Functional Outcome of Single-Bundle Arthroscopic Anterior Cruciate Ligament Reconstruction using Peroneus Longus Graft and Hamstring Graft: An Open-Label, Randomized, Comparative Study.

Background This study investigates the functional outcomes of single-bundle arthroscopic anterior cruciate ligament (ACL) reconstruction, comparing the use of two distinct graft sources: peroneus longus (PL) graft and hamstring graft. The choice of graft material in ACL reconstruction is crucial for optimal postoperative results, and this study aims to contribute valuable insights into the comparative efficacy of these two graft types. Method This open-label randomized comparative study involved a carefully selected cohort of patients undergoing single-bundle arthroscopic ACL reconstruction. Participants were randomly assigned to either the PL graft group or the hamstring graft group. Surgical procedures were conducted using standardized techniques, and postoperative rehabilitation protocols were closely monitored. Functional outcomes, including range of motion, stability, and patient-reported measures, were assessed at predefined intervals to ensure comprehensive data collection. Results The study underscores significant demographic and clinical factors in ACL reconstruction outcomes. Participants were predominantly aged 17-30 years (58.33%) with a mean age of 29.27 years and exhibited a male predominance (80.56%). Common complaints included knee pain and instability, primarily due to falls from bikes (55.56%) or sports-related trauma (44.44%). Notably, PL grafts demonstrated advantages over hamstring grafts, with longer mean length (10.11 mm vs. 8.77 mm, p=0.0001) and shorter operation times. Visual analog scale (VAS), International Knee Documentation Committee (IKDC), and Tegner Lysholm scores show no significant differences between grafts over the period of time. There is no notable foot eversion weakness or significant donor site morbidity after the PL graft harvest. Hamstring graft cases exhibit a higher incidence of altered sensation and muscle atrophy, suggesting the potential benefits of PL grafts for improved surgical outcomes. Conclusions Graft comparisons favored PL grafts due to longer length, and functional outcome assessments between the two graft types. However, foot and ankle strength assessments revealed fluctuations in strength recovery with PL grafts, highlighting the need for tailored rehabilitation. Thigh circumference variations suggested potential muscle atrophy in the hamstring graft group, along with reported paresthesia in the ipsilateral proximal leg. In conclusion, PL grafts offer potential advantages for ACL surgery, but ongoing monitoring and specialized rehabilitation are crucial.

Rare Case of Gaucher's Disease Presenting as a Solitary Swelling of the Proximal Tibia Mimicking a Musculoskeletal Tumor in an Adult: A Case Report.

Introduction: Gaucher's disease is a congenital lysosomal storage disorder caused by an autosomal recessive mutation in B-glucocerebrosidase. It is a multi-system disease, wherein patients present with hematological abnormalities, joint pain, osteonecrosis, and developmental delay. We present a case of 38-year-old male with a painless solitary soft-tissue swelling over the left proximal tibia, eventually diagnosed it to be a case of Gaucher's disease. This case is unique in the literature, because this subcutaneous Gaucher mass was not associated with a significant past history and was being evaluated as a standard approach to a bone tumor. Case Presentation: A 38-year-old man presented to our outpatient department with a solitary, painless soft-tissue swelling of the left proximal tibia noticed 6 months back, which has gradually progressed to a present size of 9x5 cm over a period of 6 months. General physical examination revealed moderate splenomegaly. Radiographs showed an osteolytic lesion in the left proximal tibia without cortical erosion. Radiographs for skeletal survey revealed similar osteolytic lesions elsewhere. Hematological investigations revealed thrombocytopenia. A serum protein electrophoresis was found to be normal and the urine was negative for myeloma proteins. Blood workup for endocrine abnormalities was within normal limits. MRI of the lesion suggests bone infarct. Biopsy from the lesion showed a giant binucleate storage cell filled with glucocerebrosides suggestive of Gaucher's disease. The diagnosis was confirmed by elevated plasma levels of glucocerebrosidases. Conclusion: Gaucher's disease is a rare metabolic disease of the bone which may mimic a primary bone tumor or metastasis. A step-wise meticulous approach with biopsy and elevated plasma levels of glucocerebrosidase helps establish the diagnosis. Once must have a high index of suspicion for Gaucher's disease in an adult with multiple osteolytic lesions without any significant past medical and surgical history.

Bilateral Traumatic Nightstick Fracture of the Ulna - A Rare Case Report and Review of the Literature.

INTRODUCTION: Unilateral isolated ulna fracture secondary to trauma are common but the bilateral nightstick fractures are quite rare in the clinical scenario. These are managed conservatively or surgically depending upon the degree of displacement, location of the fracture, fracture pattern and associated injury to other bones. Proper management of these fractures helps in getting a better outcome. The purpose of the study was to present a case of bilateral traumatic isolated ulna fracture and its management. CASE REPORT: A 33-year-old male presented to the emergency department with complaints of pain and swelling over the dorsum of both forearms with a history of assault with a bamboo stick. The mechanism of the injury was, the patient placed his both the forearms in front of the face as a defense during the assault and sustained injury to both forearms. On examination, the patient had bilateral forearm swelling with tenderness. Bony crepitus was present over both the ulna on palpation. X-ray of both forearms (radius and ulna) revealed the fracture of both right and left ulna without any associated fractures/injuries. The patient was managed surgically with open reduction and internal fixation using a 3.5 mm locking compression plate. At present, 1-year follow-up, the patient is having complete wrist, elbow ROM and supination, pronation without any pain. CONCLUSION: Bilateral traumatic Nightstick fractures of the ulna are rare and this is the first reported case of traumatic bilateral isolated ulna fracture according to author's best knowledge and literature review. Open reduction and stable internal fixation using the principles of fracture fixation along with early mobilization helps in getting better functional outcome and prevents further complications and secondary procedures. This case is unique as it helps in identifying the mode of trauma in medico legal cases like assault in cases of bilateral ulna fracture. The mode and the mechanism of injury are different in this case.

Femur Neck Osteoid Osteoma Managed with Radiofrequency Ablation - A Case Report.

INTRODUCTION: Osteoid osteoma is a benign tumor of bones involving mainly the tubular bones and rarely axial skeletons. The patient mainly complains of night pain in the affected region or the joint nearby. Pain always subsides with analgesics and gradually increased over the period of time. It is mostly missed on the plain radiograph so magnetic resonance imaging or computed tomography (CT) scan are preferred for accurate and early diagnosis of the tumor. CASE REPORT: A 20-year-old male presented with pain in the left hip region which was gradually increased over the period of 6 months and was experiencing pain more in the night, used to relieve on medications. CT scan of the left hip showed the presence of osteoid osteoma of 0.5 cm diameter, which was managed with radiofrequency ablation. Moreover, the patient had pain relief immediately after the procedure. At present 1-year follow-up, the patient is symptomless with no recurrence. CONCLUSION: The neck of femur osteoid osteomas is best managed with radiofrequency ablation as it causes less morbidity to the patient and helps in early return to normal activities with fewer complications as compared to open procedures.

Giant Cell Tumor (GCT) of the Third Metatarsal in an Elderly Patient: A Rare Case Report.

INTRODUCTION: Giant cell tumour (GCT) is a benign osteolytic, locally aggressive lesion. Seen in young adults at the epiphysis. The most common site is long bones (85-90%). GCT of the metatarsal in elderly patients is very rare. CASE REPORT: A 60-year-old male came with complaints of pain and swelling over right foot dorsal aspect since for the last past one 1 year. There was no history of trauma. X-ray foot showed an osteolytic lesion in the right third metatarsal with thinning of the cortex. MRI and fine-needle aspiration cytology confirmed the diagnosis of GCT. The patient was managed by excision with the 3rd ray amputation. At present, 1.5 years follow-up, the patient is having no pain, difficulty in walking and no evidence of clinical and radiological recurrence . CONCLUSION: Giant cell tumours could also present at uncommon sites, and they should be considered in the differential diagnosis of lytic lesions of the metatarsals. Excision with ray amputation of the involved metatarsal helps in complete removal of the lesion and helps in early weight-bearing. This is the viable alternative treatment option in managing the metatarsal GCT in elderly patients.

Subtrochanteric Femur Fracture in Monostotic Pagets Disease and its Management - A Case Report and Review of Literature.

INTRODUCTION: Paget disease of bone is a chronic progressive disease of the bone of uncertain etiology, characterized initially by an increase in bone resorption, followed by a disorganized and excessive formation of bone, leading to pain, fractures, and deformities. It can manifest as a monostotic or polyostotic disease. Pathological fracture secondary to Paget's disease requires surgical management. CASE REPORT: A 60-year-old male patient came with complaint of pain and swelling over the left hip for 30 days. The patient had a history of a trivial fall. Radiological investigations were suggestive of pathological subtrochanteric femur fracture with Paget's disease of the left femur. We managed with the long proximal femoral nail (PFN). Histopathological examination confirmed the diagnosis of Paget's disease. At present 1-year follow-up, the patient is having good radiological and functional outcome with no implant failure. CONCLUSION: Subtrochanteric pathological femur fractures in Paget's disease are best managed with the long PFN with good outcome and fewer complications, which help in early mobilization and weight-bearing. Long PFN spans the entire pathologic femur and prevents the secondary fractures.

Non -Union of Lateral Hoffa Fracture - A Case Report.

INTRODUCTION: Hoffa is a coronal fracture of the femoral condyle. It is an uncommon injury easily missed on X-rays, which later presents as a non-union. Computed tomography (CT) scan knee helps in diagnosing undisplaced fractures and planning the management. CASE REPORT: A 24-year-old male patient presented to us with complaints of pain, decreased range of knee movements, difficulty in walking and clicking sound at the left knee for 9 years. The patient had a history of trauma 9 years back. X-ray of the left knee showed the non-union of left lateral Hoffa fracture, which was managed with open reduction and internal fixation with CC screws using the lateral para patellar approach. At present 1.5 years follow-up, the patient is comfortable with no pain and having a complete knee range of motion. CONCLUSION: Although Hoffa fracture is rare, clinical suspicion, along with radiological investigations, is essential to diagnose Hoffa fracture. A missed diagnosis can lead to malunion or non-union, which predisposes to knee arthritis. Timely and proper management of Hoffa non-union with open reduction, stable internal fixation and early knee mobilization help in getting a better outcome.

Management of Distal Femur Periprosthetic Fracture in an Elderly Patient by Open Reduction and Internal Fixation With Locking Plate Osteosynthesis -: A Case Report.

INTRODUCTION: Distal femur periprosthetic fractures are rare entityies and difficult to manage. Supracondylar femur fractures are most common amongst periprosthetic fractures. They can be managed by various modalities. These fractures are often difficult to treat because of various factors likesuch as osteoporosis, communication, female gender, and poor bone stock. Fixation of supracondylar femur fracture by locking plate provides excellent results in terms of radiological and clinical outcomes. CASE REPORT: We report a case of a 70 year -year-old female with pain and swelling in the right knee since for 1 day. She had a history of fall in bathroom 1 day back. The patient was operated with total knee replacement 6 years back for grade Grade 3 osteoarthritis of the knee. The patient was known case of hypertension and was on medication for the same. We operated the patient by open reduction and internal fixation with distal femur locking plate and it provided excellent clinical outcome. CONCLUSION: Periprosthetic supracondylar femur fractures are rare entity entities and generally difficult to manage, especially in elderly patient, due to poor bone quality. The choice of implant used to treat such fractures depends on the surgeon's choice and patient's compliance. Open reduction and internal fixation with a locking plate is a good entity as it provides excellent clinical and radiological outcome.

Hibernoma Around Shoulder Joint: Diagnosis and Surgical Treatment of a Rare Presentation.

Introduction: Hibernomas are uncommon benign proliferations arising from the adipocytes of brown fat usually occurring over back, neck, shoulder, and thighs. It is an underreported entity often misdiagnosed as a lipoma. Case Report: We report a case of an otherwise healthy thirty-four-year-old male who presented with a painless swelling, with no preceding trauma, involving the right shoulder joint of three months duration. MRI revealed it to be a fatty intense lesion arising within the anterior fibers of the right deltoid. The tumor was removed en-masse with wide local excision through the deltopectoral route. The histopathology of the resected tumor was consistent with the diagnosis of hibernoma. The patient recovered the previously hindered movements at the shoulder joint 2 weeks post-operatively. Conclusion: Hibernoma should be considered as a differential diagnosis for soft tissue tumors occurring in the above-mentioned sites. It can be completely resected surgically and no recurrences post-excision have been reported till date.

A Case Report of Humerus Shaft Osteomyelitis Secondary to Local Skin Infection Treated with Saucerization.

Introduction: Osteomyelitis of the humerus shaft after local skin infection is rare clinical entity, all the principles of tibia and femur osteomyelitis are used in the humerus osteomyelitis. Early detection is best done by the magnetic resonance imaging. Surgical debridement and curettage with IV antibiotics gives good clinical outcome in the patient. Case Report: A 35-year-old female presented with discharging sinus over posterior aspect of the humerus for 1 year. Diagnosis done based on X-ray and clinical examination. The patient managed with local debridement and saucerization, on follow-up patient is doing all the daily activities and no sign of recurrence at 18 months post-operative. Conclusion: Local debridement saucerization and course of IV antibiotics according to culture sensitivity give good clinical outcome in cases of humerus osteomyelitis.

Primary Total Knee Replacement in a Case of Lateral Tibial Condyle Delayed Union with Severe Grade 4 Osteoarthritis Knee - A Case Report.

INTRODUCTION: Tibial plateau fractures are not uncommon. These fractures occur in bimodal age distribution consisting of 8% of all geriatric fractures. They usually occur as a result of low-energy trauma in the elderly. The management options include closed/open reduction and internal fixation (ORIF) using screws and plates. The osteosynthetic treatment options cause malreduction, non-union, implant failure in elderly patients due to osteoporosis and this may lead to post-traumatic arthritis, requiring total knee replacement (TKR) as a secondary procedure later. CASE REPORT: A 76-year-old male patient presented with pain and swelling in the left knee with a history of trauma to the left knee. X-ray of the left knee showed the split fracture of the left lateral tibial condyle with severe Grade 4 osteoarthritis. On examination, tenderness was present over the lateral tibial condyle. We managed with cemented primary TKR using stemmed tibial component. Postoperatively, the patient is having good knee range of motion and having no difficulty in walking and weight-bearing. Functional outcome is good as per Oxford knee score. CONCLUSION: Primary TKR is a viable alternative treatment option compared to ORIF in elderly patients with preexisting osteoarthritis with tibial condyle fractures. It helps in early mobilization, weight-bearing and avoids secondary surgical procedures.