Outcomes of Osteoid Osteoma Treated by Percutaneous CT-Guided Radiofrequency Ablation.

Introduction Osteoid osteomas are the most frequent true benign bone tumor in the adolescent age group and the third most prevalent benign bone tumor overall. This study was designed to assess the effectiveness of the procedure and correlate it with the analgesia offered because of the significant burden of this illness and new literature supporting the successful outcomes of image-guided percutaneous radiofrequency ablation (RFA) in osteoid osteoma. Methodology  This hospital-based interventional trial was carried out in a tertiary care referral center. Forty-two patients with osteoid osteoma, ranging in age from 9 to 30, were included in the study. The patients received RFA guided by computed tomography (CT), and they were postoperatively monitored at one, two, and four weeks and three, six months, and 12 months. A numerical pain scale (NPS) was used to evaluate the patient's pain both before and after the procedure. The preoperative and postoperative results were contrasted. Results A total of 42 participants were enrolled in the study. Eight (19.05%) women and 34 (80.95%) men made up the group. Complete pain alleviation (NPS=0) was attained in 42.8% and 96.4% of the study group in the first and second weeks post-procedure. Almost all patients began protected weight-bearing at one week, according to their level of pain tolerance. Osteoid osteoma of the talus was a remnant lesion in one patient that required further treatment after two weeks. During the duration of the follow-up, no problems were recorded. Conclusion Percutaneous CT-guided RFA of osteoid osteoma is a safe, minimally invasive procedure and greatly reduces the duration of hospitalization. It has excellent functional outcomes and no known complications.

A Comparative Analysis of Commonly Used Surgical Approaches for Anterior Acetabular Fractures.

Introduction Fractures of the acetabulum are inherently complex due to the anatomy of the innominate bones and also the presence of several vital neurovascular structures in the vicinity. Thus, the treatment of pelvic ring and acetabulum fractures is riddled with complexities and is considered among the most challenging surgeries for an orthopedic surgeon. When anterior access is necessary, such as in the anterior column, both columns, anterior column posterior hemitransverse, transverse, and T-type fractures, both the ilioinguinal and the anterior intrapelvic (AIP) or modified Rives-Stoppa methods are employed. The aim of this study is to compare the results from acetabular fractures treated with a modified Stoppa and ilioinguinal technique. Materials and methods We conducted a prospective cohort study to compare the outcomes of anterior acetabular fracture fixation using the modified Stoppa approach and the ilioinguinal approach. The outcomes measured were the amount of intraoperative bleeding, surgery duration, postoperative quality of fracture reduction, postoperative drain collection, and postoperative neurovascular status. The functional outcome was measured at three, six, and 12 months using the Merle d'Aubigné score. The radiological outcome was measured using the Matta scoring system. Results A significant difference was noticed in the two groups in the average blood loss and surgical duration, where the mean blood loss was 911.67 ± 143.05 ml in the ilioinguinal approach and 748.33 ± 165.30 ml in the modified Stoppa approach. While the ilioinguinal approach had a mean surgical duration of 190.33 ± 29.42 minutes, the modified Stoppa approach had 151.33 ± 23 minutes. The difference in postoperative fracture reduction in both groups was insignificant. The lateral femoral cutaneous nerve was compromised in 8.33% of cases in group A. The obturator nerve was compromised in 6.67% of cases in group B. The postoperative functional outcome was assessed by the modified Merle d'Aubigné score, and the radiological outcome was evaluated by the Matta score. The results obtained in both our study arms were comparable. Conclusion Based on our results, we can safely advocate the superiority of the Stoppa approach over a more extensive ilioinguinal approach. By virtue of being shorter in surgical duration and causing lesser blood loss, the Stoppa approach seems to be a better alternative, especially in elderly or polytrauma patients. As no difference was noted in the postoperative outcomes both clinically and radiologically, no approach showed superiority over the other in terms of patients' eventual functional outcomes.

Changes in sagittal and axial plane alignment in medial opening wedge high tibial osteotomy: a prospective observational study.

PURPOSE: Deformity correction during high tibial osteotomy is generally based on coronal plane alignment. The aim of this study was to measure changes in sagittal and axial plane alignment following medial opening wedge high tibial osteotomy [mHTO], using pre- and postoperative computed tomography [CT] scans, and correlate them with changes in coronal plane. The secondary objective was to correlate changes in functional outcomes with changes in alignment in each plane. The null hypothesis was that sagittal and axial plane alignment does not change significantly following mHTO. METHODS: This was a prospective, observational study including 30 patients of isolated medial compartment osteoarthritis of the knee joint, between 30 and 60 years of age. Preoperative and postoperative computed tomography scan of bilateral lower limbs from hip to ankle was performed. Varus angle, mechanical axis deviation [MAD] of the lower limb, medial proximal tibial angle [MPTA], tibial torsion and posterior proximal tibial angle [PPTA] were measured. Visual Analogue Scale [VAS 0-10 cm scale] was used for assessment of pain. Functional outcomes were evaluated using Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], 12 Item Short Form Survey [SF 12] and Tegner Lysholm knee scoring scale. RESULTS: Mean age of patients was 44.59 ± 8.157 years. Mean preoperative varus deformity was 11.13 ± 1.5 degrees, which got corrected to a mean valgus alignment of 3.8 ± 0.93 degrees postoperatively. The mechanical axis deviation was 4.32 ± 1.76 mm lateral to the knee joint center postoperatively. Preoperatively, all knees had external tibial torsion [27.08 ± 2.18 degrees] which was corrected to a mean external tibial torsion of 19.80 ± 3.72 degree after the surgery [P < 0.001]. The overall decrease in sagittal alignment in the present study was 3.70 ± 3.14 degree, 3.97 ± 3.06 degree, 3.92 ± 2.33 degree, for medial, middle and lateral cuts, respectively. There was a significant correlation between change in varus/valgus angle and change in TT and PPTA. Significant positive correlation was seen between change in coronal alignment and functional outcome scores. CONCLUSION: This study has shown that mHTO significantly changes torsional and sagittal alignment. This is the first study to establish relation between correction in coronal plane and associated changes in sagittal and torsional alignments.

Bilateral Traumatic Anterior Hip Dislocation - A Case Report.

Introduction: Traumatic anterior hip dislocation is less common than posterior dislocation and bilateral anterior hip dislocation is a very rare presentation. Early diagnosis and treatment are of paramount importance to prevent complications. Here, we report a case of traumatic bilateral anterior hip dislocation following a high-velocity motor vehicle accident. Case Report: A 26-year-old man was brought to the emergency department following high-energy trauma due to a motor vehicular accident. He was in considerable pain with both hips in flexion, abduction, and external rotation. There was a restriction to the range of movement at bilateral hip joints. Clinical and radiological examination revealed bilateral anterior hip dislocation. Conclusion: Isolated anterior, obturator type of dislocation involving both hip joints with no other associated bony injury is quite unusual. The diagnosis and treatment have to be prompt. The chances of complications are high.

Outcome of Neglected Talus Neck Fracture and it's Management: A Case Report.

INTRODUCTION: Talus fracture is an uncommon fracture that can be encountered on day- to- day basis. However, it is the 2nd most common tarsal bone to get fractured after calcaneum and accounts for approximately 1% of all fractures around foot and ankle. The anastomotic ring around the talar neck is highly likely to get damaged at the time of the fracture, which, in turn, hampers the blood supply to the body of talus. As a result, the bone healing is delayed and the integrity of the healed fracture is poor which leads to poor functional outcome. Almost 39% cases are missed during the initial evaluation, and talus fracture accounts for almost 50% of all the missed injuries (6-8). A high level of clinical suspicion is required to avoid missing such injuries. CASE REPORT: A 26-year-old male presented to the outpatient department with chief complaint of pain over the left foot while walking for past 6 months. There was a history of significant trauma to the foot 6 months back (fall from 12 feet) for which he sought medical advice and was managed with analgesics and rest for a couple of weeks. He presented to us 6 months later with chronic, dull aching, and continuous pain which aggravates while walking and standing. The diagnosis of the non-union fracture neck of talus was made after radiology and was managed by open reduction and internal fixation with cannulated cancellous screws along with contralateral iliac crest cancellous bone grafting. CONCLUSION: Delay in diagnosing such injuries accelerates the vascular compromise, delays timely intervention, and ultimately leads to increased morbidity.

Trochanteric Advancement and Limb Lengthening by Monorail External Fixator in Sequelae of the Septic Hip in Children - A Simpler Alternative to Other Complex Procedures.

INTRODUCTION: Acute septic arthritis of the hip in children requires prompt diagnosis and treatment. The resulting sequelae of septic arthritis are diverse. Varieties of procedures have been described in the orthopedic literature. The common goal of treatment of all these procedures is to achieve a mobile, stable, pain-free hip joint with minimal limp and limb length inequality. CASE REPORT: We present two cases of Choi's Type 2 septic hip sequelae, a 14-year-old female and a 13-year-old male, both had painless limp and limb length discrepancy managed by greater trochanteric advancement with limb lengthening by monorail external fixator at single sitting. CONCLUSION: Distal greater trochanteric advancement with limb lengthening by monorail external fixator is a useful technique to treat septic hip sequelae with stable hip joint.

Single-stage 360° Reconstruction in a Case of Solitary Vertebral Plasmacytoma of L3 vertebra - A Case Report.

INTRODUCTION: Malignant bone tumors of the spine are extremely rare with an incidence of 0.05% of primary neoplasms. Solitary plasmacytoma of the vertebra accounts for about 30% of the total within this group. CASE PRESENTATION: A 23-year-old female presented to spine clinic, with complaints of low back pain, deformity in lower back, and difficulty in walking for 3 months duration. Radiological investigations revealed destruction of L3 vertebra with soft-tissue mass around it. USG-guided biopsy from the lesion was suggestive of plasma cell dyscrasia. Routine blood investigations showed no abnormality. Urine myeloma profile and immunoelectrophoresis were done which were within normal limit and ruled out multiple myeloma. Due to the profound neurological deficit and existing instability, the patient underwent decompression, resection of tumor, anterior column reconstruction with cage, and instrumented posterior and posterolateral fusion (360° fusion) from L1-L5, before radiotherapy. The patient was subjected to 23 cycles of intensity-modulated radiotherapy and is doing good on subsequent follow-ups with good fusion. CONCLUSION: Solitary plasmacytoma of vertebra when associated with neurological deficit and/or instability should be treated with spinal stabilization surgery followed by radiotherapy to achieve good and overall predictable outcomes.

Combined Talus Fracture with Medial Malleolar Fracture: A Case report with Review of Literature.

INTRODUCTION: Combined talar body fracture with a medial malleolar fracture is rare in literature. CASE PRESENTATION: A 30-year-old female presented to our hospital with complaints of pain and swelling over the right ankle joint with difficulty in bearing weight following a motor vehicle accident. Investigation showed talar body fracture of type 2 Sneppen (classification) with an ipsilateral medial malleolar fracture. Fractured talus was openly reduced with the help of reduction clamp and appropriate sized Herbert screw applied to hold the reduction. The medial malleolar fracture was fixed with an appropriate-sized cannulated cancellous screw after confirming satisfactory reduction. The patient was followed up for wound complications, AVN changes, early osteoarthritic changes, and functional outcome. CONCLUSION: The combined talar body fracture, ankle dislocation with a medial malleolar fracture, should be managed; as soon as, a diagnosis is made to get a good functional outcome, even though the incidence of skin complication, AVN risk, and post-traumatic ankle arthritis could not be predicted even though it was absent in our case.

Migration of Rod: A Case Report of Rare Complication of Minimal Invasive Surgery in Spinal Trauma with Narrative Review of Literature.

INTRODUCTION: Traumatic spine injury is one of the leading causes of morbidity and mortality in trauma patients. Open surgical procedure is associated with increased blood loss, surgical trauma, and increased recovery period. The goal of minimally invasive surgery (MIS) is to minimize iatrogenic trauma caused by open surgery. CASE REPORT: A 39-year-old female patient presented to us with complaints of severe pain in back following a fall from ten feet height 1-day back. She was diagnosed with L1 burst fracture and was managed by indirect fracture reduction and posterior instrumented stabilization from D12 to L2 by MIS. She presented to us with complaints of pain over back after 3 months of index surgery. Neurology was intact, and ESR and quantitative CRPH were normal. X-ray showed downward and outward displacement of left connecting rod with pedicle screws in situ. CONCLUSION: Minimal invasive surgery in spine is associated with steep-learning curve and technical challenges. Mechanical complications associated with implants should be always kept in mind while planning the surgery.