Multiple Metacarpal Loss Secondary to Tuberculous Dactylitis: Challenges and Management: A Case Report.

Tuberculous dactylitis is infrequently seen after the age of 6 years. The index and middle fingers are the most common sites. Early diagnosis is essential to eradicate the infection. Delay in diagnosis and management leads to extensive involvement which may require surgical intervention. The current literature reveals conservative management gives satisfactory results in early stages. Though surgical intervention in Tuberculous dactylitis is seldom required, delay in diagnosis and management leads to extensive involvement of the bone and sequestration which does not respond to Anti Tubercular Therapy and needs staged surgical interventions. We report a case of an 11-year-old girl who presented to us after extensive involvement of 2nd and 3rd metacarpals and failed to respond to ATT even after 1.5 years of medication. She required staged surgeries to eradicate the infection which led to loss of 2nd and 3rd metacarpals. Complex reconstructive procedures of hand were required in stages and the bone loss was managed with non-vascularized Fibular strut graft. At 2 years of follow up, there is complete incorporation of the graft, and the patient has satisfactory functions of the hand and can carry out activities of daily living with ease.

Patellar Tendon Rupture During Postoperative Physiotherapy for Crouch Gait: A Case Report.

INTRODUCTION: A 14-year-old adolescent girl with spastic diplegic cerebral palsy underwent bilateral distal femur extension osteotomy and patellar tendon plication. Two and a half months after surgery, during physiotherapy, she sustained mid-substance tear of the left patellar tendon. The girl was successfully managed with patellar tendon repair and augmentation with tensor fascia lata autograft. CONCLUSION: Patellar tendon rupture during rehabilitative physiotherapy after patellar tendon plication surgery is rare. Postoperative protocols in patients with cerebral palsy are crucial and should progress gradually to improve knee range of motion. This report highlights that patellar tendon repair with fascia lata augmentation yields good outcome.

Challenges in Management of Proximal Humerus Diaphyseal Fracture in a Patient with Brachial Plexus Birth Injury: A Case Report.

CASE: Two-and-a-half-month-old boy, a known case of brachial plexus birth injury, sustained proximal humeral diaphyseal fracture. Fracture healed in varus malunion and failed to remodel subsequently. Challenges were faced in the course of the management because of progression of the deformity. Finally, the fracture united after rigid internal fixation performed at 2.5 years. CONCLUSION: Neuromuscular imbalance can lead to angular deformity at fracture site and cause unpredictable remodeling, as in our case. Conservative management may fail to achieve union with satisfactory alignment. Rigid internal fixation should be considered in such cases to achieve union.

Brachial Plexus Birth Injury due to Proximal Humeral Physeal Separation: A Case Report.

CASE: A 9-day-old male neonate presented with swelling over his left shoulder and reduced movements of the left upper extremity since birth. Radiographs raised a suspicion of a shoulder dislocation. Ultrasonography confirmed the diagnosis of proximal humeral physeal separation. Magnetic resonance imaging (MRI) revealed edema of the infraclavicular part of the brachial plexus. Conservative management was followed, and the injury remodeled completely at 2 years. CONCLUSION: Neonatal proximal humeral physeal separation poses a diagnostic challenge. Ultrasonography is helpful for diagnosis. MRI is indicated when concurrent brachial plexus birth injury is suspected. Conservative management yields good outcome in the absence of entrapped nerves and tendons.

Management of Post-osteomyelitic Large Ulna Defect in a Pediatric Patient.

Osteomyelitic sequelae in forearm pose challenges in management. Bone resorption leading to gap nonunions is further difficult to manage. We present a case of post-osteomyelitic ulna defect of 16 cm in a 6-year-old boy managed by non-vascularized fibular grafting with simultaneous correction of radius deformity and its functional outcome after 1 year.

Hip Spica Table: A Technical Note.

Introduction: Hip spica is a widely used treatment modality in the management of various paediatric orthopaedic conditions. A standardized hip spica table is not universally available and various centerres have devised their own designs. In collaboration with the local engineering team, we have designed a light weight yet sturdy, economical and portable hip spica table. Materials and Methods: Components of the spica table and their measurements are described. Technique of mounting and unmounting the patient off the table has been discussed. We have applied the hip spica using the current design in 141 children between 2009 and 2023. The same table has been used for the children aged 6 months to 10 years. We have not experienced any table breakage during spica application. The acrylic sheet was changed only once during the study period due to attrition. Conclusion: Our design has been used successfully at our center for more than 14 years. It is simple, economical, portable and durable. It can be used in dedicated pediatric orthopedic centers and can be carried easily to the field hospitals. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-023-00935-1.