Journal of Orthopedic Education

Tumor induced osteomalacia also known as oncogenic osteomalacia is a rare paraneoplastic syndrome of abnormal phosphate and vitamin metabolism caused by typically small endocrine tumors that secrete the phosphaturic hormone, fibroblast, GF-23. We present a case report of bilateral intertrochanteric fracture treated with DHS which was secondary to tumor induced osteomalacia.

Methods: 36 yrs old male, complained of difficulty in walking, weakness in both lower limbs and developed sudden onset of severe LBA radiating to buttocks and legs. Patient presented with h/o pain after he fell down from stairs and was managed conservatively elsewhere and presented to KLEH for the same complaints after 1 month. Routine investigation was done and the CT scan s/o lesion in the femur head. DOTA SCAN s/o DOTA and sclerotic lesion in the right femur head. He was started on Joule's scan. B/L DHS application and biopsy was done followed by RFA. PostOp phosphorus levels were 2.1 mg%. Repeat DOTA SCAN showed no uptake.

Result: Patient had normal RFT, biochemical evaluation showed persistent hypophosphatemia, raised ALP levels and was started on Joule's solution. Post-surgery along with RFA, repeat DOTA SCAN showed no uptake and after removal of DHS, patient had no difficulty in walking and patient's weakness and pain improved.

Conclusion: Oncogenic osteomalacia is uncommon yet curable cause of osteomalacia. The key to cure the individual cases remains reserved to the physician and his intelligence. Definitive treatment is the surgical removal of tumor with dramatic and satisfying results.

Keywords: Tumor induced osteomalacia; Paraneoplastic syndromes; Osteoporosis; Oncogenic osteomalacia.

Osteomyelitis is either an acute or chronic infection of the bone. It is most commonly seen in the lower limbs, post trauma. Osteomyelitis is very difficult to treat compared to other soft tissue infections. Patient needs prolonged hospitalization and medications for treatment of osteomyelitis. The diagnosis of osteomyelitis and the reconstruction of post traumatic osteomyelitic defect is a challenging one from surgical point of view. It needs multidisciplinary approach involving orthopedic and plastic surgeons for effective management. In this case report, we are assessing the role of WBC scan in the case of a 24-year-old gentleman with a proximal tibial fracture and popliteal artery injury and with exposed tibial bone in the knee joint following a road traffic accident, to identify osteomyelitic changes in the bone.

Keywords: Osteomyelitis; WBC scan.

Major lower limb injuries involve skin and soft tissue, bone, vascular, and neural elements, which influences evaluation and management for optimal functional outcome. In major lower limb trauma, often polytrauma, the question is whether to salvage or amputate. This issue has conflicting and confusing data. For cultural and practical reasons, patients prefer to keep a deformed limb if it's painless and functional. This review examines the management of lower limb injuries. It also answers other questions that may improve functional outcomes for patients with major limb injuries. After reading this article, participants should be able to evaluate a patient with a lower extremity wound before medical or surgical intervention, recognise that limb amputation and salvage can both be appropriate definitive treatment options, and select proper nonsurgical or surgical techniques for wound management.

Keywords: Lower limb injuries; Management; Principles.

The development of chronic osteomyelitis is most common in lower extremity post traumatic due to road traffic accidents. A multidisciplinary team has successfully adopted advanced reconstructive methods combined with orthopaedic and plastic interventions to enhance the results of chronic osteomyelitis. These procedures, known as "Hybrid reconstruction ladder", combine conventional reconstruction techniques with regenerative medicine applications. This study highlights the application of hybrid reconstruction ladder for treatment of osteomyelitis.

Keywords: Osteomyelitis; Hybrid; Reconstruction ladder.

The effectiveness of low level laser for post burns scar to reduce the size of the scar. Although low level laser therapy, its effectiveness and the process by which it reduces the size of the post burns scar are inadequate, in our study low level laser was performed on a subject with post burns scars on the trunk and evaluated the efficacy and mechanism of action of a non-invasive body contouring intervention approach using LLLT.

Keywords: Low Level Laser Therapy; Scar; Burns.

It is well known that low level laser therapy (LLLT) has a role in the wound bed preparation of ulcers, wound healing process, joint stiffness and nerve regeneration, but the role of LLLT in the scar management is doubtful and has scanty data. In this case report we are sharing our experience in treating a scar with LLLT which showed enhanced response.

Keywords: Scar; Low level laser; Vancouver Scar Scale.