Backgrounds: the aim of this study was to compare the immediate effects of a session of Reactive Neuromuscular Training (RNT) with warming up exercises on shoulder proprioception and dynamic balance in female handball players with shoulder impingement.

Methods: In this controlled laboratory study, 18 female adolescent handball players from 14 to 18 years old were recruited from Samen City. The participants participated once in the warm-up routine program and once in the RNT program. Before and after each exercise program, shoulder proprioception was measured by photogrammetry, and dynamic balance of the upper limb was measured using the Wye balance test. The paired t-tests, with a significance level of 0.05, were employed to compare pre-test and post-test data.

Results: both exercise protocols had no significant effects on shoulder repositioning error (P>0.05). However, participation in both exercise programs resulted in a significant improvement in the dynamic balance score of the upper limbs of the athletes (P<0.001). Moreover, no significant differences were observed between the effect of routine handball exercises with the effect of RNT exercises on shoulder repositioning and dynamic balance in female handball players (P>0.05).

Conclusion: It seems that routine warm-up exercises and RNT could not improve proprioception in the shoulders of student-athletes with round shoulders. However, both training methods caused a significant improvement in the dynamic balance of the upper limb, although there was no significant difference between the effects of the two methods.

Keywords: Students, Female, Proprioception, Shoulder, Therapeutic Exercises

Objectives: Proximal humerus fracture (PHF) is one of the most common upper limb fractures. PHF is more common among the elderly and usually occurrs after a fall. high-energy trauma causes this form of fracture in young persons. There are several treatment options for PFH, including surgical and non-surgical precedures. We aimed to compare the results of surgical and non-surgical treatment outcomes in Iranian patients with PHF.

Methods: This single-center cross-sectional study included 60 patients with PFHs.the patients medical records were reviewed, studied, and assesed based on demographic characteristics, underlying conditions, type of treatment, complications, and necessity for re-intervention, as well as the CONSTANT score.

Results: The mean age of the patients was 45.65 years (SD: 1.83, range:18-78 years old). Among those older than 50 years, women significantly outnumbered men by a large margin (66.7%, P =0.009), (Mean±SD age of males and females: 39.71 ± 1.52 vs 52.42 ± 1.94, respectively). Thirty-one patients received surgical treatment, while 29 patients received non-surgical care. The CONSTANT score of patients who had surgery was considerably higher than that of other patients (P =0.009, Mean±SD: 80.41 ± 1.89 against 69.82 ± 1.82); this significant relationship was only seen in the age group of 18 to 49 years.

Conclusion: PHFs were more frequent in patients over the age of 50, perticularly in women. Patients under the age of 50 and men had higher CONSTANT scores.

Keywords: Proximal humerus fracture, Treatment outcome, Cross-sectional study, trauma

Level of evidence: level 4

Introduction: Surgical fixation is required for displaced posterior cruciate ligament (PCL) tibial bony avulsion fractures or with fractures having grade 2 or more posterior instability. The purpose of this study is to evaluate the results of arthroscopic fixation of PCL tibial bony avulsion fractures using the double suture bridge technique.

Materials and methods: A retrospective study was done involving 24 patients having displaced PCL tibial bony avulsion fractures. The arthroscopic double suture bridge technique was used to fix these fractures. Patients were followed up for a period of 3 year and assessed for knee related symptoms, signs, Lysholm knee score and satisfaction.

Results: The study group consisted of 21 males and 3 females. Fracture union was achieved in all cases by 2 months post operative. The mean Lysholm knee score at follow up of 3 months, 6 months, 1 year, 2 years and 3 years was 86.6, 96.5, 98.8, 99.1 and 99.4 respectively.  At latest follow up all the patients were satisfied with their knee function with respect to pain, range of motion, stability and resumption of pre injury activity level.

Conclusion: The arthroscopic double suture bridge technique is an effective method for fixation of PCL tibial bony avulsion fractures with respect to knee stability, range of motion and resumption of pre injury activity level.

Bilateral acetabular fractures are a rare type of acetabular fracture and because of a lack of information about these types of fractures, the management of bilateral acetabular fractures is challenging. We show a case of a 25-year-old young man with a bilateral acetabular fracture (left transverse fracture of the acetabulum and right posterior column fracture of the acetabulum) secondary to severe trauma following a road accident with no other pelvic damage who was treated in our department.

Purpose: This study aims to evaluate the effectiveness and safety of Aspirin and LMWH in an arthroscopic anterior cruciate ligament (ACL) reconstruction of low-risk patients. 

Material and Methods: We conduct a single-center, assessor-blind, simple randomized clinical trial from March 2019- May 2020. 18 to 45 years old patients with ACL rupture without concomitant injury, diagnosed by magnetic resonance imaging, enrolled in the study. Selected subjects were allocated between three parallel arms of the study, with 46 participants.

 Three parallels are 8o mg aspirin bid for 14 days, LMWH subcutaneous injection for 14 days, and no treatment parallel. Effectiveness outcomes were estimated by the DVT rate and PE rate, and safety was checked out by bleeding or hemarthrosis. Orthopedists assessed knee effusion with stroke score and ask patients for any symptoms during weekly clinic visits. The radiologist performed ultrasonography of lower extremities, searching for a sign of DVT. 

Results: Mean age of participants was 31.4 + 5.6, and 93 individuals (67%) were male and 23% were female. No DVT and PE were observed. Three cases in the LMWH and one case in aspirin groups had minor surgical site bleeding. One case of hemarthrosis with normal ultrasonography occurred in the LMWH group. Regarding safety and effectiveness, there was no statistically significant difference between the parallels. 

Conclusion: Use of LMWH or Aspirin after simple arthroscopic ACL reconstruction in low-risk patients have no different effectiveness. Hence routine use of thromboprophylaxis in this setting is questionable, although adverse events are rare. 

INTRODUCTION

Tibia is a long bone of the body which bears most of the weight  and because of its subcutaneous location it is prone to injury. On the basis of location, distal tibia fractures are second in incidence next to tibia diaphyseal fractures. Intramedullary interlocking nailing has emerged as one of the suitable management options as it allows mechanical compression on weight bearing which stimulates bone healing.

MATERIAL & METHODS

We retrospectively studied 40 patients of both sex with patients  above the age of 18 years with closed fractures and grade 1,2, 3A compound fractures treated at our tertiary care center.

Clinically fracture was considered to be united when the patient was completely pain free. Patient was followed up at monthly intervals till union. At each follow up patient was assessed both clinically and radiographically and details were recorded as per proforma.

RESULTS

The evaluation of the result was done using AOFAS criteria. 33 patients had excellent functional results, 5 had good functional results, 3 had fair functional results.

In our study, 38 (95%) patients had radiological union within 24 weeks. 2 patients had union after 28 weeks

CONCLUSION

Intra-Medullary nailing is a minimally invasive procedure which preserves the soft tissue and the fracture hematoma. It maintains the length, alignment, rotation and allows micro motion at fracture site on weight bearing which stimulates the callus formation. It has a good functional outcome with gratifying results when used in extra articular distal tibia fractures.

Triphalangeal thumb is a rare congenital anomaly especially in Asian population. Traditional treatments depend on the type of deformity and the presence of concomitant anomalies and include either excision in addition to the ligament reconstruction or fusion and shortening osteotomy. Instability and stiffness are the major concerns following the traditional techniques. In this study, we report a case of right triphalangeal thumb with a small delta phalanx in a nine-year-old boy that was treated by proximal phalanx radial closed wedge osteotomy without delta phalanx resection and intracapsular dissection. The angular deformity and the appearance of the thumb was corrected by this simple procedure without resulting in instability and stiffness in the interphalangeal  joint.

Background: Missed or neglected Monteggia lesions are defined as the classical fracture-dislocation presenting at least four weeks after injury. This injury in children is often challenging to treat and requires complex methods to achieve optimal results.

Case Report: We present the case of a 6-year-old girl with a 2-month-old neglected Bado Type-I Monteggia fracture-dislocation. After mismanagement by a traditional bone setter, our patient underwent ulnar osteotomy, bone graft, and fixation with a semi-tubular plate along with open radial head reduction. Although the patient experienced wound complications at the bone graft site, she achieved an excellent outcome with restored functionality and range of motion.

Conclusion: Neglected Monteggia injuries in pediatric patients demand multifaceted treatment approaches due to their complexity and potential for long-term functional impairment. The absence of a consensus on definitive treatment underscores the importance of early diagnosis and open reduction to enhance long-term outcomes. This case report highlights the effectiveness of ulnar osteotomy, plate fixation, and open radial head reduction in achieving favorable results.

Background: Tibial plateau posteromedial rim avulsions by semimembranosus tendon are a rare entity reported in a few studies so far with controversial mechanism. They are reported to accompany anterior cruciate ligament or meniscal injuries with their main fracture planes usually oriented coronally.

Case presentation: The patients was a 52-year-old male with a hyperextension-valgus tibial plateau fracture. There was a compression fracture of the lateral and an avulsion fracture of the posteromedial plateau. However, no soft-tissue injuries were detected in our patient. The avulsed fragment was oriented axially and covered by the medial meniscal posterior horn, creating the pattern of a longitudinal tear in a meniscal ramp lesion, but actually without any soft-tissue injuries. The fragment was fixated using tension band wiring technique with two Kirschner wires and one cancellous screw to approximate it to the tibia. Radiological and functional outcomes were excellent at 12-month follow-up

Conclusions: This fracture pattern merits special attention due to its unusual presentation, causing the meniscal posterior horn to get separated from the articular surface. “Bony ramp lesion” best describes the simultaneous separation of posterior horn of medial meniscus and its underlying bony fragment; without soft-tissue injuries of a real medial meniscal ramp lesion.

Chaput tubercle fracture is a counterpart to adolescent tillaux fracture, which occurs at the anterolateral part or at the attachment site of the antero-inferior tibiofibular ligament on the distal tibia. It is rare and its presentation may not be well appreciated in X RAYS which depicts the importance of a CT scan of ankle to reveal the same. A 25-year-old gentleman presented to us in the casualty with acute onset of pain, swelling and restricted movements at the ankle joint following a road traffic accident. CT Ankle revealed a chaput fracture along with bimalleolar fracture (posterior and lateral malleoli). The complex displaced fracture was managed with open reduction internal fixation with plate osteosynthesis for the posterior malleoli and lateral malleoli, tension band wiring was done for the chaput tubercle fracture. At the end of 2 years follow up, Patient was able to mobilise without any support. Through this case report, we would like to enumerate the rarity of chaput tubercle fracture associated with bimalleolar fracture of ankle which will be evaluated better with a CT evaluation at the first place. At the same time, it gives valuable information for the preoperative surgical plan.

Osgood-Schlatter disease (OSD), a form of traction apophysitis, predominantly affects adolescents engaged in high-impact activities. While conservative management is often effective, surgical intervention becomes necessary in refractory cases. This case report details an innovative arthroscopic approach to treat adult OSD, where traditional methods failed. A 29-year-old male athlete with persistent OSD symptoms underwent arthroscopic surgery after unsuccessful non-surgical treatments. The procedure, utilizing a unique combination of portals, demonstrated positive clinical and radiological outcomes. Arthroscopic removal of the bony particle was undertaken using six portals with a novel setting (consisting of medial and lateral superior, standard, and inferior portals) to minimize the damage to the patellar tendon and intermeniscal ligaments. This setting of portals also obviates the need for fluoroscopy since it provides adequate visualization for confirmation of complete removal of the bony particle. The lower portals also provide more convenient access to the bony particle, minimizing the possibility of incomplete removal and persistence of symptoms. The patient experienced complete resolution of anterior knee pain and prominence within six months post-surgery. Arthroscopic removal of the ossicle involved the use of superior portals for optimal access and visualization. Low portals were strategically employed to eliminate the need for fluoroscopy, offering a unique advantage. Postoperative rehabilitation included immobilization followed by a gradual return to weight-bearing and full range of motion. Arthroscopic removal remains the preferred method for treating OSD, emphasizing fewer complications. However, challenges related to limited access and anatomical restoration persist.

Case description:

We report here the case of a 64-year-old male presenting pathological fractures of T6 and T7 due to pseudomyxoma peritonei extension to the pleural cavity and thoracic spine. He presented interscapular pain with mild spinal cord compression symptoms. He was treated by achieving T5-T8 laminectomy, T2-T10 pedicle fixation, and T6-T7 vertebrectomy. The postoperative course was uneventful apart from a pulmonary embolism with favorable evolution under anticoagulants. 

Conclusion: Pseudomyxoma peritonei is a rare condition, with no previously described location in the spine. Here is described the case of a PMP extension to the thorax then the spine, treated with two-level vertebrectomy, laminectomy, and posterior fusion.