Abstract: Extraosseous Ewing sarcoma is an uncommon entity in the adult population. Cardiac metastases or local invasion of a tumor into the heart is a known but also infrequent occurrence for most malignancies. We present a case of a patient with a history of extraosseous Ewing sarcoma who presented to the emergency room with chest pain and was found to have an inferior ST-elevation myocardial infarction and systemic emboli and was found to have recurrence of sarcoma invading the left atrium. PubDate: Tue, 28 Jan 2020 14:05:01 +000
Abstract: We present the first reported case of septic prepatellar bursitis with Kingella kingae in a 2-year-old female. Although it is a well-established cause of osteoarticular infections in the pediatric population, K. kingae has never been reported as the etiology for septic bursitis. A high index of suspicion is required for the diagnosis given that this organism is difficult to culture and isolate using standard laboratory methods. Our diagnosis was established through bursal fluid analysis, though oropharyngeal polymerase chain reaction (PCR) may be also be considered. Our case also builds upon prior literature suggesting that the pathophysiology of septic bursitis in children differs from that of the adult and may be more comparable to that of pediatric osteomyelitis. As an organism of increasing prevalence, K. kingae should remain high on the differential for osteoarticular or periarticular infections when cultures fail to isolate a distinct pathogen. Early diagnosis and a formal irrigation and debridement, if warranted, are crucial in preventing devastating complications of untreated septic bursitis. PubDate: Tue, 28 Jan 2020 13:50:02 +000
Abstract: We report a case of a 21-year-old healthy woman with a history of a painful growing mass in the palm of the right hand, with a trigger finger phenomenon. The mass was surgically entirely excised, and the histological findings of the tumor were those of a fibroma of the tendon sheath (FTS) starting from the flexor tendons. Although the initial outcome was good, the patient experienced the same symptoms at the same location 4.5 years later. The MRI demonstrated a mass of low intensity on T1-weighted images and high intensity on T2-weighted images and gadolinium enhancement. A second complete excision of the tumor was performed by the same senior surgeon, and the histology confirmed the recurrence of the FTS. We also reviewed the scientific literature about FTS in the hand. Most recent studies show a low rate or no recurrence at all. We hypothesize that a lot of recurrences are missed because of a short follow-up and that the recurrence rate may be higher than thought. PubDate: Tue, 28 Jan 2020 13:05:02 +000
Abstract: Comminuted distal femur fracture is a challenging injury, and care must be taken to reduce the articular fragment and acquire the sufficient stability for the metaphyseal comminution. We report the case of a AO/OTA C3-type distal femur fracture with articular malunion and metaphyseal nonunion. Articular malunion was treated with corrective osteotomy using a 3D-printed model for planning, and metaphyseal nonunion was treated with an induced membrane technique. Conclusion. Two major complications in the comminuted periarticular fracture can be addressed by an osteotomy and induced membrane technique. A 3D-printed model is a useful tool to evaluate the morphology of the malunited articular surface. PubDate: Tue, 28 Jan 2020 10:20:01 +000
Abstract: We describe a case of an isolated posteromedial ankle dislocation, without malleolar fracture, with associated dislocation of an os trigonal process after a low-energy tennis injury. We demonstrate that nonoperative treatment results in excellent functional outcome scores with minimal arthritic progression at 2 years of follow-up. We discuss pathoanatomic risk factors of pure dislocations and propose that an os trigonum is a risk factor for isolated dislocations of the ankle. PubDate: Tue, 28 Jan 2020 10:20:01 +000
Abstract: One of the biggest and commonest problems that is seen and treated by foot and ankle surgeons is the deformity where the second toe crosses over the hallux. According to available literature, this is the first published case of extraction of the proximal phalanx due to crossover toe deformity. We present the case of a 64-year-old Caucasian female with a crossover second toe deformity of her left foot. Because of this deformity, she was completely disabled to wear normal shoes and she felt intensive pain in her front part of the foot. She underwent a total extraction of the proximal phalanx of the second toe. After the operation, she was very satisfied with the status of the operated foot and the final result of the surgical treatment. The procedure that we performed could be a good possibility for the treatment of crossover second toe deformity because we got a good functional and cosmetic result, the morbidity associated with more advanced reconstruction is avoided, and the rehabilitation period was short. Patient satisfaction was high, and complications were minimal. PubDate: Mon, 20 Jan 2020 08:05:02 +000
Abstract: Summary. We report two cases of Staphylococcus lugdunensis (S. lugdunensis) septic arthritis following arthroscopic anterior cruciate ligament (ACL) reconstruction. Both initial surgical procedures were ACL reconstruction along with simultaneous collateral ligament and meniscus procedures. Patients presented with septic arthritis three and ten weeks following the index procedure. Both patients successfully recovered with early arthroscopic irrigation, debridement, and synovial culture, in addition to long-term parenteral and oral antibiotics. PubDate: Mon, 20 Jan 2020 07:50:01 +000
Abstract: Stress fractures following total hip arthroplasty in the lower limbs away from the surgical area are very rare. We report a case of stress fracture in the isolated distal fibula that presented five months after total hip arthroplasty in a patient with developmental dysplasia of the hip. A 67-year-old woman diagnosed with coxarthrosis of the right hip joint, classified as Crowe’s group 3, underwent total hip arthroplasty with acetabular reconstruction using a bulk bone graft. The surgery successfully treated the preoperative leg length discrepancy and flexion and external rotation contractures. The alignment of the right lower limbs changed from slight varus to valgus knee following surgery. The postoperative process went well; however, she experienced lateral ankle pain on the affected side five months after surgery. No obvious fracture was observed via radiograph; however, she received a subsequent diagnosis of isolated distal fibula stress fracture. Additionally, she was diagnosed with vitamin D deficiency. Valgus alignment change of the knee joint and vitamin D deficiency were considered the main causes of the stress fracture. Stress fractures should be suspected in patients complaining of unexpected pain following total hip arthroplasty, even in distant areas of the affected limb, especially in osteoporotic patients. PubDate: Mon, 20 Jan 2020 04:05:00 +000
Abstract: Introduction. Adjacent segment infective spondylodiscitis is a rare type of surgical spinal infection after lumbar fusion with few reports. We report a further case of adjacent segment infection after three-level lumbar fusion managed successfully with anti-infective therapy and revision surgery. Case Description. A clinical case of a 69-year-old female with multilevel lumbar degenerative disease received three-level fusion. The leading preoperative symptoms were relieved after decompression surgery. However, severe back pain recurred and prompted her to be rehospitalized 2 months later. The signal of spondylitis and discitis at the adjacent segment was detected by magnetic resonance imaging (MRI). No bacteria were identified despite blood cultures being taken before antibiotic treatment. After a long-term anti-infective therapy with vancomycin, the patient gained symptom relief and was discharged home. However, the patient complained of severe back pain again after long-term oral antibiotic treatment and was rehospitalized 6 months after surgery. The computed tomography (CT) scan showed obvious bony endplate destruction at the adjacent segment space. The patient received a debridement operation and autologous iliac bone graft. The infective inflammatory markers were controlled, and the infective space achieved fusion finally. Conclusion. Adjacent segment space infection is a rare reported complication that occurs after spinal fusion surgery. Conservative antibiotic therapy may not control the infection completely, and disc space debridement and autologous iliac bone graft can achieve ultimate fusion and a satisfactory outcome. PubDate: Mon, 20 Jan 2020 02:35:00 +000
Abstract: Metal hypersensitivity is a rare complication for implants especially with neuropathy involvement. There was not any previous report suggesting metal hypersensitivity manifested in the form of neuropathy or tendinopathy from metal plate implantation. Here, we present a case of a 42-year-old female with chronic ulnar wrist pain and unremarkable physical and radiological findings. Ulna shortening osteotomy with small stainless steel-made DCP and screw fixation was done. On the third day postoperative, the patient developed pain, swelling, ulnar neuropathy, and flexor tendon contracture. Severe adhesion was found around the implant and the ulnar nerve. Minimal skin patch testing reaction and pathological study suggest a cell-mediated delayed type IV hypersensitivity reaction. A titanium-made LCP was later implanted in place of the stainless steel-made DCP. The patient’s clinical status significantly improved after the operation. Metal hypersensitivity in this patient was unprecedented and unique. The severity of the reaction and its location close to the ulnar nerve may predispose to the intensity of the reaction. PubDate: Fri, 17 Jan 2020 15:35:01 +000
Abstract: Collodion baby is a rare condition in which the baby is born surrounded by membranes called collodion membranes. The evolution of these membranes is towards cracking and peeling. Sometimes, retraction leads to hypoperfusion or ischemia (especially of fingers and toes). In case of acute ischemia, surgery is necessary. We report the case of a newborn in which surgery was necessary to free both fingers and toes from constrictive bands responsible for ischemia. In the absence of surgery, the constrictive bands can lead to amputation (pseudoainhum). The purpose of this case report is to expose the management and the role of an orthopaedic surgeon in the treatment of a collodion baby. PubDate: Fri, 17 Jan 2020 15:35:00 +000
Abstract: The giant cell tumor of bone (GCTB) is a locally aggressive tumor. Reconstruction methods using β-tricalcium phosphate (β-TCP) blocks with strong compression resistance in and around the knee joint for GCTB have been reported. Among six cases of GCTB treated using this method, two recurrent cases revealed osteolysis, predominantly within the β-TCP block based on plain radiographs or computed tomography, while remodeled host bones were preserved. Implanted β-TCP blocks can function as a placeholder to preserve host bone in recurrent cases, leading to a higher probability of joint preservation. PubDate: Fri, 17 Jan 2020 12:35:00 +000
Abstract: Several reports have described the coexistence of spina bifida occulta (SBO) and spondylolysis, but the majority of defects occur at L5. No report has described the coexistence of SBO and spondylolysis at the thoracolumbar junction. We report a case of SBO with spondylolysis at L1, presenting cauda equine syndrome. A 37-year-old man presented with a gait disorder as a result of bilateral motor weakness of the lower extremities. A plain radiograph showed local kyphosis at L1-2 as a result of severe degenerative change and wedging of the vertebral body at L1. Magnetic resonance imaging (MRI) revealed degenerative disc changes and severe canal stenosis at L1-2. Computed tomography (CT) revealed SBO and spondylolysis at L1. He was diagnosed with cauda equina syndrome related to SBO and spondylolysis at L1. Posterior interbody fusion and decompression at L1-2 were performed. After surgery, his muscle power recovered to normal strength. The possible mechanisms in this case are the strain on anterior elements as a result of disruption of the posterior elements due to SBO and spondylolysis. The coexistence of SBO and spondylolysis at the thoracolumbar junction might induce at-risk status of increased strain to the anterior elements that may cause cauda equina syndrome. PubDate: Tue, 14 Jan 2020 15:50:00 +000
Abstract: Treatment of a large chronic prepatellar bursitis can be difficult to manage surgically because of a high rate of local complications and a significant chance of recurrence. We present a 2-stage technique using negative pressure dressings which produced a good outcome with no recurrence at one year after surgery. PubDate: Mon, 13 Jan 2020 15:35:01 +000
Abstract: Glomus tumors are rare benign tumors which commonly affect the hand but are seldom seen extradigitally. Less commonly seen is the glomangioma, a variant of benign glomus tumor, and even rarer is the glomangiosarcoma, a malignant variant. Determining malignancy can be difficult and an intermediate diagnosis, glomus tumor of uncertain malignant potential, has been proposed. We present a case of a 56-year-old male with a recurrent forearm mass diagnosed as a glomangioma of uncertain malignant potential. Although the characteristics and behavior of malignant cases are still incompletely understood, it is important that a high index of suspicion be maintained when approaching these tumors, especially when large or recurrent. Glomangiomas should be included in the differential diagnosis when evaluating soft tissue masses in the forearm and should be evaluated for malignant features. PubDate: Fri, 10 Jan 2020 04:35:01 +000
Abstract: In this report, we present the case of a 53-year-old man with rice body formation in the right knee caused by tuberculous arthritis (TB arthritis). The patient visited our hospital in January 2018 with a seven-month history of swelling and pain in the right knee. He had no previous history of tuberculosis, and the results of the routine laboratory tests were within normal limits; he also tested negative for rheumatoid factor. Magnetic resonance (MR) imaging revealed multiple rice bodies in the right knee, measuring 5-8 mm. He underwent an arthroscopic operation in the right knee in January 2018 and received antituberculosis polytherapy for 6 months. He was followed-up for more than 01 year. The patient regained good function of the operated knee with no evidence of recurrence during the last follow-up in February 2019. Conclusion. The biggest challenge in diagnosing tuberculosis arthritis is the consideration of its possibility in the differential diagnosis, not only in endemic countries where tuberculosis is frequent. A high level of suspicion for TB should be maintained for every infection of the knee joint, particularly in the case of intra-articular rice bodies. PubDate: Thu, 09 Jan 2020 05:35:00 +000
Abstract: Diagnosing traumatic diaphragmatic rupture (TDR) due to penetrating rib fractures is challenging because the lesions are often too small to be detected and may present years after injury. Patients with delays in diagnosis of TDR rarely present with orthopaedic-related complaints of pain. We report the case of a 52-year-old female who presented with chronic left shoulder pain following a motor vehicle accident (MVA). In addition to left-side lower rib fractures, she also sustained a left-sided splenic laceration, pneumothorax, and two-part upper humerus fracture. Fracture treatment was percutaneous pinning; the other injuries were treated nonoperatively. Her shoulder pain could not be attributed to shoulder or neck pathology. Twenty years after the MVA, she began experiencing episodes of left-sided abdominal pain and nausea. A CT scan obtained two years later revealed a diaphragm hernia, which was repaired laparoscopically. Unique aspects of this case include (1) presentation to an orthopaedic surgeon with a chief complaint of chronic shoulder pain; (2) at 22 years, this is the fourth longest case of a delay in diagnosis of TDR; and (3) the unique symptom of ipsilateral referred shoulder pain, which immediately improved after hernia repair. PubDate: Wed, 08 Jan 2020 06:35:01 +000
Abstract: Introduction. Trigger finger is ten times less common than trigger thumb in infants and children and, unlike trigger thumb, may arise from a variety of underlying causes. To our knowledge, we describe the first case of pediatric trigger finger secondary to an extraskeletal chondroma. Case Presentation. We report the case of an 11-year-old girl presenting with a typical history of triggering of the fourth finger, in whom a nodule attached to the flexor digitorum superficialis was found; clinical, ultrasound, and operative findings are described. Histological analysis was diagnostic of extraskeletal chondroma, also known as chondroma of soft tissues. Conclusion. This is a very uncommon benign cartilaginous tumor, mostly reported in patients aged 30 to 60 years (just one pediatric extraskeletal chondroma of the hand has been described), and presentation with trigger finger has been reported just once, in a 76-year-old man. This condition should be considered in the differential diagnosis of pediatric trigger finger. PubDate: Tue, 07 Jan 2020 05:35:01 +000
Abstract: Extensor tendon repairs, although common, can be difficult injuries to treat. Their treatment is tailored to the zone of the hand that is affected since varying biomechanical forces are applied to the tendon at each zone. Prompt treatment is necessary to prevent potential complications associated with these injuries. This is particularly true of Zone V extensor tendon injuries, as their mechanism is commonly a highly infectious human bite. We present the case of a human fight bite resulting in a Zone V extensor tendon injury. The delayed presentation of this case resulted in an untreated infection that caused an abscess with associated extensor tendon necrosis and rupture. Given the large gap length between the ends of the tendons, tendon repair was performed using a palmaris longus autograft. Even when these are done in a controlled setting, adhesions are common. The compromised wound bed caused irritation, erosion, and subsequent rupture of the extensor tendon of the hand. In an effort to avoid common complications such as adhesion, the repair was then wrapped with human umbilical membrane (AVIVE® Soft Tissue Membrane, AxoGen Inc., Alachua, FL) to separate adjacent tissue and reduce inflammation. Even without access to formal physical therapy, our patient had excellent functional outcomes at his final follow-up visit. The patient was able to make a loose composite fist, had no extensor lag at the MCP joints, and had extensor lag of 15 degrees at the PIP joints of digits 4-5. PubDate: Sat, 04 Jan 2020 06:35:00 +000
Abstract: Pyogenic facet joint infection is a rare but severe infection. The most common complaint on presentation is pain followed by fever, then neurologic impairment. While the lumbar spine is involved in the vast majority of cases presented in the literature, the case presented here occurred in the thoracic spine. The patient was a 48-year-old immune-competent female who presented with left back pain. Magnetic resonance imaging (MRI) indicated a facet effusion, paraspinal abscess, and epidural abscess in the level of 9th-11th thoracic vertebra. On the 6th day of treatment, she presented a neurological disorder and underwent decompressive laminectomy and surgical debridement. We observed immediate improvement as a result of the surgery. PubDate: Tue, 31 Dec 2019 07:35:02 +000
Abstract: Case. A 55-year-old male with a chronic isolated grade 3 PCL injury who demonstrates a positive quadriceps active test without activating his quadriceps musculature. Conclusion. Gravity and hamstring contraction posteriorly translate the tibia into a subluxed position. Subsequent gastrocnemius contraction with the knee flexed causes an anterior tibial translation by virtue of the mass enlargement of the gastrocnemius muscular bulk, the string of a bow effect, and the anterior origin of the gastrocnemius in relation to the posterior border of the subluxed tibia aided by the normal posterior tibial slope. PubDate: Sat, 28 Dec 2019 05:20:03 +000
Abstract: Bilateral spontaneous simultaneous fractures of the neck of femurs are extremely rare, and only a few cases have been reported in literature. They are usually following high-energy trauma or may be due to an underlying pathological process such as frailty, osteomalacia, rickets, and chronic renal disease. They can also occur following epilepsy and electric shock. We report a 79-year-old gentleman who presented with sudden onset of bilateral hip pain with a background of rheumatoid arthritis and long-term steroid treatment. The bilateral hip fractures were missed initially and later presented with completely displaced fractures of the neck of femurs. He underwent a single-stage bilateral cemented hemiarthroplasty and made a good recovery. Bilateral simultaneous fractures of the hip in patients with rheumatoid arthritis have not been reported in literature so far, and the diagnosis can be easily overlooked. In patients with bilateral hip pain, one should have a high index of suspicion. Further appropriate cross-sectional imaging in the form of CT or MRI should also be considered. PubDate: Sat, 28 Dec 2019 05:20:02 +000
Abstract: We describe the case of a 45-year-old woman who suffered an impalement injury of the pelvis with penetration of the sciatic foramen by a wooden foreign body. Following a single operation, the injury healed without complications or infection. We have taken this as an opportunity to describe the case and our standard procedure in more detail. PubDate: Fri, 27 Dec 2019 05:20:02 +000
Abstract: Background. Displaced distal clavicular fractures are generally operated on because of the high nonunion rate after nonoperative treatment. Several surgical techniques have been developed to reduce the nonunion rate and improve functional outcomes. One of them is closed reduction and minimally invasive coracoclavicular double-button fixation, which requires the integrity of the coracoid process to be performed. Case Summary. We present a 35-year-old male patient who had been successfully subjected to a modified Latarjet procedure for glenohumeral instability with bony defect treatment, and 7 months later suffered a distal clavicle fracture in his ipsilateral shoulder. With a CT scan, we analyzed the coracoid remnant size (7 mm), and we consider it enough to perform a minimally invasive double-button technique, using this remnant as a distal fixation. Postoperative and Follow-Up. Radiographic and clinical fracture union occurred 10 weeks after the procedure. The patient returned to sports at the same level he had before surgery and achieved full strength and range of motion. Conclusion. Closed reduction and minimally invasive double-button fixation of displaced distal clavicular fractures is a safe, reproducible, and versatile technique, which can even be performed without an intact coracoid process. PubDate: Tue, 24 Dec 2019 05:35:01 +000
Abstract: An 18-year-old male suffered a valgus injury to the right knee due to a fall during a bigfoot race he took part in when he was 15 years old. He visited a different hospital at the age of 15. No obvious ligament injury or fracture was noted on MRI and physical examination. However, he gradually became aware of the valgus deformity of the right knee. Finally, he could not take part in a sports activity because of right knee pain. X-ray images at the age of 18 at an initial visit to our department showed severe valgus deformity with mechanical lateral distal femoral angle (mLDFA) of 71 degrees in contrast to left mLDFA which was 87 degrees. We performed a biplane-cut distal femoral varus osteotomy (DFO). Postoperative X-ray images showed an improvement of 86 degrees in mLDFA. Bony fusion was achieved six months after surgery, and he could play several sports activity. PubDate: Mon, 23 Dec 2019 05:35:00 +000
Abstract: Isolated recurrent dislocation of the radial head (RH) is very rare, and there have been few reports describing the surgical treatment of this injury. We herein report the case of a 13-year-old girl who underwent ligament reconstruction surgery for isolated recurrent RH dislocation. Her symptoms included pain and apprehension at the elbow with the forearm in supination. A radiologic examination revealed anterior dislocation of the RH with the forearm in supination but complete reduction with the forearm in neutral to pronated positions. Surgical treatment to reconstruct the annular ligament and facilitate the radial collateral ligament was performed using an autograft with internal brace augmentation. At a 12-month follow-up examination, the patient had asymptomatic stability with recovery to sports activities. This case report describes a novel technique for the treatment of a rare pathological condition of the elbow. PubDate: Thu, 19 Dec 2019 15:20:00 +000
Abstract: We report a case of an infected total knee arthroplasty with Candida parapsilosis. The patient was successfully treated with a two-stage exchange arthroplasty, local antifungal treatment, and systemic antifungal treatment. This specific combination therapy to treat C. parapsilosis joint infection has not been previously reported. PubDate: Tue, 17 Dec 2019 07:20:00 +000
Abstract: Traumatic atlantooccipital dissociation (AOD) is a severe and usually fatal injury. Patients with assimilation of the atlas to the skull are exposed to a higher risk of injury and delay diagnosis due to the abnormal anatomy. We report two cases of acute traumatic craniocervical dislocation in patients with baseline congenital assimilation of the atlas to the skull. Computer tomography (CT) was used to identify the injury. Computer tomography angiography (CTA) showed variations of the vertebral arteries’ location on both patients. Assimilation of the atlas was complete in patient one and partial in patient two. Emergent surgical instrumentation and fusion were performed with a very careful and meticulous posterior dissection. As general rule, most of the patients with CCD will undergo occiput to C2 posterior segmental instrumentation and fusion. In the presented cases, a more extensive fusion was necessary based on the type and severity of the CCJ injury and the anatomical anomalies associated. Postoperatively, patient one remained neurologically intact and patient two died. Alternative fixation techniques should be used to minimize risk of VA injury during the surgical procedures. PubDate: Mon, 16 Dec 2019 15:35:02 +000
Abstract: Traumatic hip dislocations are potentially devastating injuries, especially in young patients, and require emergent orthopedic treatment. Given the significant amount of energy required to cause these injuries, a high index of suspicion is necessary to identify related injuries. The associated injuries, direction of dislocation, and time between injury and reduction represent the known prognostic factors, based on limited available research. Intrapelvic hip dislocations represent an uncommon variant of the traumatic hip dislocation, with all previously reported cases involving ipsilateral proximal femur fractures. We present a case of intrapelvic femoral head dislocation without an associated proximal femur fracture, as well as the maneuvers used to treat the patient via a closed reduction. PubDate: Fri, 13 Dec 2019 14:35:00 +000
Abstract: A 64-year-old woman with a spontaneous fused hip sustained a left femoral neck fracture. It was revealed that her left hip joint had a long-standing spontaneous hip fusion due to end-stage osteoarthritis. Additionally, she sustained an ipsilateral femoral intertrochanteric fracture and underwent osteosynthesis using a dynamic hip screw 8 years ago. The one-stage THA was successfully treated with no major complications and good functional recovery was obtained. The hip range of motion improved remarkably at one year after surgery. The Modified Harris Hip Score improved from an estimated 70 points before fracture to 95 points at final follow-up. PubDate: Thu, 12 Dec 2019 09:50:00 +000
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