Under Coracoid-through Clavicle Suture Fixation in Type 2 Distal Clavicle Fracture.

INTRODUCTION: Surgical management of Neer type 2 distal clavicle fractures may include tension band wiring, pre-contoured plate, hook plate or indirect fixation of coracoclavicular space by Endobutton, suture anchors, or Tightrope devices. We present our technique of suture and Mersilene tape fixation by passing them through the clavicle and under the coracoid which is a form of indirect fixation. TECHNIQUE: The fracture and the coracoid are exposed through a horizontal skin incision. The Mersilene tape and Ethibond suture are looped under the coracoid and then one limb of each is passed through the medial hole and then through the lateral hole to exit inferiorly and then tied underneath the clavicle, while the fracture is reduced. CONCLUSION: Direct fixation by means of plate has good outcomes though high complication rate. Indirect fixation by means of Endobutton and Tightrope devices has shown successful outcome with less side effects. Our method of fixation by Ethibond suture and Mersilene tape is inexpensive while having the same principles of internal fixating the clavicle to the coracoid while the fracture heals.

Idiopathic Tumoral Calcinosis with Unusual Presentation-Case Report with Review of Literature.

INTRODUCTION: Tumoral calcinosis is an uncommon disorder characterised by the deposition of calcium phosphate in periarticular tissues. The deposits are usually around large joints; but rarely can be found around small joints of hand and feet. CASE REPORT: We present the case of 13 year old female with three years history of spontaneous, progressively increasing, painful swellings along right middle finger and right heel. She was otherwise well and had normal serum calcium but elevated phosphate levels. Plain radiography demonstrated a dense lobulated cluster of calcific nodules within soft tissues consistent with a diagnosis of tumoral calcinosis. This diagnosis was confirmed on the basis of histopathological examination following surgical excision. CONCLUSION: As such tumoral calcinosis is a rare entity and with such unusual presentations like in our case, it may lead to diagnostic confusion. Tumoral calcinosis should be considered in the differential diagnosis of painful swellings developing in the vicinity of small joints of hand and feet.

Closed antegrade interlocked nailing of femoral shaft fractures operated up to 2 weeks postinjury in the absence of a fracture table or C-arm.

BACKGROUND: We present our technique of closed nailing in diaphyseal femoral fractures treated between 1 to 14 days postinjury. The purpose of the study was to demonstrate the fact that such fractures can be treated closed in the absence of a fracture table or C-arm. METHODS: In all, 200 consecutive closed femoral fractures were fixed 1 to 14 days postinjury during a period of 2 years. Skeletal traction was applied immediately at admission and sufficient weight was applied to overcome muscle spasm. In most cases, a closed nailing was successfully performed. Distal locking was achieved with either a medinov nail with wings for distal locking, or a standard nail with a jig for the distal lock. RESULTS: The average age of the patients was 30 years. Follow up ranged from 6 to 12 months. Mean duration of follow up was 10 months. All patients had a functional range of movement at the hip and knee with a normal gait. The average time taken for surgery was 90 minutes with an average blood loss of 50 to 100 mL. Time in hospital after surgery was 2 to 10 days. CONCLUSIONS: Delayed closed nailing of femoral fractures can be achieved without a C-arm or a fracture table provided adequate skeletal traction is applied preoperatively and proper attention is paid to the surgical steps as described.