BACKGROUNDMetacarpal fractures are common in adolescents and young active individuals. Mostly these are treated by conservative methods. In unstable fractures where closed reduction and final outcome are unsatisfactory, there are multiple surgical options for treating metacarpal fractures like K-wire fixation, interosseous wiring, plate osteosynthesis, etc. In this study, we assess functional outcome of closed metacarpal fractures treated with plates and screws. MATERIALS AND METHODSBetween 2014 and 2016, 20 cases of closed metacarpal fractures were studied. Fracture was approached by dorsal incision. Plate configurations were chosen according to the fracture pattern (straight plate for shaft fractures, T or L configured plates were used for periarticular fractures) and fixed with screws. Post-operative physiotherapy and followup carried out. RESULTSIn our study, all the cases showed bone union (100%). The functional result assessed by American Society for Surgery of the Hand (ASSH) Total Active Flexion score showed excellent result in 80% of the patients (16 of 20 cases), good in 10% of cases (2 of 20 cases). Stable and rigid fixation allowed early mobilisation of fingers thereby preventing stiffness and achieved overall good functional results. Although there were 10% (2 cases) of superficial infections, all settled with regular dressing and antibiotics without affecting final functional outcome. The overall results are satisfactory. CONCLUSIONPlate and screw fixation is a good option for treating closed unstable metacarpal fractures, where other modalities of fixation are less effective. The rigid stable fixation provided by plating which withstands load without failure allowed early mobilisation and achieved good functional results.
BACKGROUNDSynovial chondromatosis is a type of non-cancerous tumour arising from the intimal layer of synovial membrane of a joint. The knee is most commonly affected followed by hip, hand, wrist. Elbow and shoulder are least common; however, it can affect any joint. The tumours begin as small nodules of cartilage. The cartilage foci become pedunculated and may be sequestrated into the synovial cavity to form multiple loose bodies, often in pearly clumps resembling sago "snowstorm knee". Some tumours may be no larger than a grain of rice. Synovial chondromatosis most commonly occurs in adults ages 20 to 50 with male predominance, mechanical symptoms in joint due to loose bodies, limited range of motion. Plain radiograph shows small calcified intra-articular nodules, advanced disease shows periarticular bone erosion and extension into soft tissues. Treatment modalities are observation if asymptomatic, arthroscopic or open synovectomy. Recurrence most common with arthroscopic synovectomy. In our study, we have done arthroscopic loose body removal and synovectomy. CASE REPORTA 65-year-old male with complaints of pain and restricted range of movement of right knee for past 2 years. X-ray showed multiple intra-articular loose bodies of varying sizes, and was diagnosed as synovial chondromatosis with multiple intra-articular loose bodies in right knee. CONCLUSIONEven though the mentioned procedure requires surgical expertise, arthroscopic assisted loose body removal is an accepted novel procedure for synovial chondromatosis with multiple loose bodies.
BACKGROUNDChondrosarcoma, a malignant bone tumour constitutes about 9% of primary bone malignancies. Common in locations like proximal femur, proximal humerus and pelvis, rarely it can occur in hand. Here, we present a case of chondrosarcoma of the second metacarpal bone, because of its rarity.
A 40 years old female patient came to our hospital with pain over left iliac bone, which was gradually increased since 8 months and was unable to bear weight on left lower limb for last 2 weeks. On physical examination, tenderness was determined over the left iliac region. On neck examination, the right inferior thyroid lobe, 4 x 3 cm sized, palpable nodule and soft in consistency was noticed. Other systemic examinations revealed no abnormality. Laboratory analysis revealed serum calcium-13.9 mg/dL, serum alkaline phosphatase-812 IU/L and serum parathyroid hormone level was 2056 pg/mL and other blood investigations were found to be normal. All these findings are more in favour for hyperparathyroidism due to parathyroid adenoma.On Roentgenography an expansile, osteolytic lesion, eccentrically situated with sharp sclerosed margin involving the left iliac bone; on MRI Heterogeneous mixed signal intensity lesion replacing the normal visualised pelvic bone with right iliac bone measuring 4.5 * 4.1 cm and left iliac bone measuring 5.2 * 4.1 cm and left iliac crust lesion measuring 1.82 cm approximately.Brown tumour is a type of lesion associated with hypersecretion of parathormone. It is a benign condition. It is the terminal stage of the remodelling process in hyperparathyroid state. It is a rare clinical presentation of primary hyperparathyroidism which is probably due to adenoma, secreting parathormone (PTH). Increased PTH levels cause resorption of bone leading to polyostotic lesions. There will be reduction in bone mineral density (BMD) causing osteolytic lesions. Here, we report a case of 40 years old female who presented with pain over left iliac region. On examination, tenderness was present over left iliac region. Radiological and blood investigations were done. She was found to have osteolytic lesions over right and left iliac wing with hyperparathyroidism and on further investigations parathyroid adenoma was noted. She was treated with surgical excision of parathyroid after confirmation with the biopsy report and histopathological, biochemical investigations. At the follow-up time, patient was free of symptoms. Brown tumour is a benign lesion associated with hyperparathyroidism. Any patient with osteolytic lesion with neck swelling should be undergoing serum PTH level with whole skeletal screening, as multiple cystic lesions may present in brown tumour patient.
BACKGROUNDSubacute osteomyelitis is a type of osteomyelitis without any clinical signs and symptoms of osteomyelitis for more than 3 weeks' duration with characteristic radiological features. Cut-off between the infection and tumour is narrow. The aim of this study is to increase the awareness about increasing incidence of less common pattern of subacute osteomyelitis in our day-to-day practice. Subacute osteomyelitis radiological presentations are not always fitted into the proposed classification system, thus leading to a diagnostic trap. This article brings out the significance of histopathological examination following the surgical procedure which will aid in treatment and prognostic aspects. Total 8 patients (5 male and 3 female) who admitted in our institute have been investigated and they underwent biopsy and curettage. Histopathological, microbiological examination was done. Antibiotic sensitivity of isolated organism was assessed. In eight patients, osteomyelitis was confirmed with biopsy and culture sensitivity. They were completely cured without any recurrence or any other complications except one patient who had segmental osteonecrosis of head of femur due to the location of Brodie's abscess in neck of femur. Biopsy & Culture is mandatory to confirm the diagnosis and for the treatment aspect. So for any infection a biopsy and for any tumour culture and sensitivity should be done.
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