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ABSTRACT:Here we are reporting a case of cemento ossifying fibroma (COF) of paranasal sinus in a 45 year female presented with large mass in maxilla and extraosseous component, pain and disfigurement due to facial asymmetry and planned for surgery as the surgery is the main stay of treatment, reviewed with surgical oncologist and it was unresectable because of large extensive mass. Then we planned for radiation therapy as there was no other option available. We reviewed with literature there was not a single case treated with radiation in human being but reports are available treated with radiation therapy in horses and in other animals. On the basis of animal case reports we treated with radiation therapy. After treatment patient was improved symptomatically and living for 2 years till today. Here we are reporting this case and this may be the first reported case treated with radiation therapy in human being as per the literature available.CASE DETAIL: 45 year old female presented with nasal obstruction, Facial swelling, Proptosis left eye [ Fig. 1], Pain due to expansion of tumour, duration of more than one year. CT scan showed Mass involving bilateral maxillary sinus, eroding the pterygoid plates, destruction of sphenoid sinus, involving the orbital cavity and pushing of right eye outwards [ Fig. 2]. Tumour volume on imaging was 250cc approx. biopsy of the tumour showed [ Fig. 5] cement ossifying fibroma. Because of huge mass, bony involvement, surgery was not feasible sent for radiation oncologist for opinion. Radiation planning was done by intensity modulated radiotherapy technique [ Fig. 3] with an aim of sparing the opposite optical apparatus. Plan evaluated with acceptable constraint specification planned for 50Gy in 25 fractions. Patient completed radiation therapy over 5 weeks and with dry desquamation of skin [RTOG grade II]. Patient planned for radiation and total dose delivered 50Gy @2Gy/# Over 5 weeks. Only primary treated and lymph node spared. Patient completed radiation with RTOG grade 2 skin reactions [dry desquamation]. There was no significant morphological change at the end of radiation. At 3 month follow-up Proptosis decreased, facial swelling came down [ Fig. 4], Patient was symptom free, planned for imaging, CT scan showed decrease in tumour volume to 170cc and planned for next visit after 3 months. At the end of the treatment the response evaluated morphologically and which is an insignificant response, then patient was kept under follow up. After 3 months the Proptosis decreased, pain was minimal and patient was better than before. CT scan volume revealed around 170 cc comparing pre radiation volume of 250cc.DISCUSSION: Cemento ossifying fibroma [COF] IS a bony origin of benign cause. [1] WHO classifies COF as a fibro-osseous neoplasm, included among the non-odontogenic tumors, derived from the mesenchymal blast cells of the periodontal ligament, and with a potential to form fibrous tissue,

BACKGROUNDThe aim of the study is to compare the outcome following conservative or surgical treatment for displaced fracture of the medial process of the calcaneal tuberosity. MATERIALS AND METHODS14 men and 4 women aged 20 to 44 years chose to undergo conservative (9 feet) or surgical (10 feet) treatment by a single surgeon for closed displaced fracture of the medial process of the calcaneal tuberosity. The injury mechanism was a fall from a height of <1.5 m; the mean time from injury to treatment was 3 (range 1-7) days. Conservative treatment comprised immobilisation in a plaster cast. Surgical treatment involved fixation with a half thread cannulated screw for large fragments (in 6 feet) or a mini-plate for comminuted fragments (in 4 feet). At the final follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hind foot score was evaluated. RESULTSThe conservative and surgery groups were comparable in terms of age, gender and fracture displacement. The mean follow-up duration was 20 (range, 14-24) months. All patients had bone union; none had implant loosening or breakage. One patient with surgical treatment developed skin numbness at the medial aspect of the heel that resolved following neurotrophic drug treatment for 3 months. The surgery group achieved earlier full weight bearing (5.8 vs. 7.5 weeks, p<0.001) and return to work (5.9 vs. 8.2 weeks, p=0.048), but comparable AOFAS score (89.0 vs. 88.2, p=0.4). CONCLUSIONSurgery for displaced fracture of the medial process of the calcaneal tuberosity enabled earlier full weight bearing and return to work, but comparable AOFAS score.HOW TO CITE THIS ARTICLE: Prasad SG, Shiv Sandeep SV. Treatment options for displaced fracture of the calcaneal tuberosity.

Cancer cervix is the most common malignancy in the developed country and one of the most curable disease. Radiation treatment is the mainstay treatment for carcinoma cervix. There is also long follow up noted. After radiation treatment, radiation related late side effects like cystitis, proctitis which are seen in regular practice but one radiation related side effect called pelvic insufficiency fracture which is not very common but one of the under diagnosed, misdiagnosed and mismanaged entity is observed. Here we are explaining this entity from diagnosis to treatment with review literature.