Double Medial Elbow Bump: A Case Report of an Untreated Medial Epicondyle Fracture With Anterior Incarceration of the Fragment.

Medial epicondyle fractures are uncommon elbow injuries and require careful radiological evaluation for appropriate diagnosis and management. Missed or neglected medial epicondyle fractures, however, are reported as uncommon reports or small series. Incarceration of the medial epicondyle fragment within the elbow joint is often reported and poses therapeutic challenges. Severe displacement of the medial epicondyle fragment and its anterior incarceration within the soft tissues is a rare entity. Here, we report a two-month-old untreated case of an anteriorly displaced medial epicondyle fracture with anterior incarceration, presenting as a clinical bump adjacent to the native medial humeral condyle. This presentation of a double medial bump is uncommon and reported here for its rarity. The injury was finally managed with open reduction internal fixation of the displaced medial epicondyle fragment back to its native site along with the anterior transposition of the ulnar nerve. Good clinical outcome with full elbow range of motion and radiological union was achieved in the follow-up of 13 months.

Nail-Patella Syndrome: A Case Series From Northern India.

The nail-patella syndrome (NPS) is an uncommon entity with a characteristic set of anomalies. The presence of classical tetrad of hypoplastic or absent fingernails, hypoplastic or absent patellae, bilateral iliac horns and varying grades of elbow deformities are well elucidated in the literature. The spectrum of clinical manifestation varies, resulting in very few cases presenting to the healthcare facility or being diagnosed appropriately. We, hereby, describe our experience of three separate cases of the NPS, diagnosed on clinical and radiological basis. All cases were diagnosed incidentally and none presented to us for consultation regarding the anomalies due to this disorder. In one of the cases, a young girl was managed medically for an associated abdominal complaint. Her father was also found with the clinical features of the disorder thus making the father-daughter duo, part of our series. One case presenting with a femur fracture was managed with fracture fixation surgery leading to an uneventful healing of fracture. There was neither a history of any other family member having similar anomalies nor other systemic disorders in all three cases. Knowledge of the condition may help in improving the diagnosis of NPS and enrich the medical literature.

Pyomyositis involving the scapular muscles: A case series.

Pyomyositis or tropical pyomyositis is an uncommon infection of skeletal muscle that may be primary or secondary. Primary type has bacterial aetiology, and Staphylococcus aureus is associated in most cases. The diagnosis requires high index of suspicion and careful assessment of radiological investigations. Diagnosis often requires magnetic resonance imaging (MRI) for better delineation of the disease process, associated site involvement and exclusion of related conditions. Evacuation of pus coupled with appropriate antibiotic therapy is the mainstay and curative in most cases. Caution, however, is required due to increased morbidity, protracted course of recovery and mortality in few cases. The association with comorbidities including immunocompromised status compounds the problem. We describe our experience with this condition in a series of five cases (four male and one female) with diverse involvement of scapular muscle. All cases had primary pyomyositis except one case secondary to shoulder joint tuberculosis. Right side was involved in three and left in two cases. Infraspinatus was commonly involved, and one case had extensive involvement around scapula. All cases were managed by one or multiple aspiration, except one managed with open surgical drainage. The outcome was good in all cases with no recurrence or complication noted in their respective follow-up. Primary care centres may play important role in the early diagnosis of this condition with clinical evaluation and judicious use of imaging. Cases with severe involvement or those requiring advanced procedures may be referred to higher centres as per the requirement. Most of the times, timely diagnosis, antibiotic therapy and drainage of the pus is required and may also be performed in the primary care level through a standard protocol.