Intra-articular Olecranon Osteotomy and Adhesiolysis for Treatment of Post-traumatic Elbow Stiffness.

INTRODUCTION: Loss of motion is common in elbow trauma. Restoration of joint motion in post-traumatic stiff elbow can be a difficult, time consuming, and costly. We report a case of post-traumatic elbow stiffness treated with intra articular olecranon osteotomy and adhesiolysis. CASE PRESENTATION: A 30-year-old female, with right dominant upper extremity, presented 13 months after operated well aligned right intra articular distal humerus fracture with right elbow stiffness. She had a fixed flexion deformity of 20 degrees with flexion arc of 20-30 degrees and completely free supination and pronation. She was unable to perform the activities of daily living with affected right upper extremity. Intra-articular chevron olecranon osteotomy and adhesiolysis were done for the post-traumatic elbow stiffness. Immediate post-operative active and active assisted motion exercises of elbow joint were started. Indwelling infra clavicular catheter with continuous Ropivacaine infusion was kept for analgesia. At 6 month post-operative follow-up, she achieved 10-110 degree elbow flexion arc with completely free supination and pronation. She is able to perform the daily living activities with right upper extremity. CONCLUSION: Many different methods of treating post traumatic stiff elbow have been described, intra articular olecranon osteotomy helps in addressing intrinsic and extrinsic pathology with better results.

Urethral pull-up operation for distal and mid-penile hypospadias: a new safe method.

This case series of 51 patients (age range = 11-17 years; 30-month follow-up) describes a new modified approach to treatment of distal and mid-penile hypospadias that has fewer complications. The meatal locations were sub-coronal (51%), coronal (45%) and mid-penile (4%). Forty patients had chordee. Urethra with the corpus spongiosum was dissected off the corpus cavernosum up to the peno-scrotal junction. The distal 5 mm stenotic and avascular part of the urethral tube was excised. The elastic urethra was then stretched and sutured to form a neo-meatus. The urethra was anchored to the Buck's fascia at the glandular, sub-coronal and mid-penile levels. Meatal regression in one patient (2%), subcutaneous hematomas in two patients (4%) and wound dehiscence in two patients (4%) were the complications in the immediate postoperative period. None developed fistula, meatal stenosis or residual chordee in the 30-month follow-up.

Challenges Posed by Delayed Presentation of Mutilating Hand Injuries.

Management of mutilating hand injury is a challenge for any hand surgeon. Delay in presentation makes management even more challenging, usually because of inadequate initial assessment, inadequate debridement leading to infection, and secondary loss of tissues from exposure and desiccation. The aim is to obtain a functional hand by radical debridement, adequate assessment of the injury, appropriately timed reconstruction, and physiotherapy and rehabilitation. The hand surgeon must pay attention to the appearance of the hand by elimination of deformities, unsightly scars and bulky flaps to help to restore confidence in the patient to face the demands of daily living.

Bilateral microvascular second toe transfer for bilateral post-traumatic thumb amputation.

In bilateral thumb amputations, the functional impairment is serious and every attempt should be made to reconstruct the thumb. We report a case of bilateral post traumatic thumb amputation, reconstructed with bilateral second toe transfer. Only two such cases have been reported in literature so far. Though there are various modalities for the reconstruction of thumb, microvascular toe transfer has its own merits. The convalescent period is minimal with excellent function. It is bilaterally symmetric and aesthetically superior to the osteoplastic reconstruction. The technical details are discussed, and the long term functional and aesthetic results are presented.

Soft tissue chondroma of hard palate associated with cleft palate.

Soft tissue chondroma of palate is very rare. It has never been reported in a cleft palate patient. We report a case of 22-year-old male who came with asymptomatic swelling on the palate since birth, along with complete cleft of secondary palate. He had symptoms related to cleft palate only, i.e., nasal regurgitation and speech abnormalities. Swelling was excised and the cleft palate was repaired. Histopathological examination revealed chondroma of the palate. The patient had no recurrence after 2 years of follow-up.