It is unusual for cysticercosis to occur in the substance of the breast. Diagnosis is usually made incidentally. Only few cases are described in the literature. We here report a case of cysticercosis perched on fibroadenoma of breast found on surgical excision in a 16-year-old unmarried female patient. The patient had no discernible evidence of cysticercosis in the other organs. Surgical excision was performed and histological examination demonstrated the presence of cysticercus cellulosae larvae. Characteristic features of this uncommon location are discussed based on a review of the literature. Thus the possibility of cysticercosis of the breast should be kept in mind while considering the differential diagnosis for a breast lump.

Tumors of the small intestine are rare. Even though the small bowel accounts for 80% of the length and 90% of the mucosal surface of the gastrointestinal tract, only 3% to 6% of gastrointestinal tumors and 1% of gastrointestinal malignancies arise from the small bowel. Leiomyoma, adenoma, lipoma, haemangioma, fibroma and hamartoma of the small intestine are considered to be benign neoplasm. Most small bowel tumors are incidental findings at operation or autopsy. Here we present a case of benign tumour of the small intestine, histologically diagnosed as leiomyoma, presented in Surgery Emergency Ward with intestinal obstruction, treated conservatively with no improvement and hence subjected to emergency exploratory laparotomy which revealed intusussception and leading cause of which was a benign leiomyoma. The literature is revised emphasizing issues of pathophysiology, specific characteristics and the treatment of this tumour.

Femoral head fractures without dislocation or subluxation are extremely rare injuries. We report a neglected case of isolated comminuted fracture of femoral head without hip dislocation or subluxation of one year duration in a 36-year-old patient who sustained a high energy trauma due to road traffic accident. He presented with painful right hip and inability to bear full weight on right lower limb with Harris hip score of 39. He received cementless total hip replacement. At latest follow-up of 2.3 years, functional outcome was excellent with Harris hip score of 95. Such isolated injuries have been described only once in the literature and have not been classified till now. The purpose of this report is to highlight the extreme rarity, possible mechanism involved and a novel classification system to classify such injuries.
Adult ; Arthroplasty, Replacement, Hip ; Femur Head ; injuries ; Fractures, Comminuted ; surgery ; Hip Fractures ; surgery ; Humans ; Male

Hoffa fracture is an uncommon injury. In the literature, lateral condylar Hoffa fracture is mentioned as a more common injury pattern than medial condylar Hoffa fracture. The mechanism of injury and method of treatment is not very well described in the literature. We are presenting a rare case of comminuted medial condylar Hoffa fracture with ipsilateral patellar fracture. The mechanism of injury has not been described in the literature. Lag screw fixation, which is the most acceptable method of treatment, is not possible due to comminution. We explain the possible mechanism of injury and fix the fracture with L-buttress plate.
Bone Plates ; Bone Screws ; Femoral Fractures ; surgery ; Fracture Fixation, Internal ; Fractures, Comminuted ; surgery ; Humans

Intraarticular nonunion of tibial plateau is rare. In the literature, only 9 patients were found to be treated for intraarticular tibial plateau nonunion and they got varying results. Internal fixation along with bone grafting was done as a standard treatment in all cases. We treated 4 different profile cases of intraarticular tibial plateau nonunion in our institution by 4 different methods. We treated these cases with plaster of paris cast, internal fixation along with bone graft, arthrodesis with K-nail and total knee replacement. Case 1 was treated with plaster of paris (POP) cast as the patient refused surgery. The fracture was united and the patient was fully satisfied with full range of motion despite valgus malalignment. Case 2 was managed with open reduction internal fixation along with bone grafting. The patient had a good union and got full range of motion at the knee joint. Case 3 was treated with total knee arthroplasty due to her old age and got satisfactory result. Case 4 was an infected nonunion. Arthrodesis was done and the patient could walk with full weight bearing independently. We conclude that internal fixation along with bone grafting may not be suitable in all cases of intraarticular nonunion of tibial plateau. Causes of nonunion, present condition and range of motion of the knee joint, as well as the age of patient should be all considered and the treatment should be individualised according to each patient's situation.
Bone Transplantation ; Fracture Fixation, Internal ; Humans ; Knee Joint ; Tibia ; Tibial Fractures ; surgery

OBJECTIVETo assess the outcome of immediate plate osteosynthesis via application of antibiotic impregnated collagen fleeces (gentamicin-collagen and antibiotic sponge) which gradually release antibiotic locally in the surgical treatment of open fractures presented to us 6 hours after injury.

METHODSAll cases were treated in our tertiary level trauma center and teaching hospital including 35 patients with open fractures who were treated by immediate open reduction and plate fixation from January 2008 to August 2010. Among them, 31 patients were available for adequate follow-up and assessment. All fractures were treated by irrigation and debridement, immediate open reduction and plate fixation along with placement of antibiotic-releasing collagen fleeces around the plate just before closure of wound. Patients were assessed to determine postoperative infection, delayed union or nonunion and development of other postoperative complications. It was hypothesized that immediate plate osteosynthesis after thorough debridement and local antibiotics would give safe and acceptable clinical results in treatment of open fractures.

RESULTSThe 31 patients with adequate final follow-up were assessed at a mean time of 40 weeks (15-160 weeks). Most fractures united primarily in an acceptable time period according to area of involvement. Local wound complications (superficial infection and skin loss) were found in 3 patients (9.67%). Deep infection was noted in 2 patients (6.45%). None of these patients needed implant removal and both fractures united in due time. Delayed union was noted in 5 patients (16.13%). No patient progressed to nonunion or implant failure in long term follow-up. Excessive scarring was developed in 2 patients (6.45%).

CONCLUSIONSImmediate plate osteosynthesis after adequate debridement and placement of collagen film eluting antibiotics locally produces excellent results regarding bone union and absence of deep infections and is a safe technique in the management of open bone injuries. These sponges can be used easily with any form of internal fixation and there is no need of second surgery for the removal of these antibiotic carriers since they are bioabsorbable. Local antibiotic-impregnated collagen sponges along with systemic antibiotics for 3 to 5 days offer promising results in open fracture management.

Animals ; Collagen ; Fracture Fixation, Internal ; Fractures, Open ; surgery ; Gentamicins ; Humans ; Porifera ; Tibial Fractures ; surgery

Primary hyperparathyroidism is caused by parathyroid adenoma in the majority of cases and diagnosis is usually made biochemically. Pre-surgical localization of parathyroid adenoma is essential to limit the extent of surgery and avoid missing them at ectopic sites. Anatomical and functional imaging are used for the localization, but may fail to identify the small and ectopic parathyroid adenoma. We present a case of small sized ectopic parathyroid adenoma at unusual location detected by F-18 fluorocholine (FCH) PET/CT, where other imaging modalities failed. The post-operative histopathology confirmed the diagnosis of ectopic parathyroid adenoma.
Diagnosis ; Hyperparathyroidism, Primary ; Parathyroid Neoplasms ; Positron-Emission Tomography and Computed Tomography ; Ultrasonography

Owing to an oversight in manuscript preparation, the name of the fifth author was rendered incorrectly. The correct spelling is Divya Dahiya.

¹⁸F-Fluorocholine (FCH) PET/CT is evolving as a functional imaging modality for the preoperative imaging of abnormal parathyroid tissue(s) helping to localize eutopic and ectopic parathyroid tissue and limit the extent of surgery. FCH PET/CT may show incidental uptake in various thyroid lesions necessitating further evaluation, whereas the role of ¹⁸F-fluorodeoxyglucose (FDG) PET/CT in the detection of incidental thyroid nodules is well documented. The case of a middle-aged woman with dual pathology of parathyroid adenoma and papillary thyroid cancer detected on FCH and FDG PET/CT is presented.

Owing to an oversight in manuscript preparation, the name of the fifth author was rendered incorrectly. The correct spelling is Divya Dahiya.