Cemented Hemiarthroplasty of the Hip in a Patient with Ipsilateral Knee Arthrodesis: Surgical Difficulties and Techniques.

INTRODUCTION: Standard references such as knee and lower leg position cannot be used in patients with knee arthrodesis with destroyed distal femur anatomy. The resulting component malposition can culminate in dislocation, decreased range of motion, impingement, and wear. To our knowledge, no cases on surgical techniques have been reported in such patients. We describe a simple technique that guides a surgeon in assessing the femoral stem version in such cases. CASE REPORT: A 80-year-old female sustained right sided neck of femur fracture. She had a history of bone tumor, which was treated with resection and arthrodesis. Subsequently, the patient developed osteomyelitis which healed gradually. The difficulties, in this case, were inability to flex the knee, to determine the trans-epicondylar axis and to use the ankle as a reference. Using lesser trochanter as reference neutral rotation of the limb was determined and K wire was inserted in distal femur of the patient. A post-operative computed tomography (CT) was done to assess the stem version. CONCLUSION: Our main aim in presenting this case was to emphasize on the surgical technique. A pre-operative CT scan should be done to evaluate the distal femur anatomy and calculate the lesser trochanter versions of the normal limb. We recommend the use of K wire inserted into the distal femur after determining the neutral version of the limb and comparing the lesser trochanter profile with the normal side.

Plasma cell myeloma with unusual morphology--a series of 6 cases.

Morphological variants of plasma cells have been described in cases of Plasma cell neoplasm. Presence of these atypical forms poses difficulty in morphological diagnosis and demands the use of ancillary techniques to ascertain the nature of these atypical cells. We hereby report a series of 6 such cases where the bone marrow examination showed plasma cells with atypical morphology, leading to varied differential diagnosis; however immunophenotyping by flow cytometry in adjunct to serum electrophoresis, immunofixation and free light chain assays confirmed the diagnosis.

Open intercondylar fractures of the distal humerus: Management using a mini-external fixator construct.

Intercondylar fractures of the distal humerus are a challenging entity to treat. Open reduction-internal fixation with plating is well accepted as the standard treatment for these fractures, because it allows early mobilization and prevents joint stiffness. However, this technique may be associated with inferior postoperative results and a higher risk of infection in open fractures. External fixation appears to be an interesting option in such cases, where the results of open reduction-internal fixation with plating may be suboptimal. We present a bilateral uniplanar mini-external fixator construct for the treatment of open intercondylar distal humeral fractures. We managed 8 cases with this external fixation technique, with 6 of 8 patients achieving good to excellent results as determined by Cassebaum's rating system.