Management of Proximal Femur Aneurysmal Bone Cyst with 10-year Follow-up - A Case Report.

Introduction: Aneurysmal bone cyst is a benign, most often non-neoplastic lesion affecting the bone. Malignant transformation is reported in certain cases, although rare. It commonly occurs in young adults with around 75% of the cases occurring in the first two decades and 95% occurring in the first 3 decades. The management depends on the individual case parameters with ABC occurring in a weight-bearing area of a bone warranting an aggressive treatment plan with the consideration of preventing a pathological fracture. Case Report: A 20-year-old male patient with no other comorbidities presented to us with complaints of atraumatic right hip pain of 9-month duration. On preliminary clinical examination and imaging studies with X-rays, CT scan, and MRI, the patient was diagnosed to have an aneurysmal bone cyst (ABC) of the right proximal femur. The patient was operated with intra-lesional excision with extended curettage and prophylactic fixation with DHS plating and kept on yearly follow-up. 10-year follow-up showed complete resolution of the lesion and implant removal was done after that. Conclusion: As is clear from this case, the treatment of an aneurysmal bone cyst needs to individualized based on the patient's age, complaints, and tumor behavior in terms of its aggressiveness, size, and its extent. Often, en bloc excision with extensive curettage is required along with bone grafting and prophylactic fixation to support the bone graft and to prevent a pathological fracture and further recurrence. Implant removal if indicated should be done after complete resolution of the lesion, patient willingness, and any other medical indication.

Management of Short Proximal Femur Nail Peri-Implant Fracture of Femur Shaft with Implant Removal and Long Distal Femur Locking Plate and Bone Grafting - A Case Report.

Introduction: The rising demographic trend towards elderly population and increased incidence of osteosynthesis of proximal femur fractures are associated with increased recurrent falls and rise in incidence of peri- implant fractures. Case Report: Here, we present a difficult case of a peri-implant femur shaft fracture in a 55-year-old male, with stuck short proximal femur nail (PFN) removal followed by long distal femur plating with bone grafting showing good fracture union at 1 year with satisfactory functional outcome. Conclusion: Peri- implant femur fractures are quite rare and more commonly occur in elderly. Among all treatment modalities for intertrochanteric femur fracture fixation, the literature shows short PFN having highest comparative risk for peri-implant fractures. Implant removal followed by locking plates for long spiral fractures provides a stable, anatomical, and reliable fixation. Bone grafting augments bony union, especially in cases of bone defects .

Surgical Management of Aggressive Knee Tuberculosis with Open Subtotal Synovectomy - A Case Report and Review of Literature.

Introduction: Skeletal tuberculosis (TB) accounts for approximately 10-35% of the extra-pulmonary cases, where knee TB accounts for around 8% of extra-pulmonary TB cases after hip and spine. In about one-third of patients with extra-pulmonary TB, pulmonary TB is concomitantly found. The management of knee TB poses an initial diagnostic challenge due to its non-specific symptoms and absence of constitutional symptoms after which depending on the response to AKT - surgical intervention open or arthroscopic could be contemplated. Case Report: We have a 30-year-old female patient diagnosed with the right-sided knee TB on synovial biopsy started on anti-tubercular treatment. After 1 month of conservative middle path regimen, She presented to us with worsening knee pain and swelling over the right knee and difficulty in standing and moving out of bed as well as inability to sleep and night cries affecting significantly her activities of daily living. The patient was managed with open arthrotomy and subtotal synovectomy was done along with thorough debridement resulting in significant reduction in the pain and swelling in the post-operative period with return of range of motion with daily activities. Conclusion: As clear in our case, apart from the conventional chemotherapeutic regimen for TB, surgical management is sometimes indicated in patients with an aggressive joint infection with severe impairment in performing activities of daily living. It also helps to decrease the disease load which provides symptomatic relief to the patient and helps in recovery, thereby improving the quality of life.

A Case Report on Surgical Excision of Intracapsular Osteochondroma of Femur Neck using Mini-Arthrotomy without Hip Dislocation in a Young Female with Hereditary Multiple Exostoses.

Introduction: Osteochondromas are the most common benign bone tumors. They probably are developmental malformations rather than true neoplasms and are thought to originate within the periosteum as small cartilaginous nodules. The lesions consist of a bony mass produced by progressive endochondral ossification of a growing cartilaginous cap. Osteochondromas usually are found on the metaphysis of a long bone near the physis such as distal femur, proximal tibia, and proximal humerus. Surgical treatment for femur neck osteochondroma is difficult due to the high risk of avascular necrosis following excision. These lesions in femur are in close proximity to important neurovascular bundle and can cause symptoms related to their compression. Furthermore, the symptoms related to labral tear and hip impingement are common. Recurrence is rare and is caused by failure to remove the entire cartilaginous cap. Case Report: A 25-year-old female presented with the complaints of pain in the right hip and difficulty in walking and running for 1 year. On radiological examination, the right femur neck osteochondroma was diagnosed, it was located along the posteroinferior margin of the femur neck. Surgical removal of the lesion was done in lateral decubitus position using posterolateral approach to hip without dislocation of the femur. Conclusion: Osteochondroma at femur neck can be safely removed without surgical hip dislocation. It's necessary to remove it completely to avoid recurrence.

Management of Distal Femur Periprosthetic Fracture in an Elderly Patient by Open Reduction and Internal Fixation With Locking Plate Osteosynthesis -: A Case Report.

INTRODUCTION: Distal femur periprosthetic fractures are rare entityies and difficult to manage. Supracondylar femur fractures are most common amongst periprosthetic fractures. They can be managed by various modalities. These fractures are often difficult to treat because of various factors likesuch as osteoporosis, communication, female gender, and poor bone stock. Fixation of supracondylar femur fracture by locking plate provides excellent results in terms of radiological and clinical outcomes. CASE REPORT: We report a case of a 70 year -year-old female with pain and swelling in the right knee since for 1 day. She had a history of fall in bathroom 1 day back. The patient was operated with total knee replacement 6 years back for grade Grade 3 osteoarthritis of the knee. The patient was known case of hypertension and was on medication for the same. We operated the patient by open reduction and internal fixation with distal femur locking plate and it provided excellent clinical outcome. CONCLUSION: Periprosthetic supracondylar femur fractures are rare entity entities and generally difficult to manage, especially in elderly patient, due to poor bone quality. The choice of implant used to treat such fractures depends on the surgeon's choice and patient's compliance. Open reduction and internal fixation with a locking plate is a good entity as it provides excellent clinical and radiological outcome.

A Case Report of Humerus Shaft Osteomyelitis Secondary to Local Skin Infection Treated with Saucerization.

Introduction: Osteomyelitis of the humerus shaft after local skin infection is rare clinical entity, all the principles of tibia and femur osteomyelitis are used in the humerus osteomyelitis. Early detection is best done by the magnetic resonance imaging. Surgical debridement and curettage with IV antibiotics gives good clinical outcome in the patient. Case Report: A 35-year-old female presented with discharging sinus over posterior aspect of the humerus for 1 year. Diagnosis done based on X-ray and clinical examination. The patient managed with local debridement and saucerization, on follow-up patient is doing all the daily activities and no sign of recurrence at 18 months post-operative. Conclusion: Local debridement saucerization and course of IV antibiotics according to culture sensitivity give good clinical outcome in cases of humerus osteomyelitis.