Subacute Bacterial Infection Mimicking a Slipped Capital Femoral Epiphysis in an Obese Adolescent Male - A Case Report and Review of Literature.

Introduction: Atypical and subacute presentations of pediatric bacterial septic arthritis are difficult to diagnose due to lack of systemic manifestations and inadequate laboratory data. Furthermore, they may mimic certain well-documented pediatric disorders to confound the diagnosis and management. Case Report: The authors present a case of an adolescent obese male with features suggestive of a slipped capital femoral epiphysis (SCFE). Further investigations revealed bacterial septic arthritis which may have contributed to the slip. He was treated with an initial debridement followed by a definitive pelvic support osteotomy (PSO) with a compensatory distal femoral varus osteotomy. At 12 months, he had a satisfactory clinical and radiological outcome. Conclusion: Clinicians should have a high degree of suspicion for infection in patients presenting with atypical clinical or radiological signs of SCFE. A thorough investigation in such cases is a must, to aid in correct management. PSO is an effective salvage procedure in adolescents with septic hip sequelae.

Comparative study of various dressing techniques in diabetic foot ulcers in the Indian population: a single-center experience.

Introduction: A prospective randomized study was conducted to evaluate and compare the efficacy of conventional dressing, foam dressing, and vacuum-assisted closure (VAC) in the management of diabetic foot ulcers (DFUs). Material and methods: Ninety patients with DFU were included in the study conducted between 2018 and 2021 at a tertiary care center. Group 1 patients (n = 30) were treated with conventional dressing, group 2 patients (n = 30) with foam dressing, and group 3 patients (n = 30) with VAC dressing. The duration of treatment, number of debridement, need for the secondary procedure, cost of treatment, and duration of hospital stay were compared between the three groups. Results: There was a significant difference in the duration of treatment among the three groups with VAC being the least (group 1, 31.17 days; group 2, 24.13 days; group 3, 15.17 days). The mean number of debridement was also significantly less in the VAC group (2.37, 2.43, and 1.60, respectively). The need for the secondary procedure, like flap or skin graft, was also the least in the VAC group, although insignificant. The mean hospital stay of the study subjects was 31.17 days, 24.13 days, and 15.17 days in the 3 groups, respectively. The mean cost of the treatment was 3076.67 INR, 3717.33 INR, and 10,680 INR, respectively. Conclusion: VAC dressing is the best option amongst the available dressing modalities in terms of faster healing and a short hospital stay. Foam dressing does provide an economically viable option with better results than conventional dressing.

Delayed Presenting Radial Neck Epiphysiolysis Managed with Open Reduction and Internal Fixation with K Wires: A Case Report and Review of Literature.

Introduction: Radial neck fractures in the pediatric age group account for 1% of all fractures in children. A completely displaced fracture with an angle >30° requires operative intervention. Case Report: An 11-year-old boy with Judet IVb radial neck epiphysiolysis 4 weeks old was managed by open reduction and internal fixation with K-wires. Conclusion: Anatomic reduction must be achieved in radial neck fractures to restore their function. Open reduction and internal fixation with K wires must be considered in patients with >30° angle of inclination, neglected fracture, and failure of closed reduction.

Intrathoracic Extension of a Giant Cell Tumour of the Medial End of Clavicle: A Case Report with Review of Literature.

Introduction: The clavicle is a very rare site for primary bone tumours, and Giant cell tumours of the clavicle are even rarer. Very few cases have been reported in the literature. Method: The authors report a rare presentation of intrathoracic extension of a giant cell tumour of the medial end of the clavicle, in an 18-year-old female. The patient had painful swelling at the sternal end of the clavicle associated with a painful shoulder range of motion. Complete resection of the mass was done, preserving the lateral half of the clavicle. Result and Discussion: At a 3-year follow-up, the patient has a good clinical outcome with no signs of recurrence. Being a very rare entity, no clear guidelines are available for the management of GCT of Clavicle. Adequate resection of the tumour mass remains the mainstay of treatment and has shown promising results. Denosumab has been proved to be effective in some studies, but the high cost of treatment is a major limitation in the Indian scenario. Conclusion: Resection of the tumour mass with partial cleidectomy provided good results in this patient.

Broad Arm Sling vs Figure of 8 Bandage: The Better Choice in Conservative Management of Middle Third Clavicle Fractures in Indian Population.

Background: A prospective randomised trial was conducted to compare the results of conservative management of middle-third clavicular fracture using the figure of 8 bandage and broad-arm sling. Methods: 296 patients with middle-third clavicle fracture were included in the study conducted between March 2017 and January 2020. 152 patients were managed with figure of 8 bandage and 144 patients were managed with a broad arm sling. Results were evaluated based on clinical, radiological and functional outcomes. Visual analogue scale (VAS) for pain was used to evaluate the clinical outcomes, whereas radiological outcomes were assessed with non-union, malunion, clavicle shortening and time to union. Disability of Arm, Shoulder and Hand score (DASH), Constant score and Nottingham Clavicle Score were used to assess functional outcomes. Results: The broad arm sling group showed a significantly better VAS score in the first 4 weeks. DASH score was significantly superior in the broad arm sling group in the initial 4 weeks, but with similar outcome thereafter. Constant scores showed a good outcome for both groups at the final follow-up, whereas the Nottingham Clavicle Score was significantly superior in the broad arm sling group at the 2 year follow-up. A satisfactory outcome was achieved with respect to the radiological parameters, without any significant difference between the 2 groups. Incidence of malunion was significantly higher in figure of 8 bandage group. Conclusions: Broad-arm sling proves to be a better modality of management for middle-third clavicular fractures in terms of ease of application, pain relief, incidence of malunion, and functional outcomes.

A Solitary Ventral Scapular Osteochondroma causing Pseudo-winging of Scapula: A Case Report.

INTRODUCTION: Winging of scapula is defined as a failure of dynamic stabilizing structures that anchor the scapula to the chest wall, leading to prominence of the medial border of scapula. It could be primary, secondary, or voluntary. Primary winging could be true winging due to neuromuscular causes or pseudo-winging due to osseous or soft-tissue masses. A scapular osteochondroma is a very rare presentation site and causes pseudo-winging leading to pushing away of the scapula away from the chest wall presenting as medial border prominence. Here, we are reporting a rare case of a scapular osteochondroma causing a pseudo-winging of the scapula. CASE REPORT: A 2-year-old male child presented with painless, immobile, and non-fluctuant swelling over the left scapular region, insidious in onset and progressive in nature. On examination, a non-tender, immobile swelling was palpable with a painless and unrestricted range of motion at the shoulder joint. After evaluating radiographs and CT scan, the patient was diagnosed to have a ventral scapular osteochondroma leading to pseudo-winging of the scapula. CONCLUSION: Despite the rarity, a differential diagnosis of a scapular osteochondroma should be kept in mind while examining a young child presenting with a winged scapula.

Wedge Osteotomy with Tens Nailing in Monostotic Fibrous Dysplasia of Tibia - A Case Report.

INTRODUCTION: Titanium elastic nailing (TENS) with wedge osteotomy for the management of monostotic fibrous dysplasia (FD) of tibia is done in a 6-year-old male patient. CASE REPORT: This is a case describing monostotic FD of right tibia in a 6-year-old male patient. The patient's parents noticed a diffuse swelling in the right leg a few days after birth. It was managed conservatively till 3 years of age when the patient started complaining of pain in his right leg and difficulty in walking and running. The patient developed gradual and progressive anterior bowing in the right leg in the next 3 years. The patient was diagnosed with monostotic FD of the right tibia based on clinical and radiological findings. Wedge osteotomies were done in the tibia and fibula with TENS nailing as a definitive procedure for this patient. DISCUSSION: Management of monostotic FD of the right tibia with TENS nailing and wedge osteotomy can be a possible modality of definitive management with complete pain relief and deformity correction. CONCLUSION: Correction of deformities secondary to FD requires meticulous pre-operative planning and execution. But with proper planning, even major deformities as in our case, procedures as simple as wedge osteotomy and TENS nailing can give excellent outcomes.

Total Hip Arthroplasty after McMurray's Osteotomy - A Case Report and Review of Literature.

INTRODUCTION: Total hip arthroplasty after McMurray's osteotomy increases the operative difficulties and decreases the chances of better outcome. With the advent of modular femoral stems, minute changes can be done to individual joints, which allow intraoperative flexibility and better post-operative outcome. Thus, it should be considered as an option for complicated cases. CASE REPORT: We report a case of a 35-year-old female with chief complain of pain in the left hip while walking for the past 2 years. The patient also had difficulty in squatting and sitting cross legged. History of fracture in the left hip at 4 years of age for which McMurray's osteotomy was done. The patient was operated with total hip arthroplasty using modular Sivash range of motion (S-ROM) stem. CONCLUSION: Modular S-ROM total hip arthroplasty is a good option for treatment in cases with previous osteotomy in femur.

Total Hip Replacement and Distal Femur Shaft Non-union in a Case of Below-knee Amputation - A Case Report.

INTRODUCTION: Primary total hip replacement (THR) surgery for the neck of femur (NOF) fracture in a case of below-knee amputation with distal femur shaft non-union is rare. CASE REPORT: This case describes the traumatic right NOF fracture in a 49-year-old male patient with distal femur shaft non-union. The patient has a history of ipsilateral below the knee amputation along with right distal femur shaft fracture managed with retrograde femur nailing 10 months back following a road traffic accident. The NOF fracture was managed by primary THR as the definitive procedure after distal femur nail removal and distal femur plating with allograft for non-union. CONCLUSION: Primary THR with distal femur plating and allogenic bone grafting in such cases provides satisfactory outcomes. It allows for early ambulation and rehabilitation of the patient.

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.

Tuberculous Dactylitis in Adult - A Case Report and Review of Literature.

INTRODUCTION: Tubercular dactylitis is an uncommon form of musculoskeletal tuberculosis (TB), especially after the age of 5 years without any risk factors. CASE REPORT: A case of 49-year-old male presented with pain, swelling, and discharging sinus of proximal phalanx of third digit of the right hand with no constitutional symptoms for 2 years, with multiple failed treatment in form of antibiotic therapy. There were no risk factors such as immunodeficiency or any co-morbidities. The plain radiograph was suggestive of increased bone density with mild periosteal reaction; magnetic resonance imaging was suggestive of tubercular osteomyelitis. A biopsy was performed, the gene expert of the sample revealed TB with no drug resistance. The patient was managed with anti-tubercular drugs with complete resolution of clinical and radiological symptoms at 1-year follow-up. CONCLUSION: TB should be considered a differential in patients with chronic soft-tissue or skeletal lesions even in the absence of the usual risk factors because with treatment it still carries a good prognosis.