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Conventional periacetabular pelvic resections are associated with poor functional outcomes. Resections through surgical corridors beyond the conventional margins may be helpful in retaining greater function without compromising the oncological margins.The study included a retrospective review of 82 cases of pelvic resections for pelvic tumors. Outcomes of acetabulum preservation (Group A) were compared with complete acetabular resection (Group B). Also, we compared outcomes of Type I + half resections (Group 1) with Type I + II resections (Group 2), and Type III + half resections (Group 3) with Type II + III resections (Group 4).Group A (n = 44) had significantly better functional outcome than Group B (n = 38) with average MSTS93 score 22.3 versus 20.1 and average HHS 91.3 versus 82.5 (p 0.001). Group 1 (n = 14) and Group 2 (n = 12) had similar functional outcomes (mean MSTS93 score 22.07 vs. 21.58 [p = 0.597] and mean HHS 90.37 vs. 86.51 [p = 0.205]). Group 3 (n = 11) had significantly better functional outcome than Group 4 (n = 17), with mean MSTS93 score 22.8 versus 19.7 (p 0.001) and mean HHS 92.3 versus 80.1 (p 0.001). Oncological outcomes were similar among the groups.Transacetabular pelvic resections provide functional benefit over conventional resections without compromising oncological margins. There is a need to revisit and revise the pelvic resection planes.

Introduction: With a less than ideal health infrastructure and a vast underprivileged population in our country, many cases of Sprengel’s deformity are initially missed and are subsequently untreated. Although for best surgical results, the patient must be under the age of five, many patients present late at out tertiary care center. Thus, we evaluated the clinical results of the modified Woodward’s Procedure in such neglected cases. Methods: A retrospective study, of 16 patients aged 8-yr or above, with Sprengel’s deformity who underwent the modified Woodward’s procedure between 2006 and 2011. Clavicular osteotomy/morselization was avoided. The Cavendish scoring system was used to grade cosmesis and shoulder abduction was used to assess the functional outcome. The patients were prospectively followed up at two-years and after skeletal maturity. Results: There were ten females and six males and the average age was 9.4 years. The mean follow up was 4.2 yr. Omo- vertebral bar excision was done in 13 (81.25%) patients. The mean increase in postoperative shoulder abduction and Cavendish grades at a 2-yr follow-up were, 19.1° and 1.32 grades, respectively. None of our patients needed Clavicular osteotomy/morselisation and none developed neurological abnormalities. The was no change in the values at skeletal maturity. Conclusion: Satisfactory outcomes can be acquired by the Modified Woodward’s procedure in neglected Sprengel’s deformities. Besides a definitive cosmetic correction, the procedure also results in improvement of shoulder abduction. Clavicular Ostetomy/Morselization is not always required in cases presenting after the age of 8 years. Keywords: Woodward’s procedure; Sprengel’s shoulder, Cavendish grading, modified Woodward’s procedure; neglected Sprengel deformity.

Wrist reconstruction after distal radial tumor resection poses a challenge to the orthopedic oncologist. We evaluated the functional outcomes of centralization of the ulna with ulnocarpal arthrodesis as a method of reconstruction following resection of distal radius tumors, using impairment measures and patient-reported outcomes.Evaluation of functional outcome was performed using the Musculoskeletal Tumor Society 93 scoring system and Disabilities of the Arm, Shoulder, and Hand questionnaire. We also determined hand grip strength on the affected side, time to radiologic union at the ulnocarpal junction and reduction in wrist circumference. Local complications and oncologic outcomes were recorded.The study included 26 patients with Campanacci grade 3 giant cell tumor of the distal radius. Mean follow-up period in the study was 32.8 ± 12 months. Mean resection length was 10.3 ± 2.5 cm. Radiologic union at the ulnocarpal junction was achieved in 38.5%, 77% and 96% of the patients by 4, 5, and 6 months respectively. Mean hand grip strength was 74 ± 3.9% of the contralateral side whereas mean reduction in wrist circumference was 16.9 ± 6.4%. A good functional outcome with a mean the Musculoskeletal Tumor Society 93 score of 26 ± 1.4 and mean Disabilities of the Arm, Shoulder, and Hand score of 10.5 ± 6.3 was observed. Fracture of the ulna, hardware loosening, and reflex sympathetic dystrophy were each noted in 1 patient, with an overall complication rate of 10.7% (3/28). No patient had nonunion, infection, or local recurrence.This is a simple and effective modality of reconstruction after resection of distal radial tumors. It provides good functional outcome and preservation of good hand grip strength, with low complication rates.Therapeutic IV.

Background Reconstruction following resection of sarcomas of the upper extremity with methods described in the prevalent literature may not be possible in few selected cases. We describe surgical phocomelia or phoco-reduction as a method of limb salvage in such cases of extensive sarcomas of the upper limb with its functional and oncological outcomes. Methods Evaluation of functional and oncological outcomes was performed for 11 patients who underwent surgical phocomelia or phoco-reduction for extensive sarcomas of the upper limb between 2010 and 2019. Results The mean follow-up period in the study was 27.8 months. Five patients required a segmental resection including the entire humerus while six patients underwent segmental resection around the elbow with a mean resection length of 21.5 cm. Mean Musculoskeletal Tumor Society 93 score was 22 depicting a good functional outcome. Mean handgrip strength on the operated side was 62% of the contralateral side with preservation of useful hand function. Meantime to humeroulnar union was 6.7 months. Radial nerve palsy and implant failure occurred in one patient each. No patient developed local recurrence while three patients died of metastasis. Conclusion Surgical phocomelia is a prudent alternative to severely incapacitating amputations in situations where other reconstruction methods are not feasible.

Background Adequate reconstruction of the soft tissue defect following resection of bone tumors is challenging. Prolene mesh, despite being a useful tool, is not widely used due to the fear of deep infection. The aim of this study was to evaluate the functional outcome and complications of using a Prolene mesh in oncological reconstructions. Methods A retrospective study was conducted in bone tumor patients with soft tissue reconstruction using Prolene mesh between January 2017 and June 2019. Functional evaluation was done using MSTS 93 score. Complications were recorded and were classified as mechanical (dislocation and extension lag) or biological failure (wound problems and deep infection). Comparison was performed between groups with and without biological failure to identify predictive variables. Results Of 116 patients, 68 were males and 48 were females, with median age of 22.5 years. Thirty nine patients had tumors of proximal tibia, 23 of proximal femur, 25 of proximal humerus, 24 of pelvis, and five tumors at other sites. Approximately two-thirds (62.9%) of our patients underwent endoprosthetic reconstruction while the rest underwent either biological or cement spacer reconstructions. Excellent or good functional outcomes were reported in 98.3% patients as per MSTS 93 scoring. Complications were noted in 22 patients (18.9%), of which 16 had biological failure, with four patients requiring debridement and mesh removal. Dislocation of prosthesis occurred in 2 patients of proximal femur replacement. Overall re-surgery rate was 5.1% (6 patients). There was no statistically significant difference between the groups with or without biological failure with respect to demographics, site of tumor, type of procedure, blood loss, duration of surgery and history of chemotherapy. Conclusion Prolene mesh is a useful tool to reconstruct the soft tissue defects following bone tumor resections. It is readily available, reliable and provides reproducible results, with no added risk of wound complications.

Background and Objectives Coronavirus disease 2019 (COVID‐19) lockdown has presented a unique challenge for sarcoma care. The purpose of this study is to evaluate the early results and feasibility of surgeries for bone sarcomas during the COVID‐19 lockdown. Methods Our prospectively collected orthopaedic oncological database was reviewed to include two groups of patients‐ those who underwent surgery in the immediate 4 weeks before lockdown (non‐lockdown group) and those operated in the first 4 weeks of lockdown (lockdown group). All patients were followed‐up clinically and telephonically to collect the outcome data. Results Out of the 91 patients who qualified for inclusion, fifty were classified into the non‐lockdown group while 41 patients formed the lockdown group. Both the groups were comparable with respect to baseline demographic parameters. However, during the lockdown period 37 patients (90%) had undergone a major surgical intervention as against 24 patients (48%) in the non‐lockdown group (P

Objectives Standard guidelines regarding the management of un-displaced LC-1 type pelvic ring injury supported by data in literature are lacking, though it is considered to be stable and widely managed non-operatively. In our study we evaluated the functional outcome of LC-1 pelvic ring injury with incomplete sacral fracture managed non-operatively in patients having age more than 18 years and minimum follow-up of 6 months. Methods 46 patients having LC-1 pelvic ring injury with incomplete sacral fractures having age more than 18 years and minimum follow-up of 6 months were identified from the hospital record. All these patients were managed with non-weight bearing walking for first 3 weeks followed by weight bearing as tolerated. Patients were called in outpatient department for final evaluation of functional outcome measured according to Majeed score. Results Mean Majeed score was 82.59 ± 6.77 (excellent in 27 patients and good in 19 patients). 8 patients had fractures in addition to pelvic ring injury and 3 patients had abdominal injuries (3 excellent, 8 good). 11 patients had follow-up less than 12 months (mean Majeed score 84.36 ± 5.75; 8 excellent, 3 good) and 35 patients had follow-up more than 12 months (mean Majeed score 82.03 ± 7.04; 19 excellent, 16 good). There was no mortality in any group. Conclusion LC-1pelvic ring injury with incomplete sacrum fracture can be managed non-operatively with non-weight bearing walking for first 3 weeks followed by weight bearing as tolerated with excellent or good functional outcome. The best functional outcome for a patient is achieved within 12 months and does not change after that period. Also being a low energy trauma this injury has low mortality rate.

Introduction We treated proximal tibia fractures according to our own CT based classification in which we divided these fractures into different varus and valgus fractures. We also provide a guide for reduction of these fractures and the sequence in which different fractured fragments of proximal tibia should be fixed. Materials and methods Patients were identified from the hospital records, treated according to classification based upon mechanism of injury, from August 2014 to December 2016. Patients were called for follow up in outpatient department for evaluation. Functional evaluation was done according to Rasmussen functional grading score. Results Twenty one patients of proximal tibia fracture were treated between august 2014 to December 2016 according to our method. There were 17 male and 4 female. Age ranged from 20 year to 65 year (average 35.19 year). 17 patients were turned up for latest follow up who were analysed for Rasmusssen functional grading score. 14 patients had excellent and 3 patients had good function according to Rasmussen functional grading score. Conclusions Our classification system provides a guide for reduction of proximal tibia fractures and also tells us the sequence of different fracture fragments.

Background Pain in the immediate post-operative period after anterior cruciate ligament (ACL) surgery, apart from an unpleasant experience for the patient, can act as a barrier for static quadriceps contractions and optimum execution of the initial rehabilitation protocol resulting in slow recovery and a later return to full function for a sportsperson. There is no report in the literature comparing pain in the immediate post-operative period after using the two most widely used autografts, bone patellar tendon bone (BPTB) graft and hamstring graft. Methods The present study compared the visual analogue scale (VAS) pain score in the immediate post-operative period after arthroscopic ACL reconstruction with the BPTB and hamstring autografts. Both groups consisted of 50 patients each. The mean age of the BPTB and hamstring cohorts was 26.9 ± 7.3 years (age range 18–59 years) and 26.7 ± 9.0 years (age range 17–52 years), respectively. Unpaired t test was applied to compare pain scores between the BPTB and hamstring cohorts. Results In the present study, patients in the BPTB cohort showed higher mean pain scores across all the post-operative time intervals except at 6 h. However, the difference in the mean VAS pain score at post-operative 6, 12,18, 24, 36 and 48 h in the two groups was statistically not significant (p value of 1, 0.665, 0.798, 0.377, 0.651 and 0.215 at 6, 12, 18, 24, 36 and 48 h, respectively). Conclusions Our study concludes that the arthroscopic ACL reconstruction with BPTB autograft and hamstring autograft is associated with similar pain in the immediate post-operative period. As a result, aggressive physiotherapy regime is not affected by the type of graft being used for ACL reconstruction, as the pain scores in the immediate post-operative period are similar for both techniques. Trial registration Clinical Trials Registry-India, CTRI/2016/01/006502

A case of 22 year old male gymnast, who suffered from suprascapular neuropathy due to compression of suprascapular nerve by paralabral cysts around suprascapular notch, leading to marked atrophy of supraspinatus and infraspinatus muscles. After arthroscopic decompression of paralabral cysts, weakness and atrophy of the supraspinatus and infraspinatus muscles improved.