Sacral Osteoblastoma in a Young Male Presenting as Radicular Pain: A Rare Case Report.

Introduction: Osteoblastoma is an uncommon benign bone tumor characterized by the formation of osteoid tissue, occurring more frequently in men than in women. It is often associated with osteoid osteoma and can be found at various locations in the skeleton, although it is rare in the sacrum. Typically, these lesions involve the posterior elements of the spine, including the pedicle and the lamina. We would like to present a case of sacral osteoblastoma, clinically presenting as lumbar radiculopathy, which was treated at our institute. Case Report: A 23-year-old male presented to us with left gluteal pain radiating to the left lower limb pain for 2 years. He had multiple consultations elsewhere and was being treated as a probable case of a lumbar disc lesion with left lower limb radiculopathy. X-rays appeared normal. Magnetic resonance imaging of the lumbar spine and pelvis revealed a T2 hyperintense lesion affecting the posterior elements of S3, compressing the nerve roots. Computed tomography (CT) was a better investigation modality for osteoblastoma. En bloc excision and curettage were performed, and the histopathological analysis confirmed the diagnosis of osteoblastoma. The patient had immediate relief of symptoms postoperatively with no complications. At 2-year follow-up, the patient had no evidence of recurrence on a follow-up CT scan. Conclusion: Osteoblastomas predominantly occur in the spine, with rare instances in the sacrum. Treatment typically involves en bloc excision. Confusing clinical presentation may delay diagnosis, resulting in persistent morbidity.

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.

Unique Bilaterally Symmetrical Multifocal Osteomyelitis Presentation in a Health-care Worker with Sickle Cell Disease Secondary to Klebsiella Infection - A Case Report.

Introduction: Osteomyelitis is one of the most common infectious complications in people with sickle cell disease (SCD). The most common infecting organisms in SCD are the Salmonella species and Staphylococcus aureus; Streptococcus pneumoniae and Bacteroides species have also been described, however, osteomyelitis attributable to infection with hypervirulent Klebsiella spp. is a rare entity. We describe our experience with a rare presentation of multifocal bilateral symmetrical ulna and fibula osteomyelitis in a patient with SCD due to Klebsiella bacteremia with 1-year follow-up. Case Report: A 25-year-old female known SCD since childhood who underwent treatment for dengue at our hospital had her blood cultures positive for Klebsiella, following which she was treated with appropriate antibiotics. Two weeks following the asymptomatic period patient presented with complaints of pain over the bilateral forearm and legs. The patient was evaluated for laboratory parameters and plain radiograph of the bilateral forearm and bilateral legs. The radiological features were suggestive of osteomyelitis, showing "Bilaterally symmetrical involvement." Laboratory parameters erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were found raised. The patient was planned for biopsy and debridement of the lesion from the right ulna. The culture from the biopsy showed growth of Klebsiella sp. and was sensitive to co-trimoxazole. The patient was started on co-trimoxazole for 6 weeks and had a significant clinical improvement in the form of subsidence of pain, normalization of the blood counts along with the acute phase reactants (ESR, CRP). Conclusion: Our case contributes to the growing awareness of the unusual manifestations of this serious disease and the rarity of bilateral symmetrical involvement. Our case highlights the importance of clinician awareness, manifestations, and management of Klebsiella sp. hypervirulent strains.

Anterior Shoulder Instability in a Young Individual with Concomitant Coracoid Process Fracture Treated with the Latarjet Procedure - A Rare Case Report.

Introduction: Coracoid fracture occurs with shoulder instability due to direct humeral head impaction. Incidence coracoid fracture with shoulder dislocation is rare amounts to 0.8-2%. We encountered clinical challenge of unique combination of both shoulder instability and coracoid fracture. This technical note will describe the treatment of the same. Case Report: A 23-year-old male suffering from recurrent shoulder dislocation sustained coracoid fracture. Further evaluation showed glenoid defect of 25%. Magnetic resonance study showed on track lesion with Hill-Sach lesion of 9 mm, labral defect anteriorly with no associated rotator cuff tear. The patient was managed with open Latarjet procedure with fracture coracoid fragment with conjoint tendon as graft. Conclusion: Our purpose of reporting this technical note is to provide an option of dealing both instability and coracoid fracture in single sitting and usage of coracoid fractured fragment as an excellent graft of choice in acute presentation. However, certain limitations such as adequacy of graft in size and shape do exist operating surgeon which must be aware of the same.

Complex Compound Fracture of Tibia Managed with Distraction Osteogenesis.

INTRODUCTION: The treatment of tibia bone loss can be challenging. The surgical options for the treatment of bone loss include bone transport, vascularized fibula graft, and induced membrane. CASE REPORT: We present a case of complex compound fracture of tibia with bone loss. Interestingly patient sustained this injury in spite of having intramedullary nail in tibia which was inserted to stabilize previous fracture 9 months prior to trauma. The proximal half of the nail was protruding out of the wound at the time of presentation in emergency department. The nail was removed and stabilized with external fixator after wound closure. The bone gap and nonunion at fracture site was managed with Ilizarov fixator. At the end of treatment patient got satisfactory functional outcome. CONCLUSION: Ilizarov method is a biologic and comprehensive method for management of bone loss, non union and limb length discrepancy.

Rare Case of Extra-articular Synovial Chondromatosis of Biceps Tendon Sheath in 8 years Male Child.

INTRODUCTION: Primary synovial osteo chondromatosis (PSOC) is chondroid metaplasia with multi¬nodular proliferation of the synovial lining of a diarthrodial joint, bursa, or tendon sheath. It usually occurs in third-fifth decade and shoulder joint involvement is infrequent. It is very rare in children and primary extraarticular PSOC of the shoulder has been reported very rarely in children. CASE REPORT: We present a case of primary PSOC of the long head of biceps in 8year child. It presented as painful swelling in proximal arm. The pain radiograph was showing multiple calcified loose bodies on anteromedial aspect of humerus. MRI scan showed fluid filled cysts with calcified wall. The lesion was excised through deltopectoral approach. He had complete resolution of symptoms without recurrence at 1 year.The diagnosis was confirmed on histopathological examination. CONCLUSION: We want to emphasize that one should keep a differential diagnosis of this rare condition in patients presenting with cystic swelling with calcified wall. We further emphasize the need to follow these patients to detect recurrence or malignant transformation.