BACKGROUND Giant Cell Tumour (GCT) is a locally aggressive benign bone neoplasm characterized by proliferation of mononuclear stromal cells and many osteoclastlike multinucleated large giant cells affecting the epiphyseal segments of long bones mostly in females of 20 - 40 years age group. Distal radius is the third most common site of occurrence of GCT next to distal femur and proximal tibia. Resection or extended curettage remain the main modalities of treatment in Campanacci Grade I and II while en-bloc excision with reconstructive procedures, arthrodesis or amputation are the treatments of choice in Grade III with the latter two procedures leading to loss of joint function. Fibula being a non-weight transmitting bone of the lower limb, can be harvested in its proximal 1 / 3 rd and used for the reconstruction of the distal radius. In this study, we evaluate the functional and clinical results of resection and reconstruction using a nonvascularized fibula graft in the distal radius GCT. METHODS This is a prospective study of 20 patients diagnosed with GCT of distal radius either treated primarily at our institution or reviewed here after having been treated elsewhere. After confirmation of diagnosis, the patients underwent resection of the tumour and reconstruction of the distal radius using ipsilateral non vascularized fibula graft, fixed with dynamic compression plate. Follow-ups were done at regular intervals and radiological signs of graft healing, recurrence of tumour, wrist range of motion, and revised Musculoskeletal Tumour Rating Scale (MSTS) was used for assessing the functional outcome. RESULTS In our study, it was found that mostly females 13 (66.6 %) of the age group 30 - 35 yrs. were affected. The average grip strength achieved was 71 % (42 - 86 %) & average combined movements of 64 % (29 - 78 %) of contralateral normal side. Mean duration of union was 24 weeks (14 - 42 weeks). One case of non-union was seen which eventually achieved union with bone grafting. There was one case of soft tissue recurrence but the patient refused any further procedure. Complications were seen in 8 cases (41.6 %). We achieved excellent results in 15 (75 %), good in 2 (10 %), satisfactory in 2 (10 %) and poor in 1 (5 %) case. CONCLUSIONS We found that in GCT resection of the distal radius and reconstruction arthroplasty using autologous non-vascularized proximal fibular graft is useful in preserving the functional status as well as achieving satisfactory range of movement and grip strength with lesser chances of tumour recurrence. KEYWORDS Distal Radius, Giant Cell Tumour, Resection Reconstruction, Fibula
The neck of femur fracture is one of the commonest fracture amongst the elderly. Hemiarthroplasty is sought as the standard of treatment in these group of patients. Following surgery the resected head of femur is discarded. Though it has become a norm for routine histopathological evaluation of the head in total hip replacement but this is not the same in hemiarthroplasty. We studied 48 femoral head obtained after hemiarthroplasty in fracture neck of femur. Majority of our patients were female 28(58.33%) and the mode of injury in them was fall at home 19(67.85%) with mean waiting time for surgery 13±2.7days (Range 7.6-18.4days). We found degenerative osteoarthritis in form of Chondromalacia in 26(54.16%) patients among which males 15(57.69%) were the predominant variety presenting with a higher stage which was statistically significant in nature (P value= 0.014, χ2 value=5.994, df=1). Avascular necrosis was seen in 11(22.91%) cases. Though we found female (6) to be more affected but it was not statistically significant (P value=0.772, χ2 value=0.084, df=1). We found no cases of neoplasm or infection in our study. The histopathological study of the femur head didn't alter the further treatment plan of the patients. Hence we won't recommend doing a routine tissue study of the resected head in these group of patients without any prior positive history (like neoplasm) which will lead to savings over health expenses.
BACKGROUND Tibial shaft fracture is one of the commonest fractures encountered in orthopaedic clinics today. With recent trend being surgical management, it has increased the economic burden in developing countries like India. Thus, interest in functional cast bracing can manage many of the fractures safely with less cost and shorter hospital stay with equally good results. METHODS This prospective study included 30 patients with closed tibial shaft fracture with minimal displacements who were treated with 3 weeks of initial long leg cast followed by functional cast bracing as described by Sarmiento in 1967 with a below knee patellar tendon bearing (PTB) cast with encouraged progressive weight bearing for 6 to 9 weeks. Our goal was to achieve shortening of < 10 mm, angulations of less than 5 degrees in any plane with full range of motion at knee as per Sarmiento. RESULTS Union was seen in 25 (83 %) cases. Angulations of < 5 degrees was noted in any plane in 79 % cases. Varus and apex posterior angulations were the most common deformity. Shortening 10 mm was noted in 72 % cases with almost complete ROM of knee joint in all patients. Non-union was noticed in 2 (7 %) cases. CONCLUSIONS Functional cast bracing can still be an ideal method of management for many of the tibial shaft fractures and with better understanding of the technique and proper application, it can safely be used on other long bones as well. KEYWORDS Closed Fracture Tibia, Functional Cast Brace
Resumo Objetivo O tratamento da fratura de Colles pode deformar o pulso. Alguns estudos afirmam que essa deformidade raramente dificulta as atividades diárias, enquanto outros relatam o contrário; assim, a redução anatômica é desejável. Nosso objetivo foi analisar os resultados anatômicos e funcionais da fratura de Colles para descobrir os valores de parâmetros individuais correspondentes ao melhor desfecho funcional. Métodos Este estudo prospectivo incluiu 70 pacientes idosos com fratura de Colles. Todos os pacientes foram tratados de forma conservativa. Os parâmetros anatômicos foram a angulação dorsal, a inclinação radial e a altura radial, avaliados de acordo com Stewart et al. O resultado funcional foi avaliado segundo a tabela de pontuação de pulso Mayo. Os resultados foram analisados por meio do teste de associação do qui-quadrado, considerando o valor de p < 0,001 estatisticamente significativo. A força das associações foi analisada por razões de possibilidades com intervalos de confiança de 95%. Resultados Excelentes e bons resultados anatômicos e funcionais foram obtidos em 68,5% e 78,5% dos casos, respectivamente, com diferença estatística significativa (p = 0,0009). Dos três parâmetros anatômicos, a angulação dorsal inferior a 10° e a perda da inclinação radial inferior a 9° apresentaram associação estatisticamente significativa com os resultados funcionais (p = 0,0006), mas não a perda de altura radial inferior a 6 mm (p = 0,0568); no entanto, a perda da altura radial inferior a 4 mm foi associada de forma significativa aos desfechos funcionais (p = 0,00062). Conclusão As fraturas com redução anatômica apresentam melhores desfechos funcionais. Os parâmetros anatômicos limítrofes aceitáveis para a obtenção de resultados funcionais excelentes ou bons são angulação dorsal inferior a 10°, perda da inclinação radial inferior a 9° e perda da altura radial inferior a 4 mm.
Ewing's sarcoma rarely arises from clavicle. Total claviculectomy is a generally accepted method of treatment with good functional outcome. We report a case of a 15 year male patient diagnosed with Ewing's sarcoma clavicle treated with total claviculectomy. The purpose of our study is to evaluate the functional and oncological outcome after total resection of clavicle. This patient had full range of motion of the shoulder joint without any deficit. Thus, total claviculectomy can be considered as procedure in primary clavicular malignancy.
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