Two Very Rare Case of Simultaneous Bilateral Intertrochanteric Fracture Operated in Single Stage - A Case Report.

Introduction: Unilateral intertrochanteric fractures are common injuries in elderly population. Simultaneous bilateral intertrochanteric fractures do occur but are very rare and only a few cases have been reported in the literature. Case Report: We report two cases with different modes of injury. Both cases were fixed in a single stage by proximal femoral nailing (PFN). The first case had multiple comorbidities and after 6 weeks of follow up, she suddenly expired at home due to medical issue. The second case is the only case reported with associated bilateral superior and inferior pubic rami fracture. PFN was done in a single stage and at 1-year follow-up, the patient was having a good functional outcome. Conclusion: Simultaneous bilateral intertrochanteric fractures are very rare injuries but these are potentially life-threatening with high morbidity. Quick assessment and early single-stage stabilization with proximal femoral nail give stable fixation and good functional outcome.

Early Reimplantation of Open Total Extruded Talus: A Case Report.

Introduction: Traumatic open total extrusion of talus without soft-tissue attachment and not associated with surrounding fracture is a very rare injury which requires very high energy impact. In literature, optimal treatment protocols are yet to be established. A few options described in literature are talectomy and tibiocalcaneal arthrodesis or reimplantation of talus which may be immediate or after some interval. Case Report: A 28-year-old female suffered road traffic accident and had total open extrusion of talus without soft-tissue attachment, and we managed it with thorough debridement of the wound, saline irrigation, and immediate reimplantation of the talus with stabilization by delta frame external fixator. Proper pre- and post-operative antibiotic coverage was given as per protocol. We did not face post-operative infection, wound complication, and until 12 months followed up, there are some signs of avascular necrosis of the talus but the good functional outcome. Conclusion: With this case experience, we suggest that this is the valid treatment protocol for total extrusion of the talus, and it will provide a better hindfoot mechanism, heel height, and the patient can resume his/her daily routine activity as early as possible.

Drug eluting bioactive glass ceramics for fusion in spondylodiscitis: a pilot study.

Retrospective observational study. To determine the efficacy and safety of bioactive glass ceramics mixed with autograft in the treatment of spondylodiscitis. Thirty-four patients with spondylodiscitis underwent surgery using autologous bone graft augmented by antibiotic loaded bioactive glass ceramic granules. Twenty-five patients aging 6 to 77, completed 1-year follow-up. The lumbosacral junction was affected in 3, lumbar spine in 13, one each in the dorso-lumbar junction and sacrum, and 7 dorsal spines. The organism isolated was Mycobacterium tuberculosis in 15, Methicillin sensitive Staphylococcus aureus (MSSA) in 4, Pseudomonas aeruginosa in 4, Klebsiella pneumoniae in one, Burkholderia pseudomallei in 1, and mixed infections in 2. All patients had appropriate antibiotic therapy based on culture and sensitivity. Clinical and radiological evaluation of all the patients was done at 6 weeks, 3 months, 6 months, and 12 months after the surgery. Twenty-three patients improved clinically and showed radiographic fusion between 6 and 9 months. The patient with Burkholderia infection died due to fulminant septicemia with multi organ failure while another patient died at 9 months due to an unrelated cardiac event. The mean Visual Analogue Score (VAS) at the end of 1-year was 2 with radiological evidence of fusion in all patients. There were no re-infections or discharging wounds, and the 30-day re-admission rate was 0. Bioactive glass ceramics is a safe and effective graft expander in cases of spondylodiscitis. The absorption of antibiotics into the ceramic appears to help the elimination of infection.

Combined Posterior and Convergent Elbow Dislocation in Adult: A Rare Case Report.

Introduction: Elbow dislocations are commonly encountered by orthopedic surgeons all over. Management is straightforward and the result is generally satisfactory. However, in a small subset, associated injuries like convergent or divergent dislocations at superior radioulnar joints are present. These associated injuries are often missed initially leading to their delayed treatment and suboptimal elbow function. We report one such rare case of Convergent dislocation at the elbow. Although reported from other parts of the world till date, there has been none reported from India. It is extremely rare in adults. Twenty-three cases in children and only two in adults stand reported so far in world literature. Thus, our reporting it could be the first report of convergent dislocation at the elbow from India. To the best of our knowledge, it is only the third reported adult case in world literature. Case Report: We describe a 68-year-old male visiting a local hospital with a history of fall from a two-wheeler. An initial radiograph revealed an obvious posterior dislocation of the elbow. Closed reduction was performed, and posterior above elbow slab was given. Patient presented to us 10 days later with persistent pain. Evaluation with radiographs confirmed reduction of ulno-humeral joint but translocation of the radius and ulna which is combined posterior and convergent elbow dislocation. Conclusion: Combined posterior and convergent elbow dislocation is a rare scenario. The rarity of these associated injuries is the reason for lack of awareness. We suggest careful scrutiny of pre-reduction anteroposterior radiographic view or 3D CT in suspected cases as well as X-ray/Carm anteroposterior view in extended position of elbow on the operation table immediately after reduction before slab application in every case of elbow dislocation. Significant difficulty was encountered in open reduction in our case. This could be attributed to buttonholing of the radial head through insertion of brachialis fibers. The reporting of this surgical difficulty is important because it will help the surgeon know it beforehand and the awareness would make the surgeon take appropriate measures well in time.

Impact of COVID-19 on orthopaedic residents-an Indian perspective.

OBJECTIVES: The COVID-19 pandemic is a public health emergency causing a deleterious effect on the health system. It affected all the specialties and subspecialties in the medical field causing havoc in the health institutions. This pandemic affected both orthopaedic consultants and the residents who are under training. Our purpose was to study the impact of COVID-19 on orthopaedic residents in their professional life. METHOD: The study design was a computer-based digital online survey of the orthopaedic residents in India. The survey had 15 questions with multiple options related to the effect of COVID-19 on their orthopedic department, effect on teaching, surgical exposure, hands-on surgeries, the effect on workload, effect on mental stress, exposure to arthroplasty, arthroscopic surgeries, spine surgeries, and deformity correction surgeries. RESULTS: Elective surgeries stopped in 91% of the hospitals, academic teaching stopped in 98% of the institutions. Eighty-six percent of the residents are not getting adequate surgical exposure, 73% of the residents are getting negligible hands-on surgical training. Residents are mentally stressed related to academic examinations, academic training, and also because of COVID 19 duties. Residents are getting the least exposure in subspecialties like arthroplasty, arthroscopy, and spine. CONCLUSION: The COVID-19 pandemic not only affected the orthopaedic consultants but also the orthopaedic residents to a great extent as residents are the backbone of any department/institution. The pandemic affected significantly resident's academic teaching, surgical exposure, hands-on training and mental stress related to COVID duties, academic training disturbance, and also academic examinations.

Synovial Chondromatosis of Hip in a Young Patient Salvaged With Mini Arthrotomy Without Hip Dislocation - A Case Report.

INTRODUCTION: Synovial chondromatosis is a rare, benign disorder of the synovium, which leads to loose body formation due to metaplastic transformation. It presents as multiple cartilaginous bodies in the synovial joints, bursae and in tendon sheaths. The diagnosis often delayed in hip involvement due to insidious onset of symptoms. Surgical management is essential to manage synovial chondromatosis, which includes hip dislocation and debridement, arthroscopic removal or using arthrotomy. CASE REPORT: A 20-year-old male patient presented with complaints of pain in the left hip since 1 year and difficulty in walking for 6 months. On examination, the patient had mild tenderness over the left hip with the restriction of joint movements. He had flexion deformity of 30°, adduction and external rotation deformity of 10 and 15°, respectively. X-ray of the pelvis with both hips anteroposterior and left hip lateral view revealed calcified nodular mass over superior, inferior part of the femoral head, and anterior part of the neck with decreased joint space. As the patient was disabled with pain, stiffness especially restricted flexion and abduction and difficulty in daily routine activities, we planned for surgical excision of the loose bodies. Using lateral approach to the hip, intra-articular loose bodies were removed through arthrotomy without hip dislocation. At present 2-year follow-up, the patient is having full hip range of motion with no difficulty in squatting, sitting cross-legged, and radiological examination showed no evidence of recurrence. The patient is fully satisfied with the chosen treatment and participating in running and other sports. CONCLUSION: Although hip synovial chondromatosis are rare, early surgical intervention with complete removal of loose bodies, joint distraction for 6 weeks to allow healing, and early initiation of hip physiotherapy helps in getting better outcome even in patients with early stages of hip arthritis. The early surgical intervention also prevents the progression of the joint degeneration, which in turn helps in postponing replacement surgeries in young patients. Satisfactory outcomes can be achieved by salvaging the natural hip joint.

Parosteal Lipoma of the Proximal Phalanx of Hand.

Parosteal lipomas are rare benign tumors accounting for less than 0.1% of all primary bone tumors. Only 3 cases of parosteal lipoma have been previously described affecting the distal and middle phalanges. We describe a case of parosteal lipoma in a 45-year-old man involving the proximal phalanx of the right middle finger. The tumor was marginally excised with the osseous attachment. There was no clinical or radiological recurrence at a follow-up of 2 years, with full range of movement at the proximal interphalangeal joint.

Tuberculosis of Calcaneus - A Case Report and Review of Literature.

INTRODUCTION: Osteoarticular tuberculosis (TB) constitutes 1-3 % of cases and about 10% of osteoarticular TB affects the foot and ankle. In foot, TB calcaneus is the most commonly affected bone. CASE REPORT: A 21-year-old male presented with pain, swelling in the right heel for 5 months and difficulty in walking for 2 months. Plain X-ray (axial) view of calcaneus showed a lytic lesion in calcaneus. Biopsy was done under local anaesthesia and histologic examination revealed a characteristic granuloma, caseous necrosis, and Langhans giant cells which confirmed our diagnosis. The patient was treated with anti-TB chemotherapy for 12 months. Radiographs at 18 months follow-up showed a healed lesion. At present, the patient is comfortable with no complaints. DISCUSSION AND CONCLUSION: TB calcaneus is rare condition and a high index of clinical suspicion along with imaging studies helps in diagnosis. Conservative management with anti-TB chemotherapy for adequate duration helps in complete resolution of the infection with good functional results.

Idiopathic Proximal Radioulnar Synostosis - A Rare Case Report and Review of Literature.

INTRODUCTION: Radioulnar synostosis is a bony connection between the radius and ulna, which causes restriction of the active and passive rotational movements of the forearm such as supination and pronation, which can lead to significant functional disability in the patients. CASE REPORT: A 35-year-old male carpenter presented with the complaint of right forearm supination and pronation restriction for the past 8 months with minimal pain at the elbow region with no previous history of trauma or surgery. On examination, forearm supination and pronation movements were completely restricted with normal elbow flexion and extension and with no neurovascular deficit. X-ray of the right radius ulna with elbow revealed synostosis between proximal radius and ulna at the level of the radial tuberosity. Synostosis was removed using both anterior and posterior approaches. Postoperatively patient is having good supination and pronation movements, no pain, and difficulty in his occupation. CONCLUSION: Idiopathic proximal radioulnar synostosis should be suspected in patients having restricted rotatory movements of forearm with no previous history of trauma or surgery and this is the first reported case of idiopathic proximal radioulnar synostosis. Complete resection of the synostosis with early initiation of aggressive physiotherapy helps in getting good functional outcomes.