and requires a high degree of suspicion for its timely diagnosis and management.

Modified Technique for Patellar Tendon Repair Post-Total Knee Arthroplasty: A Case Report.

INTRODUCTION: Rupture of patellar tendon following total knee arthroplasty (TKA) is a rare but disabling complication. Results of the primary repair of the patellar tendon after the TKA are associated with higher complication rates and a poor outcome. We report a rare case of traumatic patellar rupture, 5 years after the TKA managed using a primary repair with good post-operative outcome. CASE REPORT: A 75-year-old female was operated for sequential bilateral Grade 4 osteoarthritis. Five years after the left-sided TKA, she sustained a fall while coming down the stairs and avulsed her patellar tendon on the left side. The management in our case was done by primary repair using two techniques with augmentation using autologous semitendinosus free graft. CONCLUSION: Management of a patellar tendon rupture/avulsion after TKA is unpredictable and associated with poor functional outcomes. Various methods have been described with inconsistent clinical evidences. The operating surgeon must consider the potential advantages and disadvantages of these techniques.