Idiopathic Tumoral Calcinosis with Unusual Presentation-Case Report with Review of Literature

INTRODUCTION

Tumoral calcinosis is an uncommon disorder characterised by the deposition of calcium phosphate in periarticular tissues. The deposits are usually around large joints; but rarely can be found around small joints of hand and feet.

CASE REPORT

We present the case of 13 year old female with three years history of spontaneous, progressively increasing, painful swellings along right middle finger and right heel. She was otherwise well and had normal serum calcium but elevated phosphate levels. Plain radiography demonstrated a dense lobulated cluster of calcific nodules within soft tissues consistent with a diagnosis of tumoral calcinosis. This diagnosis was confirmed on the basis of histopathological examination following surgical excision.

CONCLUSION

As such tumoral calcinosis is a rare entity and with such unusual presentations like in our case, it may lead to diagnostic confusion. Tumoral calcinosis should be considered in the differential diagnosis of painful swellings developing in the vicinity of small joints of hand and feet.

Closed antegrade interlocked nailing of femoral shaft fractures operated up to 2 weeks postinjury in the absence of a fracture table or C-arm

BACKGROUND

We present our technique of closed nailing in diaphyseal femoral fractures treated between 1 to 14 days postinjury. The purpose of the study was to demonstrate the fact that such fractures can be treated closed in the absence of a fracture table or C-arm.

METHODS

In all, 200 consecutive closed femoral fractures were fixed 1 to 14 days postinjury during a period of 2 years. Skeletal traction was applied immediately at admission and sufficient weight was applied to overcome muscle spasm. In most cases, a closed nailing was successfully performed. Distal locking was achieved with either a medinov nail with wings for distal locking, or a standard nail with a jig for the distal lock.

RESULTS

The average age of the patients was 30 years. Follow up ranged from 6 to 12 months. Mean duration of follow up was 10 months. All patients had a functional range of movement at the hip and knee with a normal gait. The average time taken for surgery was 90 minutes with an average blood loss of 50 to 100 mL. Time in hospital after surgery was 2 to 10 days.

CONCLUSIONS

Delayed closed nailing of femoral fractures can be achieved without a C-arm or a fracture table provided adequate skeletal traction is applied preoperatively and proper attention is paid to the surgical steps as described.