Outcome Analysis of Adult Distal Radius Fractures Managed during COVID-19 Pandemic.

Introduction: COVID-19 pandemic created extreme pressure situation on health care services across the globe with shortage of medical staff and beds. The management of fragility fracture also affected significantly. The distal radius fractures (DRFs) are one of the common frailty fractures. There was a significant shift in the treatment of such injuries with new guidelines leaning toward more of non-operative management. Case Report: A retrospective cross-sectional study of DRFs (DRF) treated during COVID pandemic for a period of 1 year in the United Kingdom. This included all radiologically confirmed cases of DRFs with isolated adult injuries excluding polytrauma, same limb other injuries, associated neurovascular injuries, and age below 18 years. All patient's data were collected from hospital records retrospectively from April 2020 to March 2021. There were a total of 179 patients with distal radius fracture, of which 141 (78.8%) were females and 38 (21.2%) males. The mean age was 68.2 years (SD 68.20 ± 15.63) and there were greater number of patients with intra-articular fracture. There were 28.5% (Grades 1 and 2, Group I) extra-articular fractures; 69.8% (Grades 3-8, Group II) were intra-articular fractures and 3 Barton's fractures (Group III) accounted to 1.7%. 137 patients were (76.5%) treated to non-operatively and 42 (23.5%) were treated surgically. 135 (75.4%) patients had good and 43 (24%) satisfactory clinical outcomes. 3 (1.6%) patients required osteotomy for malunited fractures. Fracture grade I and II is significantly associated with non-operative procedure (100.0% vs 84.3%) with P < 0.001. Conclusion: This study confirmed that non-operative treatment is still a good option even in intra-articular fractures. Surgical fixation should be considered in young patients and those with higher grade of fracture classification and greater angulation at presentation. A virtual physiotherapy is still a good option.

Late and Vague Presentation of Septic Arthritis of Hip in a IVDrug Abuser.

INTRODUCTION: Septic arthritis of the hip is a rare entity in acute presentation of hip pain in adults. Even though hip is the second most commonly affected joint, adult patients with septic arthritis not related to a surgical procedure represent <0.00001% of total acute admissions. CASE REPORT: We present a 32-year-old female intravenous drug abuser, positive for Hepatitis B and C who had started to inject her femoral veins 2 years ago. She presented with a 10 weeks history of radiating pain in the leg which was full, constant and diffuse in nature with hip stiffness. She was treated for sciatica by her GP. She had later visited A and E twice (5 and 8 weeks) and was again treated symptomatically. She started to have increasing pain, hip stiffness, reduced mobility, and developed swelling of both legs extending upto groin medially. The patient was apyrexial throughout these visits. She did not have back/buttock pain. X-ray showed loss of joint space with evidence of articular surface destruction. Ultrasound showed no fluid collection inside the joint and deep vein thrombosis was ruled out. Hip joint was aspirated, and cultures grew Staphylococcus aureus from the aspirate. Flucloxacillin and fucidin were started as per hospital protocol. Skin traction was applied for pain relief with active hip movements as possible. Magnetic resonance imaging demonstrated complete joint destruction post- infective septic arthritis. After 8 weeks of antibiotics, inflammatory markers improved. Follow up X-ray showed complete ankylosis of hip joint, severe restriction ofhip movements and was allowed weight bearing as possible. CONCLUSION: Risk of septic arthritis should always be considered in mind when dealing with these cohorts of patients. Threshold for septic arthritis should be much lower especially in patients with complicated history, current or ex-drug abuser and presenting with vague symptoms. Early diagnosis, detection of organisms, specific targeted antibiotics, and joint wash out with a future consideration of total hip arthroplasty when the infection has settled will help patients resume their normal function.

Nonscaphoid carpal injuries - Incidence and associated injuries.

AIMS: Nonscaphoid fractures comprise approximately 40% of all carpal fractures. But the exact incidence of these rare injuries is still not clear. Missed or late diagnosis can lead to serious ligamentous disruption and permanent wrist dysfunction. METHODS: A retrospective analysis of wrist X-rays and CT scans were carried out for a period of 3 years. Incidence and associated injuries from this study was compared with literature. A total of 33 patients were included in our study. Both wrist X-rays and CT scans were reviewed individually by two authors. DASH scores were recorded for each patient. RESULTS: There were 26 male and 7 female patients. Out of 33 patients 13 (35%) were Triquetral fractures, 10 (27%) were Hamate fractures, 5 (14%) were Capitate fractures, 4 (11%) were Lunate fractures, 3 (8%) were Trapezium fractures and 2 (5%) were Pisiform fractures. There were no Trapezoid fractures in our study. CONCLUSION: Incidence of nonscaphoid carpal fractures in our study is considerably higher when compared to literature. We propose that high index of suspicion should always be borne in mind when dealing with carpal fractures and detailed examination of wrist should be conducted even when X-rays does not show any obvious bony injuries. CT scans and other specialized images should be judiciously used in areas of suspicion for early diagnosis, to initiate immediate treatment, for early mobilisation and good functional recovery.

Unusual presentation of popliteal soft tissue sarcoma: not every swelling in the knee is a Baker's cyst.

Popliteal soft tissue sarcoma is a rare tumour, but sometimes it does pose clinical, diagnostic and management challenges. We present here a case report which initially presented as Baker's cyst as it is one of the commonest cyst in this region. It posed a diagnostic challenge even with the help of new imaging modalities. But the patient presented herself to the hospital several times with new symptoms often pointing us towards common pathologies like Baker's cyst, deep-vein thrombosis and vascular lesions but diagnosis was established only after histology. Unfortunately, at this stage, disease was so advanced and metastasised, patient reached terminal stage and refused any kind of treatment.