The triangular fibrocartilage complex (TFCC) is a well defined anatomical entity located on the ulnar aspect of the wrist joint functioning primarily to stabilize the distal radio –ulnar joint (DRUJ) and also to act as a shock absorber across the ulno-carpal joint.

BACKGROUND:Primary giant cell tumor (GCT) arising from bones of hand are rare to occur. Metacarpals are often the most common site of involvement among hand bones. There are no uniform guidelines for treatment of GCT involving metacarpals due to lack of relevant literature.OBJECTIVE:To suggest a management strategy for GCT involving metacarpals.METHODS:Retrospective review of cases of GCT involving metacarpals over a period of 15 years from 2005 to 2019 managed at department of Orthopaedics, All India Institute of Medical Sciences, New Delhi.RESULTS:A total of 12 cases of GCT involving metacarpal were included, out of which one was lost to follow-up. Four cases were recurrent, and seven were primary at the time of surgery. All the patients were operated with wide excision of the tumor. In seven patients reconstruction of the metacarpal and MCPJ was done using fibular strut graft and silastic artificial joint, while in two patients, MCPJ arthrodesis was performed using fibula and/or iliac crest bone graft. In another two patients, the MCPJ was reconstructed using reversed vascularised toe transfer. Mean follow up of the patients was 3.22 ± 2.07 years. Mean Quick DASH score at latest follow-up of patients operated with silastic joint reconstruction, reversed vascularised toe transfer and arthrodesis of MCP joints were 30.5 ± 9.5, 25 ± 2.3 and 39.8 ± 3.4 respectively. Local recurrence occurred only in one patient at one year after surgery. All the patients were pain free at latest follow-up with quite functional and cosmetically acceptable hand.CONCLUSION:Reversed vascularised metatarsal transfer has obtained better functional results compared to reconstruction with fibular grafting and silicone joint replacement but due to technical difficulties, vascularised joint transfer may not be performed in every setting and there is risk of donor site morbidities with this technique. Our strategy for the treatment of GCT involving metacarpal was to do vascularised joint transfer or arthrodesis for border digits and reconstruction with silicone joint for central digits.

Avascular necrosis of the lunate, commonly known as Kienböck's disease is a disorder that can lead to carpal collapse and the need for surgeries, which can stabilize the wrist. There are different associations with the disease but the exact etiology is unknown. Kienböck's disease is believed to result from mechanical and vascular factors in genetically predisposed individuals. The newer classification based on advanced wrist arthroscopy and MRI help in a better understanding of the disease, early diagnosis, and treatment. A review of recent literature regarding newer treatment options has shown good results in the early stages of osteonecrosis. This article intends to review an update on the etiopathogenesis, classification, and the current advanced treatment options.

The aim of our study was to evaluate clinical, radiological and functional outcomes of selected cases of percutaneous fixation of scaphoid fractures via a dorsal approach. Percutaneous fixation by dorsal approach was done in 32 patients (mean age 32.2 years) involving both fresh and late scaphoid fracture presentations (mean 17 days). Fourteen cases of B1 type, ten cases of B2 and eight cases of C type (Herbert's classification) were treated. The patients were prospectively followed up clinically and radiologically for a minimum follow-up of 14 months (mean 16 months), and functional outcome and complications were assessed. All fractures united over an average of nine weeks. There was no avascular necrosis or screw cutout with preservation of wrist movement and grip strength. There were no injuries to any at risk anatomical structures. Percutaneous fixation of scaphoid fractures through dorsal approach gives good clinical and functional outcome in acute and chronic scaphoid fractures of B1, B2 and C types (Herbert's classification).

OBJECTIVES:To assess the efficacy and safety of digastric trochanteric flip osteotomy technique in the management of acetabular fractures and to evaluate surgical outcome in terms of fracture reduction, femoral head viability of selected acetabular fractures treated operatively using a digastric trochanteric flip osteotomy and a modified Kocher–Langenbeck approach with surgical dislocation of the femoral head.DESIGN:Prospective.PATIENTS:Eighteen patients predominantly with combined transverse and posterior wall fractures or multifragmentary posterior wall fractures. OUTCOME EVALUATION: Clinical and radiographic analysis after a minimum 18 months follow-up. Methods A single modified approach involving digastric trochanteric flip osteotomy and a modified Kocher–Langenbeck approach with anterior (n = 14) or posterior (n = 4) surgical dislocation of the femoral head, was done for one or more of following reasons: intra-articular assessment of reduction in fractures with comminution, marginal impaction and involvement of the anterior column, removal of intra-articular fragments, and confirmation of extra-articular screw placement.RESULTS:At a mean follow-up of 26 months (18–40 months), the 17 patients presented with a good to excellent clinical result according to the d’Aubigné score. In all subjects, anatomical reduction was achieved during surgery. The osteotomy site healed at an average of 7 weeks and all the patients recovered abductor strength at 12 weeks. One avascular necrosis occurred in a case of posterior column plus wall fracture (who presented to us after 3 weeks). No heterotopic ossification interfering with hip function was found.CONCLUSION:This technique gives good exposure (especially in posterior wall, dome area, posterior fracture-dislocation with intra-articular fragments/femoral head fractures and T-fractures), preservation of abductor strength (which may be lost with excessive retraction of abductors to see dome area in classical posterior approach), reliable healing of osteotomy (in contrast to conventional trochanteric osteotomy) without risking the vascularity of femoral head.

INTRAOPERATIVE cardiac arrest during neurosurgical operations can occur after massive blood loss in adults and in children. 1,2,3,4 Many of these procedures are performed in positions other than supine, and this could pose a major hurdle in successful resuscitation.(3) The practice of turning the patient supine for cardiopulmonary resuscitation (CPR) during neurosurgical operations has recently been questioned.(5) Although successful resuscitation has been reported in the prone position, there are no studies available on the feasibility of CPR in the lateral position. This is a case report of cardiac arrest due to massive blood loss in a child undergoing excision of a large brain tumor in the lateral position followed by successful resuscitation in the same position.

BACKGROUNDAim of our study was to evaluate the use of Locking Compression Plate (LCP) in patients with long standing nonunions of the clavicle with osteoporotic bones.MATERIAL AND METHODSThere were a total of 11 patients. Surgery was performed for painful nonunion with shoulder dysfunction. Average time since injury was 6.9 months (3-39 months). Nonunions were stabilized by a 3.5-mm LCP, applied on the antero-inferior surface of the clavicular shaft. A six-hole LCP was used in eight cases. In three patients seven-hole LCP and in one patient eight-hole LCP was used. The fixation was supplemented by autogenous cancellous bone graft (except in hypertrophic nonunions). Patients were followed for a mean of 2.8 (1-3) years.RESULTSThe average time of radiologic union was 5.3 months (3-9 months). Union was achieved in all patients. Subjective clinical assessment was performed using the Disabilities of the Arm, Shoulder, and Hand functional score (DASH). The mean DASH score preoperatively was 42 (25-52) and postoperatively was 24 (11-34). Superficial infection and features of reflex sympathetic dystrophy were seen in one patient each.CONCLUSIONLong standing clavicular nonunion with osteopenic bone is a difficult problem to treat. Our study shows that LCPs can be an improved implant option with good fracture healing.

Prevalence of the 2 ureaplasma biovars was estimated in patients with genital tract infections by polymerase chain reaction targeting the urease and multiple-banded antigen gene. Ureaplasma was more frequently isolated in symptomatic than asymptomatic subjects (48% versus 22%) (P = 0.001). Biovar 1 was predominant; however, there was no difference in the distribution of the 2 biovars between the symptomatic and asymptomatic subjects.

BACKGROUND & OBJECTIVE Ureaplasma urealyticum has been implicated in various neonatal morbidities in preterm infants. Its association with chronic lung disease (CLD) remains controversial. The aim of this prospective study was to investigate colonization of U. urealyticum in preterm infants (with gestational age <34 wk) and to evaluate the relationship between U. urealyticum colonization and neonatal morbidity including CLD. METHODS U. urealyticum was cultured from nasopharyngeal or endotracheal aspirates collected within 24 h of birth from infant <or=34 wk gestation weighing <1800 g admitted to a Neonatal Intensive Care Unit of a tertiary care hospital in north India, and PCR was performed on the DNA extracted from these samples. RESULTS Twenty per cent of the study infants were colonized with U. urealyticum. The mean gestational age of the infants in the colonized group was less than that of non colonized infants (P<0.05). The peripheral total leukocyte counts and mortality rate were higher in infants with U. urealyticum colonization than in non-colonized infants (P<0.05). There was no significant difference between the colonized and non colonized groups with regard to the antenatal use of steroids, sex, cause of respiratory distress, use of surfactant, duration of ventilation. INTERPRETATION & CONCLUSION None of the 20 babies colonized with U. urealyticum developed CLD as compared with two (2.5%) of the non colonized group. Colonization of the airways with U. urealyticum had no significant role in development of CLD in Indian preterm infants.

Although uncommon in developed world, tuberculosis is one of the most dreaded diseases in the under-developed and developing countries. Resurgence of tuberculosis and its increasing incidence, with widespread HIV infection has lead to the reporting of infections at unusual sites. Tubercular tenosynovitis not involving bone is an extremely rare and perplexing presentation. A rare case of isolated tuberculosis of Achilles tendon without any evident primary contiguous or distant focus in a 55-year-old immunocompetent male is presented.

Bien que rare dans les pays développés, la tuberculose est une des maladies les plus redoutées dans les pays sous-développés et en voie de développement. La résurgence de la tuberculose et l'augmentation de son incidence, liée à l'étendue de l'infection due au VIH ont conduit à décrire des infections de sites inhabituels. La ténosynovite tuberculeuse, sans atteinte osseuse est une présentation extrêmement rare et trompeuse. Nous présentons le cas d'un patient de 55 ans, immunocompétent, souffrant d'une ténosynovite isolée du tendon d'Achille, sans mise en évidence d'un foyer primitif contigu ou distant.

We retrospectively reviewed 445 patients with neglected tendon and nerve injuries treated between 1983 and 2003. Of these patients, 355 patients (447 tendons) had flexor tendon injuries, 62 patients (84 tendons) had extensor tendon injuries, and 28 patients had isolated nerve injuries. (In addition to these, 48 patients had nerve injuries associated with flexor tendon injuries; making a total of 76 patients with nerve injuries.) Most of the patients presented for treatment from 2 months to 2 years after the injury. The majority (73%) of patients with flexor tendon injuries were treated by free tendon grafting. Sixty-two patients required staged reconstruction using a silicon implant. The followup ranged from 12 to 83 months (mean, 45.8 months). In flexor tendon injuries, overall excellent results were seen in 83 of 447 tendons (18.5%) and good results were seen in 70.5%. In extensor tendon injuries, 23% had excellent results, 53% had good results, 34% had poor results. Seventy-six patients (114 nerves) of neglected nerve injuries of the hand were treated during the same period. In 48 (63%) patients the nerve injury was associated with tendon injury. End-to-end repair was possible in 89 nerves and the remainder was grafted. Because nerves in the hand have a predominant sensory component, sensory recovery was seen in the majority of patients.

Chordoma is a malignant tumor arising from the remnants of the notochord. Approximately 50% of chordomas occur in the sacrococcygeal region. They are most common in the 50- to 60-year age group, and in men rather than in women. The earliest and most common symptom of sacral chordoma is sacral pain radiating to the legs. Other complaints include constipation and presence of a mass. The authors present a case of histologically proved sacral chordoma with bowel and bladder involvement. Most sacral tumors show increased uptake on radionuclide scintigraphy except chordomas, which usually have decreased uptake. This case is presented keeping in view its unusual bone scan features.

Tuberculosis of the calcaneus is a rare entity. Its incidence is reported to be nearly 1% to 2% of all cases of osteoarticular tuberculosis. Because of the low index of suspicion, it is usually diagnosed late. It occurs mostly as a result of hematogenous spread from a primary focus elsewhere in the body. We present a case of a swelling and discharging sinus of the heel in a young adult male. On histopathology, the lesion was diagnosed to be tuberculous in origin. After a standard regimen of multidrug antitubercular treatment, the discharging sinus healed with no further complaints. Scintigraphic imaging of the calcaneal lesion, both pre- and postantitubercular treatment, is presented.

We present a case of a 14-year-old boy, who presented with pain in the left thigh region for 1 year. The pain exacerbated at night, waking up the child and was relieved by salicylates. On the basis of clinical history, conventional radiography, computerized tomography and bone scintigraphy, a diagnosis of osteoid osteoma was made. The tumor was completely excised, and there was complete remission of symptoms. Six months following surgery, the pain recurred in the same region. Conventional radiography revealed dense sclerosis at the surgical site. Three-phase skeletal scintigraphy showed a focal area of increased blood pool activity followed by intense focal uptake in delayed images, characteristic of osteoid osteoma. Computerized tomography confirmed the findings of skeletal scintigraphy.