INTRODUCTION: The shoulder joint (comprising the glenohumeral and scapulothoracic joints) displays the greatest range of motion of all joints in the human body, and preservation of its stability is essential to its function. The Hill–Sachs defect is a compression fracture of the humeral head associated with instability. The Hill–Sachs lesion may be limited to the articular cartilage or may extend to the subchondral bone. PURPOSE: To identify and characterize the magnetic resonance imaging (MRI) findings in patients with Hill–Sachs lesion and to look for concomitant injuries. MATERIALS AND METHODS: This retrospective case series included 35 patients identified by search through the senior authors' databases, with cross-reference to our institutional radiologic communication system for MRI review. Baseline patient demographic data were collected, including age and sex. We retrospectively assessed all patients who were diagnosed with shoulder dislocation at our institution between 2012 and 2016. RESULTS: We identified 35 patients with a posterior Hill–Sachs lesion. The average age was 33.6 years (range, 22–70 years) and 31 patients were male (89%). There were 18 right shoulders and 17 left shoulders. Eleven patients (31.4%) had evidence of engaging Hill–Sachs lesion and 24 did not. Posterior humeral avulsion of the glenohumeral ligament (HAGL) injuries were found to be partial tears (30%) and complete tears (70%). Additional shoulder injury with the lesion occurred in 96% of identified cases. The most common concomitant injuries were recurrent shoulder joint dislocations (85.7%), posterior HAGL (71%), anterior Bankart lesions (74%), glenoid bone loss (11%), and anterior glenohumeral ligament injuries (5%). CONCLUSION: Engaging Hill–Sachs lesion on physical examination shows a trend toward more medially oriented lesion measured using modified biceps angle on MRI, and the size of engaging Hill–Sachs lesion appears significantly larger than that of nonengaging lesions on both axial and coronal images.

BACKGROUND AND OBJECTIVES: Preservation of the articular congruity is the principle prerequisite for successful recovery, following distal radius fractures. The best method of obtaining and maintaining an accurate restoration of articular anatomy, however, remains a topic of considerable controversy. The main aim of this study is to evaluate the results obtained by treatment of distal end radius fractures by external fixation. MATERIALS AND METHODS: This is a prospective controlled study; fifty cases of unstable distal end radius fractures with/without intra-articular extension were treated with uniplanar static type of external fixation using the principle of ligamentotaxis and augmentation by K-wires from July 2013 to December 2016 at our tertiary rural hospital. The age group of the patients is 18–60 years, external fixator was applied for a duration of 6–8 weeks, and cases were followed up for an average of 6–10 months postoperatively. RESULTS: Assessed as per Demerit Point System of Gartland and Werley (modified by Sarmiento 1975) for functional results and criteria for anatomical results by Sarmiento (1975) at the end of 6–8 months of follow-up. Excellent anatomical result was seen in 11 patients, good result seen in 32 patients, and fair result seen in five patients with two poor result patients. CONCLUSION: External fixation and ligamentotaxis provide better functional and anatomical results in comminuted intra-articular and unstable extra-articular wrist injuries. The functional result of treatment of distal radius fractures not only depends on the anatomical restoration of the articular surface but also depends on the associated soft tissue injuries and articular damage.

BACKGROUND: India bears the highest burden of tuberculosis (TB), i.e., about one-fourth of the total burden. Of the musculoskeletal TB, spinal TB affects half of the patients. Pharmacological treatment in the form of AKT is the mainstay of treatment of spinal TB, but surgery has its own role to play as an adjunct to AKT in selected cases. Various surgical methods and approaches are mentioned in literature. We studied the efficacy and safety of posterior only approach for decompression and internal fixation in treating thoracic and lumbar spinal TB in adults. MATERIALS AND METHODS: In this prospective randomized control study, we treated twenty patients with thoracic-lumbar TB with single-stage posterior only debridement, decompression, and transpedicular screw fixation. Preoperative and postoperative C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), kyphosis angle, visual analog scale (VAS) score and Frankel neurological grading, intraoperative blood loss, and duration of surgery were compared. Correction in kyphosis angle and loss of kyphosis angle at final follow-up was assessed. RESULTS: Sixteen male and four female patients with mean age 37.9 years were treated. Average follow-up was 14.95 months. Thirteen patients had two level involved; seven had single level. The average duration of surgery was 155 min (standard deviation [SD] 23.951). Preoperative average increase in ESR was 39.4 mm/h (SD 9.046) and 24.15 mm/h (SD 3.787) at 3 weeks. Average preoperative CRP was 15.7 mg/L (SD 5.398) and 9.05 mg/L (SD 3.456) at 3 weeks. Average preoperative kyphosis angle was 24.7° (SD 6.822) corrected to an average of 10.1° (SD 3.932) postoperative. At final follow-up, there was a mean loss of 1.4° of kyphosis angle. The average blood loss was 722.75 ml; the average duration of surgery was 228.5 min. The pain VAS dropped significantly from 7.05 (SD 1.468) to 3.9 (SD 1.209). At final follow-up, VAS was 1.7 (SD 0.864). All the patients had good neurological recovery except one. CONCLUSIONS: Single-stage posterior-only procedure is safe and effective for management of thoracolumbar spinal TB.

We present a rare case of a newborn having congenital knee dislocation (CDK) with ipsilateral developmental dysplasia of hip (DDH). This case report shows how abnormal intrauterine pressure leads to dislocation of various joints in utero. We managed this conservatively with Pavlik Harness for DDH and serial corrective casting with manipulation for CDK with a satisfactory result after follow-up of 6 months.

Malignant peripheral nerve sheath tumors (MPNSTs) are rare soft tissue sarcomas that arise from a peripheral nerve or cells associated with the nerve sheath, such as Schwann cells, perineural cells, or fibroblasts. MPNSTs account for 5%–10% of all soft tissue sarcomas. Neurofibromas in Neurofibromatosis-1 (NF-1) may undergo malignant transformation in 2%–5% of patients. We are reporting a very rare case in NF-1 patient who, presented with pathological intertrochanteric fracture of femur and liver metastasis. X-ray from left hip joint shows lytic lesion which on histopathology turned out to be MPNST. S-100 was positive confirming its neural origin. Elbow lesion which was excised later, also showed similar features with S-100 positivity. Ultrasonography abdomen showed target lesions in liver. Fine-needle aspiration cytology from liver showed scattered malignant spindle cells. A final diagnosis of metastatic MPNST was made. Although malignant transformation in neurofibromas is extremely rare when it occurs, it is associated with NF-1 in 75% of patients. This case highlights the possibility of fracture femur as the presenting complains, in patients of NF with malignant transformation. The case is unique with regard to its presentation and rarity of metastatic sites.

Patella fracture is uncommon in pediatric age group and their patella is better preserved in any class of patella fracture. We reported a case of a 13-year-old male with right patella fracture nonunion. He had open reduction and internal fixation using tension band wire device. Fracture union was monitored with serial radiographs and he was followed up for 60 weeks. There was articular surface step after surgical fixation of the patella fracture. At 34 weeks postoperative, there was complete remodeling of the articular surface with good knee function after removal of the tension band wire. Children have good capacity of bone remodeling after fracture. Little retropatella step in a child after patella fracture surgical fixation will remodel with healing.