Interesting Cases
Being one the most favorite orthopedic referral center of practitioners around we have enjoyed the privilege to tackle with very rare cases. Here are a few to share
Case1 :Sleeve avulsion fracture patella
22 years old male with RTA came with knee pain.his x ray showed sleeve avuslsion of patella.He was managed with pullout sutures through patella holding the quadriceps muscle with basketball sutures.He was managed with pullout sutures through patella holding the quadriceps muscle with basketball sutures.
Postoperatively patient was immobilized for 3 weeks with knee brace in extension. At 6 weeks patient had good range of movements & no quadriceps lag.
Case 2: Periprosthetic fracture in a patient with R.A.
65 years old female with RA on DMARD and chronic steroids has sustained fracture of distal femur.She was operated with distal femur locking plating & bone grafting Fracture united well & after 3 months patient was mobilized with full weight bearing.After 18 months she sustained twisting injury to the same limb & developed fracture starting at the previous plate proximal end. Her x ray showed
It was challenging to fix it.As removing previous implant n nailing would have given to another stress riser at distal nail near previous fracture.Which would have led to refracture at previous fracture site.retaining the original implant with transcortical locking screws would have made nailing impossible.Considering her age & co morbitiesprolonged anesthesia was again a big risk.Moreover,She needed bone grafting as she lacked osteogenic potential for better healing.
It was decided to operate her under epidural anesthesia with series of procedures.
1. Plate removal was done.
2. PFN nailing was done with distal locking bolts countersunk.
3. Bone grafting was done from iliac crest
4. Same plate was used for replating with miss a nail technique
5. Circlage wire was added proximally for more stability.
