Concomitant Ipsilateral Intracapsular and Extracapsular Femoral Neck Fractures in Young Individuals: A Report of 3 Cases.

CASES: Concomitant ipsilateral intracapsular and extracapsular fractures of the femoral neck, also termed "segmental fracture neck femur," are rare injuries, especially in physiologically young patients. We present 3 such cases that successfully underwent operative fixation with an extramedullary implant. CONCLUSION: Good clinical outcomes may be obtained after osteosynthesis with extramedullary fixation devices in concomitant ipsilateral intracapsular and extracapsular fractures of the femoral neck in young patients (<60 years). They should be followed for a long duration to look for avascular necrosis.

Z-Corrective Osteotomy in Malunited Extra-Articular Fractures of Distal Radius.

PURPOSE: We sought to assess clinical, radiological, and functional outcomes following treatment of extra-articular malunions of the distal radius using a multiplanar z-corrective osteotomy. METHODS: Fifteen patients with extra-articular distal radius malunions (13 dorsal and 2 volar) underwent z-corrective osteotomy and volar plate fixation without bone grafting. Correction and maintenance of each deformity was evaluated in terms of various radiographic indices (radial height; volar and radial tilt); osteotomy union; pain (visual analog scale); grip strength; range of motion; Disabilities of the Arm, Shoulder, and Hand scores; and Mayo wrist scores. RESULTS: The mean follow-up was 16.4 months. The mean radial height was corrected from -1.3 mm to 4.9 mm. The mean ulnar variance improved from 4.3 mm to -0.4 mm. The sagittal radial tilt and radial inclination were restored from a mean of -17.9° (dorsal) to 3.3° (volar) and from 12.0° to 17.2°, respectively. The Disabilities of the Arm, Shoulder, and Hand and Mayo wrist scores improved from means of 36 and 56 preoperatively to 24.8 and 73.3, respectively, at 6 months and further to 20.6 and 77.6, respectively, at the last follow-up. There were no nonunions or tendon-related problems. The mean pain score decreased from 4.1 preoperatively to 1.0 at 6 months and 0.8 at the last follow-up. The mean grip strength improved from 5.6 kg preoperatively to 15.6 kg at 6 months and 19.7 kg at the last follow-up. There was a statistically significant improvement in range of motion at the wrist. CONCLUSIONS: The z-osteotomy provides correction of deformity in all 3 planes, along with restoration of radial height. It also maintains a broad area of bone contact between the 2 osteotomized bone fragments, facilitating bony union and eliminating the need for bone grafting. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Tetraplegia associated with post-operative syringomyelia in spinal tuberculosis: a result of an epidural compartment syndrome?

Introduction: The commonly recognized causes of post-operative neurological deterioration in spinal tuberculosis are inadequate decompression, damage to vascular supply of the spinal cord, and multi-drug resistant organisms. There are no known cases of syringomyelia developing after surgical decompression of spinal tuberculosis. Case presentation: A teenage girl presented with rapid onset quadriparesis secondary to a tubercular epidural abscess extending from C4-T8. The neurological status deteriorated to quadriplegia immediately following decompression by hemilaminectomy at C7 and T7 levels. Investigations into the cause of neurological deterioration revealed syrinx formation at T5-9 levels. The patient had partial motor and sensory recovery in the first 3 weeks post-operatively. Tubercular infection was treated with a 1-year course of multi-drug anti-tubercular therapy. However, there was no further neurological improvement at 2 years follow-up. Discussion: Syringomyelia in tuberculosis has been associated with tubercular meningitis, intradural tuberculomas, and post-surgical vascular insult. None of these were implicated as the cause of syrinx formation in this case. We hypothesize that the rapid evolution of epidural abscess in an intact vertebral column led to an acute "epidural compartment syndrome", which caused ischemic damage to the spinal cord. Compression caused by the epidural abscess was relieved by surgical decompression, allowing the central canal to dilate and expand into the softened spinal parenchyma, hence leading to syrinx formation.

Isolated tubercular osteomyelitis of acromion: A case report and review of literature.

Tuberculosis is an infectious disease of public health interest, infecting one-third of the world population. Up to 3% of all Tubercular cases have musculoskeletal involvement with less than 1% involving the scapular. To the best of our knowledge, we present the third case of acromion involvement in reported literature. An adolescent female with complains of shoulder pain with no restriction of movements, no local symptoms, no fever, no history of tuberculosis was being treated on analgesics for three months at a primary health centre. With a provisional diagnosis of Chondroblastoma, surgical exploration was done, but pus was drained. It was realized in retrospect that tuberculosis needs to be considered as a differential diagnosis for any undefined bony pain, however uncommon the site of involvement may be, especially in Indian subcontinent.