No abstract

Introduction: Infected non-union is rare in pediatric patients. Various methods have been described in the literature to manage such cases. We present a familiar and simple technique to treat a non-union in pediatric population. Case Presentation: A 4-year-old boy came to us with a right-sided proximal forearm swelling and tenderness. Clinical and radiological features suggestive of osteomyelitis of ulna with a history of the right-sided forearm cellulitis when he was 4 months of age which was managed with incision and drainage at that time. The patient underwent surgery for surgical debridement with drilling of ulnar cortex for pus evacuation. Postoperatively, the patient developed a stress fracture at drilling site which eventually went into a non-union. In second surgery, bony union achieved with the help of non-vascularized fibular strut graft and iliac cancellous graft. Conclusion: There are numerous complications of osteomyelitis in pediatric patients and their management has been previously highlighted throughout literature. Here, we present a rare occurrence case report highlighting management of pediatric atrophic infected gap non-union of ulna by non-vascularized fibula strut stabilized by Titanium Elastic nail which offers a simple yet an elegant solution in a low-cost setting with complete bony union and restoration of function.

Introduction: Trevor’s disease also known as Dysplasia Epiphysealis Hemimelica is an uncommon epiphyseal affliction of childhood, developmental in nature with unknown etiology. It is an osteochondral lesion arising from the epiphyses and progressively increasing in size until skeletal maturity is reached. Surgical management is not advisable in cases, where there is absence of articular symptoms and mass evolution is present, until there is achievement of skeletal maturity. Pain, joint deformity, and impingement mandate surgical intervention and the result is good in cases, where the mass is juxta articular or extra-articular in location. Case Report: We report such a rare case of an 8-year-old male child who presented to us with a hard swelling over ankle with restricted movement and was promptly treated by us with medial malleolus osteotomy and surgical excision of the tumorous mass with subsequent malleolar screw fixation after establishing a diagnosis of osteochondroma of talus. Conclusion: Making a correct diagnosis with imaging and confirmation by histology is necessary, after which careful surgical planning should be carried out in cases, where bony masses are causing pain, ankle mobility hindrance, and impingement with footwear hampering daily activities, this helps prevent recurrence and its further complications.

Introduction: There have been many advances in internal fixation techniques to deal with poor quality of bone and severely comminuted intertrochanteric fractures so as to allow early ambulation. Failure rates with an internal fixation range between 3% and 12%. There have been a number of technical issues to convert these fractures into hip arthroplasty such as extraction of implants, bone deformity, bone loss, poor bone quality and associated trochanteric nonunion. Intertrochanteric fractures in osteoporotic bones which are grossly comminuted are highly unstable and difficult to treat. Rate of failure with internal fixation, with dynamic hip screws and with nail has been found to be high, especially in osteoporotic bones. Weak purchase of the internal fixation device because of osteoporosis and comminution of the fracture increases the incidence of failure of internal fixation such as cutting out the screws and displacement of the bone fragments. Case summary: 75 years male previously operated with proximal femoral nail later had fall due to which implant failed, which were manged with implant removal with bipolar hemiarthroplasty. Conclusion:Management of intertrochanteric fractures depends on age, stability of fracture, bone density. Young patient with good bone density should managed with proximal femoral nail, but in older individuals with osteoporotic bone stock hemiarthroplasty is good option. As we cannot rely on internal fixation devices to allow early full weight bearing of patients in the presence of severe osteoporosis and marked comminution at the fracture site, partial weight bearing is very difficult to be followed by these patients; thus, they shift to full weight bearing on the operated limb, causing mechanical failure. Hemiarthroplasty using bipolar prostheses for the unstable intertrochanteric fractures of the femur in elderly yields good clinical results in terms of early postoperative ambulation. This will have a direct effect on the general condition and postoperative rehabilitation.

Background: Trauma is one of the leading cause of acetabular fractures, which are becoming more common in developing nations. The treatment of displaced acetabular fractures is a difcult challenge for the orthopedic surgeon. The current study objective was to look at the functional and radiological outcomes of operated acetabular fractures. From 2018 to 2019, we retrospect Methods: ively reviewed the medical records of patients who had operatively treated acetabular fractures at a Tertiary Care Centre and had at least a one-year follow-up. The research was completed by 47 patients in total. The key objectives were functional and radiographic outcomes, as well as complications. The mean age of patients was Results: 40.06±11.84 years with male predominance (82.97%) and road trafc accident was the main reason of fracture (72.34%). The most prevalent acetabulum fracture pattern was left posterior wall (17.02%) and right both column (17.02%). The mean duration before surgery was 8.02±4.84 days. Most common post-operative complication was arthritis seen in 5(10.63%) cases followed by infection 3(6.38%). Radiological outcome was poorly xed in 7(14.90%) patients and well-xed in 40(85.10%) patients at the end of one year. In 53.19% cases Harris Hip Score was excellent followed by good in 29.79% cases. 3(6.38%) patients required secondary surgery. There was signicant association of functional outcome and duration of surgery as per Chi-Square test (p<0.05). Results suggest that operative outcome Conclusion: of acetabular fractures is reliable if judicious operative decision taken at the earliest. Anatomical to fair reduction can give excellent clinical result in these fractures. On follow up, radiological outcomes correlated well with clinical condition of the patient.