Publications by authors named "Ashwin Sathe"

16 Publications

  • Page 1 of 1

Are we neglecting long-term effects of vertebral shortening on pulmonary function in spinal tuberculosis?

Spine Deform 2021 Aug 16. Epub 2021 Aug 16.

Department of Orthopedics, Seth G S Medical College and K.E.M. Hospital, Mumbai, 400012, India.

Purpose: In developing part of the world, it is common to see complete destruction of vertebral bodies in tuberculosis. Our study aims to assess the effect of spinal tuberculosis with vertebral shortening on pulmonary function.

Methods: Fifty cases of spinal TB (14 males, 36 females) managed both operatively and non-operatively, who presented to tertiary care institute between years 2011 and 2016 were assessed. Vertebral height loss was assessed by spinal deformity index (SDI). All patients underwent pulmonary function testing using same equipment sitting in upright position.

Results: Mean age was 27.9 years (27.9 ± 11.9). 11 patients with mean SDI of 2.7 ± 1.1 showed normal lung function. 36 patients showed restrictive pattern of which 12 were mild, 14 were moderate and 10 showed severe pattern with a mean SDI of 3.8 ± 1.2, 5.6 ± 1.3 and 6.1 ± 1.4, respectively. 3 cases showed obstructive pattern. As the apex of curve shifted proximally, FVC% reduced. Increase in SDI value was associated with a fall in the vital capacity and FEV. Increase in the kyphotic angle was associated with a deleterious effect on PFT results.

Conclusions: Risk stratification of pulmonary dysfunction resulting from vertebral body height loss due to kyphosis will emphasize the need for early detection of spinal tuberculosis before deformity occurs.
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http://dx.doi.org/10.1007/s43390-021-00400-9DOI Listing
August 2021

Degenerative Cervical Spondylosis: A Cause of Vertigo?

Global Spine J 2021 Jul 16:21925682211027840. Epub 2021 Jul 16.

Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.

Study Design: Prospective observational study.

Objectives: Studying the effect of degenerative cervical spondylosis(CS) on blood flow velocity of vertebral artery (VA) during cervical spine rotation in different head positions and its association with vertigo.

Introduction: Vertigo is one of the most common complaints seen in an out-patient clinic. Its association with CS remains an enigma for a treating physician. This study planned to systematically analyze the association between vertigo and CS by evaluating VA blood flow dynamics in different head positions.

Methods: 100 patients with ages ranging from 20-80 years were recruited. First group of 50 patients with CS with vertigo were compared with second study group of 50 patients having CS without vertigo. Cervical radiographs were used to evaluate CS using cervical degenerative index (CDI). Color doppler was used to measure VA blood flow with head in neutral position and 60° lateral rotation with 30° extension. Same procedure was repeated on opposite side. Measurements performed included peak systolic blood flow velocity(PSV) and end diastolic blood flow velocity (EDV).

Results: Among patients with CS, patients having vertigo showed significantly more evident degenerative changes (CDI ≥25) (=<0.001). High grade CS patients (CDI ≥25) with vertigo had statistically significant lower blood flow parameters with head rotation in the left and right VAs as compared to CS patients without vertigo.

Conclusion: This study highlights important pathophysiological mechanism of vertigo observed in patients of CS. The magnitude of reduction in VA blood flow was significantly higher in patients with advanced CS presenting as vertigo.
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http://dx.doi.org/10.1177/21925682211027840DOI Listing
July 2021

Bilateral Traumatic Proximal Humeral Physeal Fracture in an Adolescent Child - A Rare Case Report and Review of Literature.

J Orthop Case Rep 2020 Dec;10(9):75-79

Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India.

Introduction: Proximal humerus fractures in the pediatric population are relatively uncommon accounting for <3% of all the fractures. Being the growing end of the bone, these fractures have a high threshold for conservative management. Dilemma does exist when such a fracture occurs in a borderline adolescent age group. Occurrence of bilateral physeal fractures in the same anatomical location is exceedingly rare and such a case of bilateral traumatic physeal fracture of proximal humerus has not been reported in the literature.

Case Presentation: A 14-year-old male child presented with post-traumatic pain and swelling of both the shoulders. Radiographs revealed displaced proximal humerus physeal fracture bilaterally. The displaced fracture was treated with closed reduction and percutaneous fixation using smooth Kirschner wires and cannulated screw.

Conclusion: Considering the bilateral nature of the injury and a borderline age with limited remodeling potential, a lower threshold for conservative therapy must be adopted in young active individuals. High-velocity trauma does form a major cause of such bilateral injuries, however, nutritional deficiencies and metabolic causes should be kept in mind while treating such a rare pattern of injury.
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http://dx.doi.org/10.13107/jocr.2020.v10.i09.1910DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046448PMC
December 2020

A Rare Case of Vanishing Bone Disease of Metacarpals.

J Orthop Case Rep 2021 ;11(1):101-103

Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India.

Introduction: Vanishing bone disease is rare phenomenon of idiopathic origin that leads to extensive osteolysis of bone. Prognosis of disease is unpredictable and definitive guidelines for management are still unknown. The vanishing bone disease has been reported for multiple other bones, however, this probably is the 1st time that vanishing bone disease of the metacarpals is being reported.

Case Report: A 22-year-old male presented with shortening middle finger and poor grip strength of the left hand. Serial radiographs revealed progressive concentric reduction of third and then fourth metacarpal shaft, with a sucked candy appearance. All the blood parameters were normal including calcium and parathormone levels. There was no evidence of any tumor elsewhere in the body. Biopsy showed myxoid areas, proliferating vessels interposed with skeletal muscles. Thus, based on clinical, radiological, and histopathological findings, we made the diagnosis of vanishing bone disease. The patient was treated with autologous non-vascularized fibula graft and was fixed with transverse k-wires to adjacent metacarpals. At 2-year follow-up, graft was completely incorporated and the patient gained full functional recovery.

Conclusion: Vanishing bone disease affecting the metacarpals is very rarely reported in the literature. The diagnosis should be made by excluding all the other conditions such as primary bone tumors or secondary from other sites. There are no fixed treatment guidelines. However, we could treat this condition successfully with autologous non-vascularized fibular graft.
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http://dx.doi.org/10.13107/jocr.2021.v11.i01.1982DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046473PMC
January 2021

Better late than never: Clinical outcomes of delayed fixation in thoracolumbar spinal trauma.

Eur Spine J 2021 Oct 22;30(10):3081-3088. Epub 2021 Mar 22.

Department of Orthopaedics, Indian Spinal Injuries Centre, New Delhi, India.

Purpose: To analyse factors influencing functional outcome and neurological recovery in patients undergoing delayed surgery for traumatic spinal cord injury (SCI) involving thoracolumbar spine.

Methods: Retrospective analysis of 33 patients with thoracolumbar SCI who underwent delayed surgery (≥ 72hrs post-trauma) with a minimum follow-up of 1 year (average:32.55 months) was done. The parameters studied included age, sex, co-morbidities, mode of trauma, associated trauma, level and number of vertebrae involved, fracture morphology, thoracolumbar injury classification and severity score (TLICS), maximal spinal cord compression (MSCC), signal changes in the cord, neurological deficit as per the American Spinal Injury Association (ASIA) scale, lower extremity motor score (LEMS), bowel bladder involvement, time interval between trauma and surgery.

Results: Mean time interval from injury to spine surgery was 24.45 days. At the end of 1-year follow-up, 17(51.5%), 12(36.36%), and 3(9.1%) patients had ≥ 1, ≥ 2, and ≥ 3-grade ASIA improvement, respectively. The mean LEMS rose to 33.86 from 17.09 (P < 0.001). 8 out of 20 patients with bladder involvement showed improvement. 4 patients succumbed, 22 were ambulatory, and 7 remained non-ambulatory. On comparing various parameters, pre-operative LEMS score (P-value: < 0.001), cord signal changes (P-value:0.002), and presence of cord transection (P-value:0.007) differed significantly in the above-mentioned three groups, while age (P-value:0.442), average TLICS (P-value:0.872), time from injury to surgery (P-value:0.386) did not differ significantly.

Conclusion: This study highlights that there is still a significant scope for neurological improvement even after delayed surgery in patients with thoracolumbar SCI. The lower the LEMS score at the time of presentation, signal changes in the cord and presence of cord transection have a significant influence on unfavourable clinical outcomes at the end of 1-year post-surgery.
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http://dx.doi.org/10.1007/s00586-021-06804-5DOI Listing
October 2021

Dysplasia and anomalies of atlas result in pediatric torticollis: A case report and literature review.

Surg Neurol Int 2020 29;11:471. Epub 2020 Dec 29.

Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India.

Background: Often, the cause of bony torticollis is difficult to determine, especially in cases of multiple craniovertebral junction anomalies.

Case Description: We report a rare case of a dysplastic C1 vertebra (assimilation to the right occiput and C2, a nonseparated left odontoid, and discontinuity in both anterior and posterior arches of the atlas) in a 6-year-old child with progressive torticollis. Notably, the mechanism of torticollis was not a rotatory subluxation of C1-C2, but differential growth between C1-C2. The child underwent a successful C1-C2 Goel and Harms fusion with reduction/correction of the torticollis.

Conclusion: Torticollis caused by differential growth between the C1 and C2 vertebrae resulting in a nonrotatory subluxation/torticollis in a 6-year-old child, was successfully managed with a C1-C2 Goel and Harm's fusion.
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http://dx.doi.org/10.25259/SNI_773_2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827302PMC
December 2020

Association of Thrombophilic Factors in Pathogenesis of Osteonecrosis of Femoral Head in Indian Population.

Indian J Orthop 2020 Sep 2;54(Suppl 1):33-38. Epub 2020 Jul 2.

Department of Orthopedics, Seth G. S. Medical College and KEM Hospital, 6th Floor, New Multi-Storeyed Building, Parel, Mumbai, 400012 India.

Purpose: Role of heritable blood clotting disorders, both thrombophilias and hypofibrinolysis in causing avascular necrosis (AVN) of femoral head have been studied in regions like Europe and U.S.A. This study was done to investigate the role of heritable thrombophilias in ethnic Indian population.

Materials And Methods: A case control study of 150 patients (100 cases and 50 age and sex matched controls) of Indian Ethnicity with clinico-radiographically documented idiopathic AVN of femoral head was done after ethics committee approval. DNA was extracted from the blood and PCR analysis was used to study heritable thrombophilic gene mutation (G1691A Factor V Leiden). Enzyme-linked immunosorbent assay (ELISA)-based assays, were utilized to measure antigen levels of protein C, antithrombin III levels and protein S.

Results: Nine cases out of 100 showed deficiency of Protein C (9%) while no control showed deficiency of Protein C ( value: 0.028-significant, Odds ratio: 9.791) Ten cases showed deficiency of Protein S (10%) in study population as compared to one case (2%) in control population ( value: 0.038-significant, Odds ratio: 5.44). ATIII deficiency was more prevalent in control group i.e. 22% compared to 11% in study group. Factor V mutation was present in 3% cases as compared to one (2%) in control group. ( value is 0.393-not significant).

Conclusion: Difference in thrombophilic mutations in various populations indicates possible effect of ethnicity on genetic profile in the development of AVN. This risk stratification will enable in near future early diagnosis and possible role of antithrombotics in disease prevention.
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http://dx.doi.org/10.1007/s43465-020-00181-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7474030PMC
September 2020

Anterior Distraction and Reduction with Posterior Stabilization for Basilar Invagination: A Novel Technique.

World Neurosurg 2021 01 3;145:19-24. Epub 2020 Sep 3.

Department of Orthopaedics, Indian Spinal Injuries Centre, New Delhi, India.

Background: Introduction of a posterior spacer for atlantoaxial joint distraction followed by posterior stabilization is a commonly performed procedure for irreducible atlantoaxial dislocation. We present a unique case in which posterior distraction was associated with increased risk of injury to the vertebral artery (VA) owing to its anomalous course, and hence a novel anterior distraction technique was used.

Case Description: A 45-year-old woman presented with severe neck pain for 1 month with gait imbalance and history of occipital headache for 1 year. Clinical examination revealed upper motor neuron-type findings. Hoffmann sign was positive bilaterally. Clinically, the patient had Nurick grade 4 cervical myelopathy. Magnetic resonance imaging showed basilar invagination along with Arnold-Chiari malformation and syrinx formation at C3-C4 vertebral levels. CT angiography revealed anomalous VAs directly overlying the atlanto-occipital joint. Owing to the anomalous route of the VA and unfavorable slope of facet joints, a 2-step anterior reduction followed by posterior stabilization surgery was planned. We achieved complete reduction using a 10-mm titanium cage inserted via a retropharyngeal approach. Following anterior reduction, instrumented in situ occipitocervical fusion was performed using a plate and screw construct. At 2-year follow-up, the patient is ambulating independently without gait imbalance and with successful radiologic fusion.

Conclusions: The craniovertebral junction has a unique pathoanatomy, and the course of the vertebral artery is variable. Appropriate investigations, including computed tomography angiography, with adequate surgical planning will provide a desirable long-term outcome. Our novel technique has the potential to add a new dimension to the management of irreducible atlantoaxial dislocation.
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http://dx.doi.org/10.1016/j.wneu.2020.08.220DOI Listing
January 2021

It's Never Too Late: Neurological Outcome of Delayed Decompression in Tuberculosis of Spine.

Global Spine J 2021 Jun 19;11(5):716-721. Epub 2020 May 19.

Department of Orthopaedics, 29549Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.

Study Design: Retrospective observational study.

Objective: To study the neurological recovery in patients with progressive neurological deficit undergoing delayed decompression and fixation in tuberculosis of spine.

Methods: Retrospective analysis of 50 cases with thoracolumbar tuberculosis of spine, undergoing posterior decompression and instrumentation was done. Parameters like time interval between appearance of neurological deficit to decompression surgery, maximal spinal cord compression, neurology on admission, presence of drug resistance, and number of vertebrae involved were evaluated. The subjects were divided into 2 groups depending on neurological improvement measured with LEMS (Lower Extremity Motor Score) at the end of 1-year follow-up.

Results: The mean LEMS score on admission was 27.72 (SD 12.88), which improved to 40.80 (SD 10.46) at the end of 1 year ( < .001). A total of 26 (52%) subjects were categorized into "Satisfactory" outcome (LEMS >10) group and remaining 24 subjects formed the "nonsatisfactory" outcome group. The median time interval between the appearance of neurological deficit and decompression surgery was 23.50 days in the satisfactory group and 29.50 days ( = .110) in the nonsatisfactory group. Maximal spinal cord compression was 0.370 in satisfactory group and 0.357 in nonsatisfactory group ( = .754). The mean preoperative LEMS score was 34.62 in the satisfactory outcome group while that in the nonsatisfactory outcome group was 20.25 ( < .001).

Conclusion: There is significant scope for neurological improvement even after delayed decompression and fixation in cases of tuberculosis of spine with progressive neurological deficits. Preoperative neurological status was found to be the most significant determinant of postoperative neurological outcome.
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http://dx.doi.org/10.1177/2192568220922209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165910PMC
June 2021

An audit of admissions and mortality of orthopedic indoor patients in a tertiary care hospital of India.

J Clin Orthop Trauma 2020 Jul 14;11(Suppl 4):S518-S521. Epub 2020 Apr 14.

Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India.

Introduction: Mortality in orthopaedics is different in underdeveloped, developing and developed countries depending on the health, orthopaedic and trauma care services, education status and social awareness. Analysis of mortality and causes of death is an important step to identify the risk factor. Such study is invaluable for epidemiological monitoring and health care planning.

Methods: Between September 2015 to August 2018 demographic data, timing and primary diagnosis of both mortality and admission were collected retrospectively in a leading tertiary care hospital in the city of Mumbai, India.

Results: Total admissions of 10,937 in the 3-year period with increased average monthly admission in the month of June, July and August. Trauma to be most common cause of admission and death and Road traffic accident to be the most common cause of trauma followed by slip and fall. The death rate was 0.55 per 100 admissions per year. In males most common age group was 18-60 years and in females above 60 years of age.

Conclusion: There is a link of increased admission rate in the monsoon months (rainy season) in India and road traffic accident and slip and fall. So accident prevention and health care planning and management of trauma victim, improvement of quality of life of general population will reduce trauma and related complications.
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http://dx.doi.org/10.1016/j.jcot.2020.04.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394819PMC
July 2020

Tuberculosis-The Great Mimicker: A Case of Traumatic Drainage of Cold Abscess.

World Neurosurg 2020 11 27;143:163-167. Epub 2020 Jul 27.

Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, India.

Background: Tuberculosis is characterized by cold abscess, which classically lacks the usual signs and symptoms of inflammation. This case report highlights an atypical presentation of tuberculous cold abscess in the form of appearance of massive swelling in the back overnight after a blunt trauma, mimicking post-traumatic hematoma.

Case Description: A 32-year-old man came to our outpatient department with sudden swelling over the right side of the upper back (25 × 8 × 8 cm) and loin (10 × 4 × 4 cm) after a fall from 1.5 to 2 m height the previous night. The possible differential diagnosis of a traumatic pathology, complicated by a bleeding disorder, resulting in massive hematoma was initially made. However, hematologic investigations were within normal limits. Magnetic resonance imaging suggested an anterior subligamentous abscess at the C7-T1 level tracking through the paraspinal muscles and communicating with the subcutaneous abscess, and at the L3 level, paraspinal abscess tracking to the subcutaneous plane. There was no cord compression or signal changes in the cord. Both the abscesses were pigtailed in antigravity fashion, and material was sent for culture, which proved to be tuberculosis. The patient was treated with antituberculosis treatment for 18 months and improved over the course with complete resolution of symptoms. At 4-year follow-up, the patient is asymptomatic with no evidence of recurrence.

Conclusions: Appearance of massive swelling overnight in patients with cold abscess has not been described in the literature. While evaluating an atypical presentation such as sudden post-traumatic swelling over the thoracolumbar area, the clinician should keep a differential diagnosis of tuberculous abscess and investigate clinicoradiologically to rule out tuberculosis, especially in developing countries.
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http://dx.doi.org/10.1016/j.wneu.2020.07.142DOI Listing
November 2020

Intradural Disc Herniation in the Lumbar Spine: A Case Report.

JNMA J Nepal Med Assoc 2020 May 30;58(225):345-348. Epub 2020 May 30.

Department of Orthopedics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India.

Intradural disc herniation is a rare presentation of a common pathology, comprising around 0.28-0.3% of all disc herniations. It occurs when disc material related to an intervertebral disc penetrates the spinal dura and lies in an intradural extramedullary location. A 60 years old male patient presented with complaints of low back pain and right lower limb radiculopathy of 2 weeks duration. Neurological examination revealed the weakness of extensor hallucis longus and ankle dorsiflexion with diminished sensation corresponding to fourth and fifth lumbar (L4-L5) dermatome on the right side. Magnetic resonance imaging showed a large sequestered fragment with intradural extensions and posterior longitudinal ligament tear. Intradural nerve root showed significant displacement with severe central canal and right lateral recess stenosis. Discectomy was performed along with the removal of the intradural extension. The postoperative course was uneventful.
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http://dx.doi.org/10.31729/jnma.4798DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654472PMC
May 2020

Learning from Mistakes: Pancreatic Laceration: Devastating Complication During Spine Surgery.

World Neurosurg 2020 09 6;141:81-84. Epub 2020 Jun 6.

Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India.

Background: Posterior decompression and fusion surgery is one of the most commonly performed surgeries for thoracolumbar tuberculosis with destruction of vertebral bodies. Tuberculosis causes gross destruction of the vertebral bodies and surrounding tissue, making them friable.

Case Description: We present an unusual but dreaded complication which we encountered during posterior decompression and instrumentation surgery in a 65-year-old woman with T10-11 tuberculosis of the spine. During surgical exposure, while reflecting posterior paraspinal muscles on the left side, there was an accidental slip of the Cobb elevator around the transverse process to the extent of two-thirds of its length on the left side anteriorly. The instrument was immediately withdrawn. There was no active bleeding in the field. The rest of the surgery was uneventful. In the postoperative period, however, the patient developed severe abdominal pain with abdominal distention. General surgery opinion was immediately taken and the patient was immediately investigated in the form of a computed tomography scan. It was found that there was a traumatic laceration of the pancreas. The patient underwent emergency exploratory laparotomy and repair of the pancreatic laceration. The patient required intensive monitoring and critical care unit stay and ultimately went on to recover fully over the next few weeks.

Conclusions: This case illustrates the possibility of pancreatic injury should always be kept in mind if the patient develops acute abdominal discomfort in the postoperative period. Also, a multidisciplinary approach along with intensive care backup and vigilant postoperative monitoring is of utmost importance, especially when an unusual event has occurred during the surgery.
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http://dx.doi.org/10.1016/j.wneu.2020.05.261DOI Listing
September 2020

Multidrug-resistant tuberculosis of lumbosacral spine producing extensive destruction with lumbosacral kyphosis.

BMJ Case Rep 2020 May 14;13(5). Epub 2020 May 14.

Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.

It is uncommon to get lumbosacral junction deformity due to tuberculosis. Lumbosacral junction alignment is of paramount importance in maintaining global sagittal balance. In this case report, we present a case of a 42-year-old woman with multidrug-resistant tuberculosis of lumbosacral spine with complete destruction of L3, L4 and L5 vertebra with partial destruction of L2 and S1 vertebra leading to significant shortening and lumbosacral kyphosis. The patient had severe axial low back pain, inability to sleep in supine position due to deformity and difficulty in walking due to loss of spinal alignment. The patient was treated with 6 weeks of antituberculous drugs followed by all posterior decompression with instrumentation from D10 to S2 with a reconstruction of anterior vertebral bodies with the help of an expandable cage. Antituberculous treatment was continued for 18 months. At present, the patient is asymptomatic with no neurological deficit and has completed 3.5 years of regular follow-up.
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http://dx.doi.org/10.1136/bcr-2020-234246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7232617PMC
May 2020

An Unusual Case of Aneurysmal Bone Cyst of Proximal Phalanx in a 2 Year Old Child.

J Hand Surg Asian Pac Vol 2020 Mar;25(1):114-118

Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India.

Aneurysmal bone cysts associated with tubular bones of the hand are rare and even rarer in the paediatric age-group. They are rapidly growing, destructive benign bone tumors. Multiple treatment modalities for aneurysmal bone cyst have been reported in the literature, but controversy exists regarding optimal treatment. We report a case of aneurysmal bone cyst of proximal phalanx of middle finger in a 2 year old child treated at our tertiary care hospital. The diagnosis was confirmed with pre-operative MRI, FNAC and post-operative histopathology. Curettage of the lesion and autologous bone grafting was performed. The hand was immobilized in a short below elbow slab for 4 weeks followed by physiotherapy. Excellent radiological and functional outcomes were obtained with no recurrence at a 5 year of follow up.
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http://dx.doi.org/10.1142/S2424835520720029DOI Listing
March 2020
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