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INTRODUCTION: Neglected patellar tendon ruptures are uncommon. They are challenging due to the proximal migration of patella and soft-tissue contractures. They are usually managed with autografts or allografts with or without synthetic augmentation, and fixation is done using metallic implants. CASE REPORT: A 59-year-old farmer presented with an inability to straighten his knee for 6 months after sustaining a cut lacerated wound with a sickle. He was diagnosed with a patellar tendon rupture. Tendoachilles' allograft reconstruction was done by creating transosseous tunnels in the patella and tibial tuberosity with a figure of 8 con figurations of the final construct. Synthetic augmentation and metallic implants were not used. Excellent clinical and radiological results were achieved at 3 years' follow-up. CONCLUSION: Chronic patellar tendon ruptures can be managed using allograft without the need for synthetic augmentation or fixation with implants. This gives excellent clinical and radiological results.
RESUMO
INTRODUCTION: Neglected knee dislocations are a rare entity. They present with gross degenerative changes and ligament laxity. There is no defined protocol for the treatment of arthritic knees in neglected knee dislocations. CASE REPORT: A 54-year-old male presented with pain and limp over his left knee after sustaining a knee dislocation 25 years back which was unsuccessfully reduced by open methods twice. Since the patient was a farmer and involved in heavy labor activities, we decided to avoid arthrodesis of his knee and help him ambulate immediately without any functional limitations. We performed a hinged total knee arthroplasty (TKA) which corrected the deformity, ligament laxity, and pain and helped him gain complete range of movements. The patient was followed-up till 30 months after the surgery with excellent clinical and radiological results. CONCLUSION: A hinged TKA is a reliable technique to correct a neglected knee dislocation in a single sitting provided thorough pre-operative assessment and post-operative physiotherapy are done.
RESUMO
INTRODUCTION: In chronic renal failure, plasma 1,25-hydroxyvitamin D levels decrease due to the disturbance of the hydroxylation of 25-hydroxyvitamin D in the kidney, which results in decreased calcium absorption from the intestine. This induces hypocalcemia, which increases the secretion of parathyroid hormone. Parathyroid hormone can stimulate bone resorption which renders the bone susceptible to fractures even with trivial trauma. CASE REPORT: The present case describes a 41-year-old male who was diagnosed with chronic kidney disease for 6 months and started taking Ayurvedic medications after the diagnosis was established. The patient was a known hypertensive for 10 years and the patient was not taking medications for hypertension. The patient had a trivial trauma 2 months back following which he was able to walk and carry out his daily activities. He developed pain over both the hip joints which were gradually progressive and pain increased to the point, wherein the patient was unable to walk 1 month after the episode of trivial trauma. The patient was admitted for inability to walk and a radiographic study of the pelvis revealed bilateral femur neck fracture. Since the left hip was more symptomatic, the patient underwent total hip replacement of the left hip first following which total hip replacement of the right hip was done 4 days after the first surgery. The patient started ambulating full-weight-bearing with the help of a height adjustable walker from the very next day after total hip replacement of the right hip. CONCLUSION: Although Ayurvedic medications have been in practice since centuries, their side effects need to be documented correctly. This particular case suggests the role of Ayurvedic medications in accelerating osteoporosis of the proximal femur, leading to bilateral femur neck fractures.
RESUMO
INTRODUCTION: Antiretroviral drugs are known to cause osteoporosis making the bones susceptible to fracture. Osteoporotic fractures are majorly seen in the vertebral bodies. Pathological fractures need to be fixed without much delay to start mobilization of the patients. CASE REPORT: The present case describes a 72-year-old male who was diagnosed to be human immunodeficiency virus-positive 11 months back for which the patient was on a combination of antiretroviral therapy for 11 months. The patient was a farmer by occupation. The patient presented to us with left sided hip pain for1 week with no history of trauma or fall. The patient was able to walk approximately 100m with the help of a height adjustable walker. However, activities such as squatting and sitting cross-legged were restricted for1 week. Radiographic examination revealed a fracture of the left neck of the femur. The patient was evaluated for metastasis the investigations for which were negative. Bipolar hemiarthroplasty of the hip was done since radiographically and intraoperatively no changes were noted in the acetabulum which would have changed the plan to total hip replacement. Following the surgery, patient started walking full-weight bearing from the very next day after surgery. CONCLUSION: This case concludes the potential of antiretroviral drugs such as abacavir, lamivudine and efavirenz to cause pathological fractures which has never been described in literature before.
