SUMMARYOsteochondromas, or exostoses, are overwhelmingly found as isolated lesions although they can be present within the context of multiple hereditary exostosis. Increased exostotic load associated with multiple hereditary exostosis can lead to limb-length discrepancy, increased femoral anteversion, valgus angulation, and acetabular dysplasia. Solitary osteochondromas have been linked with bursal inflammation and pain, compression on neurovascular structures, and malignant degeneration, groin and lower extremity pain. Isolated exostosis involving the femoral neck is a rare entity which is often diagnosed late when the patient is being investigated for other problems. We present a young female with a history of hip pain for 3 years with restriction of movements around the hip joint and radicular pain which turned out to be a solitary osteochondroma of the femoral neck. Surgical excision relieved the symptoms.
Radial head and neck fractures are common in young to middle age adults and are seen in nearly 20 % of acute elbow injuries in this age group. These are usually associated with high energy traumas like falls from height, road traffic accidents and sports injuries. Unilateral radial head fractures are relatively common and may be associated with other concomitant injuries. Bilateral radial head fractures are rare and are mostly seen in situations when the patient has a fall on outstretched, supinated hands or a direct fall on the elbow. These injuries can be easily missed by the attending physician if the symptoms are more severe on one side, thus neglecting the other. The treatment of these fractures may be conservative or operative, depending upon the degree of head comminution, the percentage of articular surface involved, presence of loose intra-articular fragments and angulation between the radial neck and proximal shaft. We present a case series of three patients with bilateral type 1 radial head fractures (one case having type 3 on one side) managed with brief immobilization followed by active physiotherapy and full, uneventful recovery. The emphasis in these cases is the need for a high index of suspicion in the diagnosis of multiple injuries, no matter how `trivial` the mechanism of injury and, unless the history of the mode of trauma is highly suggestive, such injuries can be missed easily and cause long term problems for the patient.
We report six cases of minimally displaced two-part patellar fractures with skin injury over the patella that were treated with percutaneous K wire fixation and compression applied using stainless steel (SS) wire. This technique makes it possible to perform early operative treatment in cases where unhealthy skin is not amenable to conventional tension band wiring. The technique employs two K wires inserted through the two fracture fragments under local or regional anaesthesia. They are then compressed using simple SS wire knots at the two ends - making it look like noodles at the end of two chopsticks. The fixation is subsequently augmented with a cylindrical plaster-of-Paris cast. The technique is simple, cheap and does not cause soft tissue injury.
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