Case Reports in Orthopedics The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Patella Dislocation with Vertical Axis Rotation: The “Dorsal Fin” Patella Wed, 25 Mar 2015 08:44:47 +0000 A 44-year-old woman presented following minor trauma to her right knee. While dancing she externally rotated around a planted foot and felt sudden pain in her right knee. She presented with her knee locked in extension with a “dorsal fin” appearance of the soft tissues tented over the patella. This was diagnosed as a rare case of an intraarticular patella dislocation, which was rotated 90 degrees about the vertical axis. Closed reduction in the emergency room was unsuccessful but was achieved in theatre under general anaesthetic with muscle relaxation. Postreduction arthroscopy demonstrated that no osteochondral or soft tissue damage to the knee had been sustained. In patients presenting with a knee locked in extension with tenting of skin over the patella (the “dorsal fin” appearance), intra-articular patella dislocation should be suspected. Attempts to reduce vertical patella dislocations under sedation with excessive force or repeatedly without success should be avoided to prevent unnecessary damage to the patellofemoral joint. In this clinical situation we recommend closed reduction under general anaesthetic followed by immediate knee arthroscopy under the same anaesthetic to ensure that there is no chondral damage to the patella or femoral trochlea and to rule out an osteochondral fracture. David Gamble, Quentin Otto, Andrew D. Carrothers, and Vikas Khanduja Copyright © 2015 David Gamble et al. All rights reserved. Rare Inferior Shoulder Dislocation (Luxatio Erecta) Wed, 25 Mar 2015 08:30:45 +0000 Although shoulder dislocations have been seen very frequently, inferior dislocation of shoulder constitutes only 0.5% of all shoulder dislocations. We share our 4 patients with luxatio erecta and present their last clinical control. 2 male and 2 female Caucasian patients were diagnosed as luxatio erecta. Patients’ ages were 78, 62, 65, and 76. All patients’ reduction was done by traction-abduction and contour traction maneuver in the operating room. The patients had no symptoms and no limitation of range of motion of their shoulder at their last control. Luxatio erecta is seen rarely, and these patients may have neurovascular injury. These patients should be carefully examined and treated by the orthopaedic and traumatology surgeons. Hakan Cift, Salih Soylemez, Murat Demiroglu, Korhan Ozkan, Vahit Emre Ozden, and Afsar T. Ozkut Copyright © 2015 Hakan Cift et al. All rights reserved. Apparent Skin Discoloration about the Knee Joint: A Rare Sequela of Metallosis after Total Knee Replacement Tue, 24 Mar 2015 12:01:35 +0000 Introduction. Metallosis is a phenomenon most commonly associated with hip replacement. However it can occur in any metallic implant subject to wear. Wear creates metal debris, which is deposited in the surrounding soft tissue. This leads to many local adverse reactions including, but not limited to, implant loosening/osteolysis, pain, and effusion. In the deeper joints, for example, the hip, metal deposits are mostly only seen intraoperatively. Case Study. A 74-year-old lady represented to orthopaedic outpatient clinic. Her principle complaint was skin discolouration, associated with pain and swelling over the left knee, on the background of a previous total knee replacement with a metal backed patella resurfacing six years. A plain radiograph revealed loosening of the patellar prosthesis. A diagnosis of metallosis was made; the patient underwent debridement of the stained soft tissue and primary revision of the prosthesis. She remained symptom-free five years after revision. Discussion. Metallosis results in metallic debris which causes tissue staining, often hidden within the soft tissue envelope of the hip, but more apparent in the knee. Metallosis may cause pain, effusion, and systemic symptoms because of raised levels of serum-metal ions. Surgical intervention with revision and debridement can have good functional results. Narlaka Jayasekera, Conor Gouk, Amit Patel, and Keith Eyres Copyright © 2015 Narlaka Jayasekera et al. All rights reserved. Irreducible Dislocation of the Great Toe Interphalangeal Joint Secondary to an Incarcerated Sesamoid Sun, 22 Mar 2015 13:33:16 +0000 Irreducible dorsal dislocation of the interphalangeal (IP) joint of the great toe is rare. We report a case of a 29-year-old gentleman who presented to the Orthopaedic Surgery Specialist Outpatient Clinic with an irreducible IP joint of the great toe that had been untreated for 4 weeks. The mechanism of injury is believed to be a combination of axial loading with a hyperdorsiflexion force when the patient fell foot first into a drain. As the patient did not report severe symptoms and a true lateral radiograph was not ordered, the dislocation was missed initially at the emergency department. The patient had continued to run and play field hockey prior to visiting us. Incarceration of the sesamoid became a block to manipulation and reduction at the specialist outpatient clinic 3 weeks later. The patient was treated with open surgical exploration, resection of the interposed sesamoid, and Kirschner-wire fixation of the IP joint followed by occupational therapy for mobilization exercises. The operative course was uneventful. At 6 months after surgery, the patient could walk, run, and return to sports. Hamid Rahmatullah Bin Abd Razak, Zi-Yang Chia, and Hwee-Chye Andrew Tan Copyright © 2015 Hamid Rahmatullah Bin Abd Razak et al. All rights reserved. Traumatic Hip Dislocation with Associated Femoral Head Fracture Thu, 19 Mar 2015 13:42:18 +0000 Dislocation of the hip is a critical injury that results from high-energy trauma. This paper describes a case of posterior dislocation of the right hip in a 35-year-old woman with associated ipsilateral femoral head fracture. Initial treatment included reduction of the right hip through posterior approach and fixation of the femoral head fracture with three absorbable screws. After 15-month follow-up, a full range of motion has been achieved and there are no signs of avascular necrosis, hip instability, or limping. The authors describe their method of surgery. H. Dortaj and A. Emamifar Copyright © 2015 H. Dortaj and A. Emamifar. All rights reserved. Irreducible Fifth Metatarsophalangeal Joint after Car Crush Injury Sun, 15 Mar 2015 10:37:33 +0000 Metatarsophalangeal joint dislocations are uncommon injuries. Herein, an irreducible dislocation of fifth metatarsophalangeal joint with fractures on the second, third, and fourth metatarsal head was reported. Joint reduction could not be achieved which necessitated open reduction. Six months after surgery the patient was walking and doing his daily activities without any complaints. He had returned to his pretrauma functional level. Fatih Turkmensoy, Samet Erinc, Omer Naci Ergin, Korhan Ozkan, and Bahattin Kemah Copyright © 2015 Fatih Turkmensoy et al. All rights reserved. Synovial Chondromatosis of the Subacromial Bursa Causing a Bursal-Sided Rotator Cuff Tear Thu, 12 Mar 2015 09:14:15 +0000 Synovial chondromatosis is an uncommon condition, and involvement of the shoulder is even more rare. We report on a 39-year-old female who presented with symptoms, radiographic features, and intraoperative findings consistent with multiple subacromial loose bodies resulting in a partial-thickness, bursal-sided rotator cuff tear of the supraspinatus muscle. She was treated with an arthroscopic removal of loose bodies, complete excision of the subacromial/subdeltoid bursa, acromioplasty, and rotator cuff repair. To our knowledge, this is the first report of arthroscopic treatment for a bursal-sided, partial-thickness rotator cuff tear treated with greater than two-year clinical and radiographic follow-up. We utilized shoulder scores, preoperative and postoperative range of motion, and imaging to assess the results of treatment and surveillance for recurrence in our patient after two-year follow-up. Julie A. Neumann and Grant E. Garrigues Copyright © 2015 Julie A. Neumann and Grant E. Garrigues. All rights reserved. A Symptomatic Spinal Extradural Arachnoid Cyst with Lumbar Disc Herniation Wed, 11 Mar 2015 11:03:49 +0000 Spinal epidural arachnoid cyst (EAC) is a rare, usually asymptomatic condition of unknown origin, which typically involves the lower thoracic spine. We report a case of posttraumatic symptomatic EAC with lumbar disc herniation. A 22-year-old man experienced back pain and sciatica after a traffic accident. Neurological examination revealed a right L5 radiculopathy. Magnetic resonance imaging demonstrated a cystic lesion at the L3 to L5 level and an L4-5 disc herniation; computed tomography myelography showed that the right L5 root was sandwiched between the cyst and the herniation. A dural defect was identified during surgery. The cyst was excised completely and the defect was repaired. A herniation was excised beside the dural sac. Histology showed that the cyst wall consisted of collagen and meningothelial cells. Postoperatively the symptoms resolved. Lumbar spinal EACs are rare; such cysts may arise from a congenital dural crack and grow gradually. The 6 cases of symptomatic lumbar EAC reported in the literature were not associated with disc herniation or trauma. In this case, the comorbid disc herniation was involved in symptom progression. Although many EACs are asymptomatic, comorbid spinal disorders such as disc herniation or trauma can result in symptom progression. Yoshinori Kadono, Takamichi Yuguchi, Yu-ichiro Ohnishi, Koichi Iwatsuki, and Toshiki Yoshimine Copyright © 2015 Yoshinori Kadono et al. All rights reserved. Complication with Removal of a Lumbar Spinal Locking Plate Mon, 09 Mar 2015 10:24:29 +0000 Introduction. The use of locking plate technology for anterior lumbar spinal fusion has increased stability of the vertebral fusion mass over traditional nonconstrained screw and plate systems. This case report outlines a complication due to the use of this construct. Case. A patient with a history of L2 corpectomy and anterior spinal fusion presented with discitis at the L4/5 level and underwent an anterior lumbar interbody fusion (ALIF) supplemented with a locking plate placed anterolaterally for stability. Fifteen months after the ALIF procedure, he returned with a hardware infection. He underwent debridement of the infection site and removal of hardware. Results. Once hardware was exposed, removal of the locking plate screws was only successful in one out of four screws using a reverse thread screw removal device. Three of the reverse thread screw removal devices broke in attempt to remove the subsequent screws. A metal cutting drill was then used to break hoop stresses associated with the locking device and the plate was removed. Conclusion. Anterior locking plates add significant stability to an anterior spinal fusion mass. However, removal of this hardware can be complicated by the inherent properties of the design with significant risk of major vascular injury. Brooke Crawford, Christopher Lenarz, J. Tracy Watson, and Dirk Alander Copyright © 2015 Brooke Crawford et al. All rights reserved. Arthroscopic Quadriceps Tendon Repair: Two Case Reports Sat, 28 Feb 2015 10:32:29 +0000 Recently, although some studies of open repair of the tendon of the quadriceps femoris have been published, there have been no reports in the literature on primary arthroscopic repair. In our present study, we present two cases of quadriceps tendon injury arthroscopically repaired with excellent results. Case 1 involved a 68-year-old man who was injured while shifting his weight to prevent a fall. MRI showed complete rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using both suture anchor and pull-out suture fixation methods via bone tunnels (hereafter, pull-out fixation). Two years after surgery, retearing was not observed on MRI and both Japan Orthopedic Association (JOA) Knee and Lysholm scores had recovered to 100. Case 2 involved a 50-year-old man who was also injured when shifting his weight to prevent a fall. MRI showed incomplete superficial rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using pull-out fixation of six strand sutures. One year after surgery, MRI revealed a healed tendon and his JOA and Lysholm scores were 95 and 100, respectively. Thus, arthroscopic repair may be a useful surgical method for repairing quadriceps tendon injury. Hidetomo Saito, Yoichi Shimada, Toshiaki Yamamura, Shin Yamada, Takahiro Sato, Koji Nozaka, Hiroaki Kijima, and Kimio Saito Copyright © 2015 Hidetomo Saito et al. All rights reserved. Bilateral and Symmetrical Anteromedial Bowing of the Lower Limbs in a Patient with Neurofibromatosis Type-I Sat, 28 Feb 2015 07:54:02 +0000 An 8-year-old girl was referred to our department because of generalized bowing of long bones (radii, ulnae, and femora) and significant bilateral and symmetrical posteromedial bowing of the tibiae and fibulae. The femora were laterally bowed whereas the tibiae and fibulae showed posteromedial bowing between the middle and distal thirds of the tibia with posterior cortical thickening effectively causing the development of bilateral congenital anterolateral bowing of the tibiae and fibulae. We referred to closing-wedge osteotomy of the left tibia along with fibular osteotomy in order to realign the deformity. Due to the delayed appearance of skin stigmata in her early life, the diagnosis of neurofibromatosis was ruled out. At the age of 9 years, café-au-lait spots and axillary freckling were apparent. Genetic tests confirmed von Recklinghausen disease (neurofibromatosis type-I (NF1)) (gene has been localised to 17q22). Interestingly, bilateral and symmetrical anteromedial bowing of the tibiae and fibulae has not been described in patients with NF-I. Ali Al Kaissi, Klaus Klaushofer, Franz Grill, and Rudolf Ganger Copyright © 2015 Ali Al Kaissi et al. All rights reserved. Conversion of a Surgical Elbow Arthrodesis to Total Elbow Arthroplasty Thu, 26 Feb 2015 09:56:12 +0000 Arthrodesis of the elbow joint addresses pain due to intra-articular pathology, but with significant functional limitations. Loss of motion at the elbow is not completely compensated by the wrist and shoulder joints and elbow fusion is thus purely a salvage procedure. Advances in joint arthroplasty have allowed surgeons to address the functional limitations of arthrodesis, but despite these advances the elbow is still one of the joint replacements with higher complication rate. Conversion of a joint fusion to arthroplasty has been reported for the hip, knee, shoulder, and ankle. The takedown of a surgically fused elbow was reported in German literature in 2013. We present the first such case report in the English literature with a 49-year-old male whose status is elbow fusion performed for trauma 31 years prior. Dominik Rog, Lee M. Zuckerman, and Barth Riedel Copyright © 2015 Dominik Rog et al. All rights reserved. Vertebral Stenting and Vertebroplasty Guided by an Angiographic 3D Rotational Unit Mon, 23 Feb 2015 12:10:17 +0000 Introduction. Use of interventional imaging systems in minimally invasion procedures such as kyphoplasty and vertebroplasty gives the advantage of high-resolution images, various zoom levels, different working angles, and intraprocedure image processing such as three-dimensional reconstructions to minimize complication rate. Due to the recent technological improvement of rotational angiographic units (RAU) with flat-panel detectors, the useful interventional features of CT have been combined with high-quality fluoroscopy into one single machine. Intraprocedural 3D images offer an alternative way to guide needle insertion and the safe injection of cement to avoid leakages. Case Report. We present the case of a 72-year-old female patient with insidious lumbar pain. Computed tomography revealed a wedge-shaped osteoporotic compression fracture of T10 vertebrae, which was treated successfully with the installation of vertebral stenting system and vertebroplasty with methacrylate guided with a rotational interventional imaging system. Conclusion. Rotational angiographic technology may provide a suitable place for the realization of high-quality minimally invasive spinal procedures, such as kyphoplasty, vertebroplasty, and vertebral stenting. New software programs available nowadays offer the option to make three-dimensional reconstructions with no need of CT scans with the same degree of specificity. Escobar-de la Garma Víctor Hugo, Jorge-Barroso Henry Luis, Padilla-Vázquez Felipe, and Balderrama-Bañares Jorge Luis Copyright © 2015 Escobar-de la Garma Víctor Hugo et al. All rights reserved. Revision of a Fractured Uncemented Revision Stem Using a Custom Designed Punch and Retrograde Through-Knee Approach Sun, 22 Feb 2015 12:35:15 +0000 We report a unique case of a fractured modular cobalt chromium connection taper Revitan (Zimmer, Warsaw, IN) revision prosthesis. Macroscopic examination revealed a fracture at the diaphyseal-metaphyseal junction of this modular component. This report highlights that fractures can still occur with modern modular prostheses. We are not aware of any published failures of the Revitan revision prosthesis. We also describe a unique method of retrieval for a broken well fixed uncemented femoral stem, using a custom designed extraction instrument via a through-knee approach. P. J. Nasr and G. S. Keene Copyright © 2015 P. J. Nasr and G. S. Keene. All rights reserved. A Challenging Case of Limb Salvage Requiring a Combination of Composite Fixation and Masquelet Technique to Address Significant Segmental Bone Loss Thu, 19 Feb 2015 10:11:59 +0000 Cases of limb salvage following skeletal trauma involving significant bone loss pose a particular challenge to the reconstructive surgeon. Certain techniques for addressing this complex issue have been advanced in recent years and have met with considerable success. The Masquelet technique involves a staged procedure in which a temporary skeletal stabilization is paired with implantation of an antibiotic spacer and left in place for 6–8 weeks, during which time a “pseudomembrane” forms around the cement spacer. During the second stage of the procedure, the pseudomembrane is incised, the antibiotic spacer removed, and bone graft is placed. We present a case of significant segmental femur loss in a 19-year-old male opting for limb salvage in which a 17-centimeter segmental loss of bone was essentially regrown using a combination of the Masquelet technique with supplemental endosteal fixation. C. Blair, A. T. Simela, and B. J. Cross Copyright © 2015 C. Blair et al. All rights reserved. Intra-Articular Giant Synovial Osteochondroma: Case Reports of the Ankle and Knee Joint Mon, 16 Feb 2015 14:22:19 +0000 Two cases of giant intra-articular osteochondromas (knee and ankle joint) are reported; pathologically they are rare representations of synovial chondromatosis. A 17-year-old man presented with a tumorous mass which had been localized in his left ankle for many years, increasing in volume during the last months. The lesion was removed by posteromedial ankle arthrotomy. The second case was observed in a 39-year-old woman with a slow-growing mass in her right knee joint. The lesion was removed from the Hoffa fat pad by open anteromedial arthrotomy. Paolo Fornaciari, Pascal A. Schai, Richard Niehaus, and Ulrich G. Exner Copyright © 2015 Paolo Fornaciari et al. All rights reserved. Tibial Tubercle Fracture in a 14-Year-Old Athlete with Bilateral Lower Pole Bipartite Patella and Osgood-Schlatter Disease Mon, 16 Feb 2015 06:54:23 +0000 We present a case of tibial tubercle fracture in a young male athlete with both bilateral bipartite patella at the lower pole (Saupe type I) and Osgood-Schlatter disease. Open reduction and internal fixation were performed to restore the extensor mechanism of the knee. Fabio Pascarella, Antonio Ziranu, and Giulio Maccauro Copyright © 2015 Fabio Pascarella et al. All rights reserved. Joint Preservation of the Wrist Using Articulated Distraction Arthroplasty: A Case Report of a Novel Technique Thu, 12 Feb 2015 11:08:48 +0000 Distraction arthroplasty of the ankle, elbow, and hip has become widely accepted and used within the orthopaedic community with excellent initial results which appear sustained. To date it has not been applied to the wrist in the same manner. A novel technique, drawn upon past success of articulated ankle distraction and static wrist distraction, was devised and evaluated by application of articulated wrist distraction performed over a 12-week period in a patient with poor functional outcome following limited wrist fusion. Posttreatment results showed improvement in range of motion (100-degree arc), subjective pain, and functional outcome measures (DASH 21.7, Mayo Wrist Score 80) comparable or better than either limited wrist fusion or proximal row carpectomy. Articulated wrist distraction initially appears to be a promising therapeutic option for the management of the stiff and painful wrist to maintain maximal function for which formal wrist arthrodesis may be the only alternative. Matt D. A. Fletcher Copyright © 2015 Matt D. A. Fletcher. All rights reserved. Lower Leg Compartment Syndrome after Appendicectomy Tue, 10 Feb 2015 09:33:48 +0000 A 10-year-old boy presented with severe left lower leg pain, uncontrolled with increasing analgesia after appendicectomy. A diagnosis of acute compartment syndrome was made after a delayed referral to the orthopaedic service. The patient subsequently underwent an emergency fasciotomy and made a good functional recovery. To the best of our knowledge this is the first reported case of paediatric lower leg compartment syndrome after appendicectomy in the literature. The case report serves to highlight the importance of maintaining a high index of suspicion for compartment syndrome. Shane C. O’Neill, Darren F. Lui, Colm Murphy, and Patrick J. Kiely Copyright © 2015 Shane C. O’Neill et al. All rights reserved. Arthroscopic Removal of a Wire Fragment from the Posterior Septum of the Knee following Tension Band Wiring of a Patellar Fracture Mon, 09 Feb 2015 14:28:19 +0000 Tension band wiring with cerclage wiring is most widely used for treating displaced patellar fractures. Although wire breakage is not uncommon, migration of a fragment of the broken wire is rare, especially migration into the knee joint. We describe here a rare case of migration of a wire fragment into the posterior septum of the knee joint after fixation of a displaced patellar fracture with tension band wiring and cerclage wiring. Although it was difficult to determine whether the wire fragment was located within or outside the knee joint from the preoperative plain radiographs or three-dimensional computed tomography (3D CT), we found it arthroscopically through the posterior transseptal portal with assistance of intraoperative fluoroscopy. Surgeons who treat such cases should bear in mind the possibility that wire could be embedded in the posterior septum of the knee joint. Yasuaki Tamaki, Takashi Nakayama, Kenichiro Kita, Katsutosi Miyatake, Yoshiteru Kawasaki, Koji Fujii, and Yoshitsugu Takeda Copyright © 2015 Yasuaki Tamaki et al. All rights reserved. Ipsilateral Hip Dysplasia in Patients with Sacral Hemiagenesis: A Report of Two Cases Mon, 09 Feb 2015 07:42:36 +0000 Sacral agenesis (SA) is a rare condition consisting of the imperfect development of any part of the sacrum. This paper describes two cases of the rare cooccurrence of ipsilateral SA and developmental dysplasia of the hip (DDH) and analyzes possible contributory factors for SA and DDH. Each of a 16-year-old female and 13-year-old female visited our hospital for left hip pain and limping. The findings of physical examinations showed a lower limb length discrepancy (left side) in both cases, as well as left hip pain without limitations of the range of motion or neurological deficits. Initial radiographs demonstrated left subluxation of the left hip with associated acetabular dysplasia and partial left sacral agenesis. MRI revealed a tethering cord with a fatty filum terminale, and periacetabular osteotomy combined with allogeneic bone grafting was performed. After the surgery, the patients experienced no further pain, with no leg length discrepancy and were able to walk without a limp, being neurologically normal with a normal left hip range of motion. The cooccurrence of SA and DDH suggests a plausible hypothesis to explain the embryogenic relationship between malformation of the sacrum and hip. Tadatsugu Morimoto, Motoki Sonohata, and Masaaki Mawatari Copyright © 2015 Tadatsugu Morimoto et al. All rights reserved. Hip Arthroplasty in a Patient with Transfemoral Amputation: A New Tip Sun, 08 Feb 2015 14:01:51 +0000 Femoral fractures in amputation stump are challenging injuries to manage. The authors describe a case of a 51-year-old patient with a right above knee amputation, who had a right hip femoral neck fracture. In this technical note, we describe a technical and surgical procedure with intraoperative tips and tricks, in which we use commonly available materials, for the safe management in such clinical situations. Hassan Boussakri, Ihab Alassaf, Samir Hamoudi, Abdelhalim Elibrahimi, Philbert Ntarataz, Abdelmajid ELMrini, and Jean Francois Dumez Copyright © 2015 Hassan Boussakri et al. All rights reserved. Unilateral Pedicle Stress Fracture in a Long-Term Hemodialysis Patient with Isthmic Spondylolisthesis Sun, 08 Feb 2015 13:21:07 +0000 Most unilateral pedicle stress fractures occur on the contralateral side of patients with unilateral spondylolysis. However, there are few reports of unilateral pedicle stress fractures in patients with bilateral spondylolysis and spondylolisthesis. We report a unique case of unilateral pedicle stress fracture in a long-term hemodialysis patient with isthmic spondylolisthesis. A 65-year-old man who had undergone hemodialysis presented with lower back pain that had persisted for several years. The patient experienced severe right lower extremity pain with no history of trauma. Computed tomography revealed unilateral pedicle fracture with bilateral L5 spondylolysis and spondylolisthesis with progression of scoliosis. The patient underwent Gill laminectomy of L5 with pedicle screw fixation at L4-S1 and interbody fusion at L5-S1. The patient’s leg pain ceased immediately, and he began walking without leg pain. In our present patient, development of scoliosis caused by destructive spondyloarthropathy may have contributed to a unilateral pedicle fracture. Keishi Maruo, Toshiya Tachibana, Shinichi Inoue, Fumihiro Arizumi, and Shinichi Yoshiya Copyright © 2015 Keishi Maruo et al. All rights reserved. Unusual Bilateral Rim Fracture in Femoroacetabular Impingement Thu, 05 Feb 2015 09:01:16 +0000 This is a report of one case of bilateral acetabular rim fracture in association with femoroacetabular impingement (FAI), which was treated with a hip arthroscopic procedure, performing a partial resection, a labral reinsertion, and a subsequential internal fixation with cannulated screws. Up to date, there are in the literature only two reports of rim fracture and “os acetabuli” in association with FAI. In the case we present, the pincer and cam resection were performed without complications; the technique used was published previously. With this technique the head of the screw lays hidden by the reattached labrum. We removed partially the fractured rim fragment and the internal fixation of the remaining portion was achieved with a screw. In the event of a complete resection of the fragment, it would have ended with a LCE angle of 18° and a high probability of hip instability. We believe that this bilateral case helps establish the efficacy and reproducibility of the technique described by Larson. Claudio Rafols, Juan Edo Monckeberg, and Jorge Numair Copyright © 2015 Claudio Rafols et al. All rights reserved. Diagnosis and Treatment of a Lateral Meniscal Cyst with Musculoskeletal Ultrasound Thu, 05 Feb 2015 06:24:06 +0000 Meniscal cysts are a relatively uncommon occurrence that may result in pain and disability in the knee. It is widely believed that meniscal cysts are secondary to fluid extrusion from a meniscus tear. Typically, diagnosis of a meniscal cyst typically requires magnetic resonance imaging (MRI) to delineate the cyst and any associated injuries. With improvements in sonographic technology, ultrasound has emerged as a sensitive modality for detection of meniscal cysts. We present a patient with a contraindication to MRI who was diagnosed with a lateral meniscal cyst by musculoskeletal ultrasound and treated with an ultrasound-guided lateral meniscal cyst aspiration and injection. Hamilton Chen Copyright © 2015 Hamilton Chen. All rights reserved. Total Knee Arthroplasty in a Patient with Bilateral Congenital Dislocation of the Patella Treated with a Different Method in Each Knee Sat, 31 Jan 2015 11:19:25 +0000 We have operated total knee arthroplasty in a patient with bilateral congenital dislocation of the patella treated with a different method in each knee. Hajime Yamanaka, Taisei Kawamoto, Hiroshi Tamai, Munetaka Suzuki, Tatsuya Kobayashi, Yawara Eguchi, and Hideyuki Nakajima Copyright © 2015 Hajime Yamanaka et al. All rights reserved. Delayed Presentation of Pharyngeal Erosion after Anterior Cervical Discectomy and Fusion Thu, 29 Jan 2015 11:18:48 +0000 Dysphagia after anterior cervical discectomy and fusion (ACDF) is common, with a prevalence ranging between 28% and 57% of cases. However, nearly all cases resolve spontaneously within 2 years, thus identifying patients who require more detailed or invasive work-up is a challenging task for clinicians. A review of literature reveals a paucity of case reports detailing work-up and successful management options. The authors performed a clinical and radiographic review of a case of a 47-year-old female who presented with persistent dysphagia 3 years following anterior cervical spine surgery and was found to have an erosive pharyngeal defect with exposed spinal hardware. The diagnosis was made with direct laryngoscopy and treatment consisted of plate removal and pharyngeal repair, followed by revision fusion with deformity correction. This case and the accompanying pertinent review of the literature highlight the importance of a thorough evaluation of dysphagia, especially in the mid- and late-term postoperative period following ACDF, when most cases of dysphagia should have been resolved. Correctly identifying the underlying etiology of dysphagia may lead to improved revision of ACDF outcomes. Unresolved dysphagia should be a red flag for surgeons as it may be the presentation of erosive esophageal/pharyngeal damage, a rare but serious complication following ACDF. Amit Nathani, Alexander E. Weber, Trevor C. Wahlquist, Gregory P. Graziano, Paul Park, and Rakesh D. Patel Copyright © 2015 Amit Nathani et al. All rights reserved. A Bullet in the Supraspinatus Compartment Successfully Removed by Arthroscopy: Case Report and Review of the Literature Wed, 28 Jan 2015 09:29:34 +0000 Arthroscopic removal of bullet from intra-articular compartment has been described for several joints. Only few reports dealing with this condition in the shoulder have been reported especially for the glenohumeral and the subacromial compartments. We report the story of a fifty-seven-year-old man presenting a bullet in the supraspinatus compartment of his left shoulder successfully removed by arthroscopy. Alexandre Galland, Alexandre Lunebourg, Stéphane Airaudi, and Renaud Gravier Copyright © 2015 Alexandre Galland et al. All rights reserved. Arthroscopic-Assisted Treatment of a Reversed Hill-Sachs Lesion: Description of a New Technique Using Cerament Mon, 26 Jan 2015 12:48:40 +0000 Purpose. Impaction fractures of the anterior aspect of the humeral head, the reversed Hill-Sachs lesion, are common in posterior shoulder dislocation. We present a new technique to address these lesions arthroscopic-assisted with the use of a bone substitute. Methods. We report the case of a 45-year-old male with a reversed Hill-Sachs lesion after posterior shoulder dislocation. Initially a glenohumeral arthroscopy is performed to address concomitant intra-articular injuries. Guided by the k-wire a cannulated sizer was inserted for reduction of the fracture under arthroscopic visualization. For reduction of the impacted part of the humeral head the subcortical defect was filled with an injectable bone substitute (Cerament) to prevent secondary dislocation. Results. X-ray at follow-up 6 months after the index procedure documents the bony remodeling of the bone substitute. At that time the patient was pain-free (VAS 0) and satisfied with the outcome (Constant score: 78, Rand-36 score: 84, Rowe score: 81) with a good ROM. Conclusions. In conclusion, arthroscopic-assisted reconstruction of reversed Hill-Sachs lesions with an injectable bone substitute is feasible and may provide patients with all the benefits of an anatomic reconstruction with decreased risks related to open surgery. S. Bark, F. Renken, A. P. Schulz, A. Paech, and J. Gille Copyright © 2015 S. Bark et al. All rights reserved. An Easily Overlooked Presentation of Malignant Psoas Abscess: Hip Pain Thu, 22 Jan 2015 13:46:04 +0000 Psoas abscess is a rare infectious disease with nonspecific clinical presentation that frequently causes a diagnostic difficulty. Its insidious onset and occult characteristics can cause diagnostic delays. It is classified as primary or secondary. Staphylococcus aureus is the most commonly causative pathogen in primary psoas abscess. Secondary psoas abscess usually occurs as a result of underlying diseases. A high index of clinical suspicion, the past and recent history of the patient, and imaging studies can be helpful in diagnosing the disease. The delay of the treatment is related with high morbidity and mortality rates. In this paper, 54-year-old patient with severe hip pain having an abscess in the psoas muscle due to metastatic cervical carcinoma is presented. Ayhan Askin, Korhan Baris Bayram, Umit Secil Demirdal, Merve Bergin Korkmaz, Alev Demirbilek Gurgan, and Mehmet Fatih Inci Copyright © 2015 Ayhan Askin et al. All rights reserved.