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.

Validation and Cross-Cultural Adaptation of the Hindi Version of the Oxford Knee Score in Patients With Knee Osteoarthritis.

INTRODUCTION: Cases of knee osteoarthritis are on the rise in India with an increasingly ageing population. A large number among them shall undergo total knee replacement, so there is a requirement for validated patient-reported outcome measures in the Hindi language. Oxford Knee Score (OKS) is one of the most commonly used patient-reported outcome measure scoring systems. The current study was designed to test and validate cross-cultural adaptation and translate the Hindi version of the Oxford Knee Score (OKS-H).  Material and Methods: The OKS-H was formulated as per recommendations for cross-cultural adaptation and translation. The OKS was tested on 162 patients with knee osteoarthritis who underwent a total knee replacement. Reliability of the OKS-H was tested using the intraclass correlation coefficient (ICC) and internal consistency was assessed using Cronbach's alpha. The construct validity was assessed using OKS-H, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short Form Survey (SF-36) questionnaire.  Results: The translation was performed with no major difficulty. The OKS was completed by 158 (97.5%) and 157 (96.9%) patients at test and retest, respectively, after one week. With an ICC of 0.87, OKS had shown good reliability. The construct validity obtained against the WOMAC and SF-36 scores was strong (ICC between 0.49 to 0.86). CONCLUSION: The translated OKS-H is a reliable and valid instrument for patient-reported outcome measures in cases of knee osteoarthritis opting for total knee arthroplasty.