A rare case of extensive neurogenic heterotopic ossification: a case report

INTRODUCTION

Neurogenic Heterotopic ossification (NHO) is a potential sequalae and a detrimental complication following neurological insult. It is characterized by formation of localized gradually progressive, peri-articular lamellar bone formation in extra-skeletal tissues. We would like to report a rare case of heterotopic ossification involving all 4 limbs, in which we tried to restore joint mobility to improve his functional status so that he could perform his daily tasks.

CASE PRESENTATION

We present a case of a 33-year-old bed ridden male, diagnosed with NHO involving all 4 limbs (bilateral hip, right knee, right shoulder, left elbow). The patient had a crippled posture, significant pain and impaired range of motion hampering movement of all four limbs which prevented him from lying down supine, sitting, walking and performing activities of daily living. After three surgeries, the patient achieved wheelchair mobilization and upright posture with the assistance of calipers.

CONCLUSION

The management of NHO requires a multidisciplinary approach involving orthopaedic surgeons, neurologists & rehabilitation specialists. Prognosis of NHO depends on factors such as extent of ossification, underlying neurological condition & patients overall health.

A Rare Presentation of Bifid Tibialis Anterior Tendon in a Case of Idiopathic Congenital Talipes Equinovarus

Introduction

Idiopathic congenital talipes equinovarus (CTEV) is one of the most extensively researched topics for decades. It has been associated with various musculoskeletal anomalies which maybe bony, vascular or involving the ligaments and muscles which may have a direct or indirect impact on its pathoanatomy. This report describes an unusual presentation of a bifid tibialis anterior tendon (TAT) in a case of CTEV. This is the first report of this kind in the literature to the best of our knowledge.

Case Report

A 4-year-old female presented with bilateral relapsed CTEV with dynamic supination previously treated with standard Ponseti protocol. The patient was treated with TAT transfer on the left side with a rare presentation of a bifid TAT where both the slips of the tendon were transferred to dorsum of the foot onto the lateral cuneiform.

Conclusion

When treating a patient of CTEV surgically, it is important to consider the possibility of a bifid TAT which is a rare musculoskeletal association. It is recommended to carefully dissect TAT to prevent under correction of the deformity in case either one of the tendon slips remains attached to its original site.

Intraprosthetic Dislocation of Dual Mobility Total Hip Arthroplasty: A Case Report and Review of Literature

Introduction

First introduced in Europe in the 1970s, dual mobility total hip arthroplasty (DM-THA) has gained popularity over years due to the reduced dislocation rates compared to standard THA. However, intraprosthetic dislocation (IPD), a rare complication where the femoral head separates from the polyethylene (PE) liner, remains a potential complication.

Case Report

A 67-year-old female presented with a transcervical neck of femur fracture. She was managed with a DM-THA. She dislocated her THA on post-operative day 18. Closed reduction was performed for the same under general anesthesia. However, she again dislocated her hip 2 days later. CT scan was done and an IPD was diagnosed. The PE liner was revised and the patient had a good outcome at 1 year follow-up.

Conclusion

When a DM-THA dislocates, it is important to consider the possibility of IPD which is a rare but unique complication associated with these systems. The recommended treatment for IPD is open reduction and replacement of the PE liner.

Study of paramagnetic defect centers in as-grown and annealed TiO2 anatase and rutile nanoparticles by a variable-temperature X-band and high-frequency (236 GHz) EPR

Detailed EPR investigations on as-grown and annealed TiO₂ nanoparticles in the anatase and rutile phases were carried out at X-band (9.6 GHz) at 77, 120-300 K and at 236 GHz at 292 K. The analysis of EPR data for as-grown and annealed anatase and rutile samples revealed the presence of several paramagnetic centers: Ti³⁺, O^-, adsorbed oxygen (O₂^-) and oxygen vacancies. On the other hand, in as-grown rutile samples, there were observed EPR lines due to adsorbed oxygen (O₂^-) and the Fe³⁺ ions in both Ti⁴⁺ substitutional positions, with and without coupling to an oxygen vacancy in the near neighborhood. Anatase nanoparticles were completely converted to rutile phase when annealed at 1000° C, exhibiting EPR spectra similar to those exhibited by the as-grown rutile nanoparticles. The high-frequency (236 GHz) EPR data on anatase and rutile samples, recorded in the region about g = 2.0 exhibit resolved EPR lines, due to O^- and O₂^- ions enabling determination of their g-values with higher precision, as well as observation of hyperfine sextets due to Mn²⁺ and Mn⁴⁺ ions in anatase.

Enoxaparin experience in percutaneous coronary intervention

To investigate the efficacy and safety of enoxaparin in 135 consecutive patients who were undergoing emergency/non-emergency percutaneous coronary intervention (PCI), a prospective, observational study of procedural anticoagulation was carried out with enoxaparin in elective, primary PCI. Documentation of the in-hospital clinical and angiographic outcomes was performed in eligible patients undergoing elective or primary PCI. This data helped to capture how patients while on anticoagulation with enoxaparin were being managed. As this was a prospective observational registry and not a randomised controlled trial, there was no single hypothesis from which to calculate the minimum sample size required. We recorded outcomes with 135 consecutive patients undergoing PCI who were enrolled in the study. While analysing the results the points taken into consideration were: Patient demography, PCI, methods of haemostasis and timing of sheath removal, dose and timing of enoxaparin and clinical and angiographic outcome. Statistical analysis was performed using statistical analysis system (SAS) software. Enoxaparin when used in PCI, can be a safe alternative to unfractionated heparin (UFH).