No abstract

Trevor's disease, also known as dysplasia epiphysealis hemimelica, is an uncommon skeletal developmental disorder representing an osteochondroma occurring in one or more epiphyses. We present 2 cases of dysplasia epiphysealis hemimelica in an 8-year-old female and a 12-year-old male who suffered from a hard swelling of the ankle joint. The female patient was treated by surgical excision and the male patient conservatively.

Giant cell tumours are aggressive lesions, albeit benign. Lesions in the hand, especially those arising from metacarpals require resection with adequate margins and definitive structural reconstructions to ensure preservation of hand architecture, function and cosmesis. Almost all the described reconstructive procedures require a stump of tumour free metacarpal base after resection, for reconstruction of the metacarpal. This report describes replacement of the entire metacarpal with a silastic prosthesis, in a case of giant cell tumour involving the entire metacarpal head and shaft to within 7 mm of the base.

We infer that T scores are the best predictors for fracture risk. A score of -2.5 or lower effectively defines patients at risk and is useful for predicting fracture risk in the Indian population. In patients with osteoporosis, whether a fall precedes the fracture or the fracture precedes a fall may not be an issue of debate, but can serve as a basis for prevention of additional fractures by instituting appropriate measures in patients at risk.

ObjectiveTreatment of closed comminuted subtrochanteric fractures using the dynamic condylar screw (DCS), with the goal of reducing operating time, blood loss, and incidence of delayed union. IndicationsComminuted subtrochanteric fractures, especially types B and C of the AO classification. Fracture line extending to piriformis fossa precluding use of an intramedullary device. Poor general condition, i.e., unable to withstand prolonged anesthesia as required in open reduction and internal fixation (ORIF)/nailing. ContraindicationsCompound fractures. Obesity. Calcar comminution is not a contraindication. Surgical TechniqueApproach either through small proximal and distal incisions or limited exposure of the fracture site without opening the region of comminution and preservation of medial fracture hematoma. DCS inserted under image intensifier control. Plate slid beneath vastus lateralis. Rotated 180° to allow barrel to slide over condylar screw. Alignment in all three planes confirmed under radiologic control. Proximal and distal screws inserted to stabilize the fracture. ResultsBetween 10/1995 and 02/1999, 28 men and three women with subtrochanteric fractures were treated with a DCS using biologic principles. Union was achieved in all 31 patients (100%) and full weight bearing possible after an average of 4.9 months. The average operating time was 2 h, and blood loss averaged 430 ml. Only one patient had a superficial infection, which settled on local debridement and antibiotics. Malunion was seen twice (6.4%) which did not require further surgery. These results are superior to open technique in respect to blood loss, surgical time, and union rate.