A 20-year-old woman presented 6 months after an initial injury to her left elbow with pain and restricted movements. She was diagnosed with a type I malunited (Hahn-Steinthal) type of capitellum fracture through radiographic studies. Classically, the treatment has been excision of the fragment, which carries a risk of valgus instability of the elbow and late osteoarthrosis. We report a case of malunited type I capitellum fracture, for which corrective osteotomy through fracture site, open reduction and internal fixation was done 6 months following missed trauma. At 24 months follow-up the capitellum fracture had united and the patient has a stable elbow and excellent range of motion. Our case demonstrates that for type I malunited capitellum fractures corrective osteotomy through fracture site and internal fixation rather than excision of the fragment in young can result in successful union and stable elbow.
BackgroundHip fractures occur frequently in the elderly population over the age of 60 years following low-energy domestic falls. The postoperative mortality after hip fracture surgery depends on numerous factors like comorbidities, pre-fall ambulatory status, nutritional status, cognition, and overall physical health. In this context, the physiological age and reserve play a vital role in mortality after hip fracture surgeries. This physiological reserve is measured in terms of "frailty." There are many frailty indices that assess the physiological reserves of an elderly patient. The modified frailty index (MFI) is one of the validated indexes predicting postoperative complications and mortality. So we concluded there is a need to assess the patients with MFI preoperatively, based on which mortality and postoperative complications could be predicted in our patients. Materials and methodsWe included 100 patients aged more than 60 years with intertrochanteric and neck of the femur fractures, who were managed surgically. We followed the patients for one year and observed the immediate and late complications and mortality at the end of one year. To reduce bias, patients with pathological fractures, revision surgeries, contralateral fractures, high-energy trauma, younger than 60 years of age, and previous proximal femur fracture surgery on the side of injury were excluded from the study. ResultsThe primary objective was to study the correlation between the MFI with one-year mortality. We observe that the MFI score had a significant effect on mortality at one year (p-value = 0.0316). With a unit increase in the MFI score, the odds of death increase by a factor of 1.52. ConclusionThere is a strong correlation between MFI with one-year mortality and postoperative complications after hip fracture surgeries in the elderly. This MFI can be used as a preoperative predictive model to predict the mortality and postoperative complications after hip fractures in the elderly. It will also help patients and their caretakers in decision-making and elucidating surgery choices.
A 70-year-old woman had become aware of a mass on the dorsal aspect of the middle phalanx of her right little nger 9 years earlier. Her medical history was unremarkable, with no traumatic injury of the right little nger. Initial examination revealed a hard, immovable swelling of 15 × 10 mm on the dorsal aspect of the middle phalanx of the right little nger. No pain, sensory disturbance, or motor dysfunction was noted. The patient underwent FNAC at Adichunchanagiri Hospital and Research Centre and features were suggestive of benign spindle lesion/possibility of peripheral nerve sheath tumor. Total excision of the tumor was performed under block. Histopathological ndings revealed circumscribed benign tumor composed of hyper cellular and hypo cellular areas, hyper cellular area shows bro collagenous tissue, spindle cells in palisading arrangement, whereas hypo cellular area shows edema with thrombosed vessels, also hyalinisation and myxoid changes at places are observed. Based on these ndings, the patient was diagnosed as having ancient schwannoma. There was no evidence of infection, pain, complications such as recurrent tumor at 6 months postoperative.
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