Cathepsin K Mutation-A Subtle Clinical Presentation.

Context: Pyknodysostosis is an uncommon inherited disorder associated with consanguinity, often presenting with sclerotic bone disease, short stature, dysmorphic features, and recurrent fragility fractures at an early age.

Case: A 34-year-old woman was evaluated for the cause of recurrent fragility fractures. She was born of a third-degree consanguineous marriage and had a twin brother who was of short stature.

The outcomes of surgical treatment for lateral Hoffa fracture nonunions.

Introduction: Lateral Hoffa nonunion are rare injuries. A significant percentage of these nonunions are due to missed acute lateral Hoffa fractures. Operative management of these injuries is difficult and complicated by the presence of bone loss, infection, and soft-tissue contractures.

The Role of the Ilizarov Ring External Fixator in the Management of Tibial Fractures with Impending/Incomplete Compartment Syndrome.

 The management of tibia fractures complicated by compartment syndrome affects the treatment and functional outcome of patients due to the complications associated with fasciotomy. The purpose of the present study is to differentiate impending/incomplete compartment syndrome (ICS) from established acute compartment syndrome (ACS) in tibial fractures, and to assess the outcome of the fixation of the Ilizarov apparatus in patients with these fractures presenting with ICS, who were not submitted to fasciotomy.  After the establishment of the inclusion and exclusion criteria, 19 patients were included in the study from January 2007 to December 2017.

Use of an Angled Blade Plate for 31A3 Intertrochanteric Fractures.

Background: A subgroup of pertrochanteric fractures-namely, the AO/OTA 31A3 fracture-continues to be a difficult problem to treat, even with cephalomedullary nails. We present the results for 26 patients with a 31A3 fracture treated with the angled blade plate.

Methods: The records of 26 consecutive patients with a 31A3 fracture that was treated operatively with the angled blade plate device between 2007 and 2012 at our center were reviewed, and the patients were contacted for follow-up.

Intravenous Mannitol reduces intracompartmental pressure following tibia fractures: A randomized controlled trial.

Purpose: Impending compartment syndrome is a common event following closed tibia fractures, which can progress to sinister compartment syndrome. Fasciotomy is the only definitive treatment available, though it has its own drawbacks and complications. Medical management at present consists of limb elevation and adequate hydration.

Time to debridement in open high-grade lower limb fractures and its effect on union and infections: A prospective study in a tropical setting.

Purpose: To prospectively evaluate whether time to debridement has any correlation with union, infection, and quality of life in high-grade lower limb fractures in a tropical setting.

Methods: A prospective cohort study was conducted at a tertiary care center in South India. Two hundred fifty-four adult skeletally mature patients with 301 grade 3 fractures involving the femur, tibia, or fibula were recruited.

Early outcome of culture-negative infection in open fractures of the lower limb: A prospective study.

Background: Culture-negative infections in open long bone fractures are frequently encountered in clinical practice. We aimed to identify the rate and outcome of culture-negative infections in open long bone fractures of lower limb.

Methodology: A prospective cohort study was conducted from November 2015 to May 2017 on Gustilo and Anderson Grade III open long bone fractures of the lower limb.

Decision making in the management of malunion and nonunion of intertrochanteric fractures of the hip.

Aim: Intertrochanteric fractures account for almost 50% of hip fractures.Nonunion and malunion of these fractures are relatively uncommon. This study reviews the outcome of 31 cases of intertrochanteric fracture failures.

Comparison of Reverse Sural Artery Flap Healing for Traumatic Injuries Above and Below the Ankle Joint.

The reverse sural artery (RSA) flap is popular among trauma surgeons to cover the distal third of the leg to the foot. However, flaps that inset in the foot seem to have a high necrosis rate. This study compared the healing of RSA flaps performed for defects proximal to the ankle versus defects distal to the ankle.

Outcome of screw post fixation of neglected posterior cruciate ligament bony avulsions.

Background: Contrary to acute posterior cruciate ligament (PCL) bony tibial avulsions, surgical management of chronic injuries is technically challenging and appears to be controversial. We sought to assess the outcome of a novel screw post augmentation technique in neglected cases.

Methods: 16 patients were followed up in a tertiary single-center retrospective study.

Management of Chronic Infected Intra-Articular Fractures of the Proximal Tibia with Ilizarov Ring Fixation.

Infected nonunion and malunion of tibial plateau are rare injuries with no standardized protocols for treatment. This study assessed the outcome of chronic infected intra-articular proximal tibial fractures with and without metaphyseal bone loss managed with the Ilizarov ring fixator. A series of six patients of intra-articular infected nonunion of the tibial plateau and two patients with malunited plateau with metaphyseal nonunion were treated in a tertiary care hospital.

Alternate Method of Arthroscopically Confirming Femoral Button Deployment for Knee Anterior Cruciate Ligament Graft Suspensory Cortical Fixation.

Accurate deployment of the femoral button on the lateral aspect of the lateral femoral condyle when using a suspensory fixation device for anterior cruciate ligament reconstruction is ideal. Direct visualization would be the most appropriate method of visualization in the lateral gutter. A previously described technique is performed with the knee in flexion.

Head salvage of an infected neck of femur fracture in an adult: a case report.

Head preservation of an infected neck of femur fracture appears to be extremely rare with no described cases in literature till date. We present the outcome of head salvage in a young adult with an infected neck of femur nonunion who in addition had chronic osteomyelitic sequelae of his entire femur with reactivation of latent infection in the distal femoral diaphysis. Osteosynthesis was performed by means of cancellous screw fixation augmented with bone substitute following a failed attempt at salvage with a valgus intertrochanteric osteotomy.

Valgus osteotomy for nonunion and neglected neck of femur fractures.

Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics. The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources.

Claw Toe Deformity of the Foot due to Foreign Body Granuloma.

Unlabelled: We present a case of dynamic claw deformity of the right third toe due to a foreign body granuloma adhering to the flexor digitorum longus (FDL) tendon at the level of the body of the metacarpal bone. The deformity was completely corrected after removal of the granuloma and lengthening of the FDL tendon. A 25-year-old woman presented with pain and claw deformity of the right third toe, which corrected with ankle plantar flexion.

Indices affecting outcome of neglected femoral neck fractures after valgus intertrochanteric osteotomy.

Objectives: To evaluate preoperative neck resorption and postoperative valgus orientation as predictors of union and functional outcome after valgus intertrochanteric osteotomy for treatment of neglected femoral neck fractures and nonunions.

Design: Retrospective cohort study.

Setting: Tertiary care center.

The efficacy of single-stage open intramedullary nailing of neglected femur fractures.

Background: Neglected femur fractures are not rare in the developing world. Treatment options include single-stage open reduction and intramedullary nailing, or open release, skeletal traction, and then second-stage open intramedullary nailing, with bone grafting. Single-stage procedures have the potential advantage of avoiding neurovascular complications secondary to acute lengthening, but they require a second operation, with potentially increased resource use and infection risk.

Functional outcome of biological condylar blade plating of subtrochanteric fractures.

Background: The aim of this study was to review high-energy subtrochanteric fractures treated biologically with the 95° angled blade plate, to assess the time to union and return to work, and to perform a functional evaluation using the traumatic hip rating scale.

Patients And Methods: This study is a retrospective review of 22 patients with 23 fractures. Twenty-one patients (96%) with 22 fractures were available for analysis.

Rapid resorption of calcium sulfate and hardware failure following corrective radius osteotomy: 2 case reports.

Bone substitutes are being increasingly used and may avert the need for autogenous bone graft in orthopedic surgery. Thus it is important to note complications that occur with them to better understand the limitations. We report on early mechanical failure of injectable calcium sulfate leading to implant failure in 2 elderly patients who had corrective osteotomies for malunited distal radius fractures.

Experience of using local flaps to cover open lower limb injuries at an Indian trauma center.

Background: Optimal care of open, high-velocity, lower limb injury requires surgical skills in debridement, skeletal stabilization, and in providing appropriate soft tissue cover. Timely coordination between orthopedic and plastic surgeons, though ideal, is often difficult. In our center, orthopedic surgeons undertake comprehensive treatment of open fractures including soft tissue cover.

Reverse sural flap cover within a ring fixator.

The ring fixator is an ideal apparatus to treat infected gap nonunion of the tibia and to correct deformity in multiple planes. However soft tissue problems may arise during transport and at docking. Although various options such as free flaps, neurocutaneous flaps, fasciocutaneous flaps and cross leg flaps are available for flap cover, this is always done prior to application of a ring fixator.

Reconstruction of traumatic medial malleolus loss: A case report.

We describe the reconstruction of the medial malleolus in a severe open ankle injury with iliac crest bone graft and sural artery flap in a young adult. At two years follow-up he had a good outcome with a painless, stable ankle with nearly full plantarflexion but restricted dorsiflexion.

Lateral gastrocnemius flap cover for distal thigh soft tissue loss.

Background: The gastrocnemius muscle flap has been used extensively for cover around the knee. However, the use of the lateral gastrocnemius for cover of the distal thigh has not been well described.

Methods: The lateral gastrocnemius flap was used in eight patients from October 2004 to February 2009 for cover of the distal thigh proximal to the knee joint.

Reconstruction of open contaminated achilles tendon injuries with soft tissue loss.

Background: Open achilles tendon injuries, present a complex problem to the treating surgeon especially if associated with tendon and soft tissue loss. We present eight such patients treated with tendon repair/reconstruction and reverse flow sural artery flap for soft tissue cover.

Patients: Eight patients (age, 12-64 years) with a spectrum of open tendo-achilles injuries of acute and chronic (infected), including loss of tendon of up to 10 cm, tendon defects with no distal attachment and one with partial loss of the calcaneum were treated between November 2005 and July 2006.

Reconstruction of complete knee extensor mechanism loss with gastrocnemius flaps.

Unlabelled: We assessed the outcome after reconstruction of traumatic, complete, infected, extensor mechanism loss attributable to high-velocity open knee injuries in eight consecutive patients (all males) who presented to us between February 2005 and September 2007 at an average followup of 24 months. All were treated with gastrocnemius flaps. The loss in extensor mechanism was the patellar tendon in five patients, patella and patellar tendon in two patients, and combined patella, quadriceps, and patellar tendon in one patient.