Chondrolysis of the hip is a rare disorder, characterized by progressive and rapid destruction of... more Chondrolysis of the hip is a rare disorder, characterized by progressive and rapid destruction of articular cartilage from both joint surfaces resulting in secondary joint space narrowing and stiffness. The authors report an unusual case of chondrolysis of the hip following mini open excision of a symptomatic acetabular labral tear. After a symptom-free period of 1 month following the excision of the torn labrum the patient started complaining of progressive hip pain and loss of movements. The rapid deterioration of the clinical functions and concentric reduction of joint space to less than 3 mm, consistent with chondrolysis, in the absence of evidence of any other hip pathology, led to the diagnosis. Intraoperatively extensive degeneration of joint cartilage was observed. Cementless total hip arthroplasty relieved the pain and allowed return to activities. The authors suspect that the use of thermal electrocautery during labral excision may have been responsible for the subsequent chondrolysis. The case is being reported not only for its rarity but also to alert treating surgeons of keeping the possibility if this condition in mind as it can pose a diagnostic dilemma.
Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numb... more Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst ...
Osteoblastoma is a rare tumor and represents about 0.8% of all bone tumors. The aggressive varian... more Osteoblastoma is a rare tumor and represents about 0.8% of all bone tumors. The aggressive variant is even rarer and difficult to diagnose. We present a case of a 17Â year old male with a tumor of the acetabulum with characteristic epithelioid osteoblasts and other features of an aggressive osteoblastoma. It is important to recognize this entity as it can be clinically confused with an osteosarcoma. Our case not only showed epithelioid morphology but also had vacuolated cytoplasm, which simulated a mucin secreting adenocarcinoma. Since treatment and prognosis for these entities is strikingly different, an accurate diagnosis becomes all the more important. This case emphasizes the need for better co-ordination between the clinician and pathologist and use of histochemical stains and immunohistochemistry apart from routine histopathology for arriving at a final diagnosis. It is essential to have a close follow-up of the patient to look for recurrence of the tumor.
A 30-year-old woman presented to our outpatient department with complaints of pain and swelling i... more A 30-year-old woman presented to our outpatient department with complaints of pain and swelling in bilateral infrapatellar regions and a discharging sinus in the right knee over the duration of one year. Radiographs showed lytic regions in bilateral patellae. Samples sent from material curetted from sinus yielded no organism but histopathology reported granulomatous inflammation. Following a fresh magnetic resonance imaging (MRI) scan that revealed the infrapatellar pad of fat communicating with the patellar lesions, an exploration and evacuation was done. Material sent revealed epithelioid cell granulomas with caseous necrosis consistent with tuberculosis (TB). The patient was put on first line anti-tubercular treatment (ATT) and has responded favourably with healing of sinus and patellar lesions. Bilateral infrapatellar bursitis is not rare. However patellar TB as a cause for OMIT is not a common diagnosis. A bilateral patellar involvement has not been reported in literature to th...
Intracapsular fracture of femoral neck is treated by anatomical reduction (preferably closed) and... more Intracapsular fracture of femoral neck is treated by anatomical reduction (preferably closed) and cannulated cancellous lag screw fixation. Malunion of these fractures have been described in the coronal plane (coxa valga or coxa vara). We reported a case of young adult patient with displaced intracapsular fracture of femoral neck that had malunited in sagittal plane with callus formation with excellent functional outcome. The radiographs revealed intracapsular fracture of femoral neck right side (Garden type 4 and Pauwel type 3). The patient was operated and closed reduction and internal fixation with three cannulated cancellous screws was performed. The postoperative radiograph revealed a loss of reduction in the lateral view. Due to this technical error, the patient was counselled for revision fixation for which he refused. At 9 months we observed union of the fracture in the displaced position by callus formation. Harris hip score at 2 years was 96 that indicate excellent functional outcome and the radiographs did not reveal any evidence of avascular necrosis of femoral head. We advised revision surgery to our patient as he had increased chances of implant failure and nonunion. However he refused the revision surgery and was continued with the suboptimal reduction. However, the fracture united and that too with callus formation, which is not a described phenomenon in neck of femur fracture.
Journal of Orthopedics, Traumatology and Rehabilitation, 2014
Pelvic fractures are one of the common cause of mortality in polytrauma patients, especially foll... more Pelvic fractures are one of the common cause of mortality in polytrauma patients, especially following high velocity trauma. The management in emergency requires good clinical judgment and access to radiological modalities. There are various classifications to define the pattern of injury in pelvic fractures. Previously, fracture patterns were described on the basis of anatomical fracture pattern on radiographs. With the introduction of concept of force vector and stability defined by Pennal and Tile, which was further modified by Young and Burgess, the corrective forces required to reduce such fractures were defined. With the introduction of these newer classification systems along with the introduction of external fixators, the mortality and morbidity has significantly reduced in pelvic fractures.
Chondrolysis of the hip is a rare disorder, characterized by progressive and rapid destruction of... more Chondrolysis of the hip is a rare disorder, characterized by progressive and rapid destruction of articular cartilage from both joint surfaces resulting in secondary joint space narrowing and stiffness. The authors report an unusual case of chondrolysis of the hip following mini open excision of a symptomatic acetabular labral tear. After a symptom-free period of 1 month following the excision of the torn labrum the patient started complaining of progressive hip pain and loss of movements. The rapid deterioration of the clinical functions and concentric reduction of joint space to less than 3 mm, consistent with chondrolysis, in the absence of evidence of any other hip pathology, led to the diagnosis. Intraoperatively extensive degeneration of joint cartilage was observed. Cementless total hip arthroplasty relieved the pain and allowed return to activities. The authors suspect that the use of thermal electrocautery during labral excision may have been responsible for the subsequent chondrolysis. The case is being reported not only for its rarity but also to alert treating surgeons of keeping the possibility if this condition in mind as it can pose a diagnostic dilemma.
Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numb... more Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst ...
Osteoblastoma is a rare tumor and represents about 0.8% of all bone tumors. The aggressive varian... more Osteoblastoma is a rare tumor and represents about 0.8% of all bone tumors. The aggressive variant is even rarer and difficult to diagnose. We present a case of a 17Â year old male with a tumor of the acetabulum with characteristic epithelioid osteoblasts and other features of an aggressive osteoblastoma. It is important to recognize this entity as it can be clinically confused with an osteosarcoma. Our case not only showed epithelioid morphology but also had vacuolated cytoplasm, which simulated a mucin secreting adenocarcinoma. Since treatment and prognosis for these entities is strikingly different, an accurate diagnosis becomes all the more important. This case emphasizes the need for better co-ordination between the clinician and pathologist and use of histochemical stains and immunohistochemistry apart from routine histopathology for arriving at a final diagnosis. It is essential to have a close follow-up of the patient to look for recurrence of the tumor.
A 30-year-old woman presented to our outpatient department with complaints of pain and swelling i... more A 30-year-old woman presented to our outpatient department with complaints of pain and swelling in bilateral infrapatellar regions and a discharging sinus in the right knee over the duration of one year. Radiographs showed lytic regions in bilateral patellae. Samples sent from material curetted from sinus yielded no organism but histopathology reported granulomatous inflammation. Following a fresh magnetic resonance imaging (MRI) scan that revealed the infrapatellar pad of fat communicating with the patellar lesions, an exploration and evacuation was done. Material sent revealed epithelioid cell granulomas with caseous necrosis consistent with tuberculosis (TB). The patient was put on first line anti-tubercular treatment (ATT) and has responded favourably with healing of sinus and patellar lesions. Bilateral infrapatellar bursitis is not rare. However patellar TB as a cause for OMIT is not a common diagnosis. A bilateral patellar involvement has not been reported in literature to th...
Intracapsular fracture of femoral neck is treated by anatomical reduction (preferably closed) and... more Intracapsular fracture of femoral neck is treated by anatomical reduction (preferably closed) and cannulated cancellous lag screw fixation. Malunion of these fractures have been described in the coronal plane (coxa valga or coxa vara). We reported a case of young adult patient with displaced intracapsular fracture of femoral neck that had malunited in sagittal plane with callus formation with excellent functional outcome. The radiographs revealed intracapsular fracture of femoral neck right side (Garden type 4 and Pauwel type 3). The patient was operated and closed reduction and internal fixation with three cannulated cancellous screws was performed. The postoperative radiograph revealed a loss of reduction in the lateral view. Due to this technical error, the patient was counselled for revision fixation for which he refused. At 9 months we observed union of the fracture in the displaced position by callus formation. Harris hip score at 2 years was 96 that indicate excellent functional outcome and the radiographs did not reveal any evidence of avascular necrosis of femoral head. We advised revision surgery to our patient as he had increased chances of implant failure and nonunion. However he refused the revision surgery and was continued with the suboptimal reduction. However, the fracture united and that too with callus formation, which is not a described phenomenon in neck of femur fracture.
Journal of Orthopedics, Traumatology and Rehabilitation, 2014
Pelvic fractures are one of the common cause of mortality in polytrauma patients, especially foll... more Pelvic fractures are one of the common cause of mortality in polytrauma patients, especially following high velocity trauma. The management in emergency requires good clinical judgment and access to radiological modalities. There are various classifications to define the pattern of injury in pelvic fractures. Previously, fracture patterns were described on the basis of anatomical fracture pattern on radiographs. With the introduction of concept of force vector and stability defined by Pennal and Tile, which was further modified by Young and Burgess, the corrective forces required to reduce such fractures were defined. With the introduction of these newer classification systems along with the introduction of external fixators, the mortality and morbidity has significantly reduced in pelvic fractures.
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Papers by Rehan Haq