Introduction: The management of gap non-union patella fractures continues to be a challenge in orthopedics. The incidence of these cases ranges between 2.7% and 12.5%. The quadriceps muscle attached to the proximal fractured fragment pulls it proximally leading to the gap at fracture site. If the gap is too large, there won’t be any fibrous union resulting in failure of quadriceps mechanism and extension lag. The primary aim is to bring the fracture fragments together and restore the extensor mechanism. Most of the surgeons prefer single-stage procedure, in which mobilization of the proximal fragment, followed by fixing with the lower fragment is done using V-Y plasty or x lengthening with or without pie Crusting. Others use of pre-operative traction to the proximal fragment using pins or ilizarov method. In our case, we used single-stage procedure whose results were encouraging. Case Report: A 60-year-old male patient presented with pain in the left knee with difficulty in walking since 3 months. The patient had road traffic accident 3 months back and sustained trauma to left knee. On clinical examination, there was palpable gap of more than 5 cm between the fracture fragments, anterior surface of femur and condyles was palpated through fracture site and knee range of motion was between 30° and 90° of flexion, and X-ray suggests of patella fracture. Midline 15 cm longitudinal incision was taken. The insertion of the quadriceps tendon over proximal pole of patella was exposed and pie crusting was done on medial and lateral side and V-Y plasty was done. SS wire was used to hold the reduction of the fragments by encirclage wiring and anterior tension band wiring done. Retinaculum was repaired and wound closed in layers. Postoperatively, long rigid knee brace was given for 2 weeks and walking with partial weight-bearing started. After suture removal at 2 weeks, full weight-bearing initiated. At 3 weeks, knee range of motion started and continued till 8 weeks. At 3 months post-operative, the patient is able to do flexion up to 90° and no extension lag is present. Conclusion: Adequate quadriceps mobilization during the surgery along with pie crusting and V-Y plasty with TBW and encirclage combined gives good functional outcome in patella gap non-unions.
<p class="abstract">Periprosthetic fractures continue to increase in frequency. This is due, in part, to the increasing number of primary and revision arthroplasties performed annually and to the increasing age and fragility of patients with such implants. All types of periprosthetic fractures can present unique and substantial treatment challenges. Here we present a case series of 3 elderly patients who came to us with periprosthetic hip fractures in previously operated case of hip hemiarthroplasty/total hip replacement done. The injuries were managed with splintage and operative procedures. Postoperatively mobilization was challenging. But patients were successfully mobilized with the help of relatives and physiotherapists. Periprosthetic fractures are becoming quite common in elderly and difficult to treat as the number of hip joint arthroplasty operative has increased in developing countries. the correct procedure is very challenging as every case needs to be treated very individualistically. A good plan always results in much reduction in the operating time and better patient post operative outcome. Postoperatively mobilization of patient and functional outcome is hampered. Proper counselling by operating surgeon, physiotherapy and postoperative rehabilitation with the help of relatives and assisting devices provides good outcome. So that early appropriate treatment and mobilization can be done with good functional outcome.</p>
Osteochondromas also called exostosis are commonest benign bone tumours. Traditionally Osteochondroma are considered as developmental malformations rather than true neoplasms and are thought to formed inside the periosteum due to separation of small epiphyseal growth plate cartilage. But recent studies suggested it’s relation with mutation in gene exotoxin 1 so now they are considered as true neoplasm. The lesions consist of a bony mass produced by progressive endochondral ossification of a growing cartilaginous cap. Most lesions are found during the period of rapid skeletal growth. Approximately 90% of patients only have a single lesion. Osteochondromas generally found on the metaphysis of a long bone near the physis like distal femur, proximal humerus, and proximal tibia. Due to risk of AVN after surgical management makes it difficult for excision. Due to close proximity to important neurovascular bundles these lesions can cause symptoms related to compression. Hip impingement is also common in these cases. Recurrence of osteochondromas are rare sometimes seen due to failure to remove the entire cartilaginous cap. A 24-year-old male presented with complaints of pain around the right hip and difficulty in walking and running since 2 year. On radiographic examination Right sided neck femur osteochondroma was diagnosed, which was located along the anteroinferior margin of the femur neck. Excision of the lesion was done in supine position using medial approach to hip without dislocation of the femur head. Femur neck osteochondroma should be removed surgically safely without dislocating hip. Osteochondroma must be removed completely with cartilagenous cap to avoid recurrence.
<p class="abstract">Distal tibia fractures account for 10% of lower limb fractures. Mode of trauma also determines the fate of soft tissue recovery. In low energy fractures soft tissue show better healing whereas fractures due to high energy trauma show high chances of soft tissue complications like poor soft tissue coverage, wound infection and necrosis. We presented a 50 years old male case of extra articular left distal tibia fibula open fracture managed by delta frame external fixator with fibular K wiring used as a definitive management with good fracture healing and range of motion 5 months postoperative. Ankle spanning external fixation is a good modality of surgical management of extra articular compound distal tibia fractures as both temporary and definitive surgical fixation.</p>
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.