Anterior cruciate ligament (ACL) reconstruction is usually recommended for young patients. Several recent articles have however reported comparable outcomes of ACL reconstruction between youth and patients in fourth or fifth age group. But in the literature there are not many reports about ACL reconstruction in patients over 70 years old. We report a case of a successful arthroscopic ACL reconstruction (using single bundle quadrupled hamstring graft) in an active 75-year-old medical practitioner. Successful outcome after ACL reconstruction can be achieved in selected older patients; chronological age is no barrier.
Aged ; Anterior Cruciate Ligament Reconstruction ; Humans ; Male

OBJECTIVEFracture of either radius or ulna with a dislocation either at the proximal or distal radioulnar joint (DRUJ) is not a common injury and is inherently unstable. Here we report a case series, with both-bone forearm fractures associated with dislocation of DRUJ, as a Galeazzi-variant type fracture-dislocation, and try to analyze this injury pattern.

METHODSThe study was based on 6 patients having Galeazzi-variant type fracture-dislocation of different age (20 to 45 years). All fractures were closed type. Two fractures involved the same level and three fractures were at different levels of radius and ulna shaft. After thorough examination and investigations they were treated with limited contact dynamic compression plate without additional fixation for DRUJ.

RESULTSAll cases were followed up for 24 weeks. The maximum incidence occurred in age group between 31 and 40 years. All the fractures of both radius and ulna were united in average time of 12 weeks. Range of motion of wrist and elbow, supination and pronation at final follow-up were normal. There was no subsequent re-subluxation or dislocation of the DRUJ in any of the cases.

CONCLUSIONGaleazzi variant in adult is a new undescribed pattern of forearm with wrist injury. Stable open reduction and internal fixation of both-bone forearm fractures is mandatory, followed by 3 to 4 weeks of immobilization in a cast for the healing of disrupted DRUJ.

The presence of anterior hip dislocation along with contralateral posterior hip dislocation in the absence of other major traumas is a distinctly rare injury pattern. We report such a case, along with a review of previous cases. A 40-year-old male patient after motorcycle skidding had posterior dislocation of the left hip and anterior dislocation of the right one without other associated injuries. The patient underwent successful closed reduction of both hips. The clinical course and follow-up assessment of the patient was uneventful.
Anemia, Sickle Cell ; Femur Head ; injuries ; Femur Head Necrosis ; Femur Neck ; Fractures, Spontaneous ; Hip Dislocation ; Humans

We report a rare case of periprosthetic posttraumatic fracture of subtrochanteric region of femur after a megaprosthesis of the knee, done for resistant nonunion of distal femur with secondary osteoarthrosis in a 51 years old man. Treatment with a locking femoral plate was able to achieve primary union with a good result.
Bone Plates ; Femoral Fractures ; etiology ; Humans ; Knee Prosthesis ; Male ; Middle Aged ; Osteoarthritis ; surgery ; Postoperative Complications

Purpose: Megaprosthesis or endoprosthetic replacement of the proximal and distal femur is a well-established modality for treatment of tumors. The indications for megaprosthesis have been expanded to the treatment of some non-neoplastic conditions of the knee and hip, with the severe bone loss associated with failed arthroplasty, communited fractures in the elderly with poor bone quality, and resistant non-union. Th aim of this study is to find out whether megaprosthesis of the knee and hip is successful in the treatment of non-neoplastic condtions. The study comprises a review of the indications, complications, and outcomes of megaprosthesis of the proximal and distal femur in non-neoplastic conditions of the knee and hip joints. Methods: We extensively reviewed the literature on non-neoplastic indications for megaprosthesis of the proximal and distal femur after performing a detailed search of the Pubmed database using the medical subject heading (MeSH) terms ‘proximal femur replacement’ or ‘distal femur replacement’ and ‘hip or knee megaprosthesis.’ The data obtained after the structured search were entered into a Microsoft Excel spreadsheet. The frequency distribution of the demographic data, indications, complications, and outcome was calculated.Result: We included ten studies (seven proximal femur replacement and three distal femur replacement) of 245 proximal femur and 54 distal femur mega prostheses for treatment of non-neoplastic conditions. Bone loss in failed arthroplasty, either due to periprosthetic fracture or deep infection, was the most common indication for megaprosthesis. Dislocation was the most common complication after proximal femur megaprosthesis, and infection was the leading cause of complications after distal femur megaprosthesis. Conclusion Megaprosthesis for treatment of non-neoplastic conditions around the distal and proximal femur is a viable option for limb salvage, with an acceptable long-term outcome. Although the complications and survival rates of megaprosthesis in non-neoplastic conditions are inferior to a primary arthroplasty of the hip and knee but are comparable or better than the mega prosthetic replacement in the neoplastic conditions. Proximal femoral megaprosthesis has higher dislocation rates and requirement for revision compared to distal femoral megaprosthesis. However, the proximal femoral megaprosthesis has lower rates of infection, periprosthetic fractures, and soft tissue complications, as compared to distal femoral megaprosthetic replacement. Both associated with aseptic loosening but not statistically significant.

Dislocation of the scapula between the ribs and into the thoracic cage is a very rare event. Scapulothoracic dissociation though has been reported, usually occurs after a severe injury and is often associated with other serious injuries like brachial plexus or chest injury, etc. Ainscow has described a rare type that may occur due to slight violence with a pre-existing condition. Cases of isolated scapular dislocation after minor trauma have not been reported frequently in the literature. It is a distinct clinical entity and needs to be differentiated from other similar conditions. Here, we present a case of painless scapular dislocation associated with trivial trauma followed by spontaneous reduction in a 10 years old girl. The patient had a recurrence of the dislocation before presenting to us. But she did not have any pre-existing condition for scapular dislocation.
Brachial Plexus ; Humans ; Joint Dislocations ; Multiple Trauma ; Scapula ; Thoracic Injuries

Background: Little has been published about TKA in windswept deformities of the knees where combined varus and valgus deformities present in the same patient. Windswept deformities present with unique problems and must be addressed as two halves of a complex entity. Through this review we aim to understand the interrelation between the deformities, examine outcomes following simultaneous bilateral total knee arthroplasty in windswept deformities, and develop an algorithm for the management of windswept deformities by total knee arthroplasty. Methods: An extensive online literature search for the keywords yielded 31 articles on which we based our review.Articles were analyzed in context to our research questions and are presented in a tabular format for quick reference and a better perspective. Results: The abnormal biomechanics and force moment of the knee cause progressive arthritis of the knee. The valgus deformity usually precedes a varus deformity on the contralateral knee in windswept deformities. Correct restoration of mechanical tibiofemoral angles by individualizing valgus correction angles have better outcomes after TKA. Conclusion A well-planned and judiciously executed simultaneous bilateral total knee replacement can offer distinct advantages to the patient and surgeon and provides optimum utilization of time and resources in the management of windswept knees.

Background: Little has been published about TKA in windswept deformities of the knees where combined varus and valgus deformities present in the same patient. Windswept deformities present with unique problems and must be addressed as two halves of a complex entity. Through this review we aim to understand the interrelation between the deformities, examine outcomes following simultaneous bilateral total knee arthroplasty in windswept deformities, and develop an algorithm for the management of windswept deformities by total knee arthroplasty. Methods: An extensive online literature search for the keywords yielded 31 articles on which we based our review.Articles were analyzed in context to our research questions and are presented in a tabular format for quick reference and a better perspective. Results: The abnormal biomechanics and force moment of the knee cause progressive arthritis of the knee. The valgus deformity usually precedes a varus deformity on the contralateral knee in windswept deformities. Correct restoration of mechanical tibiofemoral angles by individualizing valgus correction angles have better outcomes after TKA. Conclusion A well-planned and judiciously executed simultaneous bilateral total knee replacement can offer distinct advantages to the patient and surgeon and provides optimum utilization of time and resources in the management of windswept knees.

Background: McMurray’s osteotomy of the hip was a popular surgery practiced for almost 5 decades for the management of the fractured neck of the femur and hip osteoarthritis since its first description in 1936. It is an oblique, medial displacement intertrochanteric osteotomy. In the long term, McMurray's osteotomy patients develop limb length discrepancy and secondary osteoarthritis due to the altered biomechanics of the hip and may require total hip replacement (THR). THR after the previous osteotomy is more challenging than that for unoperated hip joints due to severe distortion of the hip anatomy and soft-tissue contractures. These challenges are related to distorted bony anatomy, soft-tissue contractures, and the choice of implants. Methods: Three patients with previous McMurray's osteotomy of the hip developed secondary osteoarthritis and underwent total hip replacement. We discussed specific challenges encountered during THR and techniques to deal with such problems. Results: All patients had pain-free hip, with minimal residual shortening (average, 1.2 cm) at an average follow-up of 3.67 years (range, 1 to 6 years). The Harris hip score improved significantly postoperatively and no complications were encountered. Conclusions A detailed and careful preoperative planning, correct execution of surgical techniques, and postoperative rehabilitation are the keys to the successful management of these cases.

The management of multiple complicated injured patients remains a great challenge despite advance- ments in modern medical care. We present a rare case of bilateral unstable pelvic fractures associated with bilateral segmental femoral shaft fractures.We have proposed a mechanism of such complex injury pattern and discussed the plan of management. We believe that a timely and aggressive surgical intervention to fix all the major fractures soon after medically stabilizing the patient helped our patient to overcome these serious and lethal injuries. It is necessary to establish an optimal protocol for management of such complex fractures by conducting prospective and multicentric studies in the future.
Adult ; Female ; Femoral Fractures ; diagnostic imaging ; surgery ; Humans ; Pelvic Bones ; diagnostic imaging ; injuries