Upper thoracic spondylitis tubercolosis treated by posterior approach only: A case report.

INTRODUCTION AND IMPORTANCE: Mycobacterium tuberculosis (MTB) causes an infectious disease called tuberculosis which affects lung and other site of body. Spinal tuberculosis accounts for about half of all occurrences of skeletal tuberculosis. Patients with upper thoracic spinal TB are at an increased risk of severe spinal cord injury and kyphotic deformity, which may require surgery. Several treatment modalities include debridement, chemotherapy treatment, and decompression of the spinal twine and nerves. CASE PRESENTATION: A female patient, 45 year old, came with inability to walk for 2 months. Pain had started for 1 year and it was getting worse until motor strength of both leg diminished. The patient was diagnosed spondylitis tuberculosis of thoracal 2nd ASIA B with myelopathy. We performed posterior instrumentation of Th1-Th3 continuous with decompression by laminectomy and transpedicular debridement. There was no neurological injury, wound infections, and other complications after the surgery. Outcome of the surgery was evaluated on 1 months after surgery. CLINICAL DISCUSSION: The patient has good motor function one month following the operation. Without assistance, the patient could rise and take a few steps. Furthermore, the patient felt better overall and no longer had back discomfort, indicating that the surgery also had good results. CONCLUSION: Posterior approach is feasible for internal fixation, debridement, and fusion in this case. It is minimal traumatic, good correction rate and prevents the progression of kyphosis. The spinal cord also can be decompressed with satisfactory result.

A 5-year follow-up of Girdlestone resection arthroplasty in hip infection continued by Total hip replacement: A case report.

INTRODUCTION: Resection arthroplasty of the hip was already performed for recent 100 years. This kind of surgery has been used for a wide variety of hip problems such as infection, degenerative osteoarthritis and prosthetic joint infection. Total hip replacement is remarkable procedure in order to relieve pain and restore hip function. We present this report to describe our experience in treating hip infection by used two stages of surgery. CASE PRESENTATION: A 61-years old male suffered left hip infection that leads severe destruction on his joint. He felt badly pain on his hip with significant disability associated it such as limping, restriction of movements, and shortening of the limb. The hip movements were painful and caused walking in antalgic gait. Radiologic examination at that time revealed gross destruction of femoral head as well as acetabulum, irregular and hazy joint margins with diminished joint space. Patient was diagnosed with chronic non-specific inflammation of the hip joint. RESULT: Two stages surgery were performed on this patient. Resection arthroplasty firstly performed in order to eradicate the infection completely and alleviate very bothersome pain for improvement of patient's quality of life. Two years later, after patient was ready for next stage mentally, cemented total hip replacement performed to achieve normal function of the hip. Five-years follow up functional outcome was performed. Patient was very satisfied with the result with Harris hip scores was 95. CONCLUSION: Resection arthroplasty of the hip followed by a conversion to total hip replacement in hip infection case provide complete infection eradication, good functional outcome and satisfaction for the patient. Although the procedure was time-consuming it can be a choice if the eradication of infection still in a doubt.

The lateral curved osteotomy for cubitus varus deformity in children: A case report and literature review.

INTRODUCTION: Cubitus varus deformity after malunited supracondylar humerus fracture has various surgical techniques, implant configurations, and approaches. We describe a combination of French and Dome osteotomy and novel internal fixation technique to deliver an easy, safe, fast and reproducible result based on the current best evidence. PRESENTATION OF CASE: Two cases of malunited supracondylar humerus are described. The first case involves a 3-year-old girl who presented with outstretched and supinated left arm after falling during bike riding 3 weeks earlier. We found no abnormality in radial and median nerve function, but the left arm radiographs showed a callus formation and the early stages of a malunited fracture of the supracondylar humerus. We waited two months for further radiographic evaluation and the radiographs showed the malunited supracondylar humerus with elbow flexion of only 105° and elbow hyperextension of 20°. The cubitus varus was recorded with clinical carrying angle of varus 10°. We used a combination of original French and Dome osteotomy, lateral approach, and our novel fixation technique with excellent results. The second case involved a 8-year-old boy with malunited right elbow and the surgery was done in the same manner, with the result of restoration to normal elbow range of motion. We also assessed the pain score and disabilities of the arm, shoulder and hand (DASH) score and recorded satisfactory results. CONCLUSIONS: The combination of French and Dome osteotomy for treatment of cubitus varus deformity can provide an easy, safe, and reproducible result.

Giant cell tumor of distal ulna treated using en-bloc resection combined with extensor carpi ulnaris and flexor carpi ulnaris tendon stabilization: A case report.

INTRODUCTION: Giant Cell Tumor (GCT) is a form of bone tumor which is rare, benign, and locally invasive. To date, there have not been many case reports regarding cases of GCTs on the distal ulna which made the optimum strategy in management remain controversial. In some reported cases, the patient was treated with wide excision followed by reconstructive procedure resulting in ulnar translation of the carpal bones and dynamic convergence of the ulna towards the radius. PRESENTATION OF CASE: We documented a case of 29-year-old male with distal ulna GCT, treated with en-bloc resection combined with extensor carpi ulnaris and flexor carpi ulnaris tendon stabilization. The key objectives of GCT treatments are to avoid local recurrence with sufficient resection and to maintain the function of the limbs. Specific treatment options have been suggested for en-bloc resection with or without the need for ulnar reconstruction or stabilization, even prothesis. In this case, we excised the distal portion of the ulna with some soft tissue procedure for added stability. CLINICAL DISCUSSION: Three weeks after the surgery, the patient was able to perform wrist flexion and extension, fingers abduction, adduction, and opposition with slight limitation. The DASH and PRWE score had improved gradually within 3 weeks and 6 months after the surgery. CONCLUSION: In the subsequent evaluation after six months of the surgery, the patient achieved full restoration of forearm function without any limitation.

Hypersensitivity to orthopaedic implant manifested as erythroderma: Timing of implant removal.

INTRODUCTION: Incidence of hypersensitivity to orthopaedic implant, once estimated in less than 1% of population, recently has increased to 10%. Controversies about the timing of implant removal remain, especially due to the fact that implant hypersensitivity may be a contributing factor to implant failure. We present a case report and literature reviews to establish the decision making for the timing of implant removal in the presence of implant hypersensitivity. PRESENTATION OF CASE: Female, 42 years old with nonunion of mid-shaft tibia and fibula which was treated with ORIF with conventional SAE16 stainless steel plate and bone graft. A week after, she developed a generalized rash, which is later diagnosed as erythroderma, that relapsed despite adequate systemic corticosteroid. Poor healing of surgical site wound were marked. After the implant removal, the cutaneous condition improved and no relapse were found. DISCUSSION: Management of hypersensitivity to implants involved corticosteroid administration, removal or replacement of implants, or implants coating with polytetrafluoroethylene. Currently there are no specific guidelines regulating the management of implant allergy based on the timing of the onset, especially in fracture cases. The decision-making would be straightforward if union was already achieved. Otherwise, controversies would still occur. In this paper, we proposed an algorithm regarding the steps in managing metal allergy due to implant in fracture cases. CONCLUSION: Despite the concerns regarding implant survival in hypersensitivity cases, the decision whether the implant should be removed or replaced should be based on the time and condition of the fracture healing process.