http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Thu, 16 May 2013 12:00:00 +0000 http://www.hindawi.com/crim/orthopedics/2013/967215/ Synovial cyst occurs secondary to traumatic, degenerative, or inflammatory conditions. Synovial cysts represent abnormal distension of bursae, which communicate with the joint. Giant synovial cysts are typically due to rheumatoid arthritis, other causes being trauma and synovial pseudoarthrosis. A 33-year-old male presented to an outpatient clinic with a massive swelling on his posterolateral aspect of right thigh extending from upper one-third to the knee joint which had been increasing in size over the past six months. This was associated with dull aching pain. All laboratory investigations were within normal parameters. Even FNAC was inconclusive. With time, swelling was increasing in size. Ultrasound revealed the cystic nature of swelling. MRI showed large cystic lesion 24 × 10 × 12 cm in posterolateral aspect of thigh extending up to knee joint. Following the MRI, an excision was planned. After excision, histological examination confirmed the synovial nature of the cyst, which had a collagenous wall and dense chronic inflammatory cells. As the disease is extremely rare and asymptomatic, precise diagnosis is difficult and often delayed. We consider that open surgical excision should be reserved for cases of large synovial cysts because it can provide a complete resection of the lesion and minimize the risk of recurrence. Kushagra Sinha, Rajesh Maheshwari, and Atul Agrawal Copyright © 2013 Kushagra Sinha et al. All rights reserved. Thu, 16 May 2013 11:57:56 +0000 http://www.hindawi.com/crim/orthopedics/2013/914329/ We describe a case of a 19-year-old male who presented to the South West Health Service with a septic knee, secondary to haematogenous spread from an iliacus abscess. Thus far, there have been no reported cases of haematogenous spread of infection from an iliacus abscess to an ACL reconstructed knee, let alone in a healthy young person with no risk factors. The patient has had several washouts of the knee along with the drainage of the abscess. The ACL graft was saved with the patient making a complete recovery. Vivek Eranki, Andrew Wallis, and Simon Smith Copyright © 2013 Vivek Eranki et al. All rights reserved. Thu, 16 May 2013 10:46:05 +0000 http://www.hindawi.com/crim/orthopedics/2013/965693/ Adult presentation of neglected congenital muscular torticollis (CMT) is rare. Therefore, efficacy of surgical treatment for adult CMT is unclear. We experienced a case of neglected CMT in a 28-year-old male patient and report the surgical result here. We conducted unipolar resection at the distal end of the sternocleidomastoid muscle (SCM). After surgery, the range of neck movement and head tilt improved, and his appearance was cosmetically improved despite the long-standing nature of the deformity. We concluded that surgical management of adult patients with neglected congenital muscular torticollis may be a treatment option. Song Ho Chang, Seiji Ohtori, Akihiko Okawa, Koui Kawamura, Hiroshi Saiki, Izumi Nakada, Takashi Shimada, Junichi Nakamura, Kazuhisa Takahashi, and Hiroshi Sugiyama Copyright © 2013 Song Ho Chang et al. All rights reserved. Thu, 02 May 2013 15:42:40 +0000 http://www.hindawi.com/crim/orthopedics/2013/348080/ Arthroplasty in the haemophiliac patient is associated with higher rates of infection and is traditionally performed in a younger age group. Despite this there is little evidence in the literature regarding revision arthroplasty in this cohort of patients. We describe the case of a periprosthetic fracture in a haemophiliac patient requiring revision arthroplasty, who did not consent to receiving blood products due to religious beliefs, with a successful outcome. A. P. Molloy, B. J. O'Neill, L. Molloy, B. White, H. Smyth, and T. Mc. Carthy Copyright © 2013 A. P. Molloy et al. All rights reserved. Tue, 30 Apr 2013 13:32:11 +0000 http://www.hindawi.com/crim/orthopedics/2013/539740/ Ossification of the Achilles tendon (OTA) is an unusual clinical condition. It is characterized by the presence of an ossified mass within the fibrocartilaginous substance of the Achilles tendon. The etiology of the ossification of the Achilles tendon is unknown. Review of the literature suggests that its etiology is multifactorial. The major contributing factors are trauma and surgery with other minor causes such as systemic diseases, metabolic conditions, and infections. To our knowledge, no previous reports suggest any genetic/hereditary predisposition in OAT. We report 3 siblings who have OAT with no history of any of the aforementioned predisposing factors. Could OAT have a hereditary component as one of its etiologies? Chawki Cortbaoui, Jihad Matta, and Rayan Elkattah Copyright © 2013 Chawki Cortbaoui et al. All rights reserved. Tue, 30 Apr 2013 11:21:06 +0000 http://www.hindawi.com/crim/orthopedics/2013/932521/ Nonunion of a sacral fracture is a rare but serious clinical condition which can cause severe chronic pain, discomfort while sitting, and significant restriction of the level of activities. Fracture nonunions reportedly occur most often after nonoperative initial treatment or inappropriate operative treatment. We report a case of fracture nonunion of the sacrum and pubic rami that resulted from non-operative initial treatment, which was treated successfully using bone grafting through a posterior approach and CT-guided percutaneous iliosacral screw fixation combined with anterior external fixation. Although autologous bone grafting has been the gold standard for the treatment of pelvic fracture nonunions, little has been written describing the approach. We utilized a posterior approach for bone grafting, which could allow direct visualization of the nonunion site and preclude nerve root injury. By this procedure, we were able to obtain the healing of fracture nonunion, leading to pain relief and functional recovery. Sang Yang Lee, Takahiro Niikura, Yoshitada Sakai, Masahiko Miwa, Kotaro Nishida, Ryosuke Kuroda, and Masahiro Kurosaka Copyright © 2013 Sang Yang Lee et al. All rights reserved. Mon, 22 Apr 2013 12:20:07 +0000 http://www.hindawi.com/crim/orthopedics/2013/952978/ Fractures of the tibial tuberosity are infrequent injuries that occur during adolescence. Displaced tibial tuberosity fractures are typically treated with open reduction and internal fixation. Since these fractures occur at or near skeletal maturity, growth disturbances are not seen. This paper presents a case, the first report to our knowledge, of genu recurvatum deformity after open reduction and internal fixation of a tibial tuberosity fracture. A successful treatment plan of tibial tuberosity osteotomy with proximal tibial opening wedge osteotomy was used for the correction of genu recurvatum deformity and to maintain appropriate patellar height. At eighteen-month followup, the deformity remains corrected with satisfactory functional results. This case highlights the importance of recognition of potential complications of fracture management in adolescence. Senthil T. Nathan and Shital N. Parikh Copyright © 2013 Senthil T. Nathan and Shital N. Parikh. All rights reserved. Thu, 18 Apr 2013 10:58:07 +0000 http://www.hindawi.com/crim/orthopedics/2013/291691/ Due to its advantages, ceramic-on-ceramic bearings have been widely used in young patients for almost 30 years. Long-term survivorship, low wear, and low biological reactivity to particles are some of its characteristics. Even though this material has had a lot of improvements, the risk of fracture is one of the concerns. There have been reports of fracture of ceramic in the acetabular liner and head but no fractures of both in the same patient. We report a case of a fracture in a sandwich type acetabular liner and the ceramic head in a patient involving ankylosing spondylitis. It occurred three years after the operation and with no history of direct trauma. We decided to change the bearing surfaces to metal polyethylene without removing the metal back. The patient is satisfied by the clinical results after a 5-year followup. Diego Reátegui, Sebastián García, Guillem Bori, and Xavier Gallart Copyright © 2013 Diego Reátegui et al. All rights reserved. Mon, 15 Apr 2013 09:33:36 +0000 http://www.hindawi.com/crim/orthopedics/2013/361087/ Internal snapping hip syndrome, or psoas tendonitis, is a recognised cause of nonarthritic hip pain. The majority of patients are treated conservatively; however, occasionally patients require surgical intervention. The two surgical options for iliopsoas tendinopathy are step lengthening of the iliopsoas tendon or releasing the tendon at the lesser trochanter. Although unusual, refractory snapping usually occurs soon after tenotomy. We report a case of a 47-year-old active female with internal snapping and pain following an open psoas tenotomy. Postoperatively she was symptom free for 13 years. An MRI arthrogram revealed reformation of a pseudo iliopsoas tendon reinserting into the lesser trochanter. The pain and snapping resolved after repeat iliopsoas tendon release. Reformation of tendons is an uncommon sequela of tenotomies. However the lack of long-term studies makes it difficult to calculate prevalence rates. Tendon reformation should be included in the differential diagnosis of failed tenotomy procedures after a period of symptom relief. K. Garala and R. A. Power Copyright © 2013 K. Garala and R. A. Power. All rights reserved. Wed, 10 Apr 2013 10:55:57 +0000 http://www.hindawi.com/crim/orthopedics/2013/690906/ Distal humeral periprosthetic fractures below intramedullary nail devices are complex and challenging to treat, in particular due to the osteopenic/porotic nature of bone found in these patients. Fixation is often difficult to satisfactorily achieve around the intramedullary device, whilst minimising soft tissue disruption. Descriptions of such cases in the current literature are very rare. We present the case of a midshaft humeral fracture treated with a locking compression plate that developed a nonunion, in a 60-year old female. This went on to successful union after exchange for an intramedullary humeral nail. Unfortunately, the patient developed a distal 1/5th humeral periprosthetic fracture, which was then successfully addressed with a single-contoured, extra-articular, distal humeral locking compression plate (Synthes) with unicortical locking screws and cerclage cables proximally around the distal nail tip region. An excellent postoperative range of motion was achieved. Hiren M. Divecha and Hans A. J. Marynissen Copyright © 2013 Hiren M. Divecha and Hans A. J. Marynissen. All rights reserved. Tue, 09 Apr 2013 14:50:51 +0000 http://www.hindawi.com/crim/orthopedics/2013/234278/ We report about four cases of marked subchondral osteopenia on followup radiography after trauma and prolonged disuse. This localized form of disuse osteopenia has not been reported in details beside the followup imaging of talar neck fractures, where it is known as the “Hawkins sign.” Due to its unique morphology, it can be easily recognized as a benign finding in posttraumatic followup imaging and can be morphologically distinguished from severe complications like complex regional pain syndrome type 1 (Sudeck's disease) or periarticular osteopenia in infectious arthritis. It is important for the radiologist and orthopaedic surgeon to be aware of this form of disuse osteopenia in the proper clinical context. J. Gossner, B. W. Raab, J. Larsen, and S. Breitkreuz Copyright © 2013 J. Gossner et al. All rights reserved. Mon, 08 Apr 2013 11:15:18 +0000 http://www.hindawi.com/crim/orthopedics/2013/715402/ Fibrous dysplasia (FD) is an uncommon, but well-known benign skeletal disorder. In cases affecting long bones, FD is commonly recognized to locate in the diaphyses or the metaphyses and to spare the epiphyses. In this paper, we present a rare case of polyostotic FD in a 13-year-old girl with unilateral multiple epiphyseal lesions arising in the femur, the tibia, and the fibula with the growth plates. Tomoaki Fukui, Teruya Kawamoto, Toshiaki Hitora, Yoshiki Yamagami, Toshihiro Akisue, and Tetsuji Yamamoto Copyright © 2013 Tomoaki Fukui et al. All rights reserved. Thu, 04 Apr 2013 12:04:37 +0000 http://www.hindawi.com/crim/orthopedics/2013/621476/ Modern imaging has revealed that thoracic disc herniation (TDH) has a prevalence of 11–37% in asymptomatic patients. Pain, sensory disturbances, myelopathy, and lower extremity weakness are the most common presenting symptoms, but other atypical extraspinal complaints, such as gastrointestinal or cardiopulmonary discomfort, may be reported. Our objective is to make providers familiar with TDH’s atypical symptoms to help avoid potential serious consequences created by a delay in diagnosis. We report the cases of two patients who each presented with atypical extraspinal symptoms secondary to a TDH. One patient presented with a chronic history of nausea, emesis, and chest tightness and MRI showed a large right paramedian disc herniation at T7-8. A second patient reported chronic constipation, buttock and leg burning pain, gait instability, and urinary frequency; an MRI of his thoracic spine demonstrated a central disc herniation at T10-11. TDH can present with vague extraspinal symptoms and unfamiliarity with these symptoms can lead to misdiagnosis with progression of the disease and unnecessary diagnostic tests and medical procedures. Therefore, TDH should be included in the differential diagnosis of patients with negative gastrointestinal, genitourinary, and cardiopulmonary system basic studies. Ali Shirzadi, Doniel Drazin, Sunil Jeswani, Leah Lovely, and John Liu Copyright © 2013 Ali Shirzadi et al. All rights reserved. Wed, 03 Apr 2013 15:17:01 +0000 http://www.hindawi.com/crim/orthopedics/2013/969405/ Tibial tubercle sleeve fracture is a rare injury. In concept, it is similar to the patellar sleeve fracture in a skeletally immature patient. We describe a unique case of simultaneous bilateral tibial tubercle sleeve fractures in a 12-year-old boy. Radiographs and MRI confirmed the injury. The patient underwent open surgical repair of bilateral sleeve fractures with suture anchor fixation. At the final followup, 3 years after his initial injury, the patient demonstrated full knee function bilaterally without radiographic evidence of growth disturbances. Rasesh R. Desai and Shital N. Parikh Copyright © 2013 Rasesh R. Desai and Shital N. Parikh. All rights reserved. Tue, 02 Apr 2013 17:14:12 +0000 http://www.hindawi.com/crim/orthopedics/2013/190917/ Fracture is a less common complication in seizure patients, and fractures as a consequence of convulsive seizures without direct trauma occur in 0.3% of cases. Acetabular fractures after convulsions are even more rare, and only a few cases of acetabular fracture dislocations, purely caused by convulsive activity, have been reported. Therefore, we report a case of unilateral acetabular central fracture dislocation after a seizure episode, with relevant literature review. The seizure attack occurred after contrast media (Iohexol) injection for checking the myelography. Kyung-Soon Park, Jae-Young Moon, Chang-Seon Oh, and Taek-Rim Yoon Copyright © 2013 Kyung-Soon Park et al. All rights reserved. Tue, 02 Apr 2013 11:32:52 +0000 http://www.hindawi.com/crim/orthopedics/2013/421087/ We report a case of delayed myelopathy caused by atlantoaxial subluxation without fracture. The patient was a 38-year-old male who became aware of weakness in extremities. The patient had a history of hitting his head severely while diving into a swimming pool at the age of 14 years old. At that time, cervical spine plain X-ray images showed no fracture, and the cervical pain disappeared after use of a collar for several weeks. At his first visit to our department, X-ray images showed an unstable atlantoaxial joint. After surgery, weakness of the extremities gradually improved. At 6 months after surgery, bone union was completed and the symptoms disappeared. This case shows that atlantoaxial ligament injuries are difficult to diagnose and may easily be missed. A high level of suspicion is important in such cases, since neurological compromise or deterioration may occur many years after the injury. Ryo Takamatsu, Hiroshi Takahashi, Yuichiro Yokoyama, Fumiaki Terajima, Yasuhiro Inoue, Katsunori Fukutake, and Akihito Wada Copyright © 2013 Ryo Takamatsu et al. All rights reserved. Thu, 28 Mar 2013 17:32:44 +0000 http://www.hindawi.com/crim/orthopedics/2013/472968/ A 45-year-old man presented to our clinic requesting evaluation for surgical treatment of chronic low back pain of more than 20 years duration. He was diagnosed with 3-level lumbar spondylolysis at L3–5. Direct repair using the pedicle screw and hook-rod system was conducted for all three levels. After the surgery, his low back pain completely disappeared. Six months later, he felt discomfort and heard a metallic sound as he twisted his trunk. Computed tomography and radiography indicated that the hook head for L3 and the screw head for L4 were interfering with each other, causing the sound. We confirmed bony union at L3 and removed the L3 system. Surgeons should be aware of such complications if direct repair using a pedicle screw and hook-rod system is conducted for multilevel spondylolysis. Tetsu Arai, Koichi Sairyo, Isao Shibuya, Ko Kato, and Akira Dezawa Copyright © 2013 Tetsu Arai et al. All rights reserved. Wed, 27 Mar 2013 08:48:59 +0000 http://www.hindawi.com/crim/orthopedics/2013/724960/ Takotsubo cardiomyopathy (TC) is a rare, transient cardiomyopathy, with symptoms mimicking myocardial infarction. It has been reported to typically occur in postmenopausal women and is often triggered by an intense physical or emotional event with stimulation of the sympathetic response; the exact etiology, however, is uncertain. Bone morphogenic protein (BMP) is widely used in spinal fusions and has been associated with numerous perioperative complications. BMP is known to stimulate sympathetic pathways. In this paper, we present the case of a patient with a 7-hour episode of TC after a spinal fusion with bone morphogenic protein. The patient's symptoms resolved and long-term followup has been uneventful. This is the first paper to describe TC in the setting of spine or other major orthopaedic surgery and it suggests another possible area for further investigation in peri-operative events potentially associated with the use of bone morphogenic protein. John Weaver and Jason Eubanks Copyright © 2013 John Weaver and Jason Eubanks. All rights reserved. Mon, 25 Mar 2013 11:24:14 +0000 http://www.hindawi.com/crim/orthopedics/2013/673576/ Chondroblastoma is a mostly benign bone neoplasm that typically affects the second decade of life and exhibits a lytic lesion in the epiphysis of long bones. We report an extreme case of massive, destructive chondroblastoma of the proximal humerus in a 9-year-old girl. It was difficult to differentiate using imaging information the lesion from malignant bone tumors such as osteosarcoma. Histopathological examination from biopsy proved chondroblastoma. The tumor was resected after preoperative transcatheter embolization. Reconstructive procedure for the proximal humerus was not performed due to the local destruction. The present case demonstrates clinical and radiological differentiations of the massive chondroblastoma from the other lesions and histopathological understandings for this lesion. Ichiro Tonogai, Mitsuhiko Takahashi, Hiroaki Manabe, Toshihiko Nishisho, Seiji Iwamoto, Shoichiro Takao, Seiko Kagawa, Eiji Kudo, and Natsuo Yasui Copyright © 2013 Ichiro Tonogai et al. All rights reserved. Sun, 24 Mar 2013 13:47:19 +0000 http://www.hindawi.com/crim/orthopedics/2013/953897/ Burst fractures in acute spinal traumas are a difficult problem to solve. Different approaches and techniques have been utilized, but with high incidence of morbidity and mortality, besides unsatisfactory clinical and radiological results. Mini-open approaches recently emerged and have been shown to be safe and effective in the treatment of several spinal conditions. Here we report a case of acute lumbar burst fracture at L2 treated by minimally invasive true lateral approach posteriorly instrumented with percutaneous pedicle screws. The minimum disruptive access in addition to a rigid construction allowed a lumbar corpectomy without the morbidity of standard open approaches, lowering surgery costs and accelerating the patient recovery with successfully clinical and radiological results. Rodrigo Amaral, Luis Marchi, Leonardo Oliveira, Thiago Coutinho, and Luiz Pimenta Copyright © 2013 Rodrigo Amaral et al. All rights reserved. Sun, 24 Mar 2013 11:53:02 +0000 http://www.hindawi.com/crim/orthopedics/2013/542965/ Trigger finger is a common disease, and operative treatments are often applied for it. Digital nerve injury is one of the complications of this surgical treatment, and paresthesia and sensory disturbance occur early after the operation. This paper presents a case of trigger finger appearing gradually as increasing digital nerve disorder after surgical treatment. In the second surgery, scar tissue covered the palmar MP joint where the A1 pulley had existed before, and palmar digital neurovascular tissue of the ulnar side was found on the inside of the scar. The ulnar digital nerve showed swelling like a neuroma, and bilateral digital nerves existed nearer to the center of the flexor pollicis longus tendon than normal digital nerves. Even when we operate on trigger finger by open release, we should create an appropriate surgical space for observation and be careful of digital nerve injury. Hiroyuki Tsuchie, Tomio Nishi, Hidekazu Abe, Masaaki Takeshima, and Yoichi Shimada Copyright © 2013 Hiroyuki Tsuchie et al. All rights reserved. Sun, 24 Mar 2013 10:46:38 +0000 http://www.hindawi.com/crim/orthopedics/2013/593905/ Although anterior cervical arthrodesis is an effective procedure for the treatment of cervical disorders, the method has some complications. Here, we describe this rare complication of cervical instrumentation with a literature review. A 23-year-old male patient was operated for a C6-C7 dislocation. At postoperative month 10, he presented with hemoptysis and dysphagia. Cervical roentgenograms showed anterior migrations of one broken screw and a plate-locking screw at the C6 corpus. One screw was missing. We concluded that the missing screw had perforated the esophagus and had been eliminated spontaneously through the gastrointestinal tract. No screw should migrate. Even loose screws should be noted in follow-up X-ray studies. If such findings are detected, a second operation for revision should be considered as soon as possible to prevent potentially fatal complications. Yusuf Kurtuluş Duransoy, Mesut Mete, Baha Zengel, and Mehmet Selçukı Copyright © 2013 Yusuf Kurtuluş Duransoy et al. All rights reserved. Thu, 14 Mar 2013 10:58:30 +0000 http://www.hindawi.com/crim/orthopedics/2013/703850/ Pediatric hip fractures and dislocations are rare in practice and are related to high-energy trauma. The incidence of postoperative avascular necrosis is increasing, especially in the case of transepiphyseal fractures. Surgery is the most common form of treatment, and its timing is important for prognosis of the fracture. Patients and their families should be informed about the possibility of avascular necrosis and further complications related to the fracture. Mehmet Elmadag, Hasan H. Ceylan, Ahmet Can Erdem, Kerem Bilsel, Gokcer Uzer, and Mehmet Ali Acar Copyright © 2013 Mehmet Elmadag et al. All rights reserved. Mon, 04 Mar 2013 11:47:50 +0000 http://www.hindawi.com/crim/orthopedics/2013/682075/ We report an 85-year-old woman with an L3 vertebral body fracture who presented with back pain, bilateral leg pain, and weakness after four months of conservative treatment. Because of unstable pseudoarthrosis, the L3 vertebral body collapsed in the standing position and the L3 nerve root was compressed. The indicated surgery decompressed the L3-L4 foramen and fused the unstable segment. The back pain and neurologic symptoms improved significantly following surgery. We propose that delayed neurologic deficit following an osteoporotic fracture of the lumbar body may be caused not only by retropulsion of vertebral body fragments with significant canal compromise, but also by foraminal stenosis with the late collapse of the vertebral fracture. This new pathomechanism for delayed neurologic deficit has not been previously described. If a collapse takes place in the caudal part of the vertebral body below the base of the pedicle, spine surgeons should be aware of the possibility of foraminal stenosis. Yu Sasaki, Yasuchika Aoki, Arata Nakajima, Yoshifumi Shibata, Masato Sonobe, Kazuhisa Takahashi, Seiji Ohtori, and Koichi Nakagawa Copyright © 2013 Yu Sasaki et al. All rights reserved. Mon, 04 Mar 2013 11:38:25 +0000 http://www.hindawi.com/crim/orthopedics/2013/697918/ Paralysis is the most feared postoperative complication of ACDF and occurs most often due to an epidural hematoma. In the absence of a clear etiology, inadequate decompression or vascular insult such as ischemia/reperfusion injury are the usual suspects. Herewith we report a case of complete loss of somatosensory evoked potentials (SSEPs) during elective ACDF at C4-5 and C5-6 followed by postoperative C6 incomplete tetraplegia without any discernible technical cause. A postoperative MRI demonstrated a large area of high signal changes on T2-weighted MRI intrinsic to the cord “white cord syndrome” but no residual compression. This was considered consistent with spinal cord gliosis with possible acute edema. The acute decompression of the herniated disc resulted in cord expansion and rush-in reperfusion. We postulate that this may have led to disruption in the blood brain barrier (BBB) and triggered a cascade of reperfusion injuries resulting in acute neurologic dysfunction. At 16 months postoperatively our patient is recovering slowly and is now a Nurick Grade 4. Kingsley R. Chin, Jason Seale, and Vanessa Cumming Copyright © 2013 Kingsley R. Chin et al. All rights reserved. Thu, 28 Feb 2013 18:26:49 +0000 http://www.hindawi.com/crim/orthopedics/2013/473014/ Two women, aged 81 and 61, became haemorrhagic after surgery. Their previous surgeries were uneventful with no unexpected bleeding observed. Blood tests prior to the current surgeries indicated normal values including those related to coagulation. There were no problems with the current surgeries prior to leaving the operating room. At 3 hours after the surgery, the 81-year-old patient had an outflow of the drain at 1290 grams and her blood pressure decreased. She had disseminated intravascular coagulation (DIC). The 61-year-old woman had repeated haemorrhages after her current surgery for a long time. Their abnormal haemorrhages were caused by a deficiency of coagulation factor XIII(13). The mechanism of haemorrhagic coagulation factor XIII(13) deficiency is not understood, and it is a rare disorder. The only diagnostic method to detect this disorder is to measure factor XIII(13) activity in the blood. In this paper, we used Arabic and Roman numerals at the same time to avoid confusion of coagulation factor XIII(13) with coagulation factor VIII(8) that causes hemophilia A. Akio Kanda, Kazuo Kaneko, Osamu Obayashi, and Atsuhiko Mogami Copyright © 2013 Akio Kanda et al. All rights reserved. Thu, 28 Feb 2013 09:06:51 +0000 http://www.hindawi.com/crim/orthopedics/2013/801752/ Total hip/knee arthroplasty may cause venous thromboembolism (VTE) as a postoperative complication. However, there are few reports on VTE after arthroscopic shoulder surgery. We report a patient who developed pulmonary embolism (PE) 6 days after arthroscopic rotator cuff repair but recovered without sequelae. In this case, the possibility of DVT of the lower limbs was denied by contrast-enhanced CT. Most possibly, the source of PE was deep vein thrombosis (DVT) of the upper limb under Desault fixation which showed arthroscopic surgery-related swelling postoperatively. Tadashi Yamamoto, Kazuya Tamai, Miwa Akutsu, Kazuo Tomizawa, Takuya Sukegawa, and Yutaka Nohara Copyright © 2013 Tadashi Yamamoto et al. All rights reserved. Tue, 26 Feb 2013 09:33:07 +0000 http://www.hindawi.com/crim/orthopedics/2013/535803/ We present an unusual case of a chronic, irreducible intra-articular dislocation of the patella in an elderly nursing home resident. The patient had been unable to weight bear for 3 weeks. Radiographs in the emergency department (ED) confirmed the intra-articular dislocation with the superior pole lodged in the intercondylar notch. She underwent two failed closed reduction attempts and subsequently required an open reduction under general anaesthesia. Gavin McHugh, Ed Ryan, May Cleary, Paddy Kenny, Shea O'Flanagan, and Peter Keogh Copyright © 2013 Gavin McHugh et al. All rights reserved. Sun, 24 Feb 2013 16:23:07 +0000 http://www.hindawi.com/crim/orthopedics/2013/840681/ Magnetic resonance arthrography (MRA) is commonly used to detect labral tears of the hip. Complications of MRA are unusual and include minor reactions such as chemical synovitis and urticaria. This paper presents a rapidly progressive chondrolysis of the hip in a young patient after arthrography. The patient had suffered from acute septic arthritis and was treated by emergent arthroscopic surgery followed by appropriate antibiotics. At 18 months of followup, there were no signs of active infection but evidence of joint chondrolysis. Magnetic resonance arthrography (MRA) of the hip is an invasive procedure and should therefore be recommended judiciously. Post-MRA pain is common but often mild and temporary, while post-MRA joint infection is rare; nevertheless, severe joint pain and limitation should raise suspicion for septic hip. Barak Haviv, Rafael Thein, Alon Burg, Snir Heller, Shlomo Bronak, and Steven Velkes Copyright © 2013 Barak Haviv et al. All rights reserved. Wed, 20 Feb 2013 08:34:14 +0000 http://www.hindawi.com/crim/orthopedics/2013/694359/ Asymmetric bilateral dislocations of the hips are rare injuries. Among the small number of reports in the literature, most have attributed the cause to high-velocity motor crashes. These dislocations are often seen to be associated with fractures of the proximal femur or the acetabulum. We present a case of a 45-year-old man with bilateral asymmetric dislocation of hips which were purely ligamentous in nature, without any fracture. He sustained his injuries due to a fall while getting on a moving bus. It was an unusual mechanism of injury as compared to the other cases of asymmetric hip dislocations reported in published studies. Both hips were reduced under general anaesthesia within three hours of the trauma. Skin traction and non-weight-bearing rehabilitation were continued for six weeks. After 35 months of followup, the patient remains asymptomatic. Early diagnosis and timely reduction of such dislocations under anaesthesia are necessary for prevention of complications. Rajesh Kumar Kanojia, Satya Ranjan Patra, and Sumit Gupta Copyright © 2013 Rajesh Kumar Kanojia et al. All rights reserved.