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INTRODUCTION: Compound fractures of the distal femur with large defects pose a significant challenge in management, with several options available, including external fixators, bone grafting, the Masquelet-induced membrane technique, and free vascularized fibular grafts. The Masquelet-induced membrane technique involves placing a cement spacer in the defect to create a biologically active membrane. In the second stage, the gold standard for filling the defect is an autologous cancellous bone graft of 1-2 mm in size. This study aims to examine the effects of using a non-vascularized fibula as a support combined with a cancellous graft in the Masquelet technique for treating compound fractures of the distal femur. METHODS: The study was conducted between December 2017 and December 2020 and included 11 patients who underwent the Masquelet technique. The procedure involved a lateral locked plate and an antibiotic-impregnated bone cement spacer, followed by a 20-30 mm longer ipsilateral fibula used as a strut graft. The remaining area was filled with cancellous bone from the iliac crest. The size of the defect, Time to the bony union, the average range of motion of the knee, and any complications are analysed. The final evaluation was done at 18 months using the Lower Extremity functional scale to assess functional outcomes. RESULTS: The study included 11 patients (8 male and 3 female) with a mean age of 45.8 years. The average time to bony union was 6.6 months, and the average range of motion of the knee was 2.2° to 93.3 ° (0-110 °). No complications such as infection, non-union, or implant failure were observed. CONCLUSION: The Masquelet Technique combined with a fibular strut graft is a feasible solution for complex distal femur fractures with bone loss. The non-vascularized fibula graft provides both structural support and reduces the amount of cancellous bone graft needed, which results in earlier weight bearing and improved functional outcomes.

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CASE: A 4-year-old girl presented with a 5-week-old, neglected fourth metatarsophalangeal (MTP) joint dislocation with malunion of the fourth metatarsal. A previous attempt at closed reduction had failed. The reduction was hindered by dynamic stabilizing of soft tissues around the MTP joint. Open reduction of the fourth MTP joint dislocation and corrective osteotomy of the fourth metatarsal was performed. The patient was pain-free without any cosmetic deformity at the 1-year follow-up. CONCLUSION: Prompt recognition of a MTP dislocation is vital. The long extensor tendon to the toe can hinder the closed reduction of the MTP dislocation. Osteotomy of the metatarsal malunion is necessary for stable reduction. LEVEL OF EVIDENCE: 4.

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Introduction: Osteoblastoma is a rare benign bone-forming tumor but causes considerable morbidity if left untreated. Among them, osteoblastoma of cuboid is very rarely seen and hence poses considerable diagnostic and therapeutic challenges especially when it mimics features of tuberculosis of foot. Case Report: This case report describes a rare case of cuboid osteoblastoma of the right foot in a 24-year-old female who was initially treated as TB foot elsewhere and presented to our outpatient department with non-resolving pain affecting her daily activities. She was found to have osteoblastoma of cuboid bone along with medial arch collapse and instability of mid foot. She underwent en bloc excision of the cuboid bone with lateral and medial column stabilization procedures. She made an uneventful recovery and reported no recurrence after a follow-up of 2 years. Conclusion: Cuboid osteoblastoma can present atypically with mid foot collapse and arthritis leading to an erroneous diagnosis of TB due to the concomitant inflammation. Hence, any atypical lesion of the foot should be subjected to biopsy and a confirmatory result before initiating any therapy.

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INTRODUCTION: Superior shoulder suspensory complex (SSSC) plays a key role in maintaining stable upper extremity- axial skeleton connection. Injury to one component is a common occurrence while double disruption leading to floating shoulder is a rare occurrence. Disruption of more than one component of this complex leads to significant morbidity and interferes with adequate shoulder function and requires surgical intervention. CASE REPORT: This case report describes a rare triple disruption of SSSC in a 40-year female in dominant shoulder involving fracture of lateral end of clavicle, Type 1 coracoid fracture, and an acromion fracture. She underwent operative fixation of all the components and reported excellent functional outcome at the end of 1-year follow-up. CONCLUSION: The triple disruption of the SSSC is an extremely rare injury comprising breakages of the ring at three distinct locations, which usually follow high-velocity injuries associated with other musculoskeletal and visceral injuries. Proper pre-operative evaluation and appropriate surgical intervention give good results and avoid long-term complications such as chronic pain, weakness, and subacromial impingement of shoulder.