Notes

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should be considered as a differential diagnosis in cases of a solitary and or multiple osteolytic lesions. Serum calcium and PTH level estimation at an early stage prevents missing the diagnosis and progression of disease. Early diagnosis and appropriate treatment help in rapid clinical improvement with almost total reversal of bony changes, thus avoiding devastating complications.
Calcific tendinopathy of the pectoralis major at its humeral insertion is extremely rare. Few cases have been reported in the literature. We reported a unique case of calcification of the pectoralis major insertion site and conducted a review of the existing literature to propose standardized management.

We reported a case of a 63-year-old lady, right-handed, non-smoker, homemaker without any history of trauma or symptoms suggestive of para-neoplasia syndrome. For 1 month, the patient presented severe, disabling pain of the left shoulder which occurred spontaneously, usually in the morning and after effort. The patient had painful passive terminal adduction and internal rotation. There was no neurovascular deficiency. Magnetic resonance imaging and computed tomography (CT) scan helped diagnose the calcific tendinopathy at the pectoralis major humeral insertion. Ipatasertib molecular weight Non-surgical management was performed, combining physiotherapy and painkillers. Two months' control, CT scan reported complete calcification resorption. The biologic assessment revealed hyperparathyroidism.

This rare and atypical localization can mislead the surgeon. A biological assessment to research a systemic etiology is mandatory and standardized. A biopsy is not required, radiological examinations are sufficient. Surgical treatment may be proposed in specific cases to shorten the necessary rehabilitation time.
This rare and atypical localization can mislead the surgeon. A biological assessment to research a systemic etiology is mandatory and standardized. A biopsy is not required, radiological examinations are sufficient. Surgical treatment may be proposed in specific cases to shorten the necessary rehabilitation time.
Midfoot injuries involving naviculocuneiform and calcanealcuboid joints are very rare. These injuries result from high-energy crushing trauma and most often causes dislocation of the midfoot in plantar direction.

A 30-year-old female sustained an injury to the left foot after a fall from a very low height. Ipatasertib molecular weight A radiograph of the left foot demonstrated naviculocuneiform joint and calcaneocuboid joint fracture-dislocation. This unusual pattern of injury required open reduction and internal fixation with K-wires after a failed attempt of closed reduction. K-wires were removed after 8 weeks. At 24 months follow-up, she achieved a complete range of movements of left foot and ankle without any complications.

Injuries involving naviculocuneiform and the calcaneocuboid joint can occur following low-energy impact. Such complex injuries should be diagnosed and treated as early as possible. Initial open reduction and stable anatomical fixation are the keys to achieve a good functional outcome in such kind of injuries.
Injuries involving naviculocuneiform and the calcaneocuboid joint can occur following low-energy impact. Such complex injuries should be diagnosed and treated as early as possible. Initial open reduction and stable anatomical fixation are the keys to achieve a good functional outcome in such kind of injuries.
Periprosthetic patellar fracture after total knee arthroplasty (TKA) is an uncommon yet devastating complication, and management of these fractures is challenging with unreliable results. An isolated bilateral patellar fracture is often associated with systemic diseases, steroid usage, and repeated microtrauma. link= Ipatasertib molecular weight Isolated simultaneous bilateral periprosthetic patellar fracture after TKA is seldom reported in the literature.

This report consists of two cases of simultaneous isolated closed bilateral eriprosthetic patellar fracture after TKA, treated with open reduction and internal fixation of patella using tension band wiring. Union was achieved in both cases with satisfactory knee range of motion without significant extension lag.

Regardless of the fact that surgical outcome of periprosthetic fracture of the patella has unpredictable and poor results in past, it can be considered for acute traumatic periprosthetic patella fractures with less comminution and good bone stock to avoid revision arthroplasty and poor outcome.
Regardless of the fact that surgical outcome of periprosthetic fracture of the patella has unpredictable and poor results in past, it can be considered for acute traumatic periprosthetic patella fractures with less comminution and good bone stock to avoid revision arthroplasty and poor outcome.
Perthes disease often results in a non-spherical deformed femoral head which causes pain, dysfunction, early degeneration, and arthritis in young adults. The importance of preservation of native hip in young adults has been well proven. link2 We report a case of deformed Perthes head treated with femoral head reduction osteotomy using Ganz safe surgical dislocation which is a technically demanding but highly rewarding surgical procedure.

A 18-year-old female suffering with hip pain and limp for the past 2 years was diagnosed as sequelae of Perthes disease with femoral head deformity. Pre-operative Harris hip score was 54. The patient was planned for joint preservation surgery considering the young age. link2 Ganz safe surgical dislocation was used to expose the hip joint and femoral head reduction osteotomy was done to recreate the sphericity of the femoral head. After 3-year follow-up, the patient had significant pain relief and restoration of function with no evidence of avascular of the femoral head. Post-operative Harris hip score was 82. The treatment of deformed Perthes femoral head remains controversial with no gold standard treatment. Femoral head reduction osteotomy allows the surgeon to reduce the size of the femoral head and restore sphericity of the femoral head preserving the blood supply and helps to improve the functional outcome of the patient. Our case report with 3-year follow-up is evidence to prove the same.

Femoral head reduction osteotomy using Ganz safe surgical dislocation is a safe and effective joint preservation surgery to treat deformed Perthes femoral head in adolescent and young adults.
Femoral head reduction osteotomy using Ganz safe surgical dislocation is a safe and effective joint preservation surgery to treat deformed Perthes femoral head in adolescent and young adults.
Post-traumatic amputation neuroma is one of the common complications that involve optimal functional outcomes. The current literature has a few examples of late presentation of traumatic stump neuroma. However, no available examples of late presentation of recurrent symptomatic amputation neuroma causing impaired functional outcomes have been reported.

We present a case of recurrent symptomatic stump neuroma after above-knee amputation and neurectomy for 28 years.

Late presentation of recurrent stump neuroma is an unusual condition, requiring early detection and treatment to gain better functionality. The patient scenario is unique and valuable for future management, including case awareness regarding this unique pathology.
Late presentation of recurrent stump neuroma is an unusual condition, requiring early detection and treatment to gain better functionality. link3 The patient scenario is unique and valuable for future management, including case awareness regarding this unique pathology.
Malignant bone tumors of the spine are extremely rare with an incidence of 0.05% of primary neoplasms. Solitary plasmacytoma of the vertebra accounts for about 30% of the total within this group.

A 23-year-old female presented to spine clinic, with complaints of low back pain, deformity in lower back, and difficulty in walking for 3 months duration. Radiological investigations revealed destruction of L3 vertebra with soft-tissue mass around it. USG-guided biopsy from the lesion was suggestive of plasma cell dyscrasia. Routine blood investigations showed no abnormality. Urine myeloma profile and immunoelectrophoresis were done which were within normal limit and ruled out multiple myeloma. Due to the profound neurological deficit and existing instability, the patient underwent decompression, resection of tumor, anterior column reconstruction with cage, and instrumented posterior and posterolateral fusion (360° fusion) from L1-L5, before radiotherapy. link3 The patient was subjected to 23 cycles of intensity-modulated radiotherapy and is doing good on subsequent follow-ups with good fusion.

Solitary plasmacytoma of vertebra when associated with neurological deficit and/or instability should be treated with spinal stabilization surgery followed by radiotherapy to achieve good and overall predictable outcomes.
Solitary plasmacytoma of vertebra when associated with neurological deficit and/or instability should be treated with spinal stabilization surgery followed by radiotherapy to achieve good and overall predictable outcomes.
Osteoblastomas are primary bone tumors, rarer than osteoid osteomas, and <10% of these lesions occurs in the spine. Aneurysmal bone cysts (ABCs) are rare, benign lesion of the bone and approximately 8-30% of ABCs arise in the spine, mostly in the thoracic and the lumbar regions. The association between them is quite rare in the general population.

We report a case of a 14-year-old boy, soccer player, with an osteoblastoma of the left posterior neural arc of L2 and a secondary aneurismal bone cyst compressing the left L2 nerve root, causing severe antalgic scoliosis and back pain with radiculopathy. A complete surgical excision with radicular decompression has been performed, and the histologic examination confirmed the diagnostic hypothesis (osteoblastoma + ABC). At 6 months follow-up, the patient presented a complete resolution of symptoms, but the trunk imbalance was not completely resolved.

Spine localization of osteoblastoma + ABC is rare and its diagnosis and treatment are often challenging. Complete surgical excision seems to be confirmed as the gold standard of treatment, but the option of instrumented arthrodesis should be carefully evaluated.
Spine localization of osteoblastoma + ABC is rare and its diagnosis and treatment are often challenging. Complete surgical excision seems to be confirmed as the gold standard of treatment, but the option of instrumented arthrodesis should be carefully evaluated.
Osteochondroma is the group of benign bone tumours, which are composed of spongy bone covered by a cartilaginous cap. Patients with distal ulnar osteochondromas frequently cause forearm deformities with relative ulnar shortening, wrist joint deviation, and varus bowing. Surgical ulnar lengthening is necessary to restore the carpal balance.

We report the case of multiple exostosis in a 13-year-old male with the right distal ulna osteochondroma with long-standing and progressive ulnar shortening and radial bowing treated with a limb reconstruction system. Our case is Type I Masada managed with excision of distal ulna osteochondroma and gradual ulnar lengthening without osteotomy of the radius.

Progressive ulna deformity can lead to increasing pain, joint instability, limited motion, and functional decline. For Type I, Masada ulnar lengthening is necessary, but over correction is inadvisable due to possible ulnocarpal impaction syndrome. As significant remodeling effects on the radius were observed, simultaneous radial correction can be delayed.
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