Open Access Case Report

McCune Albright Syndrome – A Case Report and Current Management Options

Ling Lee Siang, Seo Soon Teck, Sivapathasundaram A/L C. Nadarajah

Asian Journal of Orthopaedic Research, Page 1-9

McCune Albright Syndrome (MAS) is a rare, sporadic disorder caused by an activating mutation of the stimulatory G-protein alpha subunit (Gsα) gene. The disease consists of a triad of polyostotic fibrous dysplasia (PFD), café-au-lait maculae and autonomous hyperfunctional endocrinopathies such as hyperthyroidism, Cushing’s syndrome, precocious puberty, rickets/osteomalacia, excessive growth hormones, hepatic and cardiac involvements. Its estimated prevalence is between 1/100,000 and 1/1,000,000 and more commonly seen in female. The disease course is complicated by recurrent fractures resulting from PFD and the treatment is thus primarily directed at the reduction of the risk of fractures.

We are reporting a case of a 2 years old girl presented with alleged fall at home in November 2017 and sustained closed fracture of proximal third right femur. On examination, café au lait spots were noted over chest and abdomen. Blood parameters revealed hyperthyroidism and high serum alkaline phosphatase level. She was referred to paediatric team for MAS. Patient was put on hip spica and achieved fracture union after 1 month. Upon review at clinic patient was well and range of motion of right hip and knee were full. Patient was able to ambulate without aid. Unfortunately, patient presented to us again on August 2019 with alleged fall at home and sustained closed undisplaced pathological fracture distal third of left humerus. X ray left humerus showed undisplaced fracture distal third of left humerus with characteristic “ground glass” appearance. The overlying cortex was thin and expanded with radiolucent lesions within the shaft. She was treated conservatively with U slab and achieved fracture union after 2 months. Upon latest review in October 2019, patient is otherwise well, no tenderness over left humeral shaft, no neurological deficit, full range of motion over left shoulder and elbow. This case is selected for reporting due to its relatively rare incidence and we will discuss on literature review regarding this rare syndrome and highlight on its spectrum of manifestations and current management options.

Open Access Case Study

Open Multiple Volar Fractures-dislocations of the Metacarpophalangeal Joints: Case Report and Review of Literature

Mohamed Othmen Chouchène, Amira Gallas, Youssef Henane, Rami Ben Arab, Walid Bouaicha, Adel Khorbi, Mohamed Ali Sbai

Asian Journal of Orthopaedic Research, Page 10-15

Open multiple volar fractures-dislocations of metacarpophalangeal (MCP) joints are exceptional and rarely reported in literature. The presumed mechanism is forced hyperextension of MCP joint, associated with active flexion. It is a functional emergency of the hand that requires reduction and stabilization. An early and well conducted rehabilitation program allows controlling edema and avoiding stiffness of the MCP joints.

Through this paper we report the case of a 53-year-old right-handed man with open multiple volar fractures-dislocations of three long fingers. We aim to highlight the importance of an early debridement with a good reduction and stabilization of the fracture-dislocation, followed by a well conducted rehabilitation program which are the only guarantor of a good functional recovery.

Open Access Original Research Article

Outcomes of Negative Pressure Wound Therapy for Degloving Soft Tissue Injuries around the Foot and Ankle

Rohan Memon, Nishant Suvagiya, Ketan Parmar

Asian Journal of Orthopaedic Research, Page 16-20

Introduction: Main aim of the study was to evaluate the results of negative pressure wound therapy (NPWT) in patients with open wounds in the foot and ankle region.

Materials and Methods: Sixteen (16) patients with degloving injuries arounf the foot and ankle admitted in VS general hospital were treated with negative pressure wound therapy. Amongst all the patients admitted with degloving injuries the mode of injury were the following like  acute trauma, due to a traffic accident, a fall, or a crush injury, and all had wounds with underlying tendon or bone exposure. All the degloving wounds were thoroughly debrided and irrigated before Negative pressure wound therapy was applied. Dressings were changed every 3 or 4 days and treatment was continued for 18.4 days on average (range, 11–29 days).

Results: Fifteen (15) cases out of 16 developed granulation tissue in their wounds after    treatment with negative pressure wound therapy. The sizes of degloving wounds reduced from 27 cm to 15 cm after NPWT. Amongst 15 cases were granulation tissue was formed in degloving wounds a skin graft was used to cover them and in one case. A free flap was needed to cover exposed bone and tendon in one case. No major complication occurred that was directly attributable to treatment. Amongst the patients who underwent skin grafting 2 patients developed scar contracture. 

Conclusion: Thus from the above obtained observations it is concluded that negative pressure wound therapy promotes granulation of the open degloving wounds, fastens the healing process and thus reduces the healing time and saves the patient from secondary reconstructive procedures.

Open Access Original Research Article

Functional Outcome of Expert Tibial Intramedulary Nailing for Metaphyseal Distal One Third Fractures of Tibia

Rohan Memon, Drashtant Patel

Asian Journal of Orthopaedic Research, Page 21-25

Introduction: In Orthopaedics fractures of tibia remains the commonest and most challenging fractures to be treated. Various modes of treatment are described for the fixation of fractures of lower third shaft tibia. When the aim is stable fixation with early restoration of function without use of plaster, intramedullary nailing offers an attractive treatment option. Newer expeet tibia nail design have been developed for the osteosynthesis of fractures of lower third tibia. The main purpose of the study was to study functional outcomes of expert interlocking nai for management of lower third tibia shaft fractures.

Materials and Methods: This study was conducted on 20 skeletally mature patients with metaphyseal distal one third fractures of the tibia treated with Expert Tibial Nail which is having advanced proximal and distal locking options.

Results: All the patients on follow up were evaluated on the basis of Johner R, Wruhs SD criteria and were graded as excellent, good, fair and poor as per the score obtained based on deformity and moment at ankle joint. Out of 20 patients 15 (75%) patients had excellent results as they had full function as pretrauma without any residual symptoms. 3 patients (15%) had good results, 1 (5%) patients had fair results and 1 (5%) patient had poor results.

Conclusion: On the basis of the above obtained observations it seems that expert interlocking tibia nail appears to be a ideal implant for the management of lower third shaft tibia fractures.

Open Access Original Research Article

Correlation between Clinical Features and Findings Observed on Magnetic Resonance Imaging in Patients with Lumbar Disc Prolapse

Anubhav Rijal, Mahendra Paudel

Asian Journal of Orthopaedic Research, Page 26-33

Background: Lumbar disc prolapse is one of the common causes of low back pain seen in active people. There are different reports regarding the clinical significance of various magnetic resonance imaging (MRI) findings observed in these patients. The study was conducted to correlate the clinical features and MRI abnormalities.

Methodology: This prospective study was carried out in department of Orthopaedics, in tertiary referral centre, for a year. Eighty six clinically diagnosed patients of lumbar disc prolapse were included in the study. They had a complete lumbar spine MRI with 3 tesla scanner. Clinical evaluation included pain distribution, neurological signs and symptoms. The MRI findings were then correlated with clinical signs and symptoms.

Results: This study included 86 patient, mean age 41years ± 8.790, male to female ratio 1.2:1 and 49 patients (57%) were heavy workers. All patients presented with low back pain and radicular leg pain. Straight leg raising test was positive in 82.6% patients. 78 (90.7%) patients had neurological deficit (motor or sensory) and 28 patients had absent ankle reflex. There were 174 disc herniations, most common type being disc protrusion, position being centro-lateral and level being L4-L5 and L5-S1 (74.1%). There was statistically significant correlation between MRI findings of nerve root compression and SLRT (p-value = 0.035), absent ankle reflex (p-value <0.001) and neurological deficit (p-value = 0.019). There was no statistically significant correlation between type of disc herniation and neurological signs (p-value > 0.05). The clinical level at L4-L5 & L5-S1 and MRI level L4-L5 & L5-S1 had statistically significant correlation (p-value <0.001 ).

Conclusion: Straight leg raising test (SLRT), neurological deficit and absent ankle reflex correlates well with nerve root compression visible in MRI; Clinical level and MRI level also correlates significantly. The type of disc herniation does not correlate with the neurological deficit.