Supracutaneous Locking Compression Plate for Grade I &II Compound Fracture Distal Tibia—A Case Series

Background: Supracutaneous plating using a locking compression plate (LCP) as an external fixator in compound periarticular areas is facilitated by the development of anatomical plates. The soft tissue around the distal tibia is easily compromised by trauma and subsequent operative fracture treatment posing a definitive challenge in the distal tibia compound fractures. The purpose of this report is to describe our successful results using the metaphyseal locking compression plate (LCP) as an external fixator in the treatment of Grade I & II compound fractures of distal tibia. Methodology: A total of five (05) patients underwent “supracutaneous plating” of the tibia using a metaphyseal locking compression plate. Average age was 36 years. Regular screw tract dressings were done. Average period of follow-up was 15 months. Results: The plate was in situ for an average of 24 weeks. There were no clinically significant screw site infections. In all five patients the plate was kept in place until there was complete consolidation both clinically and radiologically. At the latest follow-up (average 15 months), all patients were fully weight bearing with a fully healed tibia. All patients were infection-free with well-healed wounds. Conclusion: Routinely, after initial debridement and temporary bony stabilization is provided by external fixation in compound fractures of the distal tibia with significant soft tissue injury. Most external frames for the lower leg are bulky and cumbersome, causing significant problems for the patient. To circumvent these issues, we have successfully used an anatomically-contoured supracutaneous metaphyseal locking compression plate as external fixator in a series of five patients for grade I & II compound fracture of the distal tibia.

Is Ultrasound Effective in Diagnosing Internal Derangements of the Knee?

Internal derangement of knee significantly affects daily activities of patients and management of such cases with accurate diagnosis and early treatment is of utmost importance. This study determines the benefits of arthroscopy directly and also compares the sensitivity and specificity of ultrasound, MRI and arthroscopic findings in diagnosing internal derangements of the knee. This is a prospective study of 50 cases that includes patients having knee pain and instability of joint for more than 6 weeks, symptoms of locking of knee joint or effusion and having no bony injury as confirmed by X ray. Results were analysed and sensitivity and specificity were calculated. The present study supports that the clinical diagnosis is of primary necessity, while ultrasound and MRI are additional diagnostic tools in diagnosing IDK. Arthroscopy combines more accurate diagnosing tool and therapeutic modality, which is a more convenient, economical and convincing technique to both surgeon and patient alike. Although ultrasound is less accurate than MRI, it is cost effective and available at most of the peripheral centres. So it is better to do ultrasound rather than MRI for diagnosing IDK in peripheral centres and refer to specialty clinics or tertiary centres for further diagnosis and treatment.

Management of Tibial Metaphyseal Fractures by Hybrid External Fixator

Introduction: The Hybrid External Fixator combines the advantages of the monolateral pin fixators and the circular Ilizarov wire fixators. Principle of early motion has been touted as the functional savior of major intra articular injuries in application of hybrid external fixation. Materials & Methodology: 48 patients were considered for the study with tibial fractures admitted in Mamata General Hospital from May 2011 to May 2013. Results: The union and functional outcome of hybrid external fixator in simple and complex proximal and distal metaphyseal fractures of tibia in adults was evaluated at our centre. The fractures of the proximal tibia united with an average of 13.3 weeks (12 - 16 weeks). The fractures of the distal tibia united with an average of 14.42 weeks (13 - 22 weeks) with minimal complications. Conclusion: Our study shows high satisfaction rate after fixation, provides adequate stability and allows early motion of the joint. It is also effective in extra articular fractures occurring within 5 cm of the joint as the IM nails often do not provide enough stability and plating requires extensive soft tissue dissection.

A Case Series of Various Swelling of Fingers in Adults

Patients commonly present to their general practitioner with swellings of the hand. These include a variety of diagnoses with certain lesions (for example, ganglion) being more common than others. Some may even be familiar as they are often site-specific. This article aims to provide general practitioners with clear and concise information regarding swellings to be ruled out before suspecting giant cell tumor of tendon sheath. Swellings of the hand are commonly encountered in a general practice with different diagnosis. They may arise from any tissue in the hand including skin, subcutaneous fat, muscle, nerves, vessels, tendon, bone and cartilage. Fortunately, most are benign, asymptomatic and may not require surgical intervention. Ganglions, epidermoid inclusion cysts, giant cell tumours of the tendon sheath, and swellings associated with arthropathy comprise the majority of lesion. This study includes 16 cases which are presented with similar history and presentation of finger swellings as that of giant cell tumor tendon sheath but the final diagnosis has varied.

Bilateral Achilles Tendon Xanthoma in an 18-Year-Old Patient

Background: Xanthomas are rare, non-neoplastic lesions which occur due to defect in the LDL receptors leading to their accumulation in tendons and synovium. The prevalence of heterozygous familial hypercholesterolaemia (HFH) is approximately 1 in 500. Aim: To study a rare case of bilateral achilles tendon xanthoma and its functional outcome. Case Presentation: We presented a case of xanthoma over posterior aspect of both lower third legs just above the heel in an 18-year-old female, and diagnosis was confirmed by clinical examination ultrasound and MRI, for which subtotal resection was planned and further followed up. Postoperative treatment consisted of six weeks long leg cast immobilization. After 10 weeks the patient started walking without any difficulties. Conclusion: Subtotal resection of achilles tendon xanthoma has given a good functional outcome. There is no need for reconstruction of tendon in every case.