Giant Cell Tumor of Third Metacarpal: A Rare Case Report and Review of Literature.

INTRODUCTION: Giant cell tumor (GCT) or osteoclastoma is an osteolytic, mostly benign but locally aggressive tumor occurring in young adults at the meta-epiphyseal region of long bones such as lower end of the femur, upper end of the tibia, and lower end of the radius, and proximal humerus in descending order of frequency. Only 2% of all GCT of bone occur in hand. GCT of metacarpal (MC) has different characteristics than that of other long bones. It has more aggressive behavior with involvement of entire length of MC with soft tissue extension. CASE REPORT: We are reporting a case of GCT of the 3rdMC in a 19-year-old female. She presented to us with a painful, firm, ovoid, and gradually progressive swelling measuring 4 cm × 3 cm over the dorsum of the left (non-dominant)hand, since past 6 months. Fine-needle aspiration cytology was suggestive of GCT of the tendon sheath. Pre-operative magnetic resonance imaging and computed tomography scan revealed the extent of the lesion with no neurovascular involvement. Although various reconstructive procedures to salvage the affected Ray have been reported in literature, we planned for a surgical resection of the lesion leaving behind 1 cm of healthy MC base which appeared to be normal radiologically and intraoperatively. Reconstruction of the defect was done using non-vascularized contoured fibular strut graft, fixed with 2.5 mm mini reconstruction plate, along with reconstruction of the collateral ligaments of the metacarpophalangeal joint. The histopathological study confirmed the diagnosis of GCT. CONCLUSION: GCT of hand is a rare tumor, due to its relatively more aggressive behavior and high chance of recurrence it, nevertheless, provokes quite difficult issue to solve. Prognosis, treatment, and results are directly dependent on early diagnosis and adequate therapy.

Minimally Invasive Total Hip Replacement in an Ipsilateral Post-traumatic above-knee Amputation: A Case Report.

INTRODUCTION: Total hip replacement (THR) is a highly successful operation in alleviating pain and improving the overall function of the hip, in end-stage arthritis of the hip, in otherwise fit patients. However, THR as a surgical option in post-traumatic hip arthritis with ipsilateral above-knee amputation is rarely reported. CASE REPORT: We are presenting a case report of a 30-year-old male, who had previously underwent an above-knee amputation due to road-traffic accident, presenting 24 h after the injury with segmental fracture femur and popliteal artery laceration, for which the limb could not be salvaged. He had an impacted anteroinferior dislocation of the ipsilateral hip with significant cartilage damage of the femoral head which required open reduction. Subsequently, he developed traumatic arthritis of the involved hip which required conversion to an uncemented THR, using a minimally invasive (MIS) anterolateral approach. The preoperative management, surgical technique, and postoperative rehabilitation are described to highlight the technical challenges, these lower limb amputees may present along with review of literature of such rare cases. CONCLUSION: THR in an above-knee amputee with posttraumatic hip arthritis using MIS technique is an encouraging surgical option for early functional recovery and minimizing surgical complications.

Intramuscular Arteriovenous Hemangioma of Thigh: A Case Report and Review of Literature.

INTRODUCTION: Skeletal muscle hemangiomas are uncommon soft tissue tumors; more than 90% are misdiagnosed initially. They present as chronic pain and swelling in a muscle with or without a history of trauma. Magnetic resonance imaging is the investigation of choice. Many treatment modalities for the symptomatic hemangiomas are available of which surgical excision is the most preferred. CASE REPORT: We present an unusual case of pain, swelling, and restriction of movements in the right knee following an episode of trauma in an 8-year-old boy diagnosed to have intramuscular arteriovenous hemangioma in the vastusmedialis and vastusintermedius for which he was treated by surgical excision and followed for 2 years and found to have no recurrence. CONCLUSION: Skeletal muscle hemangiomas are completely treatable; the knowledge of their natural history, clinical findings, and imaging appearances are of great importance for proper diagnosis and treatment.

Craniocervical junction tuberculosis: Usual pathology at an unusual site.

BACKGROUND: Tuberculosis (TB) of the craniocervical junction is rare even where the condition is endemic. It poses problems in both diagnosis and management if not managed in time it may cause life-threatening complications. CASE DESCRIPTION: An 18-year-old male patient presented with pain in the nape of the neck since 12 months duration which was not improving with medication. After magnetic resonance imaging of cervical spine, he was diagnosed as craniocervical junction TB. We did a transoral decompression of abscess with biopsy along with posterior decompression of cord and occipitocervical fusion. Biopsy of pathological material came as TB. He was advised for anti-tubercular therapy for 18 months. CONCLUSION: Although craniocervical junction TB is a rare disease, the outcome of treatment is good. Antituberculous drug therapy remains the mainstay of treatment after confirming the diagnosis. The surgical management options include transoral decompression with or without posterior fusion, depending upon the presence and persistence of atlantoaxial instability.

Complex Primary Total Knee Replacement (TKR) Using Prophylactic Gastrocnemius Flap and Rotating-Hinge Knee in Post-traumatic, Infective Arthritis of the Knee - A Case Report.

INTRODUCTION: Prophylactic gastrocnemius flap with primary rotating hinge knee is technically demanding in a case of neglected post-traumatic, infective arthritis of the knee, with challenges of compromised skin and soft tissues, articular bone defect, limb mal-alignment, gross instability, retained hardware and a contracted extensor mechanism with the patella fixed in the lateral gutter all in combination, is rarely reported. We report such a complex case in this study. CASE REPORT: We report a 48 year male patient with a history of fracture lateral femoral condyle of right knee due to road traffic accident 10 years back, for which he got operated with open reduction and internal fixation with cancellous screws, which subsequently got infected. Primary procedure undertaken was removal of implants, debridement, placement of antibiotic-cement spacer followed by prophylactic medial gastrocnemius flap and a temporary joint spanning external fixator. Definitive procedure undertaken, after clearance of infection in 12 weeks was conversion to a rotating hinge TKR using a lateral para-patellar arthrotomy & tibial tubercle osteotomy to address the challenges of fixed patella in the lateral gutter and contracted ligamentum patellae. At one year follow up, the knee was painless, stable, with satisfactory range of motion and improved function without any infection or aseptic lysis. CONCLUSION: Prophylactic Gastrocnemius flap cover along with rotating hinge knee arthroplasty using a lateral para-patellar approach and tibial tubercle osteotomy in a case of neglected post-traumatic, infective arthritis of knee with the complexities of limb mal-alignment, compromised skin and soft tissue, articular bone loss and ligamentous instability is a satisfactory bail out option in such a highly complex joint scenario.