Osteochondromas are benign chondrogenic lesions arising on the external surface of the bone with aberrant cartilage (exostosis) from the perichondral ring that may contain a marrow cavity also. In a few cases, depending on the anatomical site affected, different degrees of edema, redness, paresthesia, or paresis can take place due to simple contact or friction. Also, depending on their closeness to neurovascular structures, the procedure of excision becomes crucial to avoid recurrence. We report a unique case of recurrent osteochondroma of the proximal humerus enclosing the brachial artery which makes for an important case and procedure to ensure that no relapse occurs.We report a unique case of a 13-year-old female who had presented with a history of pain and recurrent swelling for 5 years. The swelling size was 4.4 cm x 3.7 cm x 4 cm with a previous history of swelling at the same site operated in 2018. CT reports were suggestive of a large well defined broad-based exophytic diaphyseal lesion in the medial side of the proximal humerus extending posteriorly. Another similar morphological lesion measuring approximately 9 mm x 7 mm was noted involving the posterior humeral shaft. The minimal distance between the lesion and the brachial artery was 2 mm just anterior to the posterio-medial growth. Two intervals were made, first between the tumor and the neurovascular bundle and the other between the anterior tumor and brachial artery followed by exostosis and cauterization of the base.Proper curettage and excision of the tumor was done after dissecting and removing the soft tissue, blood vessels, and nerves so that there were very less chances of relapse. Post-operative X-ray was done and post 6 months of follow-up, there were no changes, and no relapse was observed. Thus, when presented with a case of recurrent osteochondroma of the proximal humerus, osteochondroma could also be in proximity to important vasculature as in this case enclosing the brachial artery. Thus, proper curettage and excision should be done in such cases to avoid recurrence.
Introduction: Osteochondromas (OCEs) are benign chondrogenic lesions arising on the external surface of the bone with aberrant cartilage (exostosis) from the perichondral ring that may contain a marrow cavity also. In few cases, depending on the anatomical site affected, different degrees of edema, redness, paresthesia, or paresis can take place due to simple contact or friction. Furthermore, depending on their closeness to neurovascular structures, the procedure of excision becomes crucial to avoid recurrence. We report a unique case of recurrent OCE of the proximal humerus enclosing the brachial artery which makes for an important case and procedure to ensure that no relapse occurs. Case Report: We report a unique case of a 13-year-old female who had presented with a history of pain and recurrent swelling for 5 years. The swelling size was 4.4 cm × 3.7 cm × 4 cm with a previous history of swelling at the same site operated in 2018. Conclusion: This case report demonstrates that when presented with a case of recurrent OCE of the proximal humerus, doing proper excision of the tumor is crucial to prevent its relapse.
Background: US FDA defines non-union as fracture bone that has not completely healed in 9 months since injury and which has not shown any signs of healing over 3 consecutive months on serial x-rays. The operative treatment depends on the type of non-union. There are one-step or two-step procedures according to the principles of the 'diamond concept'. This involves the improvement of the mechanical situation (in most cases with a re osteosynthesis) and vascularization, local application of osteoconductive carriers e.g. tricalcium phosphate, vial cells from autologous bone and osteoinductive substances like bone morphogenic proteins (BMP-2 or BMP-7). Aim: To study the principles and method of fixation of non-union of distal femur with lock plates. Material and Methods: It was a prospective study including patients with non-union of distal femur admitted and examined according to protocol after obtaining informed consent from the patient and permission from the institutional ethics committee. 40 cases satisfying the inclusion criteria admitted in tertiary healthcare centre of Navi Mumbai since May 2018 to March 2020 with minimum 1 year of follow up were included in the study. Results: Patients were also evaluated as per non-union scores. The average non-union score was 19 (range 11 to 27). All of the non-unions united, at an average of 19 weeks. The average arc of knee motion improved from 85° preoperatively to 114° postoperatively. The average Neer's score improved from an average of 60.4 points (range 16 to 44 points) preoperatively to 89 points post operatively. The knee society score (Part 1) improved from an average of 51.87 points (range 36 to 68) preoperatively to 81.725 points (range 74 to 93) post-operatively. Conclusion:The operative technique respecting the biology and biomechanical principles has shown the influence of success of treating these fractures with locking plates.
Introduction: Burnout is a syndrome denoting the outcome of chronic work stress which has not been managed successfully. Burnout has only sometimes been at the forefront of studies in healthcare, where patient care and management have received more attention. This study focuses particularly on burnout of residents and healthcare workers during the COVID-19 pandemic that has changed the working environment. Material and Methods: Questionnaires in the form of surveys have been used to receive feedback regarding work experience within the bubble of isolation and high patient load unique to COVID-19 pandemic. A full and complete analysis of the research is provided after the definition, description, and measurement of burnout are given. Results: According to a review of the burnout literature, burnout affects medical students, residents, and practicing doctors, with prevalence rates ranging from 28% to 45% for each group. First-year residency during the COVID-19 pandemic, in particular, is plagued with unmanageable burnout symptoms and a depleted support system. Burnout among residents is said to be caused by time demands, a lack of control, poor work organization, naturally challenging employment settings, and interpersonal connections. Workplace solutions might take the form of burnout education, workload adjustments, diversifying job roles, stress management training, mentorship, emotional intelligence seminars, and training in emotional intelligence. In addition, developing interpersonal and professional relationships, meditation, therapy, and exercise are examples of self-directed behavioral, social, and physical activities.. Conclusion: Educators should consider including pertinent instructions and interventions during the process of instructing resident doctors. In addition, they should actively become aware of burnout. Early detection aids in better management of burnout. Keywords: burnout, COVID-19, residency, work-life balance.
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