Patient: Male, 30Final Diagnosis: Giant cell bone tumorSymptoms: Bone swelling • painMedication: —Clinical Procedure: —Specialty: OncologyObjective:Unusual clinical courseBackground:Cooper first reported giant cell tumors (GCT) in the 18th century. The clavicle is a rare site for tumors. Metastatic tumors are more common than benign. This is the first case of GCT lateral end of clavicle to be reported in the literature.Case Reports:A 30-year-man was admitted with a 1-year history of progressively increasing swelling and pain over the left lateral end of the clavicle.The plain radiograph and PET scan revealed an expansile radiolucent lesion in the lateral end of the clavicle. Swelling was epiphsio-metaphyseal in location. It demonstrated geographical type of destruction with a narrow zone of transition. There was no periosteal reaction or soft-tissue component. The mitotic activity was found to be 0–1/10 HPF. Diagnosis was confirmed histopathologically. A wide excision of the mass, including 3 cm of healthy tissue of the clavicle, was performed.Conclusions:The presence of an expansile lytic lesion of the lateral end of the clavicle should be taken seriously and complete radiological and histopathological investigation should be done and giant cell tumor of the bone should be kept in mind despite its rarity.

Introduction: Frozen shoulder is a distressing and disabling condition that progressively limits shoulder function leading to significant morbidity and loss of daily wages. Material and Methods: Study included 30 patients as per inclusion and exclusion criteria, after taking written informed consent. Patients were subjected to hydrodilation of shoulder capsule using bupivacaine (0.5%) and normal saline followed by manipulation as an outpatient procedure and home based physiotherapy plans. Ranges of motion were recorded at four instances; before procedure, after procedure, at 2 weeks and 4 weeks post procedure. Results: Total of thirty patients were enrolled in the study, of which 6 were lost to follow-up. All twenty four patients had significant improvement in range of motion immediately post procedure and at 4 weeks. Verbal Satisfaction questionnaire was taken from patients at 4 weeks for overall satisfaction reports extremely satisfied results in 17 patients, average satisfaction in 3 patients and poor in four. Conclusion: Distension hydroplasty is an effective and economical outpatient procedure for management of frozen shoulder.

Introduction: ACL repair was first performed over a century ago, but reconstruction has overwhelmingly been the surgery of choice for operative ACL ruptures since the 1970s. Modern arthroscopic surgical instrumentation has made repair of ACL tissue easier and advancements in functional tissue engineering and regenerative medicine have resulted in a renewed interest in ACL repair. This is an attractive option to restore normal patient anatomy, retaining proprioceptive fibers, and not causing donor site morbidity that can be associated with reconstructions. Material & Methods:The study included 10 consecutive patients who presented with traumatic ACL avulsions (including bony avulsions) in outpatient or emergency department in last 2 years. Our inclusion criteria were cases with primary ACL injury (avulsion / proximal or distal end) not exceeding 3 months. Patients with severe arthritis of knee, multiligamantous ligament injury, history of previous surgery, bleeding disorders, any comorbidility leading to a non-operable condition were excluded from the study. Results: Out of 10 cases three cases had an avulsion from femoral end while seven had it from the tibial end. The injury surgey interval was in a range of six days to sixtythree days. Post operatively four patients had restriction of knee extension (5 degrees) at 4 weeks follow up. Rest of the cases had attained full range of motion at four weeks. All the cases had pain free gait pattern but needed aggressive physiotherapy to reinforce the normal gait pattern. There was no clinical ACL laxity in any of the cases, whenever seen at routine follow ups Conclusion: The internal brace acts as secondary pillar which supports the strength of the repaired ligament. Patients have a better proprioception, faster recovery to work & are safe guarded against an unpredictable outcome of ACL reconstruction.

Lipoma Arborescens is a lesion arising from synovium and is characterized by diffuse increase in

Introduction: Adverse local tissue reactions after Total Hip Replacement (THR) have been widely described in literature recently as a course of aseptic loosening. Evaluation for any adverse soft tissue reactions is challenging with traditional imaging techniques like Magnetic Resonance Imaging (MRI), and are limited, due to production of metallic artifact. Ultrasound, specifically its refined form elastography, has emerged recently as a useful tool for assessing the soft tissues. Aim: To determine the incidence of soft tissue reactions in cases of THR and to evaluate role of elastography in assessment of periprosthetic soft tissue. Materials and Methods: This prospective observational study was conducted in the Department of Orthopaedics, Dr. Hardas Singh Orthopaedic Hospital, Amritsar, Punjab, India, from May 2013 to April 2014. Study comprises of consecutively followedup 66 hips which were evaluated and assessed clinically and radiologically using ultrasound elastography for periprosthetic soft tissue and degree of fibrosis. The MRI was done in patients with positive findings only. Diagnosis was then confirmed with biopsy in patients who underwent revision surgery. Incidence of clinical symptoms, implant loosening, stability of implant, various types of soft tissue reactions, pseudotumour formation and synovial hypertrophy were determined and association between clinical and radiological findings was done. Chi-square test was determined to see the statistical significance. Results: Total of 66 hips were studied in 60 patients with mean age of 56.08±16.55 years (26-95 years). The incidence of soft tissue reactions observed in the study was 83.3% (n=55), of all 66 hips 36 were symptomatic, Implant loosening was seen in 29 hips, pseudotumours were detected in 3 (4.5%) hips, cystic nodules in 2 (3.0%) hips, enlarged lymph nodes in one (1.5%) hip, fibrogranuloma in 2 (3%) hips and synovial thickening was seen in 12 hips. Association of Harris Hip Score with capsular thickness, implant stability and acetabular loosening was found to be statistically significant. Conclusion: The study shows a substantially higher incidence of soft tissue reaction and capsular hypertrophy following THR. Ultrasound elastography is a good screening tool to detect early soft tissue changes in periprosthetic tissue.