Klippel-Trenaunay syndrome (KTS) is a rare complex malformation characterized by the clinical triad of capillary malformations, soft tissue and bone hypertrophy, and venous/lymphatic malformation. Fractures of long bones in such cases are challenging to treat. A 12-year-old female with this syndrome presented with femoral shaft fracture of right thigh. She was initially kept on skeletal traction for two weeks and then she underwent closed reduction and immobilization with external fixator with uneventful intraoperative and postoperative period. Fracture united at four and half months.

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Humerus fracture is very rarely associated with ipsilateral shoulder dislocation. Here, we have reported probably the first case of compound fracture of humerus associated with a two-part fracture dislocation of ipsilateral shoulder. A 30-year-old female presented to the emergency department after a road traffic accident. The vehicle in which she was travelling skidded off the road and she got trapped. She had degloving injury over her left arm with a fracture of left humerus and anterior dislocation of ipsilateral shoulder and greater tuberosity fracture. She was managed initially with wound debridement, external fixation over humerus, closed reduction of shoulder dislocation, and open reduction and internal fixation of greater tuberosity fracture. Skin grafting was done over the wound later on. Fracture united at 4 months with a good range of movement at shoulder at the final follow-up.

BackgroundThe meniscal flounce is wavy fold in free inner border of meniscus seen during knee arthroscopy. The presence of this flounce in medial meniscus has been found to be highly predictive of normal medial meniscus. With meniscus related symptoms being commonest indication for undergoing knee arthroscopy, presence or absence of medial meniscus flounce, can be a good guiding sign. In this study, we aimed to validate the significance of the flounce sign in ruling out medial meniscus tear.MethodsA prospective study was undertaken to validate the significance of flounce sign. There were 62 patients who underwent arthroscopic surgery of the knee over the duration of one and half years. Free inner margin of medial meniscus as seen through anterolateral portal was recorded for the presence or absence of flounce. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of this sign was then calculated for diagnosing normal medial meniscus. Significance was tested with chi square test with 95 % confidence interval.ResultsA total of 62 cases were included. The sensitivity, specificity, PPV, NPV and accuracy of flounce sign was found to be 67.64 %, 92.85 %, 92 %, 70.27 % and 79.03 % respectively, and the result was significant (p value = 0.0001).ConclusionThe flounce sign has been shown to have high diagnostic value. Use of it in routine knee arthroscopy can be helpful, particularly during screening procedure and in exploring tears which are usually not seen easily through routine portals.

Caesarean section in a severely kyphotic patient presents with unique challenges. We report a case of obstructed labor in case of a pregnant lady with severe kyphosis of spine that was managed by caesarean section. Lateral recumbent position with adequate assistance and paramedian or vertical skin incision was used and found to provide good exposure. Baby was delivered by lower segment uterine incision by reverse breech extraction. Postpartum hemorrhage was managed with uterotonics and bilateral uterine artery ligation. Tubal ligation though advised was refused by the patient. Prolonged catheterization was done in view of obstructed labor. Postoperative period was uneventful.