BACKGROUND The purpose of this study was to evaluate the results of endoscopic excision of symptomatic os trigonum in symptomatic ballet dancers of Odisha. The hypothesis was that posterior endoscopic excision of the os trigonum would be safe and effective in treating PAIS related to the os trigonum. METHODS Between May 2015 and May 2018, 30 ankles of 20 consecutive patients underwent arthroscopic removal of the symptomatic os trigonum for posterior ankle impingement syndrome (PAIS) in prone position. 12 patients were male, 8 female. All patients were ballet dancers by profession where they do the dance in acute flexion of ankle. All patients were discharged on the same day and allowed full weight bearing after 2 weeks post operatively. Mean duration of postoperative follow up was 24 months and no patient was lost to follow up. Clinical evaluations were performed preoperatively & post operatively using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hind foot score and the Visual Analogue Scale (VAS) for pain. The surgical time, time to return to profession (dancing), patient satisfaction and any complications related to the surgery were assessed. RESULTS Average AOFAS ankle hindfoot score increased from 72.6 ± 5.1 (range 64-78) preoperative to 93.8 ± 3.2 (range 86-100) post-operative (p <0.05) and VAS for pain decreased from 6.8 ± 1.4 (range 5-10) preoperatively to 1.8 ± 0.8 (range 0-4) (p <0.05) at final evaluation. Average plantar flexion of the ankle increased from 27 ± 3.2 (range 20-35) degree to 43 ± 0.4 (range 40-45) degree (p <0.05) post operatively. Mean time to resumption of activity and dancing was 6 weeks (range 4-8 weeks). On physical examination, no patients showed any signs of local tenderness, & the forced planter flexion test findings were negative except in one case in which swelling persisted. There were no major intraoperative & postoperative complications in any patients. Overall patient satisfaction was high. CONCLUSIONS Endoscopic excision of a symptomatic os trigonum in those patients after failure of conservative treatment for ≥6 months using posterolateral and posteromedial portals in prone position was a safe and effective technique with least complications.
Ewing's sarcoma rarely arises from clavicle. Total claviculectomy is a generally accepted method of treatment with good functional outcome. We report a case of a 15 year male patient diagnosed with Ewing's sarcoma clavicle treated with total claviculectomy. The purpose of our study is to evaluate the functional and oncological outcome after total resection of clavicle. This patient had full range of motion of the shoulder joint without any deficit. Thus, total claviculectomy can be considered as procedure in primary clavicular malignancy.
Scaphoid fracture is a difficult fracture to deal with. This tiny twisted bone, 80% covered with joint cartilage and lying angulated by 45° in both planes deep in the wrist, has caused great frustrations among wrist surgeons. Diagnosis is difficult, classification is controversial & there is never ending debate on appropriate treatment protocol. Firstly, scaphoid fracture is prone to be missed in clinical assessment & is usually neglected as simple wrist injuries. Adding to that, this notorious fracture is often missed in first x-ray immediately after injury. Second line of investigation is a matter of debate & varies from doctor to doctor & centre to centre. This does not end here. Once diagnosed, there is no clear-cut protocol for deciding appropriate treatment technique. There is controversy regarding whether to be managed conservatively or operatively. Both have their own pros & cons. If managed conservatively, there is again no agreement in the literature as to the optimum position of immobilization (extension, ulnar deviation, neutral) or type of cast (thumb-spica, interphalangeal [IP] free/IP included, long arm/short arm). Last but the most nuisant are the complications. Scaphoid fracture is known for its complications like AVN, Non-union, arthritis owing to its peculiar blood supply, position in wrist & shape. Management of these complications are again not free of confusions & controversies. In this study we have tried our best to address these dilemmas & study this notorious bone in further detail.
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