Pathological Fracture of the Tibia in a Monostotic Anterior Cortical Fibrous Dysplasia: Hybrid Fixation with UnicorticalOsteoperiosteal Non-Vascularized Fibula Graft - A Case Report.

INTRODUCTION: Fibrous Dysplasia is a relatively rare Musculoskeletal disorders in which there is a defect in remodelling of immature bone to mature lamellar bone. Fibrous Dysplasia was first described by Von Recklinghausen in 1891, but it was Lichtenstein who labelled it polyostotic Fibrous Dysplasia in 1938. Union of Pathological Fractures in a bone affected by Fibrous Dysplasia poses a difficult set of Challenges for treating Physicians. CASE REPORT: We Report a 24 year-old female patient with a Pathological Fracture of the Tibia in a Monostotic Anterior Cortical Fibrous Dysplasia Hybrid Fixation with a UnicorticalOsteoperisoteal Non Vascularized Fibula Graft with a follow up until the union of fracture site on computed tomography scan and complete integration of unicorticalosteoperiosteal fibular graft . CONCLUSION: We provide additional and independent evidence that removal of the diseased cortex which were parts of the proximal and distal fragment and reconstruction of the defect in the cortex with a press- fitunicortical Non vascularized osteoperiosteal fibular strut graft with a hybrid fixation is a good treatment modality for monostotic fibrous dysplasia. Hybrid fixation includes retrograde intramedullary transarticular rodding extending across the subtalar and ankle joint into the tibia and augmentation of the primary fixation with a mono-planar rail Fixation in compression mode.

Cervical Myelopathy and Lumbar Spondylolisthesis in Elderly Patients with Diffuse Idiopathic Skeletal Hyperostosis (DISH) - A Case Series.

INTRODUCTION: Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory disease, which causes the ossification of spinal longitudinal ligaments and enthesis leads to stiffness in the affected segment of the spine and neurological deficit due to compression of spinal cord or nerve roots by osteophytes. CASE PRESENTATION: We present three cases of DISH, presented with cervical myelopathy, lumbar spondylolisthesis, and dysphagia. All three patients had neurodeficit and radiological examination showed cord compression, canal stenosis, listhesis, and contiguous ossification in the spine with normal sacroiliac joints. The first patient had cervical myelopathy because of compression of cord by ossified posterior longitudinal ligament, which was managed with posterior laminectomy, decompression, and stabilization. The second patient had L4-L5 listhesis with canal stenosis, which was managed with decompression, instrumentation and fusion (TLIF). The third patient had cervical myelopathy due to C6-C7 listhesis and also had dysphagia because of compression of esophagus by anterior osteophytes, which was managed with removal of anterior osteophytes and anterior discectomy and fusion (ACDF). Postoperatively, all three patients recovered completely with no residual neurodeficit. CONCLUSION: DISH can present in various ways, which depends on the site of involvement in the spine. Early surgical intervention helps in getting a better outcome in patients with neurodeficit and prevents further complications.

Comparison of two radiological methods in the determination of skeletal maturity in the Indian pediatric population.

To determine a more precise and reliable method between Greulich-Pyle (GP) and MacKay's (MK) method for the determination of skeletal age in an Indian pediatric population. We carried out a cross sectional study for the assessment of skeletal age on the basis of examination of hand and wrist radiographs of 106 patients (1-15 years of age) who presented with soft tissue injury to hand by the GP and the MK method. These radiographs were evaluated by a radiologist and an orthopedic surgeon independently. In girls, the mean age difference between chronological and skeletal age was 8 months by the GP method, whereas it was 17 months by MK method. For boys, the mean age difference was 10 months by the GP method and by MKs method, it was 20 months. By the GP method, 44% of the boys showed a more reliable estimate of age whereas it was 10% by the MK method. However, the same for girls was 25% by the GP method and 16% by the MK method. The inter-rater reliability for the raters was found to be κ=0.68 and this was statistically significant (P<0.001), 95% confidence interval (0.504-0.848). We concluded that the GP method appeared to be more reliable in the determination of skeletal age in the Indian pediatric population.

Isolated tuberculosis of scapula in a young adult.

Tuberculosis (TB) of the scapula is a very rare presentation among tuberculosis of bones and joints. The following case report describes a rare case of tuberculosis involving the inferior angle of the scapula in a young, immune-competent adult presenting with pain, swelling and an osteolytic lesion over the inferior angle of the scapula with a cold abscess. The diagnosis was confirmed on histopathology and culture, with Magnetic Resonance Imaging (MRI) acting as an adjunct to an early diagnosis. The patient was managed successfully with surgical debridement and a four-drug anti-tuberculous regimen.

Isolated tarsal navicular fracture dislocation: a case report.

UNLABELLED: Injuries to the midtarsal joints are rare. They occur in the form of various combinations such as fracture, fracture subluxation, and fracture dislocation. The largest series of 71 cases has been reported by Main and Jowett in 1975. Isolated tarsal navicular dislocations are rare injuries. Being rare, these injuries remain poorly understood. Only few case reports exist, which describe the probable mechanism of injury and optimal treatment. Of the few case reports, only one describes closed reduction with external fixator and percutaneous fixation as the treatment modality. This case report emphasizes the use of external fixation with pins in the calcaneum and not in talus as described by the earlier report. LEVELS OF EVIDENCE: Therapeutic, Level IV.

Bilateral multiligament injury of knee caused by entangled dupatta.

We report a rare case of bilateral multiligament knee injury in an 18-year-old female employed in garment industry. Patient was wearing salwar kameez and dupatta while operating an electric laundry machine. In this case we discuss a peculiar mechanism of injury caused due to wearing dupatta near working site and suggest simple preventive measures.