Hallux valgus is a common forefoot deformity characterized by medial deviation of the first metatarsal and lateral deviation of the hallux. More than 150 procedures have been described for the hallux valgus deformity with no proven superiority of one over the other. The initial osteotomies are open, and with the advent of power and micro instruments, the osteotomies were manageable via mini incisions and percutaneous procedures. The minimally invasive procedures have been divided into three generations. The first-generation osteotomies involve wedge correction. The second and third-generation osteotomies are translational. The second generation is a simple osteotomy, and the third is a chevron-type osteotomy. In our technique, we have used a hybrid procedure of second and third-generation procedures. The technique uses an ultrasonic bone scalpel to create a transverse sub-capital osteotomy which is then fixed with screws for a stable construct.
Bursitis, though treatable conservatively, very rarely can have ossification and calcification in its substance which requires surgical intervention. The patient should be investigated for any coexisting metabolic bone disorders before proceeding with surgical intervention. The excision biopsy of such a specimen has to be examined histopathologically to rule out any neoplastic etiology. We present an adult male with a painful lump over the tibial tuberosity and its management.
Background: Meniscus ramp lesions associated with anterior cruciate ligament (ACL) injuries are being increasingly reported in the literature. This study was carried out to know the incidence of ramp lesions in ACL injured patients and to study the characteristics of these patients in our population. Methods: Seventy-five patients who underwent ACL reconstruction from January 2021 to December 2021 were prospectively studied. Patients with multi-ligament injuries or a history of previous knee surgery were excluded. All patients were examined clinically and all underwent MRI examinations. The findings of arthroscopy during ACL reconstruction were recorded and analyzed. Result: Seventeen patients had ramp lesions with an incidence of 22.67%. Eight were isolated ramp lesions, and nine had other meniscus injuries. Ramp lesions were identified with 41.18% sensitivity using preoperative MRI. Thirteen out of 17 patients with ramp lesions had increased mobility of the posterior horn of the medial meniscus on anterior probing. The duration from injury to surgery was significantly longer in patients with ramp lesions as compared to patients without ramp lesions. Conclusion: A ramp lesion is not an uncommon lesion in ACL injuries and can occur either as an isolated meniscus lesion or in association with other meniscus lesions.Ramp lesions can occur in road traffic accidents as well and are not just sports-related injuries. Ramp lesions are not visible through routine anterior portal diagnostic arthroscopy and their repair adds to the stability of the knee. The absence of ramp lesions on MRI does not rule out their presence; hence, one should always look for ramp lesions in the posteromedial compartment of the knee in all cases undergoing ACL reconstruction.
Infections after arthroscopic procedures are rare. Infection due to fungal organisms is rarer and difficult to diagnose due to its insidious nature and chronic presentation but when neglected has devastating consequences. We present a 23-year-old immunocompetent adult post-arthroscopic meniscal repair with fungal surgical site infection. The patient underwent open debridement and was started on antifungals. His surgical wound healed and with physiotherapy he regained his full range of movement.
Pseudo-arthrosis of the proximal humerus is an uncommon condition that is difficult to treat. Humoral hypercalcemia from a benign tumour is a rare clinical entity and pleomorphic adenoma as its source has never been reported in the literature. We present the case of a 53-year-old gentleman with a pleomorphic parotid gland adenoma and pseudoarthrosis non-union of the proximal humerus exacerbated by symptomatic parathormone-independent hypercalcemia. The non-union is fixed using a novel technique of placing an ipsilateral cortico-cancellous iliac strut graft as a medial buttress and stabilized with a fixed-angle plate over the lateral side. Following the surgical resection of the tumour, hypercalcemia resolved and the patient improved clinically. This case is a good example of a rare endocrine disease managed by a multidisciplinary approach.
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