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Introduction Acetabular fractures are complex intra-articular fractures. The extra-pelvic ilioinguinal (IL) has been the workhorse for the anterior approach and remains the gold standard. The major difference between the IL and the Stoppa approaches is that Stoppa allows for the avoidance of the middle window of the IL approach. Hence, the modified Stoppa approach (MSA) can be adopted by a comparatively less experienced surgeon with minimal complications. The purpose of this study is to evaluate the radiological and functional outcomes of patients operated on using the MSA. Materials and methods Patients operated on by the MSA for acetabular fractures with a minimum of one year of clinical and radiographic follow-ups were reviewed. CT scans and radiographs were evaluated for the fracture pattern, time to surgery, operative time, blood loss, quality of reduction (Matta criterion), FO [Harris hip score (HHS) and Nach Merle d'Aubigne and Postel score (NMAPS)] and complications (perioperative and follow-up). Twenty-three of 26 patients with 45 acetabular fractures operated between January 2016 and November 2018 were included. Descriptive statistics were used for demographic data, and Pearson’s chi-squared statistic was calculated for the association between radiological and functional outcomes. Results Among the 23 patients, the mean age was 38.5 years (range: 15-65) with a male-to-female ratio of 18:5. The average time to surgery was 11.5 days (range: 2-32), operating time was 155 minutes (range: 90-243), and average blood loss was 650 ml (range: 500-1,250). A supplemental lateral window was used in 20 patients (87%), and three underwent the combined anterior and posterior [Kocher Langenbacks (KL)] approach. All cases were unilateral. The transverse fracture was the most common pattern (eight patients) followed by the associated both-column fracture in six and T-type, isolated anterior column fracture, and anterior column and posterior hemi-transverse fractures seen in three patients each. Iliac blade (high anterior column) fracture was seen in 14 cases and one patient had associated sacral type II fracture. Road traffic accidents accounted for 61% of the injuries and injury severity score (ISS) of >15 (polytrauma) was seen in more than 50% of the cases (associated with other organ injuries). The radiological outcome was anatomical in 52% of the cases, imperfect in 39%, and poor in 9%. The functional outcomes were good to excellent in 74% (HHS) and 79% (NMAPS) of the cases. The association and correlation between them were nonsignificant (p-value: >0.5). Two patients developed a superficial infection and three had iatrogenic obturator nerve palsy. One patient had a direct inguinal hernia, one had grade 3 bedsores, and two patients developed grade 2 arthritic changes during the follow-up. No case of vessel injury was encountered. Conclusion Adoption of the MSA for the treatment of acetabular fractures leads to a good-to-excellent anatomical reduction in most cases while providing direct visualization of the quadrilateral plate and posterior column. The learning curve is smaller for less-experienced surgeons in terms of complications and results. We recommend this technique as a viable alternative to the IL approach for anterior acetabular fixation.

The sacral canal is the continuation of the vertebral canal in the sacrum. The sacral canal contains spinal meninges, lumbar and sacral part of spinal nerves and filum terminale. So sacral canal has been used for the caudal epidural block. During routine osteology demonstration classes for undergraduate students, we observed a dry human sacrum with complete agenesis of the dorsal wall of the sacral canal. Knowledge of these variations is important to diagnose lower back pain, sciatica, caudal regression syndrome and to avoid complications related to caudal epidural block and other spinal surgeries like in placement of screw for spinal fusion.

Introduction Range of motion (ROM) is a major desirable outcome after total knee arthroplasty (TKA). The aim of our study is to analyze the variables determining postoperative knee ROM, following cruciate-substituting TKA of arthritic knees. Methods One-hundred fourteen patients out of a total of 158 patients were studied on the basis of the inclusion criteria. All patients underwent cruciate-substituting TKA in the period between September 2014 and September 2017. Variables such as age, sex, body mass index (BMI), preoperative ROM, mild-to-moderate knee deformity (in both the sagittal and coronal planes) and knee society score (KSS) were recorded for all the patients. The patients were evaluated at intervals and finally at the end of one-year post-surgery. The final ROM and KSS were noted. Data were analyzed in SPSS system using the Kruskal-Wallis test and Mann-Whitney U test. Results Patients with younger age (less than 60 years), more preoperative ROM, and less preoperative fixed flexion deformity (FFD) were found to have better postoperative ROM. The mean preoperative KSS was 42.14 ± 12.02, which improved to 90.86 ± 3.86 postoperatively. Other variables like gender, BMI, and preoperative coronal plane deformity of mild to moderate degree did not have a significant influence on postoperative ROM. Conclusion Postoperative expectations of ROM is an important factor for a successful outcome and is also related to patient satisfaction. Variables like younger age group (less than 60 years), better preoperative ROM and lower preoperative FFD are found to have a better postoperative ROM in patients undergoing cruciate-substituting TKA surgery.

Ipsilateral fracture of the shaft of femur and dislocation of the hip are very rare injuries. There always exists a dilemma regarding the treatment to reduce hip and choosing the appropriate method of fixation for a femur fracture, and a clear consensus is yet to be reached. A number of treatment methods such as the open reduction of femur and fixation followed by hip reduction have been tried so far. Ipsilateral fractures and dislocation occur due to high-energy trauma, and reduction of hip dislocation is considered as an orthopedic emergency. Here, we report a case in which we tried a novel approach by temporarily fixing the femur with an external fixator and reducing the hip dislocation. In the next sitting, we performed femur fixation in a closed manner with an interlocking intramedullary nail. We recommend that this novel method of treatment can be used for such types of injuries.

Cystic lesion around knee usually presents as painless swelling and diagnosed incidentally by imaging for any internal derangement of the knee. Few cases presented with pain. Intra-tendinous patellar ganglion is very rare in location for the disease. Ganglionic cyst usually treated by aspiration followed by steroid and surgical excision in some cases. We reported a case with anterior knee pain due to patellar intra-tendinous ganglion cyst which treated conservatively with no recurrence even after one year.

Total hip arthroplasty (THA) is the treatment of choice for Grade IV avascular necrosis of the femoral head. Dislocation following THA, although rare, is a known complication. Common causes of unsuccessful reduction include interposition of soft tissue, component loosening, malalignment, and inadequate muscle relaxation following anaesthesia. Here, we encountered a rare complication during a single-stage bilateral THA that resulted in a non-concentric reduction on the left side. The pathology was a loose bone piece, which possibly was an osteophyte that was broken.

Desmoids are rare soft-tissue tumors of the abdominal wall that may sporadically occur extra-abdominally. It manifests as clonal fibroblastic proliferation with an infiltrative tendency and capacity to recur without metastasizing. An adolescent male presented with a gradually increasing globular, non-tender, firm, non-pulsatile swelling (8 × 5 × 3 cm3) in the left popliteal fossa that had been present for five months. Following thorough investigation with imaging and Tru-cut biopsy, finally, an excisional biopsy was done. Histopathological examination confirmed a desmoid tumor, and the patient received adjuvant radiotherapy. At the one-year postoperative follow-up, there was no recurrence; the patient had been explained the prognosis. This case highlights a rare site of an extra-abdominal desmoid but with classical clinical presentation, imaging, intraoperative, and histopathological findings. Awareness and knowledge of this entity are of paramount importance for clinical practitioners.