A Rare Case of Chondromyxoid Fibroma of Calcaneum: A Case Report

Vol. 11 | Issue 1 | January-February 2023 | Page: 27-29 | Shekar Mudramaiah, Pavith Janardhan T, Ajay Krishna

DOI: https://doi.org/10.13107/jkoa.2023.v11i01.062


Authors: Shekar Mudramaiah [1], Pavith Janardhan T [1], Ajay Krishna [1]

[1] Sanjay Gandhi Institute of Trauma & Orthopaedics, Bengaluru, Karnataka, India.

Address of Correspondence

Dr. Pavith Janardhan T
Fellow in Arthroplasty, Sanjay Gandhi Institute of Trauma & Orthopaedics, Bengaluru, Karnataka, India.
E-mail: pavithjanardhan2301@gmail.com


Abstract


Chondromyxoid fibroma is a rare benign Primary tumour occurring in the calcaneum. We report a case of a 23-year-old woman with 3 months history of sudden onset right heel pain with no history of trauma. Which was exacerbated by movement such as walking and standing. A radiographic examination of the right foot and ankle revealed a lesion in the posterior part of the calcaneum. The calcaneum was further evaluated using an MRI scan which revealed a lytic lesion with clearly defined borders. The lesion was treated with curettage, iliac bone grafting, and cementing. Three months after surgery, the graft was consolidated with bone cement in place. There was no sign of recurrence at the one-year follow-up, and the patient had adequate ankle range of motion. Even though the tumour is rare, there is a need for physicians to recognize its radiological features and offer appropriate treatment options.
Keywords: Chondromyxoid fibroma, Lytic lesion, Benign primary tumour


References


1. Dorfman HD, Czerniak B. Bone tumors. Missouri: Mosby; 1998. p. 321–31
2. Wu CT, Inwards CY, O’Laughlin S, et al. Chondromyxoid fibroma of bone: a clinicopathologic review of 278 cases. Hum Pathol 1998;29(5):438-46
3. Robert K, Heck. Benign/aggressive tumors of bone. Campbell’s Operative Orthopaedics. Canale ST, Beatty JH (editors): Mosby Elsevier, Philadelphia. 2013; 1: 894
4. Jaffe HL, Lichtenstein L. Chondromyxoid fibroma of bone; a distinctive benign tumor likely to be mistaken especially for chondrosarcoma. Arch Pathol (Chic). 1948; 541-551.
5. Dürr H R, Lienemann A, Nerlich A, Stumpenhausen B, Refior HJ: Chondromyxoid fibroma of bone. Arch Orthop Trauma Surg. 2000; 120(1-2):42-7
6. Ebrahimzadeh MH, Dallouei SR. Chondromyxoid fibroma of the calcaneus. J Am Podiatr Med Assoc. 2007; 97: 223-224.
7. Oommen AT, Madhuri V, Walter NM. Benign tumors and tumor-like lesions of the calcaneum: a study of 12 cases. Indian J Cancer. 2009; 46: 234-236.
8. Wilson AJ, Kyriakos M, Ackerman LV. Chondromyxoid fibroma: radiographic appearance in 38 cases and in a review of the literature. Radiology. 1991; 179: 513-518.
9. Damle RP, Suryawanshi KH, Dravid NV, et al. Chondromyxoid fibroma of bone. JCR. 2013; 3: 228-231.
10. Zillmer DA, Dorfman HD. Chondromyxoid fibroma of bone: thirty-six cases with clinicopathologic correlation. Hum Pathol. 1989; 20: 952-964.
11. Chondromyxoid fibroma of the calcaneus: a case report and literature review. Azami MA, Lahbali O, El alami I, et al. SM J Orthop. 2017;3:1047.
12. Chondromyxoid fibroma of the calcaneus: two case reports and literature review. Roberts EJ, Meier MJ, Hild G, Masadeh S, Hardy M, Bakotic BW. J Foot Ankle Surg. 2013;52:643–649.


How to Cite this article: Mudramaiah S, Janardhan JT, Krishna A A Rare | Case of Chondromyxoid Fibroma of Calcaneum: A Case Report | Journal of Karnataka Orthopaedic Association | January-February 2023; 11(1): 27-29 | https://doi.org/10.13107/jkoa.2023.v11i01.062

 


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Editorial

Vol. 11 | Issue 1 | January-February 2023 | Page: 04 | Anil K. Bhat

DOI: https://doi.org/10.13107/jkoa.2023.v11i01.056


Authors: Anil K. Bhat [1]

[1] Department of Hand Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Address of Correspondence

Dr. Anil K. Bhat,
Associate Dean, Professor and Head Department of Hand Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
E-mail: jkoa.editor@gmail.com


Editorial


Warm wishes for the New Year and greetings from the editorial board. It is our great pleasure to showcase our issue of the Journal of Karnataka Orthopaedic Association which is being released during the 47th annual conference of the Karnataka Orthopaedic Association. This issue has articles related to technologies in total knee arthroplasties, proximal tibial fractures and very interesting case reports related to 3D printing, supercutaneous plating technique and rare case reports of PIN syndrome and calcaneal tumor.
I must admit that the issue has been brought out with great difficulty due to paucity of submissions. However, the efforts of the executive committee of KOA and many KOA members have resulted in submission of many of these articles. The editorial team has worked very hard to put the issue in place in its present form. We would also like to thank our peer reviewers for their prompt and timely reports and suggestions.
I urge our KOA members to also have a look at the previous issue of JKOA which is available online, the content of which has a very interesting review article on the management of Complex regional pain syndrome and also an unique approach to the hip joint.
As we go through the process of indexing our journal as per the NMC requirements, I request and urge our members to support us in these crucial times by regularly submitting articles which will be always remembered by our future generations. Our Journal of KOA would definitely attain the best of indexing and academic repute in the near future.

Sincerely
Dr. Anil K. Bhat
Editor in Chief, JKOA
Associate Dean, Professor and Head
Department of Hand surgery,
Kasturba Medical College, Manipal, MAHE.


How to Cite this article: Bhat AK | Editorial | Journal of Karnataka Orthopaedic Association| January-February 2023; 11(1): 04. https://doi.org/10.13107/jkoa.2023.v11i01.056

 


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Supercutaneous Plating Technique: A Case Report of Locking Plate Used as an External Fixator

Vol. 11 | Issue 1 | January-February 2023 | Page: 23-26 | Shashiraj K Shetty, Edward L Nazareth, Nirath S Hegde, Ajay Kumar, Shushruth M Devanna

DOI: https://doi.org/10.13107/jkoa.2023.v11i01.061


Authors: Shashiraj K Shetty [1], Edward L Nazareth [1], Nirath S Hegde [1], Ajay Kumar [1], Shushruth M Devanna [1]

[1] Department of Orthopaedics, Srinivas Institute of Medical Sciences and Research Centre, Mukka, Mangalore, Karnataka, India.

Address of Correspondence

Dr. Nirath S Hegde
Department of Orthopaedics, Srinivas Institute of Medical Sciences and Research Centre, Mukka, Mangalore, Karnataka, India.
E-mail: srinivascherkady@gmail.com


Abstract


Introduction: Open fracture is one of the most common and challenging healthcare problem in orthopedic practice1.Despite improvements in implant design, management of open fractures remain a challenge for the orthopedic surgeon. Locked compression plates (LCP) have advantages of angular stability from the locking-head mechanism and less irritation when compared with traditional external fixators due to their low profiles. Here is a case report of the same.
Case Report: A 50-year-old lady, a municipal worker by occupation, came to casualty with alleged history of road traffic accident and injury to right thigh and knee. Plain radiograph of of right femur with knee revealed a supracondylar fracture of right femur.
As a definitive treatment, patient underwent open reduction and supercutaneous plating. Skin grafting was done for the external wound over distal thigh. The External fixation plate for right distal knee was removed after 6 weeks and knee ROM of 0 to 100 degree flexion was achieved by one year.
Conclusion: Open fractures can be treated by external fixation using the LCP plates, which are safe, reliable and have acceptable functional outcomes with minimal complication rates. Its advantages also include ease of performing surgery and ease of removing plate after fracture healing.
Keywords: Supercutaneous plating, LCP- locking compression plate, External fixator


References


1. M griffin, M Malahias, S Hindocha, and W khan Update on the management of compound lower limb fractures
2. Kloen P. Supercutaneous plating: use of a locking compression plate as an external fixator. Journal of orthopaedic trauma. 2009 Jan 1;23(1):72-5.
3. Kerkhoffs GM, Kloen P, van der Werken C, et al. Supercutaneous plate fixation. Alternative use of the dynamic compression plate as an external fixator.TechnOrthop. 2004;18:338–343.
4. Hopf T, Osthege S. Interfragmental compression of the Zespol osteosynthesis system. Experimental biomechanical studies. Z Orthop Ihre Grenzgeb. 1987; 125(5):546-52.
5. C Xiao, F Tang, Y Zhou, et al. A locking compression plate as an external fixator for treating infected nonunion of the humeral diaphysis. BMC Surg. 2016; 16:53.
6. Ramotowski W, Granowski R Zespol: Anoriginal method of stable osteosynthesis.ClinOrthopRelat Res 1991;272: 67-75
7. Ching-HouMaa, Chin-HsienWua, Yuan-Kun Tu , Ting-Sheng Lin -Metaphyseal locking plate as a definitive external fixator for treating open tibial fractures—Clinical outcome and a finite element study: Injury, Int. J. Care Injured 2013;44:1097–1101.Source of Support:NilConflict of Interest: Nil
8. Ahmad M, Nanda R, Bajwa AS et al. Biomechanical testing of the locking compression plate: when does the distance between bone and implant significantly reduce construct stability J Injury. 2007; 38:358-64.
9. Ang BF, Chen JY, Yew AK, Chua SK, Chou SM, Chia SL, Koh JS, Howe TS. Externalised locking compression plate as an alternative to the unilateral external fixator: a biomechanical comparative study of axial and torsional stiffness.Bone & joint research. 2017 Apr;6(4):216-23.
10. Marti RK, Van der Werken C. The AO-plate for external fixation in cases.ActaOrthop Scand. 1991;62:60–62.
11. Panda SS, Panda D, Suri N. Supracutaneous plating: Use of locking compression plate as external fixator for intra-articular compound fractures. International Journal of Medical Research & Health Sciences. 2016;5(8):62-7.
12. J. B. Giles, J. C. DeLee, J. D. Heckman, and J. E. Keever, “Supracondylar-intercondylar fractures of the femur treated with a supracondylar plate and lag screw,” Journal of Bone and Joint Surgery A, vol. 64, no. 6, pp. 864–870,1982.


How to Cite this article: Shetty SK, Nazareth EL, Hegde NS, Kumar A, Devanna SM | Supercutaneous Plating Technique: A Case Report of Locking Plate Used as an External Fixator | Journal of Karnataka Orthopaedic Association | January-February 2023; 11(1): 23-26 | https://doi.org/10.13107/jkoa.2023.v11i01.061

 


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A Case Report of Posterior Interrosseous Nerve Syndrome Due to Intermuscular Lipoma

Vol. 11 | Issue 1 | January-February 2023 | Page: 20-22 | Nirath S Hegde, Edward L Nazareth, Shashiraj K Shetty, Shashank S

DOI: https://doi.org/10.13107/jkoa.2023.v11i01.060


Authors: Nirath S Hegde [1], Edward L Nazareth [1], Shashiraj K Shetty [1], Shashank S [1]

[1] Department of Orthopaedics, Srinivas Institute of Medical Sciences and Research Centre, Mukka, Mangalore, Karnataka, India.

Address of Correspondence

Dr. Nirath S Hegde
Department of Orthopaedics, Srinivas Institute of Medical Sciences and Research Centre, Mukka, Mangalore, Karnataka, India.
E-mail: srinivascherkady@gmail.com

 


Abstract


Posterior interosseous nerve compressions are rare. The compression of the posterior interosseous nerve can happen either before, or through or after the course of the nerve in the supinator muscle. Tumors could rarely lead to secondary compression of the nerve by mass effect. We describe a case of a lady aged 73 years with a posterior interosseous nerve syndrome due to an intermuscular lipoma. The patient had appreciable recovery after surgery and physiotherapy.
Keywords: Intermuscular lipoma, Posterior interosseous nerve, Compression.


References


1. Avram R, Hynes NM: Posterior interosseous nerve compression secondary to a parosteal lipoma: Case report and literature review. Can J PlastSurg 12:69–72, 2004.
2. Borman P, Tuncay F, Ulusoy G, Koçer U: Posterior interosseous nerve syndrome due to lipoma. NeurophysiolClin 40:189–191, 2010.
3. El Hyaoui H, Hassoun J, Garch A, Kassimi H, El Fatimi A: Compression of the posterior interosseous nerve by a deep lipoma. Joint Bone Spine 81:265, 2014.
4. Ishikawa H, Hirohata K (1990) Posterior interosseous nerve syndrome associated with rheumatoid synovial cysts of the elbowjoint. ClinOrthopRelat Res 254:134–139.
5. Bowen TL, Stone KH (1966) Posterior interosseous nerve paralysis caused by a ganglion at the elbow. J Bone Joint Surg Br48:774–776.
6. Valer A, Carrera L, Ramirez G (1993) Myxoma causing paralysisof the posterior interosseous nerve. ActaOrthopBelg 59:423–425.
7. Taniguchi Y, Yoshida M, Tamaki T (1999) Posterior interosseousnerve syndrome due to pseudogout. J Hand Surg Br 24:125–127.
8. De Smet L (2005) Posterior interosseous neuropathy due to compression by a soft tissue chondroma of the elbow. Actaneurol Belg105:86–88.
9. Mackinnon SE, Dellon AL, Hudson AR, Hunter DA: Chronic nerve compression—an experimental model in the rat. Ann PlastSurg 13:112–120, 1984.
10. Werner CO. Paralysis of the posterior interosseous nerve caused by tumour: brief report. The Journal of Bone and Joint Surgery. British volume. 1987 Aug;69(4):670-1.
11. Berry JB, Richard MH (1973) Parosteal lipoma producing paralysis of the deep radial nerve. South Med J 66:1298–1300.


How to Cite this article: Hegde NS, Nazareth EL, Shetty SK, Shashank S | A Case Report of Posterior Interrosseous Nerve Syndrome Due to Intermuscular Lipoma | Journal of Karnataka Orthopaedic Association| January-February 2023; 11(1): 20-22 | https://doi.org/10.13107/jkoa.2023.v11i01.060

 


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THR Using a 3D Printed Custom Made Acetabulum Component: A Case Report

Vol. 11 | Issue 1 | January-February 2023 | Page: 17-19 | Lakshith B R, Adarsh U Tuppad, Shashiraj K Shetty, Edward L Nazareth, Kumar Mihir

DOI: https://doi.org/10.13107/jkoa.2023.v11i01.059


Authors: Avinash P [1], Karthik Sangani [1], Pavith Janardhan T [1], Prajwal KN [1], Ajay Krishna, Prajwal K [1]

[1] Department of Orthopaedics, Sanjay Gandhi Institute of Orthopaedics and Trauma, Bengaluru, Karnataka, India.

Address of Correspondence

Dr. Karthkik Sangani
Orthopaedic Surgeon, Department of Orthopaedics, Sanjay Gandhi Institute of Orthopaedics and Trauma, Bengaluru, Karnataka, India.
E-mail: mrbonesthehealer@gmail.com

 


Abstract


Introduction: THR is one of the commonly performed adult arthroplasties in the world. Over the past 6 decades, Charnley low friction arthroplasty has evolved in design and concept. One among those recent advances is the use of 3D printing technology in arthroplasties. Purpose of this article is to discuss and share the details of a hip arthroplasty case where a customized 3D printed acetabulum component was used.

Case: A 3 year postop case of acetabulum fracture fixation presented with arthritis of hip. CT revealed a periacetabular massive bone loss. After considering all options, decision was made to use a 3D printed acetabulum shell.

Discussion: Complex THRs with special instrumentation and augmented implants are frequently seen in revision surgeries and post acetabulum fracture cases. Based on the size and pattern of the defect, IlioIschial cages, Triflange cups, Trabecular metal augments, CupCage constructs, Jumbo cups are some common options at a surgeons disposal while tackling an acetabulum bone loss challenge. A 3D manufactured component can be of aid when the defect is too large. It gives the advantage of being anatomically contoured. It also allows a porous structure for bone ingrowth.

Conclusion: Life size models of the pelvis and the component gives an explicit simulation of the surgery, including the component placement and trajectory of the screws. This effective preoperative planning can improve the surgical precision and reduce the complications. Literature on the survival rates and long term complications of such 3d printed acetabulum shells is limited. Studies on the long term outcomes with usage of these implants would be insightful
Keywords: 3D Printing, Complex THR, Customised acetabular shell


References


1. Madhu R et al. Outcome of surgery for reconstruction of fractures of the acetabulum—the time-dependent effect of delay. J Bone Joint Surg.2006; 86B:1197–1203.
2. Giannoudis P.Operative treatment of displaced fractures of the acetabulum: a meta-analysis. J Bone Joint Surg Br.2005; 87(1):2–9.
3. Telleria JJM, Gee AO. Classifications In Brief: Paprosky Classification of Acetabular Bone Loss. Clinical Orthopaedics & Related Research. Ovid Technologies (Wolters Kluwer Health); 2013; 471: 3725–30.
4. Sing S et al. Laser and electron-beam powder-bed additive manufacturing of metallic implants: A review on processes, materials and designs. J. Orthop. Res. 2016; 34:369–385.
5. Restrepo S, Smith EB, Hozack WJ. Excellent mid-term follow-up for a new 3D-printed cementless total knee arthroplasty [Internet]. The Bone & Joint Journal. British Editorial Society of Bone & Joint Surgery. 2021; 103B:32–7.


How to Cite this article: Avinash P, Sangani K, Pavith JT, Prajwal KN, Krishna A, Prajwal K | THR Using a 3D Printed Custom Made Acetabulum Component: A Case Report | Journal of Karnataka Orthopaedic Association | January-February 2023; 11(1): 17-19 | https://doi.org/10.13107/jkoa.2023.v11i01.059

 


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Soft Tissue Injuries Associated with Proximal Tibia Fractures

Vol. 11 | Issue 1 | January-February 2023 | Page: 13-16 | Lakshith B R, Adarsh U Tuppad, Shashiraj K Shetty, Edward L Nazareth, Kumar Mihir

DOI: https://doi.org/10.13107/jkoa.2023.v11i01.058


Authors: Lakshith B R [1], Adarsh U Tuppad [1], Shashiraj K Shetty [1], Edward L Nazareth [1], Kumar Mihir [1]

[1] Department of Orthopaedics, Srinivas Institute of Medical Sciences and Research Centre, Mukka, Mangalore, Karnataka, India.

Address of Correspondence

Dr. Lakshith B R
Junior Resident, Department of Orthopaedics, Srinivas Institute of Medical Sciences and Research Centre, Mukka, Mangalore, Karnataka, India.
E-mail: lakshithgowdajo3014@gmail.com

 


Abstract


The purpose of this study was to document the pattern of ligament and meniscal injuries that occur with proximal tibia fractures due to high energy trauma. Seventy patients with fractures of proximal tibia due to high-energy mechanisms were evaluated with magnetic resonance imaging (MRI) of the knee. All studies were reported by a single musculoskeletal radiologist who was blinded to surgical and physical findings. Of the 70 patients, there were 42 patients with AO/OTA type 41B2 (60%) fractures. On average, 70 % sustained a complete tear or avulsion of one or both cruciates.70% sustained collateral ligament injury.91% had lateral meniscal pathology.40% had medial meniscus tears. Of the 70 patients, 42 patients (60%) had Schatzker type II injuries, in which 90% had lateral meniscus tear, 80% MCL and ACL tear, 66% PCL and LCL tear. We adopted chi-square test to find the association. In our study, we found that there is a significant association between footprint avulsion of PCL and lateral meniscus (p value-0.038), between partial tear of LCL and lateral meniscus (p value-0.048), between partial tear of ACL and medial meniscus (p value-0.023). Also there is a significant association between complete tear of ACL and medial meniscus (p value- 0.019), between partial tear of PCL and medial meniscus (p value-0.007). But there is no significant association between ACL, PCL, MCL, LCL and Schatzker type (p value >0.05). We conclude MRI scanning should be considered for proximal tibia fractures due to high energy mechanism, which would help to identify and treat of associated soft tissue injuries.
Keywords: Soft tissue injury, Proximal tibia fracture, Magnetic resonance imaging, ACL, PCL, LCL, MCL, Medial meniscus and lateral meniscus.


References


1. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop.
2. Blokker CP, Rorabeck CH, Bourne RB. Tibial plateau fractures. An analysis of the results of treatment in 60 patients. Clin Orthop. 1984:193– 199
3. Vangsness CT Jr, Ghaderi B, Hohl M, et al. Arthroscopy of meniscal injuries with tibial plateau fractures. J Bone Joint Surg Br. 1994;76:488– 490
4. Bennett WF, Browner B. Tibial plateau fractures: a study of associated soft tissue injuries. J Orthop Trauma. 1994;8:183–188.
5. Colletti P, Greenberg H, Terk MR. MR findings in patients with acute tibial plateau fractures. Comput Med Imaging Graph. 1996;20:389–394.
6. Kode L, Lieberman JM, Motta AO, et al. Evaluation of tibial plateau fractures: efficacy of MR imaging compared with CT. AJR Am J Roentgenol. 1994;163:141–147
7. Delamarter RB, Hohl M, Hopp E Jr. Ligament injuries associated with tibial plateau fractures. Clin Orthop. 1990:226–233.
8. Moore TM, Meyers MH, Harvey JP Jr. Collateral ligament laxity of the knee. Long-term comparison between plateau fractures and normal.
9. Barrow BA, Fajman WA, Parker LM, et al. Tibial plateau fractures: evaluation with MR imaging. Radiographics. 1994;14:553–559.
10. Holt MD, Williams LA, Dent CM. MRI in the management of tibial plateau fractures. Injury. 1995;26:595–599.


How to Cite this article:  Lakshith BR, Tuppad AU, Shetty SK, Nazareth EL, Mihir K | Soft Tissue Injuries Associated with Proximal Tibia Fractures | Journal of Karnataka Orthopaedic Association | January-February 2023; 11(1): 13-16 | https://doi.org/10.13107/jkoa.2023.v11i01.058

 


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