Tendon Transfer for Persistent Radial Nerve Palsy Using Single-Split FCU Technique and Re-Routing of Extensor Pollicis Longus: A Prospective Study of 25 Cases.

PURPOSE: Optimal treatment of persistent radial nerve palsy is controversial. However, most authors agree that tendon transfers lead to satisfactory result in majority of patients. Triple tendon transfer using flexor carpi radialis, pronator teres, and palmaris longus is the most preferred tendon transfer. The aim of this study was to evaluate the results of a split flexor carpi ulnaris (FCU) as a single transfer in such patients and compare our results with other transfers from the available literature. MATERIALS AND METHODS: A total of 25 patients (20 males and 5 females: mean age: 30.9 years) were selected for FCU split transfer in persistent radial nerve palsy injury from April 2014 to May 2015. All patients were followed up with a mean followup of 1 year. Clinical outcomes were assessed using Bincaz score. RESULTS: Using Bincaz score, 68% of our patients had good-to-excellent result, while 32% patients had fair and none had bad results. Wrist extension was comparatively less in high radial nerve palsy as compared to low radial nerve palsy patients, but all patients were functionally independent. Power grip was assessed using a jammer dynamometer. All patients had adequate grip strength and good active extension of the wrist and fingers. CONCLUSION: Single transfer using split FCU can be a preferred alternative in patients of low radial nerve palsy, it can be considered for high radial nerve patients in whom multiple donors are absent due to the nature of injury, for example, brachial plexus injury.

Bilateral central acetabular fracture dislocation in a young patient due to seizure activity: a case report and review of the literature.

Various musculoskeletal injuries are well known complications of epilepsy either because of direct trauma or because of unbalanced forceful muscle contraction. We report a case of non-traumatic bilateral central acetabular fracture dislocation due to seizure activity induced by neurocysticercosis of the brain, which was managed conservatively and obtained reasonable good outcome. This case highlights the importance of proper evaluation in young non-osteoporotic patients who have experienced an epileptic attack without any previous history. It is also imperative to mention that these patients should be thoroughly examined neurologically to find out the exact etiology and should be treated accordingly to prevent future seizure activity.

Gossypiboma of the Thigh Mimicking Soft Tissue Sarcoma: Case Report and Review of Literature.

INTRODUCTION: Foreign body granulomas due to surgical swab left after surgery (Gossypiboma) are rare. There are few cases of such lesion after orthopaedic procedure in thigh. Presentations vary from pathological fracture to painless mass. Gossipyboma with radiological appearance of soft tissue sarcoma are rare and we report one such case. CASE REPORT: 32 year old male laborer had fracture shaft femur 13 years back which went into malunion after conservative treatment. Osteoclasis, open reduction and K-nailing was done at 6 months. Fracture united and K nail was removed 3 years later. Patient was asymptomatic for 10 years after which he presented to us with swelling and pain in the medial aspect of thigh. Radiograph showed soft tissue mass with excavating lesion of the posteromedial aspect of femur resembling soft tissue sarcoma. Biopsy revealed cystic lesion with sterile fluid with no malignant cells. Explorations of the lesion lead to discovery of shredded surgical swab. Complete removal of all granulomatous tissue was done and patient was given hip spica for 3 months after which he was gradually mobilized and is currently walking full weight bearing at one year follow up. CONCLUSION: Cases with radiologically destructive lesions close to previous surgery scars should be assessed with gossypiboma as one of the differentials.

Ilizarov hip reconstruction in skeletally mature young patients with chronic unstable hip joints.

PURPOSE: Hip reconstruction with subtrochanteric valgus extension pelvic support osteotomy and distal femoral osteotomy for lengthening and varus correction is one of the options available for salvage of chronic unstable hips and is also known as Ilizarov hip reconstruction (IHR). This study evaluated the outcomes and complications associated with IHR in skeletally mature young patients. METHODS: Twelve patients (7 males, 5 females) with a mean age of 23 years underwent IHR for chronically dislocated hips due to various causes. Preoperative clinical and radiological evaluations were used to determine the site of osteotomies and the required angulations. Postoperatively the patients were followed up clinically and radiologically for a minimum of 36 months. Ilizarov fixator was removed when adequate lengthening was achieved and there was radiological evidence of union. Harris Hip Score was used to document hip function preoperatively and at final evaluation. RESULTS: Significant improvements occurred in limb length discrepancy (LLD) 5.11 cm preoperatively to 0.9 cm at final evaluation, Harris Hip Score 44.33 points preoperatively to 70.83 points (p < 0.0001) at final evaluation. Trendelenberg sign disappeared completely in nine patients and was delayed in three at final evaluation. The abduction at the hip increased from the preoperative mean of 12.08° (range 0°-25°) to 22.5° (range 15°-35°) postoperatively. The fixed flexion deformity at the hip decreased from 22° (range 10°-35°) preoperatively to 3° postoperatively (range 0°-10°). The amount of free flexion at the operated hips decreased from the preoperative mean of 88.33° (range 70°-120°) to 70.42° (range 45°-105°) at final follow up. The mean fixator interval was 7.33 months (5-12 months) and the mean follow up duration was 59.4 months (38-86 months). CONCLUSIONS: IHR is effective in improving the hip biomechanics, correcting the LLD and eliminating the Trendelenberg sign. Lengthy period of fixator wear, knee stiffness and pin tract infections, though minor are known limitations of this procedure.