Case Reports in Orthopedics The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Bilateral Hip Joint Hylan G-F 20 Granulomatous Synovitis due to Viscosupplementation Injections Mon, 25 Aug 2014 09:08:30 +0000 We present the diagnosis of bilateral granulomatous inflammation of the hip joints associated with Hylan G-F 20 viscosupplementation injections. Clinicians recommending therapeutic Hylan injections for the management of hip arthritis should maintain clinical awareness regarding this potential complication. Patrick Weinrauch, Robert Trigger, and George Tsikleas Copyright © 2014 Patrick Weinrauch et al. All rights reserved. Parosteal Osteoma of the Clavicle Mon, 25 Aug 2014 00:00:00 +0000 Introduction. Osteoma is a benign, slowly growing, asymptomatic, osteogenic neoplasm. Osteoma of a bone other than the skull and facial bones is extremely rare. An extremely rare case of parosteal osteoma is reported. Case Presentation. A 51-year-old woman presented with a large mass in the left supraclavicular fossa. Radiographs and computed tomography revealed a well-defined, 9 × 6 cm, lobed mass in the midportion of the clavicle. Magnetic resonance imaging revealed that it had the same density as cortical bone. An open biopsy was performed to rule out malignant bone tumours, and parosteal osteoma was diagnosed. Four years after the biopsy, the patient was asymptomatic. Conclusion. A rare case of parosteal osteoma of the clavicle was described. Open biopsy is required to rule out a malignant bone tumour, even if parosteal osteoma is suspected based on the clinical course and imaging findings. Takao Inokuchi, Toshiaki Hitora, Yosiki Yamagami, Hideki Nishimura, and Tetsuji Yamamoto Copyright © 2014 Takao Inokuchi et al. All rights reserved. Osteomyelitis Caused by Candida glabrata in the Distal Phalanx Sun, 24 Aug 2014 06:01:57 +0000 Osteomyelitis caused by Candida glabrata is rare and its optimal treatment is unknown. Here we report a case of osteomyelitis caused by C. glabrata in the distal phalanx in a 54-year-old woman. Despite partial resection of the nail and administering a 1-month course of antibiotics for paronychia, the local swelling remained and an osteolytic lesion was found. C. glabrata osteomyelitis of the distal phalanx was later diagnosed after curettage. Thereafter, the patient was treated with antifungal agents for 3 months. The infection eventually resolved, and radiological healing of the osteolytic lesion was achieved. Antifungal susceptibility testing should be performed in the case of osteomyelitis caused by nonalbicans Candida species, due to their resistance to fluconazole. Shunichi Toki, Naohito Hibino, Koichi Sairyo, Mitsuhiko Takahashi, Shinji Yoshioka, Masahiro Yamano, and Tatsuhiko Henmi Copyright © 2014 Shunichi Toki et al. All rights reserved. Anterior Spinal Artery Syndrome: Reversible Paraplegia after Minimally Invasive Spine Surgery Wed, 20 Aug 2014 11:43:19 +0000 Background Context. Percutaneous balloon kyphoplasty is an established minimally invasive technique to treat painful vertebral compression fractures, especially in the context of osteoporosis with a minor complication rate. Purpose. To describe the heparin anticoagulation treatment of paraplegia following balloon kyphoplasty. Study Design. We report the first case of an anterior spinal artery syndrome with a postoperative reversible paraplegia following a minimally invasive spine surgery (balloon kyphoplasty) without cement leakage. Methods. A 75-year-old female patient underwent balloon kyphoplasty for a fresh fracture of the first vertebra. Results. Postoperatively, the patient developed an acute anterior spinal artery syndrome with motor paraplegia of the lower extremities as well as loss of pain and temperature sensation with retained proprioception and vibratory sensation. Complete recovery occurred six hours after bolus therapy with 15.000 IU low-molecular heparin. Conclusion. Spine surgeons should consider vascular complications in patients with incomplete spinal cord syndromes after balloon kyphoplasty, not only after more invasive spine surgery. High-dose low-molecular heparin might help to reperfuse the Adamkiewicz artery. J. Bredow, J. Oppermann, K. Keller, F. Beyer, C. K. Boese, K. Zarghooni, R. Sobottke, P. Eysel, and J. Siewe Copyright © 2014 J. Bredow et al. All rights reserved. Arthroscopic Debridement of the Posterior Compartment of the Knee after Total Knee Arthroplasty Mon, 18 Aug 2014 12:26:49 +0000 Arthroscopic debridement of the posterior compartment of the knee after total knee arthroplasty is difficult because it is tough to obtain intercondylar notch views. Herein, we performed arthroscopic debridement of the posterior compartment of an infected knee after total knee arthroplasty by using a transseptal portal in a 62-year-old woman with rheumatoid arthritis. Palpation of anatomical landmarks and posterior capsule protection are important for safe creation of a transseptal portal following to making 2 posterior portals. Tsuyoshi Ohishi, Tomotada Fujita, Daisuke Suzuki, Kazufumi Yamamoto, Hiroki Ushirozako, and Yukihiro Matsuyama Copyright © 2014 Tsuyoshi Ohishi et al. All rights reserved. An Unusual Knee Trauma: Combined Rupture of Medial Collateral Ligament and Patellar Tendon Mon, 18 Aug 2014 06:37:47 +0000 We present the case of a combined lesion of the medial collateral ligament (MCL) and patellar tendon of the knee in a 45-year-old man, after a fall while skiing. Although there are numerous publications concerning associated tears of MCL and other knee ligaments, a combination of MCL tear with a rupture of the patellar tendon is very rare. After a review of the literature and treatment guidelines about these lesions, the clinical case is described and discussed. This knee trauma was treated with a transosseous reinsertion of the patellar tendon, which was reinforced by an allograft of fascia lata, followed by a direct suture of the MCL, which was reinforced with the lateral semitendinosus tendon. T. De Baere, J. De Muylder, and A. Deltour Copyright © 2014 T. De Baere et al. All rights reserved. Osteonecrosis of Femoral Head Occurred after Stent Placement of Femoral Artery Sun, 17 Aug 2014 12:00:53 +0000 We present a case of osteonecrosis of femoral head (ONFH) that occurred after stent angiography of femoral artery for the treatment of arteriosclerosis obliterans (ASO) of left inferior limb in a 76-year-old woman. No case of late collapse of femoral head as a complication of endovascular procedure such as stent placement has been previously documented. We considered that ONFH occurred after detaining stent at a junction of left deep femoral artery for the treatment of the ischemia of left lateral and medial femoral circumflex artery. Akiyoshi Shimatani, Fumiaki Inori, Taku Yoshida, Masahiko Tohyama, Sadahiko Konishi, and Hirotsugu Ohashi Copyright © 2014 Akiyoshi Shimatani et al. All rights reserved. Successful Nonoperative Treatment of Isolated Popliteus Tendon Avulsion Fractures in Two Adolescents Thu, 14 Aug 2014 13:27:46 +0000 Isolated popliteal tendon avulsion fractures are relatively uncommon in the pediatric population as other posterolateral lateral structures are often involved. This report describes two skeletally immature male patients who presented with knee injuries without ligamentous instability and were subsequently diagnosed with isolated popliteus tendon avulsion fractures. Both of these patients were managed nonoperatively and had subjectively full recoveries. As the treatment for isolated popliteal tendon avulsion fractures is still unclear, the report here may contribute to strategies regarding conservative treatment of these injuries. Scott D. McKay, Andrew Holt, Thomas Stout, and Viola Qafalijaj Hysa Copyright © 2014 Scott D. McKay et al. All rights reserved. Intra-Articular Polyacrylamide Hydrogel Injections Are Not Innocent Wed, 13 Aug 2014 12:25:24 +0000 Osteoarthritis is a chronic disorder characterized by joint cartilage degeneration with concomitant changes in the synovium and subchondral bone metabolism. Many conservative treatment modalities, one of which is intra-articular injections, have been described for the treatment of this disorder. Traditionally, hyaluranic acid and corticosteroids are the agents that have been used for this purpose. Recently, polyacrylamide hydrogels are being used widely. Biocompatibility, nonbioabsorbability, and anti-infectious effect obtained by silver addition made polyacrylamide hydrogels more popular. In this paper, we present a case and the method of our management, in whom host tissue reaction (foreign body granuloma, edema, inflammation, and redness induration) has been observed, as the first and unique adverse effect reported in the literature. Murat Tonbul, Mujdat Adas, Taner Bekmezci, and Ahmet Duran Kara Copyright © 2014 Murat Tonbul et al. All rights reserved. Surgical Treatment of a Rare Isolated Bilateral Agenesis of Anterior and Posterior Cruciate Ligaments Wed, 13 Aug 2014 00:00:00 +0000 The isolated bilateral agenesis of both cruciate ligaments is a rare congenital disorder. A 17-year-old male came to our attention due to an alteration in gait pattern, pain, and tendency to walk on the forefoot with his knee flexed. The patient did not recall previous injuries. Upon physical examination anterior and posterior chronic instability were observed. Radiographic examination of both knees showed hypoplasia of the tibial eminence, a hypoplastic lateral femoral condyle, and a narrow intercondylar notch. MRI brought to light a bilateral agenesis of both posterior cruciate ligaments. Arthroscopic evaluation confirmed bilateral isolated agenesis of both cruciate ligaments. We recommended a rehabilitation program to prepare the patient for the arthroscopic construction of both cruciate ligaments. G. Cerulli, A. Amanti, and G. Placella Copyright © 2014 G. Cerulli et al. All rights reserved. Unusual Presentation of Pseudoaneurysm with Trochanteric Fracture Femur with Associated Long-Term Antiepileptic Therapy Tue, 12 Aug 2014 09:24:46 +0000 Arterial injury following impalement due to a trochanteric hip fracture-fragment per se has been documented rarely. We report a case of pseudoaneurysm of profunda femoris artery at the first perforator branch in a 48-year-old male, with trochanteric hip fracture following a fall during an epileptic episode. Persistent recalcitrant pain, globular swelling in the groin, unexplained drop in the haemoglobin level, and color doppler ultrasonography findings were salient features to the diagnosis. Additionally, we collected all reported cases of pseudoaneurysm associated with hip fractures. We reviewed the literature regarding the incidence, treatment, and prognosis for the same. Acute vascular injury was probably caused by the spikes of fractured lesser trochanter which was found to be displaced superomedially. All trochanteric fractures especially those with displaced lesser trochanter fragment should be closely watched for the possibility of vascular injury. Early diagnosis and treatment in a staged manner can prevent the catastrophic vascular event and hence the limb. Nipun Rana, Gajanand Dhaked, Satish Sharma, and Sandeep Tripathi Copyright © 2014 Nipun Rana et al. All rights reserved. Paradoxical Cerebral Fat Embolism in Revision Hip Surgery Mon, 11 Aug 2014 08:01:03 +0000 The incidence of clinical fat embolism syndrome (FES) is low (<1%) whilst fat embolism (FE) of marrow fat appears to occur more often (Mellor and Soni (2001)). Paradoxical brain FE may occur in patients undergoing hip orthopedic surgery who have an undocumented patent foramen ovale (PFO). We report a case of an eighty-year-old male patient, who underwent a scheduled revision hip surgery suffering a paradoxical cerebral FE. Nicolás S. Piuzzi, Gerardo Zanotti, Fernando M. Comba, Martin A. Buttaro, and Francisco Piccaluga Copyright © 2014 Nicolás S. Piuzzi et al. All rights reserved. Charcot Spine and Parkinson’s Disease Wed, 06 Aug 2014 08:11:50 +0000 Charcot spine is rare condition whose association with Parkinson’s disease (PD) has not been reported yet. The authors reported the cases of two patients with PD who developed Charcot spine. Both patients presented with a history of back pain and bilateral radicular leg pain. They had complete clinical and radiological assessment. Lumbar spine was involved in both patients. Clinical features and response to treatment were described. In the first case, circumferential fusion and stabilization were performed on the dislocated vertebral levels. A solid and stable fusion of the spine was obtained with satisfactory clinical outcome. Surgical treatment has been recommended to the other patient. In both cases, no other neurological etiology was found to account for Charcot spine. In conclusion, Charcot spine is associated with several neurological affections but has not previously been reported in association with Parkinson’s disease. Philippe Loriaut, Sylvie Rozenberg, Patrick Boyer, Benjamin Dallaudière, Frederic Khiami, Elhadi Sariali, and Hugues Pascal-Moussellard Copyright © 2014 Philippe Loriaut et al. All rights reserved. Pachydermodactyly Treated with Tranilast in a Young Girl Wed, 06 Aug 2014 07:22:45 +0000 Introduction. Pachydermodactyly is a rare disease with asymptomatic swelling of proximal interphalangeal joints. This disorder should be considered in the differential diagnosis of juvenile idiopathic arthritis or rheumatoid arthritis. However, pachydermodactyly is not well recognized by many orthopaedic surgeons and rheumatologists. Case Presentation. We report herein a case of a 13-year-old girl with pachydermodactyly. She presented to our clinic with symmetrical swelling of digits II through V without functional loss for the last 4 years. X-ray examination demonstrated no bone or joint destruction and magnetic resonance images showed only thickened skin tissues. No inflammatory signs were seen with laboratory blood tests. We reached a diagnosis of pachydermodactyly by exclusion. We had administered tranilast to her for 6 months and her symptom slightly improved. Conclusion. It is important to recognize pachydermodactyly and be able to differentiate it from other causes of PIP joint swelling such as rheumatoid arthritis, although pachydermodactyly is rare and benign. Physicians including orthopaedists and rheumatologists should make a prompt diagnosis to avoid unnecessary investigations and prevent the patient from receiving inappropriate treatment with steroids or cytotoxic agents. On the other hand, tranilast might be an effective drug to pachydermodactyly. Chikahisa Higuchi, Tetsuya Tomita, and Hideki Yoshikawa Copyright © 2014 Chikahisa Higuchi et al. All rights reserved. Inflammatory Pseudotumor Complicated by Recurrent Dislocations after Revision Total Hip Arthroplasty Mon, 04 Aug 2014 07:11:31 +0000 A 71-year-old female with a history of right total hip arthroplasty presented with an enlarging pseudotumor. Pseudotumor is a known complication following metal-on-metal and metal-on-conventional polyethylene and metal-on-highly cross-linked polyethylene implants. Revision total hip arthroplasty following resection of pseudotumor has resulted in an increase in incidence of postoperative complications. Despite stable implants, these complications arise from the amount of soft tissue damage combined with the loss of tissue support around the resected hip. Our case is a clear example of a major complication, recurrent dislocation, following resection and revision surgery. John Ryan Quinn, Jason Lee, and Ran Schwarzkopf Copyright © 2014 John Ryan Quinn et al. 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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.