Case Reports in Orthopedics The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Atlantoaxial Subluxation due to an Os Odontoideum in an Achondroplastic Adult: Report of a Case and Review of the Literature Thu, 26 Nov 2015 11:36:23 +0000 The authors report the first example of an adult achondroplastic dwarf with progressive quadriparesis secondary to atlantoaxial subluxation as a consequence of an os odontoideum. Actually, craniocervical region is a frequent site of compression and myelopathy in achondroplasia particularly in children as a result of small foramen magnum and hypertrophied opisthion. Moreover, very rarely in achondroplastic patients, coexistence of atlantoaxial instability as the sequel of os odontoideum can result in further compression of the already compromised cervicomedullary neural tissues, the scenario that has been reported only in five achondroplastic children. Herein, a 39-year-old achondroplastic male suffering such an extremely rare combination is presented. With C1-C2 screw rod instrumentation, atlas arch laminectomy, limited suboccipital craniectomy, and release of dural fibrous bands, reduction, decompression, and stabilization could be achieved properly resulting in steady but progressive recovery. Abolfazl Rahimizadeh, Housain F. Soufiani, Valiolah Hassani, and Ava Rahimizadeh Copyright © 2015 Abolfazl Rahimizadeh et al. All rights reserved. Ten-Year Follow-Up of Desarthrodesis of the Knee Joint 41 Years after Original Arthrodesis for a Bone Tumor Wed, 25 Nov 2015 13:08:44 +0000 Introduction. The main indication for knee arthrodesis in tumor surgery is a tumor that requires an extensive resection in which the joint surface cannot be preserved. We report a patient that had knee desarthrodesis 41 years after giant cell tumor resection followed by a knee arthrodesis. This is the longest reported follow-up after desarthrodesis and conversion to total knee arthroplasty (TKA), almost ten years. Case Report. A 71-year-old man with a distal femoral giant cell tumor had undergone a resection of the distal femur and knee arthrodesis using Kuntscher nail in 1962. In July 2003 he experienced gradually increasing pain of his left knee. We performed a desarthrodesis and conversion to TKA in 2005. The postoperative period passed uneventfully as his pain and gait improved, with gradually increasing range of motion (ROM) and no infection. He now walks independently, with no brace or contractures. Conclusion. Desarthrodesis of the knee joint and conversion to TKA are a difficult surgical choice with a high complication risk. However, our patient’s life style has improved, he has no pain, and he can ascend and descend stairs more easily. The surgeon has to be very meticulous in selecting a patient for knee arthrodesis and counseling them to realize that their expectations may not be achievable. Ahmed Hamed Kassem Abdelaal, Norio Yamamoto, Katsuhiro Hayashi, Akihiko Takeuchi, Shinji Miwa, Hiroyuki Inatani, and Hiroyuki Tsuchiya Copyright © 2015 Ahmed Hamed Kassem Abdelaal et al. All rights reserved. Surgical Management of Unilateral Soft Tissue Swelling around the Proximal Interphalangeal Joint in an Adolescent: A Case Report of Pachydermodactyly Tue, 24 Nov 2015 11:00:29 +0000 Pachydermodactyly (PDD) is a rare and benign acquired form of digital fibromatosis, characterized by asymptomatic fusiform soft tissue hypertrophy of the lateral aspect of the proximal interphalangeal (PIP) joints of the fingers. The etiology of PDD remains unknown, but it usually affects healthy males around the age of puberty. It can be misdiagnosed as inflammatory rheumatic diseases, especially as juvenile chronic arthritis. Here, we report a case of PDD in an 18-year-old man who had progressive fusiform swelling of the PIP joint on his left middle finger. Although he had no pain or functional limitation of movement, he chose to undergo surgical resection of the lesion to obtain a conclusive diagnosis and to rectify the deformity’s appearance. Histologically, the lesion was characterized by coarse fibrosis in the adipose tissue, peripheral nerve fibers, and eccrine glands; this is compatible with a diagnosis of PDD. Naoki Kato, Mamoru Niitsu, Tetsuya Kawabe, Eiichi Arai, and Keizo Fukumoto Copyright © 2015 Naoki Kato et al. All rights reserved. A Rare Case of Tumoral Calcium Pyrophosphate Dihydrate Crystal Deposition Disease of the Wrist Joint Tue, 17 Nov 2015 13:46:55 +0000 Introduction. Tumoral calcium pyrophosphate dihydrate (CPPD) crystal deposition disease (CPPDCD), also known as tophaceous calcium pyrophosphate deposition disease (CPDD), is a tumorlike lesion, and it should be distinguished from usual CPDD that causes severe joint inflammation and arthralgia. A case of tumoral CPPDCD of the wrist joint that required differentiation from synovial osteochondromatosis is described. Case Presentation. The patient was a 78-year-old woman with a 5-year history of nodular lesions at the right wrist that had gradually increased in size. An excisional biopsy and a histological examination of the excised nodular lesions by hematoxylin and eosin (H&E) staining were performed, demonstrating numerous polarizable, rhabdoid, and rectangular crystals, surrounded by fibroblasts, macrophages, and foreign body-type giant cells, consistent with tumoral CPPDCD. Conclusion. Tumoral CPPDCD, especially at the wrist joint, is rare, and, to the best of our knowledge, only 2 articles have been published. This case seems to need further follow-up for recurrence, because tumoral CPPDCD may recur after complete or incomplete surgical excision. Osamu Nakamura, Yoshio Kaji, Yoshiki Yamagami, Kounosuke Yamaguchi, Hideki Nishimura, Natsuko Fukuoka, and Tetsuji Yamamoto Copyright © 2015 Osamu Nakamura et al. All rights reserved. Hybrid Stabilization of Thoracic Spine Fractures with Sublaminar Bands and Transpedicular Screws: Description of a Surgical Alternative and Review of the Literature Mon, 16 Nov 2015 08:59:55 +0000 Stabilization of unstable thoracic fractures with transpedicular screws is widely accepted. However, placement of transpedicular screws can cause complications, particularly in the thoracic spine with physiologically small pedicles. Hybrid stabilization, a combination of sublaminar bands and pedicle screws, might reduce the rate of misplaced screws and can be helpful in special anatomic circumstances, such as preexisting scoliosis and osteoporosis. We report about two patients suffering from unstable thoracic fractures, of T5 in one case and T3, T4, and T5 in the other case, with preexisting scoliosis and extremely small pedicles. Additionally, one patient had osteoporosis. Patients received hybrid stabilization with pedicle screws adjacent to the fractured vertebral bodies and sublaminar bands at the level above and below the pedicle screws. No complications occurred. Follow-up was 12 months with clinically uneventful postoperative courses. No signs of implant failure or loss of reduction could be detected. In patients with very small thoracic pedicles, scoliosis, and/or osteoporosis, hybrid stabilization with sublaminar bands and pedicle screws can be a viable alternative to long pedicle screw constructs. Marie-Therese Unterweger, Frank Kandziora, and Klaus J. Schnake Copyright © 2015 Marie-Therese Unterweger et al. All rights reserved. Rotator Interval Lesion and Damaged Subscapularis Tendon Repair in a High School Baseball Player Thu, 05 Nov 2015 12:06:05 +0000 In 2013, a 16-year-old baseball pitcher visited Nobuhara Hospital complaining of shoulder pain and limited range of motion in his throwing shoulder. High signal intensity in the rotator interval (RI) area (ball sign), injured subscapularis tendon, and damage to both the superior and middle glenohumeral ligaments were identified using magnetic resonance imaging (MRI). Repair of the RI lesion and partially damaged subscapularis tendon was performed in this pitcher. During surgery, an opened RI and dropping of the subscapularis tendon were observed. The RI was closed in a 90° externally rotated and abducted position. To reconfirm the exact repaired state of the patient, arthroscopic examination was performed from behind. However, suture points were not visible in the >30° externally rotated position, which indicates that the RI could not be correctly repaired with the arthroscopic procedure. One year after surgery, the patient obtained full function of the shoulder and returned to play at a national convention. Surgical repair of the RI lesion should be performed in exactly the correct position of the upper extremity. Tomoyuki Muto, Hiroki Ninomiya, Hiroaki Inui, Masahiko Komai, and Katsuya Nobuhara Copyright © 2015 Tomoyuki Muto et al. All rights reserved. Multifocal Osteonecrosis Secondary to Chronic Alcohol Ingestion Thu, 05 Nov 2015 06:38:27 +0000 Multifocal osteonecrosis is a relatively rare disorder with an estimated incidence of around 3% among patients diagnosed as having osteonecrosis. Multifocal osteonecrosis is caused by the several conditions including corticosteroid treatment, coagulation disorders, connective tissue disorders including systemic lupus erythematosus (SLE), inflammatory bowel disease, renal transplantation, and underlying malignancies. Alcohol abuse is one of the risk factors for osteonecrosis, and alcohol-induced osteonecrosis is 5% among all the osteonecrosis. Furthermore, the overall incidence of alcohol-induced multifocal osteonecrosis was approximately 6% among all the osteonecrosis induced by the alcohol. Therefore, here, we report an extremely rare case of alcohol-induced multifocal osteonecrosis involving three joints (two knees and one hip) and review the related literature. Kazu Matsumoto, Hiroyasu Ogawa, and Haruhiko Akiyama Copyright © 2015 Kazu Matsumoto et al. All rights reserved. An Unusual Cause of Posterior Elbow Impingement: Detachment of a Hypertrophied Posterior Fat Pad Tue, 03 Nov 2015 09:33:30 +0000 We report a case of a 47-year-old woman who developed posterior impingement of the elbow due to detachment of a hypertrophied posterior fat pad. She reported acute left elbow pain after leaning back onto a hard object with her hand and subsequently experienced a “catching” sensation. Comparison with the magnetic resonance images of a normal elbow revealed a hypertrophied posterior fat pad interposed between the olecranon and olecranon fossa in both elbows, with the fat pad in the left elbow located more inferiorly than that in the right elbow. Elbow arthroscopy showed the olecranon fossa covered by the fat pad, a portion of which was detached from the rest of the pad. Debridement of the detached portion was performed until no impingement was evident. Postoperatively, full extension of the elbow did not elicit pain. Clinicians should include this pathology among the differential diagnoses for posterior elbow pain. Daisuke Hamada, Tetsuya Matsuura, Kosuke Sugiura, Tadahiro Higuchi, Naoto Suzue, Tomohiro Goto, Takahiko Tsutsui, Keizo Wada, Shoji Fukuta, and Koichi Sairyo Copyright © 2015 Daisuke Hamada et al. All rights reserved. Repair of Unstable Posterior Sternoclavicular Dislocation Using Nonabsorbable Tape Suture and Tension Band Technique: A Case Report with Good Results Tue, 03 Nov 2015 09:32:43 +0000 Posterior sternoclavicular joint dislocation (PSCJD) is quite a rare condition. Nearly half of the closed reduction attempts fail due to various reasons. In this paper, we present a 25-year-old male patient who was admitted to the emergency department in our hospital after having a motor-vehicle accident. It was decided to do PSCJD after physical and imaging studies. Following necessary preparations, closed reduction was attempted with abduction-traction maneuver under general anesthesia; however, adequate stabilization could not be achieved and redislocation was detected during control. Therefore, joint was stabilized with tension band technique using 6 mm polyamide nonabsorbable type suture during open reduction. Painless and complete range of motion in shoulder was achieved at the postoperative 10th week. Ekrem Aydın, Turan Cihan Dülgeroğlu, Ali Ateş, and Hasan Metineren Copyright © 2015 Ekrem Aydın et al. All rights reserved. Migration of the Anterior Spinal Rod to the Right Thigh, a Rare Complication of Anterior Spinal Instrumentations: A Case Report and a Literature Review Tue, 03 Nov 2015 06:29:37 +0000 Posterior and anterior fusion procedures with instrumentation are well-known surgical treatments for scoliosis. Rod migration has been described as unusual complication in anterior spinal instrumentations; migration beyond pelvis is a rare complication. A 32-year-old female presented to the consultant with right thigh pain, rod migration was diagnosed, rod extraction by minimal approach was performed, and spinal instrumentation after nonunion diagnosis was underwent. A rod migration case to the right thigh is presented; this uncommon complication of spinal instrumentation should be ruled out as unusual cause of sudden pain without any other suspicions, and long-term follow-up is important to prevent and diagnose this problem. Camino Willhuber Gaston, Taype Zamboni Danilo, Carabelli Guido, Barla Jorge, and Sancineto Carlos Copyright © 2015 Camino Willhuber Gaston et al. All rights reserved. Posterolateral Corner Injury Associated with a Schatzker Type 2 Tibial Plateau Fracture Tue, 27 Oct 2015 07:22:45 +0000 Isolated posterolateral corner (PLC) injuries are rarely seen with tibial plateau fractures and can be missed during the initial assessment. The objective of this paper is to present a case of a Schatzker type 2 tibial plateau fracture with associated isolated PLC injury and give a discussion on physical exam, diagnostic studies, and treatment options. A twenty-five-year-old female sustained a concomitant Schatzker type 2 fracture and PLC injury. Magnetic Resonance Imaging showed an isolated PLC disruption. Open reduction-internal fixation was performed with subsequent PLC repair. At sixteen months postoperatively, the patient had full range of motion and strength of her knee and no signs of laxity. This case emphasizes the importance of physical exam and appropriate imaging modalities in order to diagnose and treat this significant injury in a prompt fashion. In this case, surgical fracture fixation and subsequent repair of the PLC provided a good clinical outcome. Boris A. Zelle, James R. Heaberlin, and Matthew C. Murray Copyright © 2015 Boris A. Zelle et al. All rights reserved. Calcinosis Universalis of the Elbow: A Rare Case with Classical Presentation Thu, 22 Oct 2015 08:18:53 +0000 Juvenile Dermatomyositis (JDM) is a rare autoimmune disease in children and adolescents. In these patients calcinosis might be the most characteristic symptom. However there are only few reported cases of intramuscular calcinosis in Dermatomyositis. We report a case of calcinosis universalis (CU) of the elbow in JDM successfully treated with broaching. The patient, a 24-year-old woman, suffered from a long history of JDM. On examination she presented with a fistula lateral to the olecranon and pain of the right elbow joint. Plain X-rays displayed a diffuse pattern of multiple periarticular, subcutaneous, and intramuscular calcifications. The patient underwent surgery for histological and microbiological sampling as well as broaching. Intraoperatively sinus formation and subfascial hard calcium deposition were found. Due to the risk of collateral tissue damage, incomplete broaching was performed. A local infection with Staphylococcus was diagnosed and treated with antibiotics. On six-week and 30-month follow-up the patient was free of pain and had very good function. Calcifications on standard radiographs had almost resolved entirely. This case report gives a summary on calcinosis in Dermatomyositis and adds a new case of recalcitrant CU to the literature. Broaching surgery proved to be a reliable treatment option in symptomatic calcinosis. Sebastian Philipp Boelch, Thomas Barthel, Sascha Goebel, Maximilian Rudert, and Piet Plumhoff Copyright © 2015 Sebastian Philipp Boelch et al. All rights reserved. Medial Patellofemoral Ligament Reconstruction in a Below-Knee Amputee Thu, 22 Oct 2015 06:13:48 +0000 Patellar instability is a common finding in patients with below-knee amputation and yet management options are not commonly described in the literature. We describe the first reported case of a medial patellofemoral ligament reconstruction using allograft in a patient with a below-knee amputation. Clinical outcome at two-year follow-up remains very good. Sherif El-Tawil, Marian Elfons Tawafig, and Jonathan Miles Copyright © 2015 Sherif El-Tawil et al. All rights reserved. Uncommon Variant of Type II Monteggia Fracture with Concomitant Distal Humeral Fracture Thu, 15 Oct 2015 13:02:25 +0000 Monteggia fracture-dislocation, a common injury sustained by pediatric population, is a rare entity in adults. It was first observed by Giovanni Battista Monteggia and later classified by Bado into 4 groups. The term “Monteggia equivalent or variant” was introduced to describe certain injuries with similar radiographic pattern and biomechanism of injury. Since then various types and their variants have been described in the literature. We present a complex fracture pattern in a 55-year-old male not previously described in the literature along with its treatment modality and favorable outcome. Jihad F. Matta, George S. El Rassi, Hicham G. Abd El Nour, and Rachel El Asmar Copyright © 2015 Jihad F. Matta et al. All rights reserved. Detached Anterior Horn of the Medial Meniscus Mimicking a Parameniscal Cyst Thu, 15 Oct 2015 12:12:55 +0000 We report a case of a detached anterior horn of the medial meniscus with anterior knee pain. Preoperative magnetic resonance images of the knee were initially interpreted as a parameniscal cyst. Arthroscopic examination revealed subluxation of the anterior horn of the medial meniscus due to detachment from its anterior tibial insertion. Arthroscopic fixation with a suture anchor was successful and the cystic lesion was no longer visible on postoperative images. Shoji Fukuta, Takahiko Tsutsui, Tetsuya Matsuura, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, and Koichi Sairyo Copyright © 2015 Shoji Fukuta et al. All rights reserved. A Bizarre, Unexplained, and Progressive External Rotation of the Shoulder as a Presentation of a Metastatic Deposit in the Rotator Cuff Mon, 12 Oct 2015 14:29:24 +0000 We describe the first reported case of a tumour deposit within the rotator cuff presenting as a bizarre, progressive, and fixed external rotation deformity of the shoulder. It is also the first reported case to our knowledge of an oesophageal primary metastasising to the rotator cuff. Sherif El-Tawil, Aditya Prinja, and Jeremy Stanton Copyright © 2015 Sherif El-Tawil et al. All rights reserved. Occipital Condyle Fracture with Accompanying Meningeal Spinal Cysts as a result of Cervical Spine Injury in 15-Year-Old Girl Mon, 12 Oct 2015 08:12:03 +0000 The occipital condyle fracture is rare injury of the craniocervical junction. Meningeal spinal cysts are rare tumors of the spinal cord. Depending on location, these lesions may be classified as extradural and subdural, but extradural spinal cysts are more common. We present the case of a 15-year-old girl who suffered from avulsion occipital condyle fracture treated with use of “halo-vest” system. We established that clinical effect after completed treatment is very good. Control MRI evaluation was performed 12 months after removal of “halo-vest” traction, and clinically silent extradural meningeal spinal cysts were detected at the ventral side of the spinal cord in the cervical segment of the spine. Due to clinically silent course of the disease, we decided to use the conservative treatment. The patient remains under control of our department. Łukasz Wiktor and Ryszard Tomaszewski Copyright © 2015 Łukasz Wiktor and Ryszard Tomaszewski. All rights reserved. Patellofemoral Joint Replacement and Nickel Allergy: An Unusual Presentation Mon, 12 Oct 2015 07:26:27 +0000 Metal allergy is an unusual complication of joint replacement that may cause aseptic loosening and necessitate joint revision surgery. We present the case of nickel allergy causing aseptic loosening following patellofemoral joint replacement (PFJR) in a 54-year-old male. Joint revision surgery to a nickel-free total knee replacement was performed with good results. Our literature review shows that there is no evidence to guide the management of metal allergy in PFJR. The evidence from studies of total knee replacement is limited to retrospective case series and case reports and gives contradictory recommendations. The optimal management strategy for metal allergy in PFJR is not clear. We recommend allergy testing in patients with history of metal allergy and use of an allergen-free implant in those with positive tests. As there is no gold standard test to establish metal allergy, the choice of test should be guided by availability and recommendation from the local unit of dermatology and allergy testing. We recommend investigation for metal allergy in patients with implant loosening where other causes have been excluded. Farhan Syed, Edward Jenner, and Mohammad Faisal Copyright © 2015 Farhan Syed et al. All rights reserved. Leclercia adecarboxylata Musculoskeletal Infection in an Immune Competent Pediatric Patient: An Emerging Pathogen? Mon, 12 Oct 2015 07:25:45 +0000 Case. An immune competent pediatric patient presented with a persistent lower extremity infection with Leclercia adecarboxylata after a penetrating injury. This case report details the presentation, clinical course, and treatment. Conclusion. Leclercia adecarboxylata has increasing reports in immunosuppressed and adult patients with musculoskeletal infection. This case now indicates that Leclercia adecarboxylata is a potential pathogen in immune competent children in musculoskeletal tissue. W. Jeffrey Grantham, Shawn S. Funk, and Jonathan G. Schoenecker Copyright © 2015 W. Jeffrey Grantham et al. All rights reserved. Secondary Radial Nerve Palsy after Minimally Invasive Plate Osteosynthesis of a Distal Humeral Shaft Fracture Thu, 08 Oct 2015 13:13:16 +0000 Minimally invasive plate osteosynthesis is a widely used procedure for the treatment of fractures of the femur and the tibia. For a short time it is also used for the treatment of humeral shaft fractures. Among other advantages, the ambassadors of this technique emphasize the lower risk of nerve injuries when compared to open reduction and internal fixation. We report the case of secondary radial nerve palsy caused by percutaneous fixation of a plate above the antecubital fold. The nerve did not recover and the patient needed a tendon transfer to regain active extension of the fingers. This case points to the importance of adequate exposure of the bone and plate if a humeral shaft fracture extends far distally. Ursina Bichsel and Richard Walter Nyffeler Copyright © 2015 Ursina Bichsel and Richard Walter Nyffeler. All rights reserved. Cascading Adjacent Level Vertebral Compression Fractures Necessitating a Series of Eleven Kyphoplasties Mon, 05 Oct 2015 11:43:42 +0000 Vertebral kyphoplasty is a procedure used for the treatment of compression fractures. While early randomized-controlled trials were equivocal regarding its benefits, more recent RCTs have shown favorable results for kyphoplasty with regard to pain relief, functional recovery, and health-care related quality of life compared to control patients. Risks of kyphoplasty include but are not limited to cement extrusion, infection, hematoma, and vertebral body fracture of adjacent levels. We describe a case of a 66-year-old male attorney who underwent eleven kyphoplasties in an approximately one-year period, the majority of which were for fractures of vertebrae adjacent to those previously treated with kyphoplasty. Information on treatment was gathered from the patient’s hospital chart and outpatient office notes. Following the last of the eleven kyphoplasties (two at T8, one each at all vertebrae from T9 to L5), the patient was able to function without pain and return to work. His physiologic thoracic kyphosis of 40 degrees prior to the first procedure was maintained, as were his lung and abdominal volumes. We conclude that kyphoplasty is an appropriate procedure for the treatment of vertebral compression fractures and can be used repeatedly to address fractures of levels adjacent to a previous kyphoplasty. Evan Curatolo, Matthew Reuter, Adil Samad, Daniel Flynn, Marc Menkowitz, and Steve Paragioudakis Copyright © 2015 Evan Curatolo et al. All rights reserved. A Huge Capital Drop with Compression of Femoral Vessels Associated with Hip Osteoarthritis Sun, 04 Oct 2015 15:45:27 +0000 A capital drop is a type of osteophyte at the inferomedial portion of the femoral head commonly observed in hip osteoarthritis (OA), secondary to developmental dysplasia. Capital drop itself is typically asymptomatic; however, symptoms can appear secondary to impinge against the acetabulum or to irritation of the surrounding tissues, such as nerves, vessels, and tendons. We present here a case of unilateral leg edema in a patient with hip OA, caused by a huge bone mass occurring at the inferomedial portion of the femoral head that compressed the femoral vessels. We diagnosed this bone mass as a capital drop secondary to hip OA after confirming that the mass occurred at least after the age of 63 years based on a previous X-ray. We performed early resection and total hip arthroplasty since the patient’s hip pain was due to both advanced hip OA and compression of the femoral vessels; moreover, we aimed to prevent venous thrombosis secondary to vascular compression considering the advanced age and the potent risk of thrombosis in the patient. A large capital drop should be considered as a cause of vascular compression in cases of unilateral leg edema in OA patients. Tomoya Takasago, Tomohiro Goto, Takahiko Tsutsui, Kenji Kondo, Daisuke Hamada, Ichiro Tonogai, Keizo Wada, and Koichi Sairyo Copyright © 2015 Tomoya Takasago et al. All rights reserved. Can Total Wrist Arthroplasty Be an Option for Treatment of Highly Comminuted Distal Radius Fracture in Selected Patients? Preliminary Experience with Two Cases Tue, 29 Sep 2015 13:57:36 +0000 We present two case reports of successful primary shortening of the forearm and total wrist arthroplasty (TWA) using the new angle-stable Maestro Wrist Reconstructive System (WRS) for treatment of highly comminuted distal radius fracture in selected autonomous patients. In a 56-year-old male patient with adequate bone stock, insertion of the noncemented Maestro WRS was combined with ulnar shortening osteotomy. In an 84-year-old female patient with poor osteoporotic bone stock, insertion of the radial cemented Maestro WRS was combined with ulnar head resection. Both patients could resume their work without additional surgery after TWA. At the 1-year follow-up, there were no changes in position of either implant without signs of loosening, no impingement, and no instability of the distal radioulnar joint or the distal ulna stump. All clinical parameters (DASH score, pain through VAS, and grip strength) were satisfactory. Both patients reported that they would have the same procedure again. Further experience is needed to validate this concept. Ingo Schmidt Copyright © 2015 Ingo Schmidt. All rights reserved. Acromioclavicular Dislocation Associated with Coracoid Process Fracture: Report of Two Cases and Review of the Literature Tue, 29 Sep 2015 09:18:14 +0000 Acromioclavicular dislocation associated with coracoid process fracture is a rare injury. Herein we reported two further cases with such combination of injuries and reviewed all previously published cases in current literature. In this review, we discussed the demographic characteristics, mechanism of injury, diagnosis, and treatment options extensively. Ozkan Kose, Kerem Canbora, Ferhat Guler, Omer Faruk Kilicaslan, and Hasan May Copyright © 2015 Ozkan Kose et al. All rights reserved. Bicruciate Ligament Reconstruction in a Professional Rugby Player: Clinical Presentation and Literature Review Tue, 29 Sep 2015 08:41:14 +0000 The association of an anterior cruciate ligament (ACL) tear and a posterior cruciate ligament (PCL) injury is rare in athletes, and to our knowledge it has never been described in a professional rugby player. We report the case of a 27-year-old international professional rugby player who presented with an ACL tear associated with chronic posterior laxity on a former PCL tear. The procedure associated arthroscopic ACL and PCL reconstruction in a one-stage operation with two autografts, bone-patellar tendon-bone and hamstring tendon, respectively. At 7 months postoperatively, the patient had returned to playing rugby at the same level of play. The therapeutic strategy successfully met the established goals of returning to sports at the same level of play with excellent functional results after 2 years of follow-up. A literature review was performed via PubMed. The inclusion criteria were the studies in English language, assessing the return-to-sport after bicruciate ligament reconstruction in athletes. Eight studies were included in analysis. Only one study has focused on the return-to-sport in 24 competitive athletes and two other studies have included 1 professional athlete each. The overall rate of the return-to-sport after bicruciate reconstruction varied between 100% and 50%. Yoann Bohu, Shahnaz Klouche, Serge Herman, Antoine Gerometta, and Nicolas Lefevre Copyright © 2015 Yoann Bohu et al. All rights reserved. Talar Neck Fracture after United Tibiotalar Fusion Tue, 29 Sep 2015 06:17:40 +0000 Tibiotalar arthrodesis is a well-established treatment for tibiotalar arthritis, for example, in younger high demand patients. Talar neck fractures are less common though well-recognised sequelae of foot ankle trauma. Here we present the clinical case of a 69-year-old male who presented to our institution with a nonunion of a talar neck fracture, having undergone a left tibiotalar fusion 24 years previously. To the authors’ knowledge, this injury has only been described once previously in the literature. However, the original case described a fracture sustained in the very early postoperative period following tibiotalar fusion, postulated to be secondary to postimmobilisation osteopaenia or stress risers from metalwork. The aetiology in this case is likely due to axial compression transmitted to the talar neck via the calcaneus. The predisposing factors for nonunion are discussed, highlighting the importance of vigilance for this injury in any patient with concomitant tibiotalar fusion and foot trauma. The management of this patient is discussed. W. Platt, M. Welck, and B. Rudge Copyright © 2015 W. Platt et al. All rights reserved. Combined Vascular and Orthopaedic Approach for a Pseudotumor Causing Deep Vein Thrombosis after Metal-on-Metal Hip Resurfacing Arthroplasty Sun, 20 Sep 2015 13:59:12 +0000 Introduction. Metal-on-metal (MoM) hip resurfacings have been associated with a variety of complications resulting from adverse reaction to metal debris. Pseudotumors have rarely been reported to cause deep venous thrombosis (DVT). Study Design. A case report and a review of the literature. Case Presentation. A 75-year-old female who had left metal-on-metal hip resurfacing 6 years ago presented with left groin pain associated with unilateral lower limb edema and swelling. By duplex and MRI studies, our patient had an extensive soft tissue necrosis associated with a large pelvic mass causing extensive DVT of the lower limb secondary to mechanical compression of the left iliac vein. Results. Our case was initially treated for DVT followed by dual surgical approach. The pseudotumor was excised through a separate iliofemoral approach and revision of the hip implant was undertaken through a posterior approach in the same setting. An inferior vena cava (IVC) filter was inserted to minimise the perioperative risks of handling the iliac veins. Conclusion. A combined approach with vascular surgeons is required. Combined resection of the pseudotumor and revision of the metal bearing surfaces is essential, in order to achieve a good surgical outcome in this rare complication. Hossam Abdel-Hamid, Jonathan Miles, Richard W. J. Carrington, Alister Hart, Alex Loh, and John A. Skinner Copyright © 2015 Hossam Abdel-Hamid et al. All rights reserved. Traumatic Dislodgement of Tibial Polyethylene Insert after a High-Flex Posterior-Stabilized Total Knee Replacement Sun, 20 Sep 2015 10:38:44 +0000 Many pathologic entities can produce a painful total knee replacement (TKR) that may lead to potential prosthetic failure. Polyethylene insert dissociation from the tibial baseplate has been described most frequently after mobile-bearing and cruciate-retaining TKRs. However, only 3 tibial insert dislocations in primary fixed-bearing High-Flex posterior-stabilized TKRs have been reported. We present a new case of tibial insert dislocation in a High-Flex model that shares similarities and differences with the cases reported, facilitating the analysis of the potential causes, which still remain undefined. Juan Felix Astoul Bonorino, Pablo Ariel Isidoro Slullitel, Gonzalo Rodrigo Kido, Santiago Bongiovanni, Renato Vestri, and Lisandro Carbó Copyright © 2015 Juan Felix Astoul Bonorino et al. All rights reserved. Fracture of the Fabella: An Uncommon Injury in Knee Sun, 13 Sep 2015 13:44:10 +0000 The fabella is a sesamoid bone that may contribute to the stabilization of the posterolateral knee corner and it can very occasionally act as a source of atypical and rare knee pain and functional impairment. Fracture of the fabella is a rare but important clinical entity which may be overlooked clinically and radiographically. However, it causes an intermittent mechanical pain of the knee and it can mistakenly harm another knee pathology like intra-articular loose body. We report a case of a 21-year-old man who was sustaining a fracture of fabella following vehicle accident. Taoufik Cherrad, Jamal Louaste, Hicham Bousbaä, Larbi Amhajji, and Rachid Khaled Copyright © 2015 Taoufik Cherrad et al. All rights reserved. Total Hip Arthroplasty after Treatment of an Atypical Subtrochanteric Femoral Fracture in a Patient with Pycnodysostosis Thu, 10 Sep 2015 14:14:04 +0000 The authors describe the case of a 51-year-old woman with an osteonecrosis of her right femoral head after treatment of an atypical subtrochanteric fracture caused by pycnodysostosis. She had this fracture after a low-trauma fall. She was of short stature with typical facial features, short stubby hands, and radiological features including open cranial sutures, obtuse mandible, and generalized skeletal sclerosis. The majority of cases of atypical subtrochanteric fractures are associated with long-term use of bisphosphonates; some occur in bisphosphonate-free patients. We report a rare case of total hip arthroplasty (THA) in a patient with pycnodysostosis who developed an osteonecrosis of the femoral head after treatment of an atypical subtrochanteric femoral fracture. We performed cementless THA in combination with a plate and cables. Cementless THA is a potential intervention in a patient with pycnodysostosis; although the bone quality may have been sclerotic, healing is not a problem in this condition. Takahito Yuasa, Koichi Maeda, Kazuo Kaneko, and Kazunori Yoshikata Copyright © 2015 Takahito Yuasa et al. All rights reserved.