Fixation with multiple K-wires and PRP injection as an effective way to manage heel pad avulsion.

The treatment of acute heel pad avulsion differs significantly from managing other soft tissue injuries due to its unique soft tissue structure. This case report outlines a scenario involving a male in his 20s who suffered heel pad avulsion without a calcaneal fracture but with an ipsilateral medial malleolus fracture after a twisting injury to the ankle caused by a road traffic accident. Immediate action was taken within 24 hours of the injury, involving thorough debridement of the wound, fixation to the calcaneum using multiple K-wires, primary suturing and internal fixation of the medial malleolus with two cannulated cancellous screws. Postoperative care included PRP (platelet-rich plasma) injections into the wound twice, removal of K-wires after 6 weeks and allowing walking with full weight bearing after 8 weeks. A year later, the wound had completely healed, and the patient was comfortably walking pain-free with full weight-bearing capabilities.

Aneurysmal Bone Cyst of the Third Metatarsal Treated Using Free Nonvascular Fibular Strut Graft-A Rare Case Report.

Introduction: An aneurysmal bone cyst (ABC) is an unusual, non-cancerous bone lesion that is characterized by its lytic (causing bone loss), hemorrhagic, and expanding nature. ABCs are relatively rare, making up only 1% of all bone tumors. These cysts are typically found in long bones and the spine but are very rarely seen in the metatarsal bones, making such occurrences quite uncommon. Case Report: In this case report, we present a case of ABC of the 3rd metatarsal in a 26-year-old female with complaints of long-standing foot pain and gradually increasing swelling of the dorsum of the foot. After radiological evaluation, she had undergone histopathological evaluation. An en bloc resection of the metatarsal along with the tumor mass was performed and the gap was replaced with an ipsilateral fibular strut graft. Histopathological examination of the resected tissue was suggestive of ABC without any evidence of malignancy. At the end of 1 year of follow-up, she is now completely pain free with intact rom of foot and ankle. Conclusion: The present study aims to describe a case of ABC of the metatarsal, a condition that not only poses a diagnostic dilemma but also constitutes a challenge in the management of lesion.

Post-injection quadriceps contracture treated with horizontal distal Z quadricepsplasty: A Case Report.

Introduction: Post-injection quadriceps contracture (PIQC) is a rare disease entity nowadays as the route of injection has been changed from intramuscular to intravenous. Many types of quadricepsplasty were described with different complications. Case Report: A 5-year 6-month-old boy was presented with right quadriceps contracture which was managed with distal horizontal Z quadricepsplasty and immobilization with a slab in an early post-operative day. After 4 weeks of static quadriceps exercise, then range of motion exercises was started. Conclusion: PIQC is a rare entity and can be treated successfully with horizontal z plasty. Knee range of movement can be achieved without any significant extension lag and skin complications.

A Rare Case of Tuberculosis as a Cause of Lytic Lesion of Talus Without Adjacent Bone Involvement in a Four-Year-Old Child.

Extra-pulmonary tuberculosis still remains an important differential diagnosis for chronic musculoskeletal ailments in developing countries like India and may involve any part of the body without characteristic systemic features. We are presenting a rare case of a four-year-old female child, who came to our tertiary-care hospital with chief complaints of pain in the left foot along with a gradually increasing swelling over the dorsum of the foot for the past five months. There was no history of trauma or constitutional symptoms. The serum inflammatory markers were found raised, and X-ray and magnetic resonance imaging revealed an isolated lytic lesion in the talus bone. Debridement, as well as curettage of the lesion, was done, both as a diagnostic and therapeutic procedure. A caseous cheesy material was evacuated and sent for microbiological and histopathological evaluation, which revealed the presence of acid-fast bacilli and granulomatous lesion confirming the diagnosis of tuberculosis. The patient was started with anti-tubercular chemotherapy, which continued for a total duration of 14 months, along with foot and ankle immobilization in a below-knee cast for three months. After completion of therapy, there was complete resolution of the lytic lesion on x-ray, with full symptom relief, and a full range of movement of the ankle was obtained. In cases with longstanding pain and swelling of the foot, with or without associated systemic symptoms, tuberculosis should be considered as a strong differential diagnosis even in young children, especially in developing countries. Diagnostic and therapeutic curettage along with anti-tubercular chemotherapy can result in a good functional outcome in such patients.

Diaphyseal Aclasis With Pes Anserinus Syndrome.

We describe the case of a 20-year-old man who presented with a bony swelling over the medial proximal tibia that caused pain along the pes anserinus tendons, and a history of multiple asymptomatic bony swellings. Wide extraperiosteal resection of the swelling relieved the symptoms with a good outcome within a year. This report describes the pictorial pathoanatomy of a relatively rare association of pes anserinus syndrome caused by osteochondroma in an adult patient. Proximal tibial osteochondromas can also present as pes anserinus syndrome in adult patients with diaphyseal aclasis. Large swellings require wide excision to relieve the stretching pain of pes tendons.

Type 2 Salter-Harris Physeal Injury of the Proximal Phalanx of Great Toe: A Case Report and Review of Literature.

Fractures involving the physes are peculiar to the pediatric age group with growing bones. These injuries, if not managed with due precaution, can lead to complications like physeal arrest and the development of deformity. Such injuries are much more common in the upper limbs as compared to the lower limbs. Physeal injuries involving the small bones of the foot are extremely rare. To date, no case of Salter-Harris type 2 physeal injury involving proximal phalanx of the great toe has been reported in the English literature. We report the first such case of a 10-year-old child who sustained a Salter-Harris type 2 physeal injury of the right great toe proximal phalanx. The fracture was managed conservatively with splintage of the great toe, and the child had good outcome at one year without any adverse sequelae.

A Rare Case of Isolated Type III Salter-Harris Physeal Injury of the Distal Ulna.

Pediatric distal forearm fractures are very commonly seen in orthopedic and trauma services. The majority of such fractures involve either distal radius alone or concomitant with distal ulna physis. Isolated injuries of the distal ulna physis are exceedingly rare. Moreover, only one case of isolated Salter-Harris type III distal ulnar physeal injury has been reported in English literature. We report the second such case of isolated distal ulnar physeal injury with Salter-Harris type III pattern in a 15-year-old male child. The injury was treated conservatively in a short-arm splint for four weeks with a good outcome. At the last follow-up of one year, there was no physeal abnormality or growth disturbance detected. Such injuries need to be ruled out in all pediatric distal forearm fractures and can be managed conservatively, if undisplaced, with good outcomes. These patients also need regular monitoring till the closure of the physis to look for the development of any ulnar shortening or deformity due to physeal growth arrest.

Thirty-day mortality of patients with hip fracture during COVID-19 pandemic and pre-pandemic periods: A systematic review and meta-analysis.

BACKGROUND: Timely intervention in hip fracture is essential to decrease the risks of perioperative morbidity and mortality. However, limitations of the resources, risk of disease transmission and redirection of medical attention to a more severe infective health problem during coronavirus disease 2019 (COVID-19) pandemic period have affected the quality of care even in a surgical emergency. AIM: To compare the 30-d mortality rate and complications of hip fracture patients treated during COVID-19 pandemic and pre-pandemic times. METHODS: The search of electronic databases on 1st August 2020 revealed 45 studies related to mortality of hip fracture during the COVID-19 pandemic and pre-pandemic times. After careful screening, eight studies were eligible for quantitative and qualitative analysis of data. RESULTS: The pooled data of eight studies (n = 1586) revealed no significant difference in 30-d mortality rate between the hip fracture patients treated during the pandemic and pre-pandemic periods [9.63% vs 6.33%; odds ratio (OR), 0.62; 95%CI, 0.33, 1.17; P = 0.14]. Even the 30-d mortality rate was not different between COVID-19 non-infected patients who were treated during the pandemic time, and all hip fracture patients treated during the pre-pandemic period (OR, 1.03; 95%CI, 0.61, 1.75; P = 0.91). A significant difference in mortality rate was observed between COVID-19 positive and COVID-19 negative patients (OR, 6.99; 95%CI, 3.45, 14.16; P < 0.00001). There was no difference in the duration of hospital stay (OR, -1.52, 95%CI, -3.85, 0.81; P = 0.20), overall complications (OR, 1.62; P = 0.15) and incidence of pulmonary complications (OR, 1.46; P = 0.38) in these two-time frames. Nevertheless, the preoperative morbidity was more severe, and there was less use of general anesthesia during the pandemic time. CONCLUSION: There was no difference in 30-d mortality rate between hip fracture patients treated during the pandemic and pre-pandemic periods. However, the mortality risk was higher in COVID-19 positive patients compared to COVID-19 negative patients. There was no difference in time to surgery, complications and hospitalization time between these two time periods.

Role of Autologous Fibula Strut Graft in Surgical Management of Tubercular Spondylitis by Anterior Approach: A Prospective Study.

BACKGROUND: Decompression of cord in tubercular paraplegia is a mainstay treatment with favorable neurological improvement. Anterior decompression and stabilization with autologous bone grafts promotes fusion of affected segment of spine and prevents further progression of deformity. The objective of this study is to assess the role of autologous fibula strut graft in correction of tubercular kyphosis without instrumentation. METHODS: Twenty patients of tubercular spine (Gulhane Askeri Tip Akademisi type II or III) with paraplegia were treated with anterior decompression, debridement, and stabilization with various autologous bone graft in combination without instrumentation. Patients were further grouped as follows (10 in each group): group A includes patients where autologous fibula strut, rib, and iliac crest grafts were used in combination; group B includes patients where only autologous rib and iliac crest grafts were used. Results were analyzed in terms of neurological recovery (Frankel grade), graft union time (graft uptake), correction and progression of kyphotic deformity, and graft subsidence. RESULTS: Patients in both groups A and B show similar neurological recovery from Frankel grade A/B to E. Group A (fibula strut group) patients show mean correction of 6.7° (3°-22°) in kyphosis with no loss of correction after a 2-year follow-up, whereas patients in group B (nonfibular strut group) show increase in kyphosis in immediate postoperative period without further progression on follow up. Graft uptake was good in all 19 cases, and graft subsidence was seen in 1 patient of group A. CONCLUSIONS: Bone grafting is indispensable in surgical management of tubercular spine. It allows fusion of affected segment and prevents further progression of deformity. However, the neurological recovery of patient depends upon the adequate decompression of cord, debridement, and adequate stabilization of anterior and middle column vertebral body height loss. The use of autologous fibular strut graft along with cancellous graft is superior to only cancellous grafts in terms of kyphosis correction.

Non-concentric Reduction Due to Entrapped Loose Bone Piece During a Single-stage Bilateral Total Hip Arthroplasty.

Total hip arthroplasty (THA) is the treatment of choice for Grade IV avascular necrosis of the femoral head. Dislocation following THA, although rare, is a known complication. Common causes of unsuccessful reduction include interposition of soft tissue, component loosening, malalignment, and inadequate muscle relaxation following anaesthesia. Here, we encountered a rare complication during a single-stage bilateral THA that resulted in a non-concentric reduction on the left side. The pathology was a loose bone piece, which possibly was an osteophyte that was broken.