BackgroundCarpometacarpal joint fracture dislocation of the second to fifth finger is a rare hand injury associated with high energy trauma. Due to severe swelling and overlapping of bones on the radiograph of wrist-hand, dislocations are missed. We reported a series of six patients with rare carpometacarpal joint fracture dislocation treated with open reduction.MethodsWe retrospectively studied six cases of carpometacarpal joint fracture dislocation. All patients were treated with open reduction and internal fixation with Kirschner wire. Functional assessment was done with Quick Disabilities of the Arm, Shoulder and Hand score (Quick DASH score) at regular intervals.ResultsAverage Quick DASH score was improved from 75.76 to 1.9 from 6 weeks to 18 months of duration. Of the six patients, three patients had a Quick DASH score of 0 at the end of 18 months.ConclusionsCareful hand examination and radiographic assessment is necessary to avoid missed diagnosis of carpometacarpal joint fracture dislocation. Early open reduction and internal fixation lead to excellent recovery of hand function.

Background The Lancet Commission on Global Surgery established the Three Delays framework, categorising delays in accessing timely surgical care into delays in seeking care (First Delay), reaching care (Second Delay), and receiving care (Third Delay). Globally, knowledge gaps regarding delays for fracture care, and the lack of large prospective studies informed the rationale for our international observational study. We investigated delays in hospital admission as a surrogate for accessing timely fracture care and explored factors associated with delayed hospital admission. MethodsIn this prospective observational substudy of the ongoing International Orthopaedic Multicenter Study in Fracture Care (INORMUS), we enrolled patients with fracture across 49 hospitals in 18 low-income and middle-income countries, categorised into the regions of China, Africa, India, south and east Asia, and Latin America. Eligible patients were aged 18 years or older and had been admitted to a hospital within 3 months of sustaining an orthopaedic trauma. We collected demographic injury data and time to hospital admission. Our primary outcome was the number of patients with open and closed fractures who were delayed in their admission to a treating hospital. Delays for patients with open fractures were defined as being more than 2 h from the time of injury (in accordance with the Lancet Commission on Global Surgery) and for those with closed fractures as being a delay of more than 24 h. Secondary outcomes were reasons for delay for all patients with either open or closed fractures who were delayed for more than 24 h. We did logistic regression analyses to identify risk factors of delays of more than 2 h in patients with open fractures and delays of more than 24 h in patients with closed fractures. Logistic regressions were adjusted for region, age, employment, urban living, health insurance, interfacility referral, method of transportation, number of fractures, mechanism of injury, and fracture location. We further calculated adjusted relative risk (RR) from adjusted odds ratios, adjusted for the same variables. This study was registered with ClinicalTrials.gov, NCT02150980, and is ongoing. Findings Between April 3, 2014, and May 10, 2019, we enrolled 31 255 patients with fractures, with a median age of 45 years (IQR 31-62), of whom 19 937 (63•8%) were men, and 14 524 (46•5%) had lower limb fractures, making them the most common fractures. Of 5256 patients with open fractures, 3778 (71•9%) were not admitted to hospital within 2 h. Of 25 999 patients with closed fractures, 7141 (27•5%) were delayed by more than 24 h. Of all regions, Latin America had the greatest proportions of patients with delays (173 [88•7%] of 195 patients with open fractures; 426 [44•7%] of 952 with closed fractures). Among patients delayed by more than 24 h, the most common reason for delays were interfacility referrals (3755 [47•7%] of 7875) and Third Delays (cumulatively interfacility referral and delay in emergency department: 3974 [50•5%]), while Second Delays ...

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Background: In adult acquired hypophosphatemic osteomalacia is generally associated with Biochemical abnormalities. Aims and Objective: To study Hypophosphatemic Osteomalacia in Neck femur fracture : A case series of 10 patients. Methodology: This was a cross-sectional study carried out in the department of Orthopedics from Aug 2015 to August 2016 in the patients who complained of Bilateral Hip (Groin) Pain and inability to walk were; Clinical, Radiological and all laboratory investigations whenever required were done and patients which were having final diagnosis of hypophosphatemic Osteomalacia in Neck femur fracture were included into the study during the study period. All details of the patients like age, sex and clinical features were noted. The data analysis was done by Excel software for windows 10. Result: In our study we have seen that the majority of the patients were in the age group of 60-70(40%), followed by 50-60 (20%), >70 (20%), 40-50 (10%), 30-40 (10%). The majority of the patients were Female (60%) and Males were 40%. The most common clinical features were Bilateral Hip (Groin) Pain (100%), Inability to walk (90%), Bilateral femur fracture (Xray) in 30%, Unilateral femur fracture (X-ray ) in that Left was predominant i.e. 50% and Right were 20%. In the laboratory findings the all parameters were apparently normal except high Serum ALP level, low Serum Phosphorus level. Treatment and Outcome: Patient were treated conservatively they advised bed rest and supplementation of Tab. Endocal Forte OD, Protocol Supplement 2tsp with milk BD Adophos Sachet in ½ glass of Water QID, Tab. Rocaltrol (2.5) QID, average Patient were walking without support in an average 2 weeks, Pain decreased and also there is improvement of haematological parameter , X-ray shows signs of healing fracture. Conclusion: Hypophosphatemic Osteomalacia is commonly missed due to nonspecific signs and symptoms, but thorough investigation of blood and radiograph required for non-traumatic hip pain. This is rare condition needs high index of suspicion. This is totally curable by conservative Methods.

Acute hematogenous osteomyelitis of the patella is a rare entity in the children and is often associated with delayed diagnosis due to the variable and non-specific presentation. Advanced imaging like bone scintigraphy, MRI and CT scan is often required to diagnose the condition. Arthrotomy, debridement and curettage of the dead and necrotic material followed by antibiotics for 4-6 weeks are the mainstays of the treatment. We present a case of a 6 years old female child with acute hematogenous osteomyelitis of the patella.