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Competing Interests: Competing interests: None declared.

Competing Interests: Competing interests: None declared.

A young adult man in 20s presented with bow leg deformity of both the knees, since childhood and bilateral knee pain for the last 4 years. Plain radiographs of both the knees confirmed bilateral genu varum deformity, more on the right side (16.2°) as compared with left (12.3°). He was managed surgically by a single-stage bilateral medial opening wedge high tibial osteotomy, using a synthetic bone substitute of a tri calcium phosphate. After the healing of osteotomies at 3 months, the patient was pain free and walked comfortably with normal lower limb alignment., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

A 25-year-old pregnant woman reported suffering from an aggressive giant cell tumour of the distal humerus extending into the elbow joint. The successful management required a careful evaluation of the various treatment options due to her pregnancy. Surgical excision of the mass was performed. The residual bone defect was reconstructed with an elbow mega-prosthesis. The patient made a pain-free recovery with a good range of motion and delivered the baby at term with no complications., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Charcot's joint is a type of neuro-arthropathy, where asymmetrical damage of the involved joint happens haphazardly, without following any described pattern. We present a rare case of Charcot's joint involving the knee joint in an adult male following spina bifida. His knee joint was successfully fused after two surgeries. Later, he sustained a fracture through the arthrodesis after a fall, which we managed surgically. The fracture through the knee arthrodesis was managed surgically by an open reduction and internal fixation, using a 14-hole broad low contact dynamic compression locking plate with bone grafting. Union was achieved at the knee arthrodesis site in 6 months. Fracture through a fused knee requires surgical management. Re-arthrodesis was done using a stable fixation. Postoperative rehabilitation should include protected weight bearing with braces and splints until a sound bony union is achieved., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

A 23-year-old female-treated patient of osteomalacia and secondary hyperparathyroidism with hypophosphatemia presented with a 5-year history of bilateral groin pain and stiffness of both hips and difficulty in walking. Plain radiographs of the pelvis showed bilateral coxa vara deformity. She was managed surgically by a single-stage bilateral subtrochanteric corrective osteotomy with the internal fixation. After the osteotomy healing at 3 months, the patient was pain free and walked comfortably with an increased range of hip motion., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None declared.

Competing Interests: Competing interests: None declared.

Langerhans cell histiocytosis (LCH) commonly occurs in children. It mimics infection and many benign and malignant tumours. This disease mainly involves the spine, skull and long bones, and its incidence is sporadic in the small bones of the foot and hand. We could not find any case reports with the involvement of a metatarsal bone, and hence, awareness about its possibility is essential to suspect it as a differential diagnosis of lytic lesions in the foot bones and therefore treat it judiciously. We have reported a case of a 35-year-old woman with spontaneous onset of pain over her right foot for the last year. An extensive curettage was performed, where the histology confirmed the features of LCH. Awareness about this entity and its differential diagnosis may help to clinch and early diagnosis and to treat effectively., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Conflicts of Interest: None declared.

We report a rare case of proximal fibular fatigue fracture developing 14 years after total knee arthroplasty in a known case of rheumatoid arthritis. A valgus deformity of the knee can put abnormal stress on the upper fibula leading to its failure. We believe that, as the fibula acts as an important lateral strut, its disruption due to a fracture led to rapid progress of the valgus deformity of the knee in this patient., (2016 BMJ Publishing Group Ltd.)

Tuberculosis has been declared a 'Global Emergency' by the WHO. Owing to the magnitude of the problem, knowledge of unusual presentations at rare sites can help identify the disease early and achieve good to fair results. We present one such rare case of a child with an anterior midline swelling. An anterior midline swelling in a child raises multiple diagnostic possibilities. Although cervical lymphadenitis is a common cause of neck swelling, tuberculous suprasternal notch abscess, secondary to lymphadenitis, has rarely been described. Radiological investigations revealed necrotic tissue in the base of the suprasternal notch. The diagnosis was made using needle aspiration and cytology, which was suggestive of tuberculous lymphadenitis for the neck swelling. Antituberculous therapy gave good results, with complete healing of the ulcer and resolution of the abscess., (2016 BMJ Publishing Group Ltd.)

Focal hand dystonia (FHD) is characterised clinically by a task-specific symptom and typical electromyography findings of a characteristic pattern of cocontraction of the agonist and antagonist muscles of the hand and forearm. The aetiopathogenesis of this condition is still not clear. We present a case of a patient with an unusual aetiology for this condition, in the form of retained hardware in the distal radius. This patient had complete resolution of symptoms after removal of a retained radial plate. Thorough history-taking, clinical examination and necessary investigations are the cornerstones for making a diagnosis of FHD., (2016 BMJ Publishing Group Ltd.)

Multicentric giant cell tumours (GCTs) are very rare and account for less than 1% of all GCTs of bone. We report a case of a young woman with metachronous multicentric GCTs with 5 documented lesions in the same lower limb. The initial lesion started during the first trimester of pregnancy around her right pelvis, which rapidly progressed as a painful swelling with gradually restricted mobility of her right hip joint. The radiological appearance of this tumour was that of a GCT and biopsy confirmed the diagnosis. The role of positron emission tomography (PET) has been highlighted to detect occult lesions. A possible hormonal correlation for these tumours has been discussed. The patient was managed successfully by an aggressive surgical approach for knee and talar lesions, whereas repeated embolisation and denosumab injections were given to treat her pelvic lesion., (2015 BMJ Publishing Group Ltd.)

Radial club hand is an intercalary congenital deformity involving the forearm, wrist and hand. A congenital absence of radius (partial or complete) and ulnar bowing are classical radiographic abnormalities seen in this condition. This deformity is usually treated surgically in infants and young children but the management of this problem in an adult is complex and challenging. We present a neglected case of an adult with severe and rigid deformity that was successfully treated by one-stage correction involving ulnar osteotomy and wrist arthrodesis, simultaneously., (2015 BMJ Publishing Group Ltd.)

We report a rare case of a young man with hereditary multiple exostoses (HME) who presented with severe pain in the hips, requiring bilateral total hip arthroplasty (THA), along with excision of the exostoses. The reported incidence of exostoses around the hip has been reported from 30% in some series to 90% in other studies of HME. These patients may remain asymptomatic, but if not, their symptoms are usually related to the presence of the exostoses itself and the possibility of hip osteoarthrosis is frequently overlooked. This may account for a low incidence of THA for this condition. Surgical management often remains challenging as such lesions are not commonly encountered in the clinical practice and are often very difficult to treat., (2015 BMJ Publishing Group Ltd.)

We present a unique case of bilateral skeletal metastasis below the knee in a patient with renal cell carcinoma. In this rarest of rare cases, bony metastases were the first presentation of a primary tumour. Incidentally, the primary tumour (renal cell carcinoma) involved the solitary kidney of the patient and the same patient also had coexisting carcinoma of the prostate., (2014 BMJ Publishing Group Ltd.)

Chronic renal disease is often associated with secondary hyperparathyroidism (HPP) and rarely with tertiary HPP. Hip arthritis with protrusio acetabuli, secondary to tertiary HPP, is a rare case scenario and has not been described well in the literature. We present a rare case of bilateral hip arthritis with protrusio acetabuli secondary to renal osteodystrophy due to tertiary HPP. The diagnosis and aetiology of hip arthritis and its treatment have been discussed along with a detailed review of literature of skeletal lesions due to HPP.

The use of bisphosphonates (BPs) is universally accepted in the management of osteoporosis. However, a small percentage of patients have been recognised to develop atypical subtrochanteric fractures of the femur with the prolonged use of BPs. We report a rare case of bilateral insufficiency lesions in the proximal femora, where a major subtrochanteric fracture developed with a minor fall. This was successfully treated with internal fixation using proximal femoral nail.