Sessile Pelvic Osteochondroma: A Rare Case That Required Abdominal Wall Reconstruction After Excision.

Osteochondroma are the most common benign tumours of the bone presenting in the young age group. Commonly found at the metaphysis of the long bones and mostly pedunculated; atypical locations and sessile appearances have also been described in literature. Due to the risk of conversion to malignant chondrosarcoma, the recommended treatment of these lesions is complete excision. We encountered a similar sessile growth in the pelvic region of a 21-year-old male with complaints of pain and swelling. After thorough investigation, excisional biopsy was performed and abdominal wall repair was reinforced with a polypropylene mesh. Careful evaluation, adequate investigations and meticulous surgical treatment can avoid potential problems in managing these tumours.

Ball tipped guide wire for broken nail removal: a case report.

A broken intramedullary nail is a well-known complication of non-union of femur shaft fractures. Numerous surgical techniques have been presented before in patients with non-union of long bone fractures. We report the surgical technique used to perform removal of the broken distal segment of a nail in a patient who achieved uneventful union after intramedullary nailing of closed femur shaft fracture. A ball-tipped guidewire was inserted through the broken segment of the femur nail. A pre-bend plain wire was then inserted. With the help of a vise-grip, both wires were twisted in order to make a secure handle between guidewires and a broken implant. With the help of a mallet upward-directed blows were applied to extract a broken segment of the nail. We found ball-tipped guidewire technique a useful and effective technique in removing the broken distal portion of the nail.

One Bone Forearm: A Valid Option For Treating Post Infection Bone Deficiencies.

Surgical fixation of radius to ulna has been described in the literature at various instances when deficiencies of either of the bones are encountered. The main concept of one bone forearm relies on an intact elbow and wrist articulations so a stable functioning limb can be achieved after union of radius to the ulna. This case report elaborates post infection loss of proximal ulna treated with fixation to radius.

Pseudomonas as trespassers in diabetic foot infections: More questions and fewer answers.

OBJECTIVE: To assess microbiological isolates from diabetic foot ulcers presented at a tertiary care teaching hospital. METHODS: The prospective observational study was conducted at department of Orthopaedics, Liaquat National Hospital Karachi, from January 2009 to October 2011, and comprised patients with diabetic foot ulcers (Wagner grading 1-4). Grade 0 and 5 were excluded. Wound swabs or tissue biopsies were taken before the induction of antibiotic prophylaxis according to the standard aseptic protocols. SPSS 16 was used for statistical analysis. RESULTS: Of the 250 patients in the study, 151(60.4%) were male with an overall mean age of the subjects of 46±8.1 years. Mean duration of diabetes was 14±6.7 years. Based on Wagner's grading, 90(36%) patients had grade 1, 58(23.2%) grade 2, 97(38.8%) grade 3, and 5(2%) grade 4. The most common isolates were polymicrobial in 90(36%) patients and pseudomonas aeruginosa in 87(34.8%). Resistance antibiogram for pseudomonas aeruginosa showed sensitivity against Imipenem, Aztreonam, Ceftazidime, Ciprofloxacin and Gentamicin. CONCLUSIONS: The isolation of pseudomonas aeruginosa gives an idea about the recent microbial spectra from our region and should prompt the need for multi-centre studies from South Asia to devise treatment guidelines for this part of the world.

Knee dislocations and popliteal artery injury: A single centre experience from Karachi.

OBJECTIVE: To determine the association of popliteal artery injury with simple knee dislocations or knee fracture dislocations, and to evaluate the role of clinical assessment and colour Doppler ultrasound examination in diagnosing these injuries. METHODS: The prospective case series study was done at the Liaquat National Hospital, Karachi, and comprised patients with simple knee dislocations or knee fracture dislocations presenting between February 2013 and April 2014. All patients underwent clinical assessment including distal pulse examination and signs of vascular trauma. Following reduction of dislocation, repeat clinical examination and assessment of limb with colour Doppler ultrasound was carried out. RESULTS: Out of 9 patients in the study, 6(66.7%)had simple dislocations, while 3(33.3%) sustained fracture dislocations of the knee. Two (22%) patients sustained injury to the popliteal artery which was effectively managed via surgical treatment. Clinical examination of the affected extremities effortlessly revealed the 2(22%) vascular trauma cases. Doppler ultrasound was carried out in 8(89%) cases and it successfully excluded 7(78%) cases for vascular trauma and identified 1(11%) injury with reduced flow. This case underwent computed angiography scan and later surgery revealed popliteal artery trauma. Doppler ultrasound was not carried out in 1(11%) case which was a spontaneously relocated knee with hard signs of vascular injury. CONCLUSIONS: Popliteal artery injury can be a limb-threatening complication following trauma to the knee. Carefully performed clinical examination and colour Doppler ultrasound are effective tools for identification of such cases.