Case Reports in Orthopedics http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Bilateral Atypical Femoral Fractures in a Patient with Multiple Myeloma Treated with Intravenous Bisphosphonate Therapy Tue, 22 Jul 2014 09:49:27 +0000 http://www.hindawi.com/journals/crior/2014/452418/ Bisphosphonates are currently the standard approach to managing bone disease in multiple myeloma. Bisphosphonates have high bone affinity that inhibits osteoclastic activity and additionally reduces the growth factors released from malignant or osteoblastic cells, thereby impairing abnormal bone remodeling which leads to osteolysis. However, patients of multiple myeloma may be at a higher risk of atypical femoral fractures because the treatment for malignant myeloma requires notably higher cumulative doses of bisphosphonates. Here we present a patient with bilateral atypical femoral fractures and multiple myeloma treated with intravenous bisphosphonate therapy. Ichiro Tonogai, Tomohiro Goto, Daisuke Hamada, Toshiyuki Iwame, Shinji Yoshioka, Takahiko Tsutsui, Yuichiro Goda, Hiroshi Egawa, and Koichi Sairyo Copyright © 2014 Ichiro Tonogai et al. All rights reserved. Spinal Hydatidosis Relapse: A Case Report Mon, 21 Jul 2014 00:00:00 +0000 http://www.hindawi.com/journals/crior/2014/207643/ Human cystic echinococcosis (CE) is a zoonosis caused by the larval stage of the Echinococcus granulosus and the most common sites affected are the liver and lung in approximately 80–90% of cases. The hydatid bone represents the 0.5–2.5% of all cases and localization cord is present about 50% of the time. This benign and commonly asymptomatic disease may simulate an aggressive malignancy because of osseous destruction and aggressive extension. We report a case of a 42-year-old male patient, presented with an unusual spinal hydatidosis relapse, related to anthelmintic drug therapy withdrawal after 10-year treatment. The man had previous excision of chest and hepatic hydatid cysts (resp., 10 and 3 years ago) and after primary mediastinal and spinal involvement (3 years ago) he was lost to follow-up and discontinued drug therapy. The patient underwent surgery and the postoperative histopathology confirmed the diagnosis. The patient recovered with no complications. Despite significant progress in diagnostic imaging, pharmacological and surgical therapy, spinal CE remains associated with high morbidity. Roberto Fiori, Irene Coco, Marco Nezzo, Gisèle Kabunda, Giuseppe Emmanuele Umana, Mario Francesco Fraioli, and Giovanni Simonetti Copyright © 2014 Roberto Fiori et al. All rights reserved. An Unusual Case of Clear Cell Chondrosarcoma with Very Late Recurrence and Lung Metastases, 29 Years after Primary Surgery Sun, 20 Jul 2014 07:12:23 +0000 http://www.hindawi.com/journals/crior/2014/109569/ Clear cell chondrosarcoma is a rare bone neoplasm with low-grade clinical course and the potential to metastasize to the skeleton and lungs. The aim of this report is to present a case that is extremely rare, but in accordance with the literature where the clear cell chondrosarcoma reportedly has a tendency for late metastases. In our patient the primary surgery was intralesional, since it was mistakenly interpreted as a benign tumour in the early 80s. The local recurrence and lung metastases occurred, however, 29 years after the initial treatment. The local recurrence was resected with wide margins, no additional surgery or oncological treatments were given, and two and half years postoperatively patient is doing well and there is no progression in the disease. In conclusion, it is important to have a long follow-up to the clear cell chondrosarcoma patients even for decades or lifelong, because the malignancy tends to metastasize or recur after an extended period. The course of metastasized disease may be unusually slow, so relatively aggressive treatment in metastasized and recurring cases is justified. Minna Laitinen, Jyrki Nieminen, and Toni-Karri Pakarinen Copyright © 2014 Minna Laitinen et al. All rights reserved. Intra-Articular Osteoid Osteoma Mimicking Juvenile Arthritis Thu, 17 Jul 2014 12:07:32 +0000 http://www.hindawi.com/journals/crior/2014/912609/ In case of intra-articular osteoid osteoma, misdiagnosis as juvenile arthritis may occur, delaying adequate treatment. We report cases of intra-articular osteoid osteomas in children that were misdiagnosed and initially inappropriately treated with intra-articular corticoid injection. Diagnosis of osteoid osteoma was finally given by CT-scan and appropriate treatment by radiofrequency ablation or surgical ablation was performed. Clinicians and radiologists should be aware of the potentially confusing clinical and imaging findings associated with intra-articular osteoid osteoma. Sidi Yaya Traore, Dana Ioana Dumitriu, and Pierre-Louis Docquier Copyright © 2014 Sidi Yaya Traore et al. All rights reserved. Bicondylar Hoffa Fracture Successfully Treated with Headless Compression Screws Wed, 16 Jul 2014 12:03:06 +0000 http://www.hindawi.com/journals/crior/2014/139897/ Bicondylar coronal plane fracture, eponymically named Hoffa fractures, is an extremely rare injury. We present a case of isolated unilateral bicondylar Hoffa fracture that was successfully treated with open reduction and internal fixation using headless compression screws with satisfactory results. We inserted posteroanteriorly oriented Acutrak screws perpendicular to the fracture plane via lateral parapatellar arthrotomy, which provided excellent compression across the fracture. Sang Yang Lee, Takahiro Niikura, Takashi Iwakura, Yoshitada Sakai, Ryosuke Kuroda, and Masahiro Kurosaka Copyright © 2014 Sang Yang Lee et al. All rights reserved. An Unusual Presentation of Charcot Arthropathy Caused by Syringomyelia Mimicking a Soft Tissue Tumor Sun, 13 Jul 2014 11:54:02 +0000 http://www.hindawi.com/journals/crior/2014/760861/ Charcot arthropathy is a chronic, degenerative condition and is associated with decreased sensorial innervation. Numerous causes of this arthropathy have been described. Here we report a case of neuropathic arthropathy secondary to syringomyelia which was misdiagnosed as a soft tissue tumor and treated surgically and additionally with radiotherapy at another institution. The patient had clinical and radiological signs of syringomyelia, associated with a limited range of motion, swelling, and pain in the affected joint. Neuropathic arthropathy, although less common, should be considered in cases of unexplained joint swelling, pain, and limited range of motion of the affected joint. Cuneyd Gunay, Ebru Atalar, and Baybars Ataoglu Copyright © 2014 Cuneyd Gunay et al. All rights reserved. Bioabsorbable Suture Anchor Migration to the Acromioclavicular Joint: How Far Can These Implants Go? Thu, 10 Jul 2014 08:45:37 +0000 http://www.hindawi.com/journals/crior/2014/834896/ Few complications regarding the use of bioabsorbable suture anchors in the shoulder have been reported. What motivated this case report was the unusual location of the anchor, found in the acromioclavicular joint which, to our knowledge, has never been reported so far. A 53-year old male with previous rotator cuff (RC) repair using bioabsorbable suture anchors presented with pain and weakness after 2 years of surgery. A suspicion of retear of the RC led to request of a magnetic resonance image, in which the implant was found located in the acromioclavicular joint. The complications reported with the use of metallic implants around the shoulder led to the development of bioabsorbable anchors. Advantages are their absorption over time, minimizing the risk of migration or interference with revision surgery, less artifacts with magnetic resonance imaging, and tendon-to-bone repair strength similar to metallic anchors. Since the use of bioabsorbable suture anchors is increasing, it is important to know the possible complications associated with these devices. Giovanna Medina, Guilherme Garofo, Caio O. D’Elia, Alexandre C. Bitar, Wagner Castropil, and Breno Schor Copyright © 2014 Giovanna Medina et al. All rights reserved. Solitary Fibrous Tumor of the Lumbar Spine: The Great Mimicker—Report of the Fifth Case Wed, 09 Jul 2014 08:01:48 +0000 http://www.hindawi.com/journals/crior/2014/852830/ Solitary fibrous tumor (SFT) is a rare neoplasm occurring in the central nervous system. It rarely occurs in the spine. This paper reports the fifth case of SFT in a 34-year-old female and focusses on differential diagnosis and importance of surgical treatment. Amer Sebaaly, Lara Raffoul, and Ronald Moussa Copyright © 2014 Amer Sebaaly et al. All rights reserved. Unilateral Carpal Tunnel Syndrome Caused by an Occult Ganglion in the Carpal Tunnel: A Report of Two Cases Sun, 06 Jul 2014 09:14:56 +0000 http://www.hindawi.com/journals/crior/2014/589021/ Carpal tunnel syndrome (CTS) usually presents bilaterally and a secondary nature should be suspected in patients with unilateral symptoms, especially those with a long-standing history, and when the symptomatic hand shows severe neurophysiologic impairment, while the contralateral hand is neurophysiologically intact. Space-occupying lesions are known to cause CTS and the incidence of space-occupying lesions in unilateral CTS is higher than that of bilateral CTS. It is easy to detect a mass when it is palpable; however, occult lesions are usually overlooked. Whenever a patient presents with unilateral symptoms and unilateral neurophysiologic impairment, the possibility of a space-occupying lesion compressing the median nerve should be kept in mind in the differential diagnosis. This study presents two cases with an occult ganglion in the carpal tunnel compressing the median nerve and causing unilateral symptoms of CTS. We stress on the importance of imaging studies in patients with unilateral symptoms that are usually not used in CTS. The reported patients were evaluated and magnetic resonance images revealed an intratunnel space-occupying lesion. Merter Yalcinkaya, Yunus Emre Akman, and A. Erdem Bagatur Copyright © 2014 Merter Yalcinkaya et al. All rights reserved. Osteoblastoma of the Os Capitatum Thu, 03 Jul 2014 00:00:00 +0000 http://www.hindawi.com/journals/crior/2014/241716/ An osteoblastoma is a primary benign bone tumor, which is rarely seen in hand bones. Osteoblastoma is generally seen in spine, pelvis, and long bones. However, there are a few case reports of osteoblastoma in wrist and hand bones. To our knowledge, up to now, only one male patient with osteoblastoma in capitate bone was reported. We report the first female case of osteoblastoma of capitate bone and discuss diagnosis and treatment. Çağrı Kaptan and Halil Atmaca Copyright © 2014 Çağrı Kaptan and Halil Atmaca. All rights reserved. Trevor’s Disease: A Literature Review regarding Classification, Treatment, and Prognosis apropos of a Case Tue, 24 Jun 2014 00:00:00 +0000 http://www.hindawi.com/journals/crior/2014/940360/ Background. Dysplasia epiphysealis hemimelica (DEH) is rare and its main characteristic is osteochondromas of the epiphysis of long bones. Methods. We report a case of DEH of the ankle in an 8-year-old boy that was resected in 2005. Additionally we collect all the reported cases of DEH. The literature is reviewed regarding the treatment, prognosis, long term function, and patterns and areas affected by DEH. Results. In our case no complications were noted and our patient remains asymptomatic. Reviewing the literature we found that 73 authors have reported 144 cases from 1926 to 2013. We propose and describe a new classification that correlates with prognosis. According to our classification DEH is classified as types 1 with single lower limb involvement, 2 with multiple lower limb, 3 with single upper limb, 4 with multiple upper limb, 5 with upper and lower limb, and 6 with spine. Conclusions. All single lesions should be followed up and if indicated a whole body nuclear bone scan can be useful in identifying the existence of multiple affected joints. Type 1 lesions have better prognosis than 2 and have less chances of developing OA even if not resected. Resection, even if partial, can be a successful treatment for DEH. Georgios Arealis, Vassilios S. Nikolaou, Andrew Lacon, Neil Ashwood, Keith Hayward, and Charalampos Karagkevrekis Copyright © 2014 Georgios Arealis et al. All rights reserved. Massive Femoral Osteolysis Secondary to Loosening of a Cemented Roughened Long Stem: A Case Report Mon, 23 Jun 2014 07:58:36 +0000 http://www.hindawi.com/journals/crior/2014/840267/ The surface finish of a femoral stem plays an important role in the longevity of cemented total hip arthroplasty. In efforts to decrease the rate of aseptic loosening, some prostheses have been designed to have a roughened surface that enhances bonding between the prosthesis and cement, but clinical outcomes remain controversial. We present a rare case of massive osteolysis with extreme femoral expansion that developed after cemented revision total hip arthroplasty. The destructive changes in the femur were attributable to abnormal motion of the stem and were aggravated by the roughened precoated surface of the long femoral component. Revision surgery using a total femur prosthesis was performed because there was insufficient remaining bone to fix the new prosthesis. The surgical technique involved wrapping polypropylene meshes around the prosthesis to create an insertion for the soft tissue, which proved useful for preventing muscular weakness and subsequent dislocation of the hip. Yasuaki Tamaki, Tomohiro Goto, Daisuke Hamada, Toshihiko Nishisho, Kiminori Yukata, Suzue Naoto, Hiroshi Egawa, and Koichi Sairyo Copyright © 2014 Yasuaki Tamaki et al. All rights reserved. Minimally Invasive Microendoscopic Resection of the Transverse Process for Treatment of Low Back Pain with Bertolotti’s Syndrome Thu, 19 Jun 2014 08:11:39 +0000 http://www.hindawi.com/journals/crior/2014/613971/ Bertolotti’s syndrome is characterized by anomalous enlargement of the transverse process of the most caudal lumbar segment, causing chronic and persistent low back pain or sciatica. We describe the case of a 45-year-old woman who presented with left sciatic pain and low back pain due to a recurrent lumbar disc herniation at L4-5 with Bertolotti’s syndrome. Selective L5 nerve root block and local injection of lidocaine into the articulation between the transverse process and sacral ala temporarily relieved the left sciatic pain and low back pain, respectively. To confirm the effect of local injection on low back pain, we gave a second local injection, which once again relieved the low back pain. Microendoscopic resection of the pseudoarticulation region and discectomy successfully relieved all symptoms. This report illustrates the effectiveness of minimally invasive resection of the transverse process for the treatment of low back pain with Bertolotti’s syndrome. Yoichiro Takata, Toshinori Sakai, Kosaku Higashino, Yuichiro Goda, Kazuaki Mineta, Kosuke Sugiura, and Koichi Sairyo Copyright © 2014 Yoichiro Takata et al. All rights reserved. Intradural Extramedullary Capillary Hemangioma in the Upper Thoracic Spine: A Review of the Literature Wed, 18 Jun 2014 08:55:05 +0000 http://www.hindawi.com/journals/crior/2014/604131/ Capillary hemangiomas are benign tumors found in the skin and soft tissues in younger people. They occur in the central nervous system only rarely, and intradural occurrence is extremely rare. We report here a 60-year-old man presenting with thoracic girdle pain and progressive gait disturbance. Magnetic resonance images of the thoracic spine showed a  mm, well-defined intradural mass at the T2 level, compressing the spinal cord laterally. Relative to the spinal cord, the mass was hypo- to isointense on T1-weighted images and relatively hyperintense on T2-weighted images, with strong enhancement on contrast-enhanced T1-weighted images. The patient underwent T1-2 hemilaminectomy with resection of the intradural extramedullary tumor, which showed characteristics of a capillary hemangioma on histologic examination. The patient’s symptoms improved following the surgery and no clinical or radiological evidence of recurrence was noted at the 2-year follow-up. We present this case with a review of the literature, highlighting features for differential diagnosis. Yoichiro Takata, Toshinori Sakai, Kosaku Higashino, Yuichiro Goda, Fumitake Tezuka, and Koichi Sairyo Copyright © 2014 Yoichiro Takata et al. All rights reserved. The Relationship between Osteoporosis and Osteoarthritis of the Knee: A Report of 2 Cases with Suspected Osteonecrosis Tue, 17 Jun 2014 09:32:31 +0000 http://www.hindawi.com/journals/crior/2014/514058/ Knee specimens of two osteoporotic patients who underwent unilateral knee arthroplasty for suspected osteonecrosis of the knee were examined histologically. Preoperative findings of magnetic resonance images in both patients were consistent with the diagnosis of osteonecrosis of the medial femoral condyles, although plain X-rays showed minimal degenerative changes. In both patients, preoperative bone mineral densities of the femoral condyle and proximal tibia of the affected side were lower than those of the unaffected side. Pathological examination of the resected femoral condyle and proximal tibia showed almost intact joint cartilage, healing of the collapsed subchondral bone, and significant trabecular bone loss. Histologically, no evidence of osteonecrosis, including empty lacunae of the trabecular bone, was observed. These findings indicated that subchondral bone collapse caused by osteoporosis, but not osteonecrosis, initiated the osteoarthritic change of the affected knee. This report emphasizes that there may be cases of progressive local osteoarthritis caused by fracture of subchondral bone because of osteoporosis. Akira Horikawa, Naohisa Miyakoshi, Yoichi Shimada, and Hiroyuki Kodama Copyright © 2014 Akira Horikawa et al. All rights reserved. Squamous Cell Carcinoma in Combination with a Symbrachydactyly: Initial Management and Long-Term Followup Sun, 15 Jun 2014 00:00:00 +0000 http://www.hindawi.com/journals/crior/2014/684130/ A 68-year-old female patient presented with a rapidly growing, exulcerating tumor of the left hand in the area of a congenital symbrachydactyly at the digiti II and III. A biopsy of the tumor showed a squamous cell carcinoma. Further workup showed two suspicious axillar enhancements with no evidence of bony infiltration and no further metastasis. An amputation of the second and third ray of the left hand at the metacarpal level and additionally an axillar revision and lymph node dissection were performed and confirmed the suspicion of a squamous cell carcinoma, fortunately without affection of any lymph nodes. After 9 years the patient showed an excellent function of the left hand. Symbrachydactyly malformations and squamous cell carcinoma of the hand are both rare conditions. We could not find a reference that shows a common genetic condition to both and so far this is the first description of a squamous cell carcinoma in the region of a symbrachydactyly. It remains unclear whether our case is a coincidence of two rare independent diseases or there is a pathogenetic link between the malformation and the tumor on a genetic level. Tomas Sanchez, Daniel Walder, and Philipp Esenwein Copyright © 2014 Tomas Sanchez et al. All rights reserved. Concurrent Rotator Cuff Tear and Axillary Nerve Palsy Associated with Anterior Dislocation of the Shoulder and Large Glenoid Rim Fracture: A “Terrible Tetrad” Thu, 12 Jun 2014 09:33:12 +0000 http://www.hindawi.com/journals/crior/2014/312968/ We present a case of concurrent rotator cuff tear and axillary nerve palsy resulting from anterior dislocation of the shoulder and a large glenoid rim fracture—a “terrible tetrad.” A 61-year-old woman fell on her right shoulder. Radiographs showed anterior dislocation of the shoulder with a glenoid rim fracture, and an MRI two months after injury revealed a rotator cuff tear. Upon referral to our hospital, physical and electrophysiological examinations revealed axillary nerve palsy. The axillary nerve palsy was incomplete and recovering, and displacement of the glenoid rim fracture was minimal and already united; therefore, we surgically repaired only the rotator cuff tear three months after injury. The patient recovered satisfactorily following the operation. In patients whose axillary nerve palsy is recovering, surgeons should consider operating on rotator cuff tears in an attempt to prevent rotator cuff degeneration. Fumiaki Takase, Atsuyuki Inui, Yutaka Mifune, Tomoyuki Muto, Yoshifumi Harada, Takeshi Kokubu, and Masahiro Kurosaka Copyright © 2014 Fumiaki Takase et al. All rights reserved. Free Medial Meniscal Fragment Which Mimics the Dislocated Bucket-Handle Tear on MRI Mon, 09 Jun 2014 00:00:00 +0000 http://www.hindawi.com/journals/crior/2014/647491/ The bucket-handle meniscal tear is a specific type of meniscal injuries which has specific signs on MRI. An attached fragment displaced away from the meniscus with any type of tear causes bucket-handle tear of the meniscus. Magnetic resonance imaging (MRI) is the most commonly used diagnostic tool for meniscal injuries. We present a case of free medial meniscal fragment which mimics the dislocated bucket-handle tear on MRI. The presence of “fragment within the intercondylar notch sign” and “the absence of the bow tie sign” may be an indication of a free meniscal fragment. This should be considered during diagnosis. Faik Türkmen, İsmail Hakkı Korucu, Cem Sever, Mehmet Demirayak, Gani Goncü, and Serdar Toker Copyright © 2014 Faik Türkmen et al. All rights reserved. Fixation of a Periprosthetic Intertrochanteric Hip Fracture below a Birmingham Hip Resurfacing Thu, 05 Jun 2014 08:43:00 +0000 http://www.hindawi.com/journals/crior/2014/393984/ This case report involves a 56-year-old female (Mrs X) with a traumatic intertrochanteric hip fracture with subtrochanteric extension below a previous Birmingham hip resurfacing. Periprosthetic fractures following hip resurfacing are usually subcapital and treated with a revision or conservative management. We present an unusual surgical problem with an interesting solution stabilising the fracture using a proximal femoral locking compression plate (LCP). Eight months following surgery the patient is able to walk pain free and there is good fixation and stability. J. Macdonald, A. Robinson, and I. Brown Copyright © 2014 J. Macdonald et al. All rights reserved. Recurrent Catastrophic Ceramic Femoral Head Failure in Total Hip Arthroplasty Wed, 04 Jun 2014 11:13:04 +0000 http://www.hindawi.com/journals/crior/2014/837954/ Fracture of a modern ceramic head component in total hip replacement is an uncommon but catastrophic complication. Hence, the occurrence of a second ceramic head fracture in the same hip replacement of an individual represents a perishingly rare event. We present the case as a means of highlighting potential risk factors for ceramic head fracture and suggest possible management strategies in such cases. S. M. M. Tai, L. Parker, N. J. de Roeck, and J. A. Skinner Copyright © 2014 S. M. M. Tai et al. All rights reserved. Gunshot Wound in Lumbar Spine with Intradural Location of a Bullet Wed, 04 Jun 2014 09:02:32 +0000 http://www.hindawi.com/journals/crior/2014/698585/ The presence of a migratory bullet in the spinal canal after a gunshot injury is a rare finding, specially without causing permanent neurologic damage. We present the case of a patient who suffered a gunshot wound with an entry point in the posterior arc of L2-L3 and a migratory bullet detected at the level of L5-S1 in the CT scan. The patient complained about intense headache, dizziness, and variable sensitive impairment in lower legs apparently depending on the patient’s position in bed. We decided to remove the bullet in order to prevent the delayed neurological damage and lead toxicity. We discuss technical details of this surgery. G. Bordon and S. Burguet Girona Copyright © 2014 G. Bordon and S. Burguet Girona. All rights reserved. An Unusual Complication Seen in a Six-Year-Old Girl Treated with Open Reduction and Pemberton Osteotomy for Neglected Developmental Dysplasia of the Hip: A Femoral Neck Fracture Sustained during Passive Motion under General Anesthesia Mon, 26 May 2014 08:07:28 +0000 http://www.hindawi.com/journals/crior/2014/804098/ Despite the screening programs for newborn children with hip ultrasonography, neglected developmental dysplasia of the hip (DDH) is still continuing to be a problem in the east and southeast parts of our country. The main complications are redislocation, avascular necrosis, and joint stiffness. We present an unusual complication, femoral neck fracture during passive motion under general anesthesia, of a six-year-old girl with neglected DDH treated by open reduction and Pemberton osteotomy without femoral shortening. The fracture was treated by open reduction and internal fixation combined with proximal femoral shortening. After 5 years the patient had excellent clinical results, no avascular necrosis was seen, and the radiologic appearance was type IA according to modified Severin classification. In conclusion older children with neglected DDH are more likely to have joint stiffness after open reduction. If there is even a little doubt about joint stiffness after open reduction, one should not refrain from femoral shortening. Also passive motion under general anesthesia should be applied very carefully with fluoroscopic control. Vedat Uruc and Samet Karabulut Copyright © 2014 Vedat Uruc and Samet Karabulut. All rights reserved. Discoscopic Findings of High Signal Intensity Zones on Magnetic Resonance Imaging of Lumbar Intervertebral Discs Wed, 21 May 2014 13:08:21 +0000 http://www.hindawi.com/journals/crior/2014/245952/ A 32-year-old man underwent radiofrequency thermal annuloplasty (TA) with percutaneous endoscopic discectomy (PED) under local anesthesia for chronic low back pain. His diagnosis was discogenic pain with a high signal intensity zone (HIZ) in the posterior corner of the L4-5 disc. Flexion pain was sporadic, and steroid injection was given twice for severe pain. After the third episode of strong pain, PED and TA were conducted. The discoscope was inserted into the posterior annulus and revealed a migrated white nucleus pulposus which was stained blue. Then, after moving the discoscope to the site of the HIZ, a migrated slightly red nucleus pulposus was found, suggesting inflammation and/or new vessels penetrating the mass. After removing the fragment, the HIZ site was ablated by TA. To our knowledge, this is the first report of the discoscopic findings of HIZ of the lumbar intervertebral disc. Kosuke Sugiura, Ichiro Tonogai, Tetsuya Matsuura, Kosaku Higashino, Toshinori Sakai, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Yoichiro Takata, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Kenji Kondo, Fumitake Tezuka, Kazuaki Mineta, Makoto Takeuchi, Mitsuhiko Takahashi, Hiroshi Egawa, and Koichi Sairyo Copyright © 2014 Kosuke Sugiura et al. All rights reserved. Bilateral Pseudarthrosis of the Femoral Neck in a 25-Year-Old Male with Hereditary Hypophosphatemic Rickets Thu, 15 May 2014 16:13:34 +0000 http://www.hindawi.com/journals/crior/2014/312712/ Hereditary hypophosphatemic rickets (HHR) is a rare disorder of renal phosphate wasting and the most common form of heritable rickets. Here, we report a case of an active 25-year-old male with HHR showing atraumatic bilateral femoral neck pseudarthrosis after 4 years of consecutive knee pain. A conservative therapy was administered, taking into account both the risks of surgical treatment and the little impairment even in the sport activities which the patient experienced. Joris Anthonissen, Christian Ossendorf, Thomas Vetter, Björn Habermann, and Pol M. Rommens Copyright © 2014 Joris Anthonissen et al. All rights reserved. Median Nerve Compression in Carpal Tunnel Caused by a Giant Lipoma Sun, 04 May 2014 07:16:29 +0000 http://www.hindawi.com/journals/crior/2014/654934/ A lipoma is a common, benign soft-tissue tumor that rarely arises in the upper limb. When one does occur in the hand, the location of the lipoma can cause nerve compression, which can mimic carpal tunnel symptoms. Magnetic resonance imaging is the visualization modality of choice for diagnosis and surgical planning of lipomas. Surgical resection is recommended to relieve the neurological manifestations of this disease. The surgeon should always suspect liposarcoma first before voluminous, atypical, or recurrent tumors are considered. F. Fazilleau, T. Williams, J. Richou, V. Sauleau, and D. Le Nen Copyright © 2014 F. Fazilleau et al. All rights reserved. Elbow Dislocation with Complete Triceps Avulsion Wed, 30 Apr 2014 09:54:42 +0000 http://www.hindawi.com/journals/crior/2014/636504/ Radio-ulnar Fracture dislocation of the elbow is a high-energy trauma which can be associated with significant ligamentous injury in adults. We report an unusual triad of injury in a patient with avulsion injury of the triceps. This injury can be thought of as a variant of “terrible triad” with dislocation of radio-ulnar joint, radial head fracture, and medial collateral ligament injury with avulsion of the triceps. Elbow has to be stabilized with early repair of the ligaments for a successful outcome. S. V. Karuppiah and D. Knox Copyright © 2014 S. V. Karuppiah and D. Knox. All rights reserved. Evaluation of Gait Performance of a Hemipelvectomy Amputation Walking with a Canadian Prosthesis Mon, 14 Apr 2014 12:44:01 +0000 http://www.hindawi.com/journals/crior/2014/962980/ Background. Hemipelvectomy amputation is a surgical procedure in which lower limb and a portion of pelvic are removed. There are a few studies in the literature regarding the performance of subjects with hip disarticulation during walking. However, there is no study on gait analysis of hemipelvectomy subject. Therefore, the aim of this paper was to evaluate the gait and stability of subject with hemipelvectomy amputation. Case Description and Methods. A subject with hemipelvectomy amputation at right side was involved in this study. He used a Canadian prosthesis with single axis ankle joint, 3R21 knee joint, and 7E7 hip joint for more than 10 years. The kinetic and kinematic parameters were collected by a motion analysis system and a Kistler force platform. Findings and Outcomes. There was a significant difference between knee, hip, and ankle range of motions and their moments in the sound and prosthesis sides. In the other side, the stability of the subject in the anteroposterior direction seems to be better than that in the mediolateral direction. Conclusions. There was a significant asymmetry between the kinetic and kinematic performance of the sound and prosthesis sides, which may be due to lack of muscular power and alignment of prosthesis components. M. T. Karimi, M. Kamali, H. Omar, and Javid Mostmand Copyright © 2014 M. T. Karimi et al. All rights reserved. Snapping Knee Caused by Medial Meniscal Cyst Sun, 13 Apr 2014 14:03:46 +0000 http://www.hindawi.com/journals/crior/2014/151580/ Snapping phenomenon around the medial aspect of the knee is rare. We present this case of snapping knee caused by the sartorius muscle over a large medial meniscal cyst in a 66-year-old female. Magnetic resonance images demonstrated a large medial meniscal cyst with a horizontal tear of the medial meniscus. Arthroscopic cyst decompression with limited meniscectomy resulted in the disappearance of snapping, and no recurrence of the cyst was observed during a 2-year follow-up period. Tsuyoshi Ohishi, Daisuke Suzuki, Kazufumi Yamamoto, Tomohiro Banno, Hiroki Ushirozako, Yoichi Koide, and Yukihiro Matsuyama Copyright © 2014 Tsuyoshi Ohishi et al. All rights reserved. Ossicle in Anterior Cruciate Ligament: A Rare Occurrence Sun, 13 Apr 2014 08:28:32 +0000 http://www.hindawi.com/journals/crior/2014/616715/ The occurrence of an intra-articular ossicle is not rare in the knee, with reports suggesting the existence of meniscal osscile. There are also reports describing the attachment of the posterolateral bundle of the anterior cruciate ligament (ACL) to an accessory ossicle. However, despite an extensive search of the English literature we did not find much written about an intrasubstance ossicle in the ACL. We present the case of a 13-year-old male with an intrasubstance ossicle in the anteromedial bundle of the ACL of his right knee. Ashish Devgan, Reetadyuti Mukhopadhyay, Amanpreet Singh, Paritosh Gogna, Rohit Singla, and Narender Kumar Magu Copyright © 2014 Ashish Devgan et al. All rights reserved. Skin Necrosis Associated with Thromboprophylaxis after Total Knee Replacement Sun, 06 Apr 2014 12:34:25 +0000 http://www.hindawi.com/journals/crior/2014/139218/ Thromboprophylaxis are routinely given to prevent venous thromboembolism (VTE) in patients after total hip and knee replacement surgeries. Low molecular weight heparin (LMWH) (fractioned heparin) is effective in the prevention and treatment of VTE. The predicable effect of LMWH has popularized it for routine clinical use. Although LMWH has lesser complication rate, compared to unfractioned heparin (UFH), sporadic clinical complication has been reported. We report a rare case of skin necrosis secondary to use of LMWH tinzaparin used for routine thromboprophylaxis after total knee replacement. S. V. Karuppiah and A. J. Johnstone Copyright © 2014 S. V. Karuppiah and A. J. Johnstone. All rights reserved.