Case Reports in Orthopedics The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Combined Effect of a Locking Plate and Teriparatide for Incomplete Atypical Femoral Fracture: Two Case Reports of Curved Femurs Tue, 26 May 2015 09:27:04 +0000 In surgical treatment for atypical femoral fractures (AFFs), reconstruction nail fixation is recommended for both complete and incomplete fractures. Although it has been reported that AFF is affected by many factors, The ASBMR Task Force 2013 Revised Case Definition of AFFs states that a curved femur is often seen in Asian patients. It is sometimes difficult to insert a nail into a femur in incomplete AFF patients with severely curved femurs. We report two incomplete bisphosphonate-related AFF patients with marked femoral curvatures treated by locking plates and teriparatide, showing early bone unions and favorable long-term outcomes. Hiroyuki Tsuchie, Naohisa Miyakoshi, Tomio Nishi, Hidekazu Abe, Toyohito Segawa, and Yoichi Shimada Copyright © 2015 Hiroyuki Tsuchie et al. All rights reserved. Simultaneous Bilateral Femoral Neck Stress Fracture in a Young Stone Mason Tue, 26 May 2015 08:37:21 +0000 Unilateral stress fractures of the femoral neck are very uncommon and bilateral involvement is even rarer. They commonly occur in athletes, military recruits, older persons, or individuals with underlying metabolic disorders and very seldom in normal individuals. We present a rare case of simultaneous bilateral fracture neck of femur in a 25-year-old man who came with complaints of pain in bilateral groin for 1 month. There was no history of trauma or history suggestive of excessive activity prior to the onset of pain, but there was history of lifting heavy weights daily. On evaluation with MRI scan bilateral fracture of the femur neck was diagnosed and patient was operated on bilaterally with internal fixation done using dynamic hip screw. Patient then regained his routine activity over a period of 6 months and on follow-up at 1 year no avascular necrosis changes were seen in the femur head. We presented this case because of its unusual presentation and the diagnostic challenge it poses. Nikhil A. Khadabadi and Kiran S. Patil Copyright © 2015 Nikhil A. Khadabadi and Kiran S. Patil. All rights reserved. Atlantoaxial Subluxation after Pyogenic Spondylitis around the Odontoid Process Sun, 24 May 2015 12:40:08 +0000 Study Design. A case report and review of the literature. Objective. The aim of this study was to describe the conservative management of pyogenic spondylitis around the odontoid process. Summary of Background Data. Atlantoaxial subluxation after pyogenic spondylitis is rare. The therapeutic approach to infection of the upper cervical spine is controversial. Methods. Medical chart and radiological images of a 76-year-old male patient were retrospectively reviewed. Radiography revealed atlantoaxial subluxation, and an abscess was seen around the odontoid process on magnetic resonance images. Intravenous antibiotics and a halo vest were used to treat the patient. We then observed the patient’s conservative treatment course. Results. C-reactive protein levels returned to normal 4 weeks after administration of the intravenous antibiotics. The patient’s muscle weakness also completely recovered 8 weeks after administration of the intravenous antibiotics. Because the patient was able to walk without any support, surgical treatment was not necessary. Conclusions. Pyogenic spondylitis of the upper cervical spine is a rare manifestation. Surgical or conservative treatment must be selected carefully based on the patient’s symptoms. If early diagnosis and treatment can be provided to the patients, conservative treatment can be achieved. Atsushi Hasegawa, Mitsuru Yagi, Masakazu Takemitsu, Masafumi Machida, Takashi Asazuma, and Shoichi Ichimura Copyright © 2015 Atsushi Hasegawa et al. All rights reserved. A Case Report of Implant Fracture of Extensively Porous-Coated, Distally Fixated Cementless Long Stem: Detailed Course of Stem Bending Development Thu, 21 May 2015 12:54:19 +0000 We report the fracture of a cementless long stem in a distally fixated, extensively porous-coated femoral prosthesis used for revisional total hip arthroplasty (THA) 9 years previously in a 48-year-old woman, measuring 58 kg in weight and 155 cm in height. Following resolution of an infection 7 years after the revisional THA, a series of posterior dislocations occurred up until 7 months before sudden stem fracture. Extensive radiographic imaging evidence indicated a gradual progression of bending in the stem, and scanning electron microscope energy dispersive X-ray spectroscopy revealed oxygen in the medial and lateral sections, suspecting in vivo corrosion. We retrospectively examined the detailed course of stem bending development prior to stem fracture. The stem bending immediately after the revisional THA, at the first dislocation, and immediately before the stem fracture was 0°, 1.9°, and 5.2°, respectively. We consider that the cyclic loading with poor proximal bone support, distal fixation, and small diameter were the potential risk of this implant fracture. However, the course of stem bending development suggested that repeated operations and several dislocations might have aggravated the implant fatigue in the present case. Tomohiro Mimura Copyright © 2015 Tomohiro Mimura. All rights reserved. Simultaneous Disruption of the Pubic Symphysis and Sacroiliac Joint during Vaginal Birth Wed, 20 May 2015 08:37:29 +0000 Background. Puerperal diastasis of the pubic symphysis is a rare intrapartum complication. This report presents the case of a woman who experienced synchronous pubic symphysis and sacroiliac joint separations induced by vaginal delivery. Case. A 32-year-old woman (gravida 2, parity 2) with an uncomplicated prenatal course developed acute-onset anterior pubic pain during vaginal delivery. The pain persisted postpartum and was exacerbated by leg movement. Physical and radiographic examinations showed a pubic symphyseal separation of 2.4 cm, accompanied by a 10 mm disruption of the left sacroiliac joint. The patient was treated conservatively with pain-relief medication; bed rest, mostly in the left lateral decubitus position; closed reduction and application of a pelvic binder; use of a walker; and physical therapy. Conclusion. The patient responded to conservative management. She was essentially pain-free and regained movement and ambulation by 12 weeks postpartum. Hakan Çıçek, H. Levent Keskın, Ümit Tuhanıoğlu, Kasım Kiliçarslan, and Hasan Ulaş Oğur Copyright © 2015 Hakan Çıçek et al. All rights reserved. Myxoinflammatory Fibroblastic Sarcoma: A Radiographical, Pathological, and Immunohistochemical Report of Rare Malignancy Mon, 18 May 2015 12:47:41 +0000 Myxoinflammatory fibroblastic sarcoma (MIFS) is a rare, painless, and intermediate (rarely metastasizing) fibroblastic tumor, which commonly occurs in the extremities, with an equal sex predilection. This sarcoma is composed of a mixed inflammatory infiltrate along with spindled, epithelioid, and bizarre tumor cells in a background of hyaline and myxoid areas. In spite of such a distinctive morphology, the tumor can be a diagnostic challenge, simulating inflammatory conditions as well as neoplastic nature. For accurate diagnosis, the tumor requires extensive clinical, radiological, and pathological investigations. We present a case of MIFS in a 19-year-old female who presented with a mass in the left ankle. After appropriate excision and postoperative radiation therapy, she is free of disease, including recurrence and metastasis, at 12 years postoperatively. Michitaka Kato, Takuji Tanaka, and Takatoshi Ohno Copyright © 2015 Michitaka Kato et al. All rights reserved. Expandable Total Humeral Replacement in a Child with Osteosarcoma Mon, 18 May 2015 12:11:38 +0000 Case. A right-handed 8-year-old female patient presented with a conventional, high-grade osteosarcoma involving her right humerus; through-shoulder amputation was recommended. After consultation, total humerus resection with expandable, total humeral endoprosthesis reconstruction was performed with a sleeve to encourage soft-tissue ingrowth. At three-year follow-up she has received one lengthening procedure and her functional scores are excellent. Conclusion. Total humeral resection and replacement in the pediatric population are rare and although early reports of expandable total humeral endoprosthesis outcomes demonstrate high failure rates, this patient’s success indicates that expandable total humeral replacement is a viable option. Eric R. Henderson, Jidi Gao, John Groundland, Odion Binitie, and G. Douglas Letson Copyright © 2015 Eric R. Henderson et al. All rights reserved. Double-Layered Lateral Meniscus Accompanied by Meniscocapsular Separation Mon, 18 May 2015 07:20:53 +0000 We report an extremely rare case of double-layered lateral meniscus accompanied by meniscocapsular separation. The upper accessory meniscus was connected with the posterior horn and middle segment of the lower normal meniscus and was more mobile than the lower normal meniscus. A meniscocapsular separation was evident at the overlapping middle segment. Clinical symptoms were significantly improved by the resection of the upper accessory meniscus and the repair of the meniscocapsular separation. Careful arthroscopic analysis of other associated pathologies together with this rare abnormality was needed to achieve clinical improvement. Aki Fukuda, Akinobu Nishimura, Shigeto Nakazora, Ko Kato, and Akihiro Sudo Copyright © 2015 Aki Fukuda et al. All rights reserved. Iliopsoas Abscess (together with Bullet) Resulting from a Firearms Injury Thu, 14 May 2015 14:18:04 +0000 Psoas abscess, which is a rarely encountered infection, is defined as the accumulation of suppurative fluid within the fascia surrounding the psoas and iliac muscles. It is categorised as being primary or secondary. Although there are reports in the literature of secondary psoas abscess from foreign bodies, to the best of our knowledge, this is the first reported case of psoas abscess developing due to a bullet, following a firearms injury. The patient was first seen in the Emergency Department following a firearms injury in the posterolateral lumbar region and as the neurovascular examination was normal, the patient was discharged after 24 hours of observation. One month later, the patient presented again to the polyclinic with a high temperature and back pain. As a result of physical examination and tests, a diagnosis was made of psoas abscess and percutaneous drainage was applied under ultrasonography guidance. The complaints improved but, 10 days later with an increase in pain and indications of infection, open abscess drainage was applied and the bullet was removed. At the 6-month follow-up examination, the patient had no complaints. Yunus Güzel, Sadettin Çiftçi, Ali Özdemir, and Mehmet Ali Acar Copyright © 2015 Yunus Güzel et al. All rights reserved. Revision of Carpal Tunnel Release due to Palmaris Longus Profundus Thu, 14 May 2015 12:28:49 +0000 Purpose. The palmaris longus profundus has been documented throughout the literature as a cause of carpal tunnel syndrome. We present a case of palmaris profundus tendon removal during the revision of carpal tunnel release. Method. During a carpal tunnel release in a 66-year-old woman, palmaris profundus tendon was found inside the tunnel under the transverse carpal ligament, just above the median nerve, but it was left intact. The patient complained of pain in the hand at night and weakness of her hand one month after surgery. We decided on a revision of the carpal tunnel release. The palmaris profundus tendon was found and was removed. Results. The patient had a normal postoperative course. Two months later she returned to her normal activities and was asymptomatic. Conclusions. When a palmaris profundus muscle is located in carpal tunnel, we recommend its excision during carpal tunnel release. This excision will eliminate the possibility of recurrent compression over the median nerve. Lyrtzis Christos, Natsis Konstantinos, and Pantazis Evagelos Copyright © 2015 Lyrtzis Christos et al. All rights reserved. Polyarticular Septic Arthritis Caused by Haemophilus influenzae Serotype f in an 8-Month-Old Immunocompetent Infant: A Case Report and Review of the Literature Tue, 12 May 2015 07:37:46 +0000 Background. The standard use of vaccinations against pathogens has resulted in a decreased incidence of musculoskeletal infections caused by these previously common bacterial pathogens. Consequently, the incidence of infections caused by atypical bacteria is rising. This report presents a case of septic arthritis caused by non-type b H. influenzae in a pediatric patient. Methods. We report a case of an infant with polyarticular septic arthritis caused by H. influenzae serotype f. A literature review was conducted with the inclusion criteria of case reports and studies published between 2004 and 2013 addressing musculoskeletal H. influenzae infections. Results. An 8-month-old female presented with pain and swelling in her right ankle and left elbow. The patient was diagnosed with septic arthritis and underwent incision and drainage. Wound and blood cultures were positive for Haemophilus influenzae serotype f. In addition to treatment with IV antibiotics, the patient underwent immunocompetency studies, which were normal. Subsequent follow-up revealed eradication of the infection. Conclusions. Haemophilus influenzae non-type b may cause serious invasive infections such as sepsis or septic arthritis in children with or without predisposing factors such as immunodeficiency or asplenia. Optimal treatment includes surgical management, culture driven IV antibiotics, and an immunologic workup. Raheel Ahmed Ali, Sheldon L. Kaplan, and Scott B. Rosenfeld Copyright © 2015 Raheel Ahmed Ali et al. All rights reserved. Late Nontraumatic Dissociation of the Femoral Head and Trunnion in a Total Hip Arthroplasty Mon, 11 May 2015 12:14:15 +0000 Background. Modular total hip arthroplasties are increasingly popular because customisation allows optimal restoration of patient biomechanics. However, the introduction of component interfaces provides greater opportunities for failure. We present a case of late nontraumatic dissociation of the head-neck interface, more than 10 years after insertion. Case Description. A 58-year-old woman had a left metal-on-metal total hip arthroplasty in 2002 for hip dysplasia. Following an uneventful 10-year period, she presented to hospital in severe pain after standing from a seated position, and radiographs demonstrated complete dissociation of the modular femoral head from the stem, with the femoral head remaining in its cup. There was no prior trauma or infection. Mild wear and metallosis were present on the articulating surface between the femoral head and trunnion. Soft tissues were unaffected. Discussion and Conclusions. This is the latest occurrence reported to date for nontraumatic component failure in such an implant by more than 7 years. The majority of cases occur in the context of dislocation and attempted closed reduction. We analyse and discuss possible mechanisms for failure, aiming to raise awareness of this potential complication and encouraging utmost care in component handling and insertion, as well as the long term follow-up of such patients. Simon J. M. Parker, Wasim Khan, and Simon Mellor Copyright © 2015 Simon J. M. Parker et al. All rights reserved. Common Peroneal Nerve Palsy with Multiple-Ligament Knee Injury and Distal Avulsion of the Biceps Femoris Tendon Thu, 07 May 2015 09:51:32 +0000 A multiple-ligament knee injury that includes posterolateral corner (PLC) disruption often causes palsy of the common peroneal nerve (CPN), which occurs in 44% of cases with PLC injury and biceps femoris tendon rupture or avulsion of the fibular head. Approximately half of these cases do not show functional recovery. This case report aims to present a criteria-based approach to the operation and postoperative management of CPN palsy that resulted from a multiple-ligament knee injury in a 22-year-old man that occurred during judo. We performed a two-staged surgery. The first stage was to repair the injuries to the PLC and biceps femoris. The second stage involved anterior cruciate ligament reconstruction. The outcomes were excellent, with a stable knee, excellent range of motion, and improvement in the palsy. The patient was able to return to judo competition 27 weeks after the injury. To the best of our knowledge, this is the first case report describing a return to sports following CPN palsy with multiple-ligament knee injury. Takeshi Oshima, Junsuke Nakase, Hitoaki Numata, Yasushi Takata, and Hiroyuki Tsuchiya Copyright © 2015 Takeshi Oshima et al. All rights reserved. A Rare and Interesting Case of a Massive Secondary Spinal Chondrosarcoma and Review of the Literature Sun, 03 May 2015 13:49:51 +0000 Chondrosarcoma, the second most common primary malignancy of the bone, is malignant cartilage forming tumour that very rarely involves the axial skeleton. It may arise as a primary bone tumour or as a secondary lesion from a preexisting benign cartilaginous neoplasm such as osteochondroma or enchondroma. A rare case of a massive secondary lumbar spine chondrosarcoma is presented. Management consisted of an initial posterior spinal stabilization and fusion and then a curative radical en bloc tumour resection. A review of the literature is also presented. Anthony Adimonye Copyright © 2015 Anthony Adimonye. All rights reserved. Total Hip Arthroplasty for Rapidly Destructive Coxarthrosis in a Patient with Severe Platelet Deficiency due to Liver Cirrhosis and Immune Thrombocytopenic Purpura Sun, 03 May 2015 12:20:26 +0000 Rapidly destructive coxarthrosis (RDC) causes rapid and extreme destruction of the hip joint, which was reported by Postel and Kerboull. RDC is commonly unilateral and occurs mostly in elderly women. Immune thrombocytopenic purpura (ITP) is characterized by a low platelet count that is the result of both immune-mediated platelet destruction and suppression of platelet production. In patients with ITP undergoing surgery, bleeding associated with a low preoperative platelet count can lead to unsuccessful outcomes. To the best of our knowledge, there has been only one report describing total hip arthroplasty (THA) for patients with ITP and there have been no reports of THA for RDC with a very low platelet count due to liver cirrhosis (LC) and ITP. We report the case of a patient who had right RDC and a very low platelet count due to LC and ITP in whom THA was successfully performed. Furthermore, this case was also unique in that her platelet count increased after THA. THA for right RDC might resolve ITP by relieving inflammation of the right hip since her platelet count recovered after THA. Shunpei Hama, Fumiaki Inori, Dai Momose, and Sadahiko Konishi Copyright © 2015 Shunpei Hama et al. All rights reserved. Reconstructive Osteotomy for Ankle Malunion Improves Patient Satisfaction and Function Wed, 29 Apr 2015 12:56:26 +0000 Treatment of chronic symptoms caused by a malunion is a difficult problem in orthopedic surgery. We encountered a case of ankle malunion at our hospital about 1 year after the first operation. The patient had been unable to walk with weight-bearing but regained the ability to walk after reconstructive osteotomy of the fibula. Functional scores for the foot and ankle were significantly improved after intervention. Reconstructive osteotomy appears to represent a good option for ankle malunion. Fumiaki Inori, Masahiko Tohyama, Hiroyuki Yasuda, Sadahiko Konishi, and Akeo Waseda Copyright © 2015 Fumiaki Inori et al. All rights reserved. Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy Tue, 28 Apr 2015 09:37:07 +0000 Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL) travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL) described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion. Jorge Pablo Batista, Jorge Javier del Vecchio, Pau Golanó, and Jordi Vega Copyright © 2015 Jorge Pablo Batista et al. All rights reserved. Glanzmann’s Thrombasthenia Diagnosed following Knee Arthroscopy Mon, 27 Apr 2015 13:19:17 +0000 A 41-year-old man with an unremarkable medical history presented with a painful knee after a sports injury. He was diagnosed with a medial meniscal tear. Symptoms did not abate after 6 months of physical therapy, and he underwent arthroscopic partial medial meniscectomy. A week after beginning physical therapy he experienced a knee effusion, decreased ROM, and inability to flex his quadriceps. His knee was aspirated. Blood tests were ordered and his complete blood count, liver functions tests, and INR/PTT were normal. The patient had recurrent effusions requiring three additional joint aspirations. Ten weeks after the initial surgery, the patient underwent a second arthroscopy, during which a hematoma was removed and a synovectomy performed. The patient continued bleeding from the incisions after portals were sutured, and he was admitted to the hospital. A hematologist was consulted and comprehensive platelet aggregation testing revealed previously undiagnosed Glanzmann’s thrombasthenia. The patient began treatment with platelet infusions and desmopressin and progressed to a full recovery. Clinical suspicion for surgical patients with unusual repetitive postoperative bleeding should include previously undetected rare bleeding disorders even in adults. John E. Zvijac, Sharhabil S. Ammus, Fernando Aran, and Gary M. Kiebzak Copyright © 2015 John E. Zvijac et al. All rights reserved. Secondary Subacromial Impingement after Valgus Closing-Wedge Osteotomy for Proximal Humerus Varus Mon, 27 Apr 2015 13:01:10 +0000 A 31-year-old construction worker had been suffering from both the motion pain and the restriction of elevation in his right shoulder due to severe varus deformity of humeral neck, which occurred after proximal humeral fracture. The angle for shoulder flexion and abduction was restricted to 50 and 80 degrees, respectively. Valgus closing-wedge osteotomy followed by the internal fixation using a locking plate was carried out at 12 months after injury. Postoperatively, the head-shaft angle of the humerus improved from 65 to 138 degrees. Active flexion and abduction angles improved from 80 to 135 degrees and from 50 to 135 degrees, respectively. However, the patient complained from a sharp pain with a clicking sound during shoulder abduction even after removal of the locking plate. Since subacromial steroid injection temporarily relieved his shoulder pain, we assumed that the secondary subacromial impingement was provoked after osteotomy. Thus, arthroscopic subacromial decompression was carried out at 27 months after the initial operation, which finally relieved his symptoms. In the valgus closing-wedge osteotomy, surgeons should pay attention to the condition of subacromial space to avoid causing the secondary subacromial impingement. Hirotaka Sano, Masayuki Kamimura, Akira Oizumi, and Shuji Isefuku Copyright © 2015 Hirotaka Sano et al. All rights reserved. Ascending Tonic Clonic Seizure Syndrome after Percutaneous Vertebroplasty Tue, 21 Apr 2015 13:15:30 +0000 Background Context. Cement leakage is not a rare complication of vertebroplasty, but ascending tonic clonic seizure syndrome is exceptionally rare. We herein report the first case to our knowledge of this complication related to vertebroplasty. Purpose. We herein report the first case of ascending tonic clonic seizure syndrome following epidural cement leakage after percutaneous vertebroplasty in a patient with multiple osteoporotic compression fractures. Study Design. Case report. Methods. A 64-year-old woman with T8, T10, L2, and L4 osteoporotic compression fractures underwent percutaneous vertebroplasty using polymethylmethacrylate. 40 minutes after the procedure the patient started suffering back and leg pain, having repetitive myoclonic jerks lasting 15 seconds of the lower extremities, spasm of the back, dyspnea, sinus tachycardia, hypoxemia, and metabolic acidosis. Results. The patient recovered completely due to a combination of early effective resuscitation and considered definitive management. Conclusions. Percutaneous vertebroplasty with polymethylmethacrylate is relatively safe but has few dangerous complications, which should be prevented by a meticulous technique and excellent image quality. Guido Zarattini, Adam Farrier, and Federico Sibona Copyright © 2015 Guido Zarattini et al. All rights reserved. A Case of Neglected Bilateral Anterior Shoulder Dislocation: A Rare Entity with Unusual Mechanism of Injury Mon, 20 Apr 2015 08:53:53 +0000 Bilateral shoulder dislocations are rare, and if they occurred, posterior type of dislocations is common. Bilateral anterior shoulder dislocations are very rare and occur due to trauma with unique mechanism of injury. We report a case of unreduced simultaneous bilateral anterior dislocations of shoulder without associated fractures in a forty-year-old man following a unique mechanism of injury; both hands of the patient were pulled from either side. To the best of our knowledge, this unusual mechanism of injury has not been reported in the literature. Raghuram Choulapalle, Ramu Chokkarapu, Ravi Kanth Kolluri, Sreedhar Reddy Anne, Shanmuga Raju Perumal, Pavan Kumar Avadhanam, and Ramesh Bheemanathuni Copyright © 2015 Raghuram Choulapalle et al. All rights reserved. Patellar Tendon Rupture after Lateral Release without Predisposing Systemic Disease or Steroid Use Wed, 15 Apr 2015 13:43:52 +0000 Arthroscopic technique for lateral release is the most widely used procedure for the correction of recurrent dislocations of the patella. In the relevant literature, several complications of lateral release are described, but the spontaneous patellar tendon rupture has never been suggested as a possible complication of this surgical procedure. Patellar tendon rupture is a rather infrequent and often unilateral lesion. Nevertheless, in case of systemic diseases (LES, rheumatoid arthritis, and chronic renal insufficiency) that can weaken collagen structures, bilateral patellar tendon ruptures are described. We report a case of a 24-year-old girl with spontaneous rupture of patellar tendon who, at the age of 16, underwent an arthroscopic lateral release for recurrent dislocation of the patella. This is the first case of described spontaneous patellar tendon rupture that occurred some years after an arthroscopic lateral release. S. De Giorgi, A. Notarnicola, G. Vicenti, and B. Moretti Copyright © 2015 S. De Giorgi et al. All rights reserved. Primary Total Knee Arthroplasty Twenty Years after Distal Femoral Cement Augmentation of a Giant Cell Tumor Tue, 07 Apr 2015 16:32:11 +0000 We present a case of knee reconstruction 20 years after treatment of a giant cell tumor (GCT) with curettage and cementation. There is currently an ongoing debate whether cement or allograft bone is the preferred material for filling the void after GCT curettage. In this case we were able to readily implant a primary total knee replacement without disturbing the existing well-interdigitated large cement bolus and did not require any stems or augments for the reconstruction. Given the ease of TKR implantation in this patient, we feel that the use of cement following curettage of a GCT lesion is a better choice than allograft bone which may not provide enough structural support for the knee reconstruction and lead to a much more extensive procedure. Alejandro Zylberberg, Gillian Bayley, Luca Gala, and Paul R. Kim Copyright © 2015 Alejandro Zylberberg et al. All rights reserved. Rapid Destruction of the Humeral Head Caused by Subchondral Insufficiency Fracture: A Report of Two Cases Mon, 06 Apr 2015 08:18:08 +0000 Rapidly destructive arthritis (RDA) of the shoulder is a rare disease. Here, we report two cases, with different destruction patterns, which were most probably due to subchondral insufficiency fractures (SIFs). Case 1 involved a 77-year-old woman with right shoulder pain. Rapid destruction of both the humeral head and glenoid was seen within 1 month of the onset of shoulder pain. We diagnosed shoulder RDA and performed a hemiarthroplasty. Case 2 involved a 74-year-old woman with left shoulder pain. Humeral head collapse was seen within 5 months of pain onset, without glenoid destruction. Magnetic resonance imaging showed a bone marrow edema pattern with an associated subchondral low-intensity band, typical of SIF. Total shoulder arthroplasty was performed in this case. Shoulder RDA occurs as a result of SIF in elderly women; the progression of the joint destruction is more rapid in cases with SIFs of both the humeral head and the glenoid. Although shoulder RDA is rare, this disease should be included in the differential diagnosis of acute onset shoulder pain in elderly female patients with osteoporosis and persistent joint effusion. Kenichi Goshima, Katsuhiko Kitaoka, Junsuke Nakase, and Hiroyuki Tsuchiya Copyright © 2015 Kenichi Goshima et al. All rights reserved. A Rarely Seen Multilevel Thoracic Vertebral Fracture after a Nocturnal Hypoglycemic Convulsion Attack Sun, 05 Apr 2015 12:36:56 +0000 A 49-year-old male presented with acute midthoracic severe back pain following a witnessed nocturnal convulsion attack. There was no history of trauma and the patient had a 23-year history of Type I diabetes mellitus. MRI scans of the thoracic spine revealed compression fractures at T5, T6, T7, and T8 vertebrae. The patient was treated conservatively. At 17 months after the initial diagnosis, the complaints of back pain had been resolved and the patient was able to easily undertake daily living activities. Hypoglycaemia is a common problem in diabetic patients treated with insulin. Convulsions may occur as a consequence of insulin-induced hypoglycemia. Nontraumatic compression fractures of the thoracic spine following seizures are a rare injury. Contractions of strong paraspinal muscles can lead to compression fracture of the midthoracic spine. Unrecognized hypoglycaemia should be considered to be a possible cause of convulsions in insulin-dependent diabetic patients. The aim of this report is to point out a case of rarely seen multilevel consecutive vertebrae fractures in a diabetic patient after a nocturnal hypoglycaemic convulsion attack. Ebru Atalar, Cuneyd Gunay, Hakan Atalar, and Tugba Tunc Copyright © 2015 Ebru Atalar et al. All rights reserved. Inflammatory Myofibroblastic Tumor of the Thigh: Presentation of a Rare Case and Review of the Literature Sun, 05 Apr 2015 09:42:12 +0000 Inflammatory myofibroblastic tumors are uncommon neoplasms; presentation of these tumors in the lower extremities is extremely rare. We present a case of a 47-year-old male with fever, fatigue, and a slow-growing thigh mass. The inflammatory markers were elevated and the MR images showed a well-defined intermuscular lesion with mild heterogeneous enhancement. The lesion was excised and histologic examination was consistent with an inflammatory myofibroblastic tumor. No adjuvant therapy was needed and the patient remained asymptomatic with no evidence of tumor recurrence during the 2 years of follow-up. O. D. Savvidou, V. I. Sakellariou, O. Papakonstantinou, E. Skarpidi, and P. J. Papagelopoulos Copyright © 2015 O. D. Savvidou et al. All rights reserved. Long Term Follow-Up of a Successful Lower Limb Replantation in a 3-Year-Old Child Thu, 02 Apr 2015 11:21:20 +0000 Replantation of the lower extremity has controversial indications but nevertheless it may be considered in carefully selected patients who present early and are expected to show good functional recoveries. Here we present a successful replantation in a 3-year-old boy who has made excellent recovery with no functional deficit evident at 12 years of follow-up. He sustained a traumatic amputation at the level of distal tibia when he fell of a “Qing Qi” (motorcycle rickshaw). Replantation was attempted at 8 hours cold ischemia time with the tibia shortened 4 cm and all tendons, vessels, and nerves repaired. Patient required a second procedure during the same hospital stay for skin coverage. Patient made good recovery with ambulation without support at 6 months, less than 3 cm limb length discrepancy, plantar and dorsiflexion power 4/5, and recovery of sensation over the foot. Now at 12 years of follow-up patient has a normal gait and has integrated into society with no functional deficit. Considering the functional outcome of our case, replantation should be attempted whenever possible and feasible especially in children. Akbar Jaleel Zubairi and Pervaiz Mahmood Hashmi Copyright © 2015 Akbar Jaleel Zubairi and Pervaiz Mahmood Hashmi. All rights reserved. Extrinsic Subclavian Vein Compression after Osteosynthesis of a Midshaft Clavicular Fracture in an Athlete Wed, 01 Apr 2015 08:33:42 +0000 Clavicle fractures are common injuries. Traditionally, nonsurgical management has been favored; however, recent evidence has emerged indicating that operative fixation produces lower nonunion rates, better functional outcomes, improved cosmesis, and greater patient satisfaction. Although clavicle fixation has been considered a safe procedure, several complications related to plate fixation have been reported. We report a case of a 21-year-old basketball player that had a vascular complication associated with internal fixation of a clavicle fracture. An external compression of the subclavian vein was attributed to a long screw of a precontoured clavicular plate. Although vascular complications associated with clavicle fixation are rare, they may be limb and even life threating. It is advisable that surgeons take measures to avoid them especially when placing the medial screws. Luciano A. Rossi, Nicolas S. Piuzzi, Santiago L. Bongiovanni, Ignacio Tanoira, Gaston Maignon, and Maximiliano Ranalletta Copyright © 2015 Luciano A. Rossi et al. All rights reserved. Rotationplasty with Vascular Reconstruction for Prosthetic Knee Joint Infection Mon, 30 Mar 2015 13:59:36 +0000 Rotationplasty is used most often as a function-preserving salvage procedure after resection of sarcomas of the lower extremity; however, it is also used after infection of prosthetic knee joints. Conventional vascular management during rotationplasty is to preserve and coil major vessels, but recently, transection and reanastomosis of the major vessels has been widely performed. However, there has been little discussion regarding the optimal vascular management of rotationplasty after infection of prosthetic knee joints because rotationplasty is rarely performed for this indication. We reviewed four patients who had undergone resection of osteosarcomas of the femur, placement of a prosthetic knee joint, and rotationplasty with vascular reconstruction from 2010 to 2013. The mean interval between prosthetic joint replacement and rotationplasty was 10.4 years and the mean interval between the diagnosis of prosthesis infection and rotationplasty was 7.9 years. Rotationplasty was successful in all patients; however, in one patient, arterial thrombosis developed and necessitated urgent surgical removal and arterial reconstruction. All patients were able to walk independently with a prosthetic limb after rehabilitation. Although there is no consensus regarding the most appropriate method of vascular management during rotationplasty for revision of infected prosthetic joints, vascular transection and reanastomosis is a useful option. Masahide Fujiki, Shimpei Miyamoto, Fumihiko Nakatani, Akira Kawai, and Minoru Sakuraba Copyright © 2015 Masahide Fujiki et al. All rights reserved. Total En Bloc Spondylectomy for Locally Aggressive Vertebral Hemangioma Causing Neurological Deficits Mon, 30 Mar 2015 12:15:41 +0000 Vertebral hemangiomas are common; however, aggressive vertebral hemangiomas with extraosseous extensions causing neurological deficits are rare. The treatment for this subtype of hemangioma remains controversial, since there are few reports on long-term clinical outcomes or tumor recurrence rates. We describe a case of aggressive vertebral hemangioma treated by total en bloc spondylectomy, with a literature review focusing on long-term recurrence. A 52-year-old male with a two-month history of numbness in the bilateral lower extremities was referred to our hospital. Imaging studies showed a tumor originating in the T9 vertebra and extending to the T8 and T10 vertebrae, with extraosseous extension causing spinal-cord compression. Ten months after onset, the patient presented with progressive paraparesis and hypalgesia. Total en bloc spondylectomy was performed, and pathology was consistent with cavernous hemangioma. Motor and sensory deficits improved significantly, and no signs of recurrence are seen at 2.5 years after operation. A review of literature revealed a recurrence rate of 12.7% (10/79 cases). The available evidence indicates satisfactory long-term outcomes for total tumor resection without adjuvant radiotherapy. Ryo Ogawa, Tomohiro Hikata, Shuji Mikami, Nobuyuki Fujita, Akio Iwanami, Kota Watanabe, Ken Ishii, Masaya Nakamura, Yoshiaki Toyama, and Morio Matsumoto Copyright © 2015 Ryo Ogawa et al. All rights reserved.