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The prolapse of the intervertebral disc is most common cause of sciatica; rare causes of sciatica are pelvic fractures, pelvic tumors, piriformis syndrome, a rupture of medial head of gastronemius and sacroiliac joint dysfunction. We report the case of a 30-year-old male with a paralabral cyst of the hip joint with an acetabular labral tear causing sciatica. Our patient had an acetabular labral tear caused by a repetitive micro-trauma and external rotation injury. The diagnosis of the paralabral cyst with acetabular labral tear was based on clinical examination and histopathological examinations, and Magnetic resonance imaging findings. The patient underwent successful surgical excision of paralabral cyst and surgical repair of an acetabular labral tear. The present case reinforces the need for clinicians to be vigilant about rare causes of sciatica. [ABSTRACT FROM AUTHOR]

Introduction: Schwannomas that arise within the muscle plane are called intramuscular schwannomas. The low incidence of these tumours and the lack of specific clinical features make preoperative diagnosis difficult. Herein, we report our experience with intramuscular schwannomas. We present details of the clinical presentation, radiological diagnosis and management of these tumours. Methods: Between January 2011 and December 2013, 29 patients were diagnosed and treated for histologically proven schwannoma at the National University Hospital, Singapore. Among these 29 patients, eight (five male, three female) had intramuscular schwannomas. Results: The mean age of the eight patients was 40 (range 27-57) years. The most common presenting feature was a palpable mass. The mean interval between surgical treatment and the onset of clinical symptoms was 17.1 (range 4-72) months. Six of the eight tumours (75.0%) were located in the lower limb, while 2 (25.0%) were located in the upper limb. None of the patients had any preoperative neurological deficits. Tinel's sign was present in one patient. Magnetic resonance (MR) imaging showed that the findings of split-fat sign, low signal margin and fascicular sign were present in all patients. The entry and exit sign was observed in 4 (50.0%) patients, a hyperintense rim was observed in 7 (87.5%) patients and the target sign was observed in 5 (62.5%) patients. All patients underwent microsurgical excision of the tumour and none developed any postoperative neurological deficits. Conclusion: Intramuscular schwannomas demonstrate the findings of split-fat sign, low signal margin and fascicular sign on MR imaging. These findings are useful for the radiological diagnosis of intramuscular schwannoma. [ABSTRACT FROM AUTHOR]

Vagino-vesico-cutaneous fistula is a rare condition characterised by continuous dribbling of urine and secondary infection of the involved areas with poor self-esteem. Osteomyelitis is delayed complication of radiotherapy treatment for cervical cancer. Treatment of these conditions is a challenging entity especially after previous surgery and irradiation. We present a case of vesicocutaneous -- vesico vaginal fistula with osteomyelits of the right pubic bone which was a late complication of post-cervical cancer radiotherapy. [ABSTRACT FROM AUTHOR]

Introduction: The proximal humerus is the third most common site for primary sarcoma of bone. Since the 1970's the treatment of primary bone sarcoma has changed from amputation to limb salvage. This has been due to advances in chemotherapy, imaging and surgical techniques. The literature has shown that the survival after limb salvage is similar to that of amputation. The optimum method of reconstruction of the shoulder remains controversial Aims & Objectives: The aim of our study was to review the cases of primary bone sarcoma of the proximal humerus treated at GCRI Material and Methods: 12 patients were treated, of which 9 were ogs, 3 were ewings.4 patients were treated with endoprosthetic reconstruction and 8 were treated with Nail Cement Spacer. They were followed up for functional and Oncological outcome. Mean age of patients was 15.Follow up period of study ranged from 6 months to 2 year with mean of 16 months Result:Good functional outcomes were achieved with good MSTS score .At end of 2 yrs there was one LR.It was treated with FQ amputation. Conclusion:Proximalhumerus resection and reconstruction provides good functional outcomes in patients with proximal humerus sarcoma. [ABSTRACT FROM AUTHOR]

Introduction Pelvic bone sarcoma requires a multi-disciplinary treatment to achieve adequate oncologic local control and functional limb. Methods We have evaluated the results of internal hemipelvecotmy from 2010 to 2017 .23 patients with pelvic bone tumors (13 with Ewing's sarcoma, 9 with Osteosarcoma, 1 with chondrosarcoma) were treated by surgical resection. Results The mean follow-up was 18 months (0.3-5) years. In 12 patients reconstruction was performed and 11 were without reconstruction. A total of 3 patients (13%) had an infection develop at a mean follow up of 1 month. Surgical debridement's and antibiotics in three patients led to complete recovery. One patient had sciatic nerve injury. One patient had injury to femoral vein; was treated with femoral vein reconstruction. Two patients (9%) developed a local recurrence and were treated with best supportive treatment. Distal pulmonary metastases were seen in four patients and treated with supportive treatment. One patient died of disseminated intravascular coagulation with deep vein thrombosis two months following surgery. Five-year disease-specific survival rates of all patients were 83%. The mean functional MSTS score was 18(14-24). Conclusions Internal hemipelevectomy is an effective method of limb salvage following surgical management of pelvic bone sarcomas. The surgical site infection and flap necrosis tend to be minor complication and can be managed leading to optimal outcomes and justifies the need for this complex surgery. [ABSTRACT FROM AUTHOR]

Superficial ulnar artery is an uncommon variation in which the ulnar artery is having its course superficial to the flexors of the forearm and may arise directly from axillary or brachial arteries. The proper understanding and knowledge of variation of arterial systems is helpful for judicious planning of various reconstructive procedures in oncological, orthopaedic and reconstructive surgeries. We present a case of variant course of ulnar artery which was noted during exploration of a right distal forearm wound. We suggest few clinical recommendations to avoid iatrogenic complications due to variation in arterial system. [ABSTRACT FROM AUTHOR]

Background: Ewing's sarcoma is highly aggressive bone tumor having predilection for younger age groups with t (11,22) translocation, recombines the FLI-1 and EWS genes on chromosome 22. This disease requires multi-disciplinary treatment withneo-adjuvant chemotherapy followed by surgery or radiotherapy and adjuvant chemotherapy. This study was aimed to assess the demographic distribution, clinical behaviour and oncological outcome of Ewings Sarcoma involving upper extremity., Methods: From 2015 to 2022, 45 patients of upper extremity Ewing's sarcoma underwent treatment at a territory cancer centre. A total of 26 patients treated with surgical management were included in the study comprising 15 males (57.7 %) and 11 females (42.3 %). Mean age of presentation was 26 years (3-43 years). The most common site for Ewings sarcoma of upper extremity was Humerus(42 %) followed by Scapula(27 %), Radius(15 %), Ulna(8 %), Metacarpals(4 %) and Clavicle(4 %). Out of 26 cases, 19 (73%) underwent limb salvage surgery and 7 (27%) underwent ampuation surgery., Results: In limb salvage group reconstruction with Extra-corporeal radiotherapy (ECRT), Ulna centralization, Megaprosthesis and 3D printed scapula was performed following wide resection of tumor. In Amputation group ray resection in one case and forequarter amputation was performed in six cases. Mean serum LDH value was 335 IU/L (2.3X Normal value) and serum albumin was 4.04 gm/dl. Mean tumour necrosis after neo-adjuvant chemotherapy was 68 %. Out of 26 cases, 19(73 %) cases underwent limb salvage and 7 patients underwent amputation surgery. Out of 26, 13 (50 %) patients developed metastasis on follow up. The Event free survival (EFS) in current study was 70 % at 12 months and 40 % at 24 months. Mean Event free survival (EFS) in current study was 33.5 months (22.3-44.6) and Median Event free survival (EFS) in current study was 25 months (19.7-30.2)., Conclusion: This study characterises demographic and oncologic outcomes of upper extremity ewings sarcoma in Indian subpopulation. Pain and swelling were prominent clinical findings at presentation in patients with upper extremity Ewing's sarcoma. The survival rate following limb salvage surgery in Ewings sarcoma of upper extremity was comparable to that of patients with amputation surgery. Ewings sarcoma of upper extremity was associated with higher LDH level which was raised more than twice the normal range and can led to worse oncologic outcomes. A comparative study on upper extremity and lower extremity ewings sarcoma will be of help to improve literature on this rare disease., Competing Interests: None., (© 2023 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)

Background: Opinion remains divided as to whether excision of needle biopsy tract is beneficial and affect the prognosis. The aim of the study was to compare the outcomes in patients of primary malignant bone tumor who had undergone surgery with or without biopsy tract excision., Methods: From January 2017 to June 2020, 240 patients with primary malignant bone tumors who underwent percutaneous needle biopsy followed by surgery were included. We categorized patients into Biopsy tract excision (Group1:185 patients) and Non Biopsy tract excision (Group 2:55 patients). Median follow-up of patients was 58.6 months (range; 12-61.8months)., Results: Demographics, histopathological type, tumor location, type of surgery were similar in biopsy tract excision and non excision group. We found biopsy tract seeding in two cases out of 185 (1.1 %). Local recurrence in biopsy tract excision and non excision group was observed in 3.2 % and 1.8 % respectively with p value 0.58. The mean local recurrence free survival rate in group 1 and 2 was 60 and 44 months respectively. Limb salvage was performed in 71.6 % and in amputation in 28.3 % cases. The local recurrence in limb-salvage and amputation group was observed in 3.4 % (6/172) and 1.4 % (1/68) respectively., Conclusion: There was no significant difference in the rate of local recurrence between patients who were treated by biopsy tract excision or non tract excision. Percutenous needle bone biopsy tract leads to minimal risk of tumor seeding during surgical resection of primary bone tumors.We recommend the further multi centre studies with more number of patients to reach a consensus on resection of needle biopsy tract during surgical management of primary bone tumors., Competing Interests: NIL., (© 2023 Published by Elsevier B.V. on behalf of Professor P K Surendran Memorial Education Foundation.)

Background: Adequate lymphadenectomy in middle- and lower-third esophagus cancer is still a matter of debate. This study aims to find out the extent of histopathological supracarinal lymph nodes positivity rate to establish an adequate lymph node dissection in esophageal squamous cell carcinoma cases operated up-front or after neoadjuvant chemotherapy (CT) + radiotherapy (RT) and its short-term oncological outcome., Materials and Methods: After approval from institutional board review, a retrospective study was conducted from April 2017 to September 2019. A total of 76 patients having mid- or lower-third carcinoma esophagus were operated at our institute for partial/total esophagectomy with extended two-field lymph node dissection were followed. Intraoperative nodal stations were harvested separately and lebeled individually according to the Japanese Esophageal Classification and sent for histopathological examination., Results: The patients had an average age of 52 years. Histologically all were squamous cell carcinoma (SCC). Forty-four patients received preoperative concurrent RT plus drug therapy, whereas 18 cases were operated up-front. Fourteen patients were operated after palliative treatment (CT/RT). The average total lymph node yield was 22 nodes (range 3-69). In 26 patients (34.2%), lymph nodes were positive (N+ disease). Supracarinal nodes were positive in 20 cases (26.31%). The average supracarinal lymph node yield was 10.33 nodes (range 2-32). Five patients (6.5%) had only supracarinal lymph nodes positive on histopathological examination. Seventeen patients had a complete pathological response rate (pCR)., Conclusion: In cases of mid-third esophageal carcinoma, extended two fields with supracarinal lymphadenectomy is strongly recommended even after the patient has received neoadjuvant treatment, although the same for lower-third/gastroesophageal (GE) junction tumors should be considered.

Background: The purpose of this meta-analysis is to provide an evidence-based overview of the effectiveness of corticosteroid injection for the treatment of stenosing tenosynovitis (trigger digits). We have analysed only randomised control trials (RCTs) which compared the effectiveness of corticosteroid injections with control injections. Methods: The Cochrane Library, PubMed, Medline, Web of Science and Scopus were searched to identify relevant studies. The keywords for search in the database were ('stenosing tenosynovitis' OR 'trigger finger') AND injections. After screening titles and abstracts of these studies, full-text articles of studies that fulfilled the selection criteria were obtained. For the meta-analysis, we determined the pooled mean failure rate, odds ratio (OR), relative risk (RR) and 95% confidence intervals (CI) for the risk of failure rate between the corticosteroid injection group and the control group through the random-effects model. Results: Six RCTs were found that involved 368 participants. The corticosteroid injection group included 190 patients and 178 patients were included in the control group. The pooled estimate of successful treatment in the corticosteroid injections group was 63.68 ± 5.32% and that in the control group was 27.53 ± 11.52%. The pooled RR of treatment failure between the corticosteroid injection group and the control group was 0.49 (95% CI 0.40-0.60). The pooled OR of treatment failure between the corticosteroid injection group and the control group was 0.18 (95% CI 0.08-0.44). All the included studies reported either mild or no complications with corticosteroids or placebo injections. Conclusions: In the treatment of stenosing tenosynovitis, the corticosteroid injections have better outcomes compared to the control injections and this meta-analysis provides significant evidence of the effectiveness of corticosteroid injection for stenosing tenosynovitis with minimal adverse effects. Level of Evidence: Level II (Therapeutic).

Intraosseous ganglion cyst is a rare bone tumor and the lesion could often be missed. The diagnosis could be delayed so proper radiologic investigation and index of suspicion is necessary .Differential diagnoses of painful cystic radiolucent carpal lesion are osteoid osteoma, osteoblastoma and intraosseous ganglion. Curettage of the scaphoid lesion and filling of void with bone graft provides good functional outcomes. The cyst contains mucoid viscous material without epithelial or synovial lining. We present a case of 30 years old male with intraosseous ganglion cyst of scaphoid which was treated with curettage and bone grafting. Rarely ganglion cyst is found in small bones of hand and should be considered as differential diagnosis of chronic radial wrist pain.

The prolapse of the intervertebral disc is most common cause of sciatica; rare causes of sciatica are pelvic fractures, pelvic tumors, piriformis syndrome, a rupture of medial head of gastronemius and sacroiliac joint dysfunction. We report the case of a 30-year-old male with a paralabral cyst of the hip joint with an acetabular labral tear causing sciatica. Our patient had an acetabular labral tear caused by a repetitive micro-trauma and external rotation injury. The diagnosis of the paralabral cyst with acetabular labral tear was based on clinical examination and histopathological examinations, and Magnetic resonance imaging findings. The patient underwent successful surgical excision of paralabral cyst and surgical repair of an acetabular labral tear. The present case reinforces the need for clinicians to be vigilant about rare causes of sciatica.