'PRUT' - A cadaveric study to understand the mechanism of this rare paediatric elbow injury with a comprehensive review of literature.

Introduction: Proximal radio-ulnar translocation (PRUT) with elbow dislocation, without a fracture, is an extremely unusual injury. Case: A 6-year-old female child presented to us with posterior elbow dislocation, PRUT and incomplete ulnar nerve palsy. A hematoma aspiration and reduction of the elbow joint were done with a hyper-supination manoeuvre to reverse the translocation. She was managed with an above-elbow cast for 4 weeks and showed good radiological and functional outcomes on subsequent follow-ups until 1 year. Conclusion: Early recognition of PRUT and a thorough clinico-radiological assessment are mandatory when dealing with paediatric elbow injuries. Our cadaveric study with illustrations defines the mechanism of this rare injury for better understanding.

An isolated subcutaneous paraspinal pseudo-tumor-more to it than meets the eye-a case report and review of literature.

A 4-year-old male child presented to us with a paraspinal pseudo-tumor over the mid-back region with pain being his only symptom. On initial ultrasonography, it was presumed to be a nerve sheath tumor, but on an excision biopsy and histopathology, it proved to be a subcutaneous cysticercosis. Furthermore, an MRI of the brain showed a ring enhancing lesion with vasogenic edema, which confirmed the diagnosis of a neurologically symptomless neurocysticercosis. We treated the patient with albendazole and a short course of dexamethasone. There was complete resolution of the painful subcutaneous swelling, and the patient remained neurologically symptomless at all subsequent follow-ups. Resolution of the brain lesions was seen in the 6-month MRI follow-up. Although rare, orthopedic surgeons should consider the possibility of parasitic infections when dealing with small near-asymptomatic soft tissue paraspinal swellings of uncertain etiology. A thorough investigation in such cases can be lifesaving.

Perineal injuries in patients with complex femoral fractures operated on a fracture table using traction and counter traction: A case series and review of the literature.

Introduction: PA fracture table with a perineal post for counter traction is frequently used in the surgical treatment of lower limb fractures. Nevertheless, persistent use of the perineal post has been linked to serious side effects. We discuss our experience treating genitoperineal wounds due to traction table. Methods: During a month, our facility treated 3 patients who had genitoperineal injuries related to the usage of a traction table. We assessed the clinical appearance of these perineal injuries, the length of the operation, the treatment strategy, the clinical results, and the length of the hospital stay. Result: After surgery, partial thickness necrosis in the region including the scrotum and perineum developed in all patients. Two patients who had necrotic tissue infections received surgical debridement. In all cases, the wound healed fully with secondary intention by continued cleaning, dressing, and appropriate antibiotics. Conclusion: Genitoperineal skin necrosis caused by a perineal traction post necessitates surgical debridement and prolongs hospitalization. Orthopaedic surgeons should utilize several techniques such as proper perineal post diameter, length of surgery, positioning of the limb during surgery, etc. to lower the likelihood of this problem.

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.

Biological Reconstruction of the Coracoclavicular Ligament with Semitendinosus Autograft and Repair of Distal Clavicle Fractures.

Most of the options available to treat distal clavicle fractures involve hardware-related complications and high failure rates. This study aims to determine the outcome of distal clavicle fractures treated by a technique that combines biological reconstruction of the coracoclavicular ligament with semitendinosus autograft with reinforced fibrous tissue tapes. In this retrospective study, 8 patients with displaced distal third clavicle fracture cho's IIB or II C were operated on with the described surgical technique between 2018 and 2021. The results were assessed by comparing the preoperative Constant Murley score and the postoperative DASH score. In addition to these variables, several other variables were also assessed, such as the coracoclavicular distance, the time until union, and all intraoperative and postoperative complications. The study included eight patients with an average age of 36.5 years, and the average time from surgery to recovery was five days. According to Cho's classification, all eight patients achieved radiographic union within 89 days. Of the eight cases, six were classified as II C and two as II B. The follow-up period was an average of 13 months. During the postoperative period, the Constant Murley score score increased from 22.2 preoperatively to 92.2 postoperatively. The mean DASH score was 89.6, and the mean postoperative DASH score was 7.75. In terms of the coracoclavicular distance, the mean preoperative was 20.2 mm, and the mean postoperative was 10.3 mm. One patient experienced a minor wound complication after surgery, treated with secondary suturing after the operation. No intraoperative complications occurred. There was no donor site morbidity observed in the patients. It has been demonstrated that the use of this technique in displaced unstable distal clavicle fractures using a fiber tape and a semitendinosus autograft results in a satisfactory union and excellent clinical outcomes with very few complications.

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.