Background:A number of techniques have been described to reattach the torn distal biceps tendon to the bicipital tuberosity. We report a retrospective analysis of single incision technique using an endobutton fixation in sports persons.Materials and Methods:The present series include nine torn distal biceps tendons in eight patients, fixed anatomically to the radial tuberosity with an endobutton by using a single incision surgical technique; seven patients had suffered the injuries during contact sports. The passage of the endobutton was facilitated by using a blunt tipped pin in order to avoid injury to the posterior interosseous nerve. The patients were evaluated by Disabilities of the Arm, Shoulder and Hand (DASH) score and Mayo elbow score.Results:The average age of the patients was 27.35 years (range 21–42 years). Average follow-up was 41.5 months (range 24–102 months). The final average flexion extension arc was 0°–143°, while the average pronation and supination angles were 77° (range 70°–82°) and 81° (range 78°–85°), respectively at the last followup. All the patients had a Disabilities of the Arm, Shoulder and Hand (DASH) score of 0 and a Mayo elbow score of 100 each. All the seven active sports persons were able to get back to their respective game. There was no nerve injury or any other complication.Conclusions:The surgical procedure used by us is a simple, safe and reproducible technique giving minimal morbidity and better cosmetic results.

Recent reports on atypical femoral fracture have raised concerns about the long-term use of bisphosphonate. More recent case series focus specifically on the subtrochanteric fractures. But, there is relatively rarity and unawareness of atypical fracture in upper extremity. We report forearm fracture in two women receiving long-term bisphosphonate therapy. First woman presented with pain in the forearm and both thighs and radiographs showed incomplete fractures in a proximal ulnar shaft and bilateral femoral shaft. The other woman had a fracture in the radial shaft. This report suggests atypical fractures associated long-term use of bisphosphonate could occur in bones other than femur. More study is required to identify the magnitude of clinical features of this emerging concern.

Treatment of displaced radial neck fractures is challenging and controversial, as the risk of unsatisfactory outcome increases after operative as well non-operative treatment. Between 2004 and 2012, we treated 14 children with type IV fracture of radial neck with mean angulation of 72.8°, using the modified Metaizeau technique. The average follow-up was 39 months. Heterotrophic ossification and transient posterior interosseous nerve palsy were the only complication seen in two patients who had to undergo open reduction. We feel that the inability to achieve closed reduction can be attributed to loss of periosteal hinge. We obtained 100 % excellent clinical outcome and 79 % excellent radiological outcome at final follow-up. The modified closed intramedullary pin reduction technique proved to be minimal invasive technique for displaced radial neck fractures by allowing stable anatomic reconstruction while avoiding all the complications of classical Metaizeau technique.

Varus posteromedial rotatory instability refers to one of the complex elbow fracture-dislocation caused by anteromedial coronoid fracture with disruption of lateral collateral ligament (LCL). Recent clinical and biomechanical studies have demonstrated that this unstable complex injury resulted in incongruence of joint, which could lead to early posttraumatic arthritis. With reports of poor result after conservative treatment, surgical treatment including anteromedial fixation and LCL repair has been strongly recommended to achieve stable joint. This case series describes three patients with anteromedial coronoid fracture who were managed conservatively with excellent outcomes. This report suggests that anteromedial coronoid fracture associated with posteromedial rotatory instability might be treated using conservative treatment in selective cases when anteromedial coronoid fracture is minimally displaced and there is no evidence of elbow subluxation.

This study aims to retrospectively evaluate the results of soft tissue distraction using Ilizarov in relapsed clubfeet following a previous posteromedial soft tissue release. This study, as compared with previous studies, has a cohort of patients with relapsed clubfeet only following posteromedial soft tissue release. Fifteen patients (16 feet) were assessed using the International Clubfoot Study Group score and plantigrade foot was achieved in all except one patient who had equinus deformity. Fourteen feet were graded as showing excellent or good result on the basis of the International Clubfoot Study Group (ICFSG) score. Although no patient had an ICFSG score of 0, parental satisfaction was good. This report supports the use of Ilizarov as the benefits offered outweigh the risk of associated complications, making this potentially cumbersome apparatus a useful tool in the armamentarium to treat relapsed clubfeet following soft tissue release.

Background Overstuffing of the radiocapitellar joint during metallic radial head arthroplasty has been reported to cause loss of elbow flexion, capitellar erosion, and earlyonset osteoarthritis. Although this is known, there is no agreed-on measurement approach to determine whether overstuffing has occurred. Questions/purposes We therefore hypothesized that overlengthening the radial head during radial head arthroplasty changes the ulnar variance in the wrist. Methods Seven cadaveric radii were implanted with radial head prostheses of increasing thickness. Each specimen was implanted successively with increasingly thick radial head prostheses measuring 2, 4, and 6 mm thicker than the native radial head, and radiographs were taken after implantation of each prosthesis. The ulnar variance with each prosthesis was measured using the method of perpendiculars.Results The ulnar variance of the native and 2-mm (p = 0.04), 4-mm (p = 0.008), and 6-mm (p = 0.008) overly thick radial head prosthesis-implanted states decreased significantly with each incremental increase in prosthetic head thickness. Conclusions Implantation of thicker radial head prostheses decreased the ulnar variance. Our results indicate ulnar variance could be used to detect overstuffing of radial head prostheses. Clinical Relevance The simplicity and reliability of ulnar variance make it a potentially useful indicator of overlengthening after radial head arthroplasty.

Introduction Double injury patterns in the form of Monteggia or Galeazzi fracture dislocation represent a spectrum of forearm injuries which are severe and usually necessitate operative intervention. Association of ulnar dislocation with proximal radioulnar disruption with fracture of the radial shaft, without dislocation of radiohumeral joint, represents a rare and unusual double injury pattern which is not classified under the Bado classification system. Although easy to identify, understanding the injury morphology ensures proper treatment. The aim of this study is to present an unusual case of Monteggia variant. Case Report A 26-year-old male presented following a road traffic accident with posterior dislocation of ulna and proximal radioulnar disruption with radial shaft fracture at the junction of proximal and middle third; radial head maintained its relation with capitellum. Valgus instability necessitating treatment could be demonstrated despite of posterolateral stability even after close reduction and fixation of radius. Conclusion This injury may be classified as an unusual variant of Monteggia fracture dislocation with emphasis on associated management of medial collateral ligament depending on the patient's profile and fracture personality for optimal results.

Symptomatic bipartite patella is uncommon, and to ensure good outcome, patient selection is the key. Mostly assigning the pain origin to the nonfused fragment is easy though, in few cases, can be a serious dilemma, especially in the absence of direct tenderness over nonfused fragment. The decision of surgical intervention is solely made on the criteria of exclusion of other causes in the presence of persistent anterior knee pain. The literature focuses on different treatment techniques and outcomes with a rare attempt to add to the currently available supporting tests to affirmatively ascertain the cause–pain relation to the bipartite fragment. This article defines the synchondrosis block to assist the surgeon in isolating the source of pain to bipartite fragment in symptomatic knee.