Notes

"Cerebral venous nasal thrombosis sequel regarding COVID Encephalitis; a rare presentation".
ACJ pseudo-dislocations are rare injuries. There is limited evidence in guiding the management of such injuries. selleck chemicals Our proposed technique of fixation with suture anchor, endo button and temporary stabilisation with K-wire can provide promising results.
An arterial pseudo aneurysm formation is an unusual complication following intramedullary nail distal locking screw insertion. During such surgical procedure, arterial laceration might damage the wall, allowing blood leakage into the soft- tissue surrounding. Only few records are available regarding such injuries.

A 19-year-old male diagnosed with femoral shaft fracture after a trauma event, was treated using Antegrade Long Intra-Medullary Nail with distal locking screw. Following post-operative serial blood count indicating a consistent decrease in his Haemoglobin levels, a Computed Tomography angiogram was performed and showed an arteriovenous fistula of the lateral superior geniculate artery. The artery was coiled, and haemoglobin levels were stabilized again.

A distal interlocking screw should be carefully placed, including blunt dissection before the drilling and screw placement. In addition, blood counts were proved essential in routine.
A distal interlocking screw should be carefully placed, including blunt dissection before the drilling and screw placement. In addition, blood counts were proved essential in routine.
Alkaptonuria is a rare autosomal recessive metabolic disorder characterized by accumulation of homogentisic acid (HGA) due to an inherited deficiency of the enzyme HGA oxidase. Unlike rheumatoid arthritis which affects the small joints of the hands and feet, ochronotic arthropathy predominantly involves the large weight-bearing joints such as hips, knees, and spine. The knee is the most common joint to be affected. Ochronotic arthropathy is usually managed conservatively, but for severely affected hip and knee joints, replacement is considered.

This report describes a case of 57-year-old male who presented with bilateral knee osteoarthritis who was incidentally diagnosed with ochronosis intraoperatively during total knee arthroplasty, its challenges faced and post-operative functional outcome after 18 months follow-up.

This case report highlights the need for high index of suspicion for preoperative diagnosis of ochronotic arthropathy. Difficult spinal anesthesia should be anticipated. Friable and stiff tendon due to ochronotic involvement can put the extensor tendon at risk of rupture during retraction of patella intraoperatively. Post-operative active quadriceps rehabilitation should be done with caution due to friable tendon.
This case report highlights the need for high index of suspicion for preoperative diagnosis of ochronotic arthropathy. Difficult spinal anesthesia should be anticipated. Friable and stiff tendon due to ochronotic involvement can put the extensor tendon at risk of rupture during retraction of patella intraoperatively. Post-operative active quadriceps rehabilitation should be done with caution due to friable tendon.
Heterotopic ossifications (HO) are a well-recognized but infrequently encountered condition. In the lower limb, the literature commonly reports the formation of HO around the hip after surgeries. However, HO is uncommon around the knee and a rare complication after open fixation of posterior cruciate ligament (PCL) avulsion fracture.

Here, we describe a case of HO in a 42-year-old patient with multiligament injury, including PCL and arcuate ligament avulsion, partial ACL tear, and medial meniscus root tear with suspected vascular compromise. He underwent open reduction and internal fixation of PCL avulsion fracture and medial meniscus root repair after the injury. At a 6-week follow-up, a plain radiograph revealed posterior capsule HO which kept increasing over successive follow-ups compromising his knee function. The patient was not willing for any mode of intervention for the same at any given time.

HO after open PCL avulsion fixation is an uncommon entity. This article sheds light on how open fixation of PCL bony avulsion in a multiligament injured knee could result in a HO.
HO after open PCL avulsion fixation is an uncommon entity. This article sheds light on how open fixation of PCL bony avulsion in a multiligament injured knee could result in a HO.
Acute painless bilateral foot drop without bowel/bladder involvement is a very rare presentation of lumbar degenerative disorders. Only a few cases have been published on it in the literature. An early intervention could prove to be very helpful for the neurological recovery.

We present three cases where patients developed acute onset bilateral foot drop without radiculopathy and without bowel/bladder involvement. The first case was due to acute lumbar disc herniation, the second was caused by acute disc prolapse in a pre-existing asymptomatic lumbar canal stenosis, and the third one precipitated in a progressive degenerative severe lumbar spinal stenosis. Two cases (case reports 1 and 3) underwent minimal invasive decompression while the other case (case report 2) underwent instrumentation+ decompression + fusion. Case 1 and 2 with a short duration of symptoms showed good neurological recovery, whileereas Case 3 with longer duration of complaints did not improve.

Patients presenting with painless bilateral foot drop without cauda equine syndrome should be evaluated for spinal causes besides central nervous systemCNS, peripheral nerve, metabolic and autoimmune causes. Any finding in support of lumbar degenerative disease as the cause after excluding other causes should prompt for surgical decompression of the spine as an early intervention might help patient recover back to a normal and active lifestyle.
Patients presenting with painless bilateral foot drop without cauda equine syndrome should be evaluated for spinal causes besides central nervous systemCNS, peripheral nerve, metabolic and autoimmune causes. Any finding in support of lumbar degenerative disease as the cause after excluding other causes should prompt for surgical decompression of the spine as an early intervention might help patient recover back to a normal and active lifestyle.
Large defects following resection in the gluteal region are challenging. Of note, there are a limited number of fairly morbid options for reconstruction.

A 65-year-old female presented with complaints of an enlarging mass in the left buttock over the past several months. A high-grade sarcoma was diagnosed based on a biopsy. The final diagnosis was an undifferentiated pleomorphic sarcoma based on the resected tumor. An 11-cm tumor with surrounding tissues, including the great gluteal muscle, was resected, which resulted in a 17-cm full thickness defect. The defect was reconstructed with a transposition flap elevated from the lateral thorax. A transposition flap can cover large buttock defects without sacrificing other muscles.

Moreover, a transposition flap is esthetically acceptable because most of the operative scar is within the buttock area. A transposition flap reconstruction is one of the several options for large defects after soft-tissue sarcoma resection in the buttock.
Moreover, a transposition flap is esthetically acceptable because most of the operative scar is within the buttock area. A transposition flap reconstruction is one of the several options for large defects after soft-tissue sarcoma resection in the buttock.
Paget's disease of bone (PDB) is a metabolic bone disease presenting as polyostotic or monostotic lesions of the spine. Although common in the Anglo-Saxon population, it is rare on the Indian subcontinent. Neurological complications though infrequent can be severe in pagetic spine.

We report a case of a polyostotic variant of PDB involving lumbar spine (L2 vertebrae), iliac bones, and femur presenting as chronic low back pain and neurological deficit, i.e., cauda equina syndrome. On initial workup, a diagnosis of PDB was made and given cauda equina compression with neurological deficit, posterior spinal decompression, and biopsy was performed. The histopathological evaluation confirmed the diagnosis and the patient was treated with bisphosphonates for 6 months, along with serial monitoring of alkaline phosphatase levels.

Through this case report, we hope to emphasize that PDB should be considered as a possible cause of neurological symptoms at presentation, especially in elderly patients. Also furthermore, early surgical intervention followed by bisphosphonates therapy can lead to favorable outcomes in such patients.
Through this case report, we hope to emphasize that PDB should be considered as a possible cause of neurological symptoms at presentation, especially in elderly patients. Also furthermore, early surgical intervention followed by bisphosphonates therapy can lead to favorable outcomes in such patients.
Atypical femoral fractures (AFF) are associated with the use of bisphosphonates (BPs) or denosumab. However, few cases that meet the characteristics of these fractures, as established by the American Society of Bone and Mineral Research, have occurred in patients who have never used antiresorptive drugs.

We report a case of AFF in a 67-year-old woman who had never used antiresorptive medications. The history and comorbidities of the patient, the characteristics of the fracture, and the subsequent treatment are presented.

AFFs may occur even in patients who have never been exposed to BPs or denosumab. The absence of antiresorptive osteoporosis therapy and the lack of radiographic focal periosteal reaction in the lateral femoral cortex, as in our case, can make it difficult to detect and prevent the disorder. Prolonged use of proton pump inhibitors and Vitamin D deficiency-related osteomalacia may contribute to the occurrence of these fractures. Further studies are required to accurately understand all inciting factors contributing to the development of AFFs.
AFFs may occur even in patients who have never been exposed to BPs or denosumab. The absence of antiresorptive osteoporosis therapy and the lack of radiographic focal periosteal reaction in the lateral femoral cortex, as in our case, can make it difficult to detect and prevent the disorder. Prolonged use of proton pump inhibitors and Vitamin D deficiency-related osteomalacia may contribute to the occurrence of these fractures. Further studies are required to accurately understand all inciting factors contributing to the development of AFFs.
Calcaneal osteomyelitis is a complicated entity and much more challenging to treat. We present a case of calcaneal osteomyelitis treated with debridement, curettage and filling bone defect with antibiotic mixed calcium sulphate pellets.

A female patient presented with pain, swelling and purulent discharge from the left heel. Culture studies and magnetic resonance imaging findings were suggestive of osteomyelitis of the calcaneum. The patient was planned for definitive treatment, and remission was achieved with systemic antibiotics, debridement, curettage, and filling dead space with antibiotic mixed calcium sulphate pellets.

Calcaneal osteomyelitis is very resistant to treatment and results in poor functional outcome. Management of calcaneal osteomyelitis with single-stage strategy using antibiotic mixed calcium sulphate effectively eradicates the disease to attain overall good functional outcome for the patient.
Calcaneal osteomyelitis is very resistant to treatment and results in poor functional outcome.
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