Case Reports in Orthopedics http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Lipoblastoma and Lipoblastomatosis of the Lower Leg Mon, 15 Sep 2014 05:55:04 +0000 http://www.hindawi.com/journals/crior/2014/582876/ Lipoblastoma is a benign lesion of immature fat cells that is found almost exclusively in pediatric population. This tumor is a rare tumor that occurs in infancy and early childhood, accounting for less than 1% of all childhood neoplasm. It is more common in male than in female and often presents as an asymptomatic, rapidly enlarging, soft lobular mass on the extremity. Although benign, it gives great difficulty in its management, due to its extensions into different facial planes, especially in lipoblastomatosis. Thus, complete surgical excision is the treatment of choice. Achmad Fauzi Kamal, I Gde Eka Wiratnaya, Errol Untung Hutagalung, Marcel Prasetyo, Evelina Kodrat, Wahyu Widodo, Zuhri Effendi, and Kurniadi Husodo Copyright © 2014 Achmad Fauzi Kamal et al. All rights reserved. Bilateral, Simultaneous Medial Meniscus Bucket Handle Tears in a 23-Year-Old Female Thu, 11 Sep 2014 12:11:38 +0000 http://www.hindawi.com/journals/crior/2014/689130/ Traumatic tears of the meniscus are well reported in the literature. Rarely, bilateral meniscal tears occur. A PubMed search found that only three cases of bilateral medial meniscus bucket handle type tears have been reported. Treatment options range from partial meniscectomy to repair of the meniscal tear. Repair is reported to be more successful in the vascular red-red or red-white zones. We present the case of a 23-year-old female who sustained simultaneous bilateral medial meniscus bucket handle type tears in an automobile accident. She was treated in a staged fashion with knee arthroscopy. Her meniscus tears were both found to be in the vascularized zone and meniscal tear repair was conducted. At two weeks postoperatively, she had excellent resolution of her symptoms and has returned to pain-free weight-bearing. She has remained pain-free at six-month follow-up. Brett Walker and Andrew Limbert Copyright © 2014 Brett Walker and Andrew Limbert. All rights reserved. Cervical Bone Graft Candida albicans Osteomyelitis: Management Strategies for an Uncommon Infection Wed, 10 Sep 2014 05:55:58 +0000 http://www.hindawi.com/journals/crior/2014/986393/ Candida osteomyelitis in the current literature is an emerging infection. The factors contributing to its emergence include a growing population of immunosuppressed patients, invasive surgeries, broad-spectrum antibiotics, injection drug users, and alcohol abuse. The diagnosis requires a high degree of suspicion. The insidious progression of infection and the nonspecificity of laboratory and radiologic findings may contribute to a delay in diagnosis. The current case concerns a 27-year-old man with a spinal cord injury who, after undergoing anterior cervical fixation and fusion surgery, developed postoperative systemic bacterial infection and required long-term antibiotic therapy. After six months, a CT scan demonstrated an almost complete anterior dislocation of the implants caused by massive bone destruction and reabsorption in Candida albicans infection. The patient underwent a second intervention consisting firstly of a posterior approach with C4–C7 fixation and fusion, followed by a second anterior approach with a corpectomy of C5 and C6, a tricortical bone grafting from the iliac crest, and C4–C7 plating. The antifungal therapy with fluconazole was effective without surgical debridement of the bone graft, despite the fact that signs of the bone graft being infected were seen from the first cervical CT scans carried out after one month. Carlo Brembilla, Luigi Andrea Lanterna, Andrea Risso, Giuseppe Bonaldi, Paolo Gritti, Bruno Resmini, and Andrea Viscone Copyright © 2014 Carlo Brembilla et al. All rights reserved. Spontaneous Cervical Intradural Disc Herniation Associated with Ossification of Posterior Longitudinal Ligament Tue, 09 Sep 2014 05:12:53 +0000 http://www.hindawi.com/journals/crior/2014/256207/ Intradural herniation of a cervical disc is rare; less than 35 cases have been reported to date. A 52-year-old man with preexisting ossification of posterior longitudinal ligament developed severe neck pain with Lt hemiparesis while asleep. Neurological exam was consistent with Brown-Séquard syndrome. Magnetic resonance images showed a C5-6 herniated disc that was adjacent to the ossified ligament and indenting the cord. The mass was surrounded by cerebrospinal fluid signal intensity margin, and caudally the ventral dura line appears divided into two, consistent with the “Y-sign” described by Sasaji et al. Cord edema were noted. Because of preexisting canal stenosis and spinal cord at risk, a laminoplasty was performed, followed by an anterior C6 corpectomy. Spot-weld type adhesions of the posterior longitudinal ligament to the dura was noted, along with a longitudinal tear in the dura. An intradural extra-arachnoid fragment of herniated disc was removed. Clinical exam at 6 months after surgery revealed normal muscle strength but persistent mild paresthesias. It is difficult to make a definite diagnosis of intradural herniation preoperatively; however, the clinical findings and radiographic signs mentioned above are suggestive and should alert the surgeon to look for an intradural fragment. Dachuan Wang, Haifeng Wang, and Wun-Jer Shen Copyright © 2014 Dachuan Wang et al. All rights reserved. One-Stage Femoral Osteotomy and Computer-Assisted Navigation Total Knee Arthroplasty for Osteoarthritis in a Patient with Femoral Subtrochanteric Fracture Malunion Mon, 08 Sep 2014 06:08:21 +0000 http://www.hindawi.com/journals/crior/2014/645927/ Extra-articular femoral deformity in total knee arthroplasty (TKA) is realigned by either intra-articular correction or extra-articular osteotomy. The more distant the deformity is away from knee joint, the more likely it is corrected by the former method. No report described the use of antegrade cephalomedullary femoral nail to fix the osteotomy followed by computer-assisted navigation TKA. This report described the unusual use of this method to manage a 64-year-old man with femoral subtrochanteric fracture malunion and osteoarthritis of knee. He demonstrated a satisfactory functional outcome and good lower limb alignment. C. H. Jason Fan Copyright © 2014 C. H. Jason Fan. All rights reserved. Adjacent Lumbar Disc Herniation after Lumbar Short Spinal Fusion Sun, 07 Sep 2014 05:37:16 +0000 http://www.hindawi.com/journals/crior/2014/456940/ A 70-year-old outpatient presented with a chief complaint of sudden left leg motor weakness and sensory disturbance. He had undergone L4/5 posterior interbody fusion with L3–5 posterior fusions for spondylolisthesis 3 years prior, and the screws were removed 1 year later. He has been followed up for 3 years, and there had been no adjacent segment problems before this presentation. Lumbar magnetic resonance imaging (MRI) showed a large L2/3 disc hernia descending to the L3/4 level. Compared to the initial MRI, this hernia occurred in an “intact” disc among multilevel severely degenerated discs. Right leg paresis and bladder dysfunction appeared a few days after admission. Microscopic lumbar disc herniotomy was performed. The right leg motor weakness improved just after the operation, but the moderate left leg motor weakness and difficulty in urination persisted. Koshi Ninomiya, Koichi Iwatsuki, Yu-ichiro Ohnishi, Toshika Ohkawa, and Toshiki Yoshimine Copyright © 2014 Koshi Ninomiya et al. All rights reserved. Traumatic Distal Ulnar Artery Thrombosis Wed, 03 Sep 2014 08:34:53 +0000 http://www.hindawi.com/journals/crior/2014/983160/ This paper is about a posttraumatic distal ulnar artery thrombosis case that has occurred after a single blunt trauma. The ulnar artery thrombosis because of chronic trauma is a frequent condition (hypothenar hammer syndrome) but an ulnar artery thrombosis because of a single direct blunt trauma is rare. Our patient who has been affected by a single blunt trauma to his hand and developed ulnar artery thrombosis has been treated by resection of the thrombosed ulnar artery segment. This report shows that a single blunt trauma can cause distal ulnar artery thrombosis in the hand and it can be treated merely by thrombosed segment resection in suitable cases. Ahmet A. Karaarslan, Ahmet Karakaşlı, Aslan Mayda, Tolga Karcı, Hakan Aycan, and Şenol Kobak Copyright © 2014 Ahmet A. Karaarslan et al. All rights reserved. Temporary Sternoclavicular Plating for an Unusual Double Clavicle Fracture (Medial Nonunion, Lateral Acute) Complicated by an Intraoperative Pneumothorax Tue, 02 Sep 2014 12:42:06 +0000 http://www.hindawi.com/journals/crior/2014/206125/ Double (segmental) clavicle fractures, involving both the medial and lateral aspects of the clavicle, are very uncommon. Even less common is an asynchronous double fracture with one of the fractures being a nonunion. We report the case of a 30-year-old healthy male patient who had an unusual double clavicle fracture (medial nonunion, lateral acute) that occurred in separate traumatic events during motocross (motorcycle) racing. His fractures were treated surgically in two stages. In the first stage a long reconstruction plate was used that spanned onto the sternum and two transcortical screws were placed into the manubrium to enhance purchase for the deficient bone of the medial clavicle. In accordance with the preoperative plan, the medial one-third of the plate and the medial four screws (of the total 13 used) were removed. Although our patient had an excellent final result, he did have an intraoperative pneumothorax that was treated uneventfully with a chest tube. Medial clavicle fractures are difficult to treat, especially if they are nonunions and surgical complication rates can be high. Our case is one of the few that has been described where temporary sternoclavicular plating was successful in achieving an excellent long-term outcome. John G. Skedros, Alex N. Knight, Chad S. Mears, and Tanner D. Langston Copyright © 2014 John G. Skedros et al. All rights reserved. Congenital Deficiency of Distal Ulna and Dislocation of the Radial Head Treated by Single Bone Forearm Procedure Sun, 31 Aug 2014 11:09:51 +0000 http://www.hindawi.com/journals/crior/2014/526719/ Congenital deficiency of part of distal ulna affecting the distal radio-ulnar joint is a rare disorder. It is even rarer to find the association of proximal radio-ulnar joint dislocation along with distal ulnar deficiency. This type of congenital forearm anomaly is difficult to treat. Conversion to a single bone forearm in the expense of pronation-supination movement is a viable option. By doing so the elbow and wrist can be stabilized; however movement is possible in only one plane. We are describing here a girl of 8 years having proximal radio-ulnar joint dislocation along with deficiency of distal ulna treated by converting into a single bone forearm. Paragjyoti Gogoi, Anshuman Dutta, Arun Kumar Sipani, and Arup Kumar Daolagupu Copyright © 2014 Paragjyoti Gogoi et al. All rights reserved. Acute Nontraumatic Clavicle Fracture Associated with Long-Term Bisphosphonate Therapy Sun, 31 Aug 2014 00:00:00 +0000 http://www.hindawi.com/journals/crior/2014/986718/ Cases of osteonecrosis of the jaw, insufficiency fractures and atypical low energy or atraumatic fractures of pelvis, femur (subtrochanteric/mid-shaft/distal-third), tibia, fibula, metatarsal, humerus, and ulna related to long-term bisphosphonate therapy have been reported in the literature. We present the case of an acute nontraumatic clavicle fracture, associated with long-term bisphosphonate therapy, which to our knowledge has not been reported previously. This case highlights the need of critical evaluation of patients with atypical fractures during long-term bisphosphonate therapy. Shen Hwa Vun, Yahya Husami, Sajan Shareef, and Diane Bramley Copyright © 2014 Shen Hwa Vun et al. All rights reserved. Nonunion of the First Sternocostal Synchondrosis Accompanied by Sternoclavicular Joint Synovitis Thu, 28 Aug 2014 11:35:26 +0000 http://www.hindawi.com/journals/crior/2014/798329/ Injury to the sternocostal synchondrosis of the first rib is quite rare. We report one such case in a 50-year-old man with nonunion of the first sternocostal synchondrosis accompanied by synovitis of the sternoclavicular joint. He first underwent arthroscopic surgery of the left sternoclavicular joint. Postoperatively, the patient’s symptoms decreased by half, but another pain and crepitus at the inferior lateral portion of the sternoclavicular joint developed. Since MRI and functional CT reexaminations revealed nonunion of the first sternocostal synchondrosis, resection arthroplasty of the first sternocostal joint was performed. This resulted in immediate resolution of the symptoms. At 2-year follow-up, his symptoms disappeared entirely with no limited range of motion of the shoulder. Makoto Takeuchi, Tomohiro Goto, Kiminori Yukata, Naoto Suzue, Daisuke Hamada, Toshihiko Nishisho, Ichiro Tonogai, Tetsuya Matsuura, and Koichi Sairyo Copyright © 2014 Makoto Takeuchi et al. All rights reserved. Thrombosis of the External Jugular Vein: A Rare Complication of a Proximal Humerus Fracture Treated with Collar and Cuff Immobilisation Wed, 27 Aug 2014 11:50:56 +0000 http://www.hindawi.com/journals/crior/2014/283790/ We report the case of an 87-year-old woman who developed a thrombosis of her external jugular vein after sustaining a proximal humerus fracture managed nonoperatively with a collar and cuff. At review in fracture clinic she was found to have an enlarged external jugular vein which was subsequently found to be thrombosed. Her collar and cuff had been applied very tightly and it was felt by the ENT team to be the cause of the thrombosis of her external jugular vein. She was fully anticoagulated with warfarin after subsequently developing a deep vein thrombosis in the subclavian and axillary veins. She made a full recovery following anticoagulation. In this case, we review the potential causes of this rare and underdiagnosed condition, as well as the usual investigations and treatments. We also review the common complications of this fracture and the alternative treatment options available. Michael Gale, Simon Craxford, Leia Taylor, Helen Montgomery, and Simon Pickering Copyright © 2014 Michael Gale et al. All rights reserved. Bilateral Hip Joint Hylan G-F 20 Granulomatous Synovitis due to Viscosupplementation Injections Mon, 25 Aug 2014 09:08:30 +0000 http://www.hindawi.com/journals/crior/2014/494073/ 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 http://www.hindawi.com/journals/crior/2014/824959/ 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 http://www.hindawi.com/journals/crior/2014/962575/ 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 http://www.hindawi.com/journals/crior/2014/205732/ 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 http://www.hindawi.com/journals/crior/2014/568417/ 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 http://www.hindawi.com/journals/crior/2014/657296/ 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 http://www.hindawi.com/journals/crior/2014/727949/ 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 http://www.hindawi.com/journals/crior/2014/759419/ 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 http://www.hindawi.com/journals/crior/2014/150709/ 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 http://www.hindawi.com/journals/crior/2014/809701/ 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 http://www.hindawi.com/journals/crior/2014/896968/ 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 http://www.hindawi.com/journals/crior/2014/140757/ 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 http://www.hindawi.com/journals/crior/2014/631346/ 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 http://www.hindawi.com/journals/crior/2014/132854/ 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 http://www.hindawi.com/journals/crior/2014/792781/ 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 http://www.hindawi.com/journals/crior/2014/452418/ Bisphosphonates are currently the standard approach to managing bone disease in multiple myeloma. Bisphosphonates have high bone affinity that inhibits osteoclastic activity and additionally reduces the growth factors released from malignant or osteoblastic cells, thereby impairing abnormal bone remodeling which leads to osteolysis. However, patients of multiple myeloma may be at a higher risk of atypical femoral fractures because the treatment for malignant myeloma requires notably higher cumulative doses of bisphosphonates. Here we present a patient with bilateral atypical femoral fractures and multiple myeloma treated with intravenous bisphosphonate therapy. Ichiro Tonogai, Tomohiro Goto, Daisuke Hamada, Toshiyuki Iwame, Shinji Yoshioka, Takahiko Tsutsui, Yuichiro Goda, Hiroshi Egawa, and Koichi Sairyo Copyright © 2014 Ichiro Tonogai et al. All rights reserved. Spinal Hydatidosis Relapse: A Case Report Mon, 21 Jul 2014 00:00:00 +0000 http://www.hindawi.com/journals/crior/2014/207643/ Human cystic echinococcosis (CE) is a zoonosis caused by the larval stage of the Echinococcus granulosus and the most common sites affected are the liver and lung in approximately 80–90% of cases. The hydatid bone represents the 0.5–2.5% of all cases and localization cord is present about 50% of the time. This benign and commonly asymptomatic disease may simulate an aggressive malignancy because of osseous destruction and aggressive extension. We report a case of a 42-year-old male patient, presented with an unusual spinal hydatidosis relapse, related to anthelmintic drug therapy withdrawal after 10-year treatment. The man had previous excision of chest and hepatic hydatid cysts (resp., 10 and 3 years ago) and after primary mediastinal and spinal involvement (3 years ago) he was lost to follow-up and discontinued drug therapy. The patient underwent surgery and the postoperative histopathology confirmed the diagnosis. The patient recovered with no complications. Despite significant progress in diagnostic imaging, pharmacological and surgical therapy, spinal CE remains associated with high morbidity. Roberto Fiori, Irene Coco, Marco Nezzo, Gisèle Kabunda, Giuseppe Emmanuele Umana, Mario Francesco Fraioli, and Giovanni Simonetti Copyright © 2014 Roberto Fiori et al. All rights reserved. An Unusual Case of Clear Cell Chondrosarcoma with Very Late Recurrence and Lung Metastases, 29 Years after Primary Surgery Sun, 20 Jul 2014 07:12:23 +0000 http://www.hindawi.com/journals/crior/2014/109569/ Clear cell chondrosarcoma is a rare bone neoplasm with low-grade clinical course and the potential to metastasize to the skeleton and lungs. The aim of this report is to present a case that is extremely rare, but in accordance with the literature where the clear cell chondrosarcoma reportedly has a tendency for late metastases. In our patient the primary surgery was intralesional, since it was mistakenly interpreted as a benign tumour in the early 80s. The local recurrence and lung metastases occurred, however, 29 years after the initial treatment. The local recurrence was resected with wide margins, no additional surgery or oncological treatments were given, and two and half years postoperatively patient is doing well and there is no progression in the disease. In conclusion, it is important to have a long follow-up to the clear cell chondrosarcoma patients even for decades or lifelong, because the malignancy tends to metastasize or recur after an extended period. The course of metastasized disease may be unusually slow, so relatively aggressive treatment in metastasized and recurring cases is justified. Minna Laitinen, Jyrki Nieminen, and Toni-Karri Pakarinen Copyright © 2014 Minna Laitinen et al. All rights reserved.