Case Reports in Orthopedics The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Ascending Tonic Clonic Seizure Syndrome after Percutaneous Vertebroplasty Tue, 21 Apr 2015 13:15:30 +0000 Background Context. Cement leakage is not a rare complication of vertebroplasty, but ascending tonic clonic seizure syndrome is exceptionally rare. We herein report the first case to our knowledge of this complication related to vertebroplasty. Purpose. We herein report the first case of ascending tonic clonic seizure syndrome following epidural cement leakage after percutaneous vertebroplasty in a patient with multiple osteoporotic compression fractures. Study Design. Case report. Methods. A 64-year-old woman with T8, T10, L2, and L4 osteoporotic compression fractures underwent percutaneous vertebroplasty using polymethylmethacrylate. 40 minutes after the procedure the patient started suffering back and leg pain, having repetitive myoclonic jerks lasting 15 seconds of the lower extremities, spasm of the back, dyspnea, sinus tachycardia, hypoxemia, and metabolic acidosis. Results. The patient recovered completely due to a combination of early effective resuscitation and considered definitive management. Conclusions. Percutaneous vertebroplasty with polymethylmethacrylate is relatively safe but has few dangerous complications, which should be prevented by a meticulous technique and excellent image quality. Guido Zarattini, Adam Farrier, and Federico Sibona Copyright © 2015 Guido Zarattini et al. All rights reserved. A Case of Neglected Bilateral Anterior Shoulder Dislocation: A Rare Entity with Unusual Mechanism of Injury Mon, 20 Apr 2015 08:53:53 +0000 Bilateral shoulder dislocations are rare, and if they occurred, posterior type of dislocations is common. Bilateral anterior shoulder dislocations are very rare and occur due to trauma with unique mechanism of injury. We report a case of unreduced simultaneous bilateral anterior dislocations of shoulder without associated fractures in a forty-year-old man following a unique mechanism of injury; both hands of the patient were pulled from either side. To the best of our knowledge, this unusual mechanism of injury has not been reported in the literature. Raghuram Choulapalle, Ramu Chokkarapu, Ravi Kanth Kolluri, Sreedhar Reddy Anne, Shanmuga Raju Perumal, Pavan Kumar Avadhanam, and Ramesh Bheemanathuni Copyright © 2015 Raghuram Choulapalle et al. All rights reserved. Patellar Tendon Rupture after Lateral Release without Predisposing Systemic Disease or Steroid Use Wed, 15 Apr 2015 13:43:52 +0000 Arthroscopic technique for lateral release is the most widely used procedure for the correction of recurrent dislocations of the patella. In the relevant literature, several complications of lateral release are described, but the spontaneous patellar tendon rupture has never been suggested as a possible complication of this surgical procedure. Patellar tendon rupture is a rather infrequent and often unilateral lesion. Nevertheless, in case of systemic diseases (LES, rheumatoid arthritis, and chronic renal insufficiency) that can weaken collagen structures, bilateral patellar tendon ruptures are described. We report a case of a 24-year-old girl with spontaneous rupture of patellar tendon who, at the age of 16, underwent an arthroscopic lateral release for recurrent dislocation of the patella. This is the first case of described spontaneous patellar tendon rupture that occurred some years after an arthroscopic lateral release. S. De Giorgi, A. Notarnicola, G. Vicenti, and B. Moretti Copyright © 2015 S. De Giorgi et al. All rights reserved. Primary Total Knee Arthroplasty Twenty Years after Distal Femoral Cement Augmentation of a Giant Cell Tumor Tue, 07 Apr 2015 16:32:11 +0000 We present a case of knee reconstruction 20 years after treatment of a giant cell tumor (GCT) with curettage and cementation. There is currently an ongoing debate whether cement or allograft bone is the preferred material for filling the void after GCT curettage. In this case we were able to readily implant a primary total knee replacement without disturbing the existing well-interdigitated large cement bolus and did not require any stems or augments for the reconstruction. Given the ease of TKR implantation in this patient, we feel that the use of cement following curettage of a GCT lesion is a better choice than allograft bone which may not provide enough structural support for the knee reconstruction and lead to a much more extensive procedure. Alejandro Zylberberg, Gillian Bayley, Luca Gala, and Paul R. Kim Copyright © 2015 Alejandro Zylberberg et al. All rights reserved. Rapid Destruction of the Humeral Head Caused by Subchondral Insufficiency Fracture: A Report of Two Cases Mon, 06 Apr 2015 08:18:08 +0000 Rapidly destructive arthritis (RDA) of the shoulder is a rare disease. Here, we report two cases, with different destruction patterns, which were most probably due to subchondral insufficiency fractures (SIFs). Case 1 involved a 77-year-old woman with right shoulder pain. Rapid destruction of both the humeral head and glenoid was seen within 1 month of the onset of shoulder pain. We diagnosed shoulder RDA and performed a hemiarthroplasty. Case 2 involved a 74-year-old woman with left shoulder pain. Humeral head collapse was seen within 5 months of pain onset, without glenoid destruction. Magnetic resonance imaging showed a bone marrow edema pattern with an associated subchondral low-intensity band, typical of SIF. Total shoulder arthroplasty was performed in this case. Shoulder RDA occurs as a result of SIF in elderly women; the progression of the joint destruction is more rapid in cases with SIFs of both the humeral head and the glenoid. Although shoulder RDA is rare, this disease should be included in the differential diagnosis of acute onset shoulder pain in elderly female patients with osteoporosis and persistent joint effusion. Kenichi Goshima, Katsuhiko Kitaoka, Junsuke Nakase, and Hiroyuki Tsuchiya Copyright © 2015 Kenichi Goshima et al. All rights reserved. A Rarely Seen Multilevel Thoracic Vertebral Fracture after a Nocturnal Hypoglycemic Convulsion Attack Sun, 05 Apr 2015 12:36:56 +0000 A 49-year-old male presented with acute midthoracic severe back pain following a witnessed nocturnal convulsion attack. There was no history of trauma and the patient had a 23-year history of Type I diabetes mellitus. MRI scans of the thoracic spine revealed compression fractures at T5, T6, T7, and T8 vertebrae. The patient was treated conservatively. At 17 months after the initial diagnosis, the complaints of back pain had been resolved and the patient was able to easily undertake daily living activities. Hypoglycaemia is a common problem in diabetic patients treated with insulin. Convulsions may occur as a consequence of insulin-induced hypoglycemia. Nontraumatic compression fractures of the thoracic spine following seizures are a rare injury. Contractions of strong paraspinal muscles can lead to compression fracture of the midthoracic spine. Unrecognized hypoglycaemia should be considered to be a possible cause of convulsions in insulin-dependent diabetic patients. The aim of this report is to point out a case of rarely seen multilevel consecutive vertebrae fractures in a diabetic patient after a nocturnal hypoglycaemic convulsion attack. Ebru Atalar, Cuneyd Gunay, Hakan Atalar, and Tugba Tunc Copyright © 2015 Ebru Atalar et al. All rights reserved. Inflammatory Myofibroblastic Tumor of the Thigh: Presentation of a Rare Case and Review of the Literature Sun, 05 Apr 2015 09:42:12 +0000 Inflammatory myofibroblastic tumors are uncommon neoplasms; presentation of these tumors in the lower extremities is extremely rare. We present a case of a 47-year-old male with fever, fatigue, and a slow-growing thigh mass. The inflammatory markers were elevated and the MR images showed a well-defined intermuscular lesion with mild heterogeneous enhancement. The lesion was excised and histologic examination was consistent with an inflammatory myofibroblastic tumor. No adjuvant therapy was needed and the patient remained asymptomatic with no evidence of tumor recurrence during the 2 years of follow-up. O. D. Savvidou, V. I. Sakellariou, O. Papakonstantinou, E. Skarpidi, and P. J. Papagelopoulos Copyright © 2015 O. D. Savvidou et al. All rights reserved. Long Term Follow-Up of a Successful Lower Limb Replantation in a 3-Year-Old Child Thu, 02 Apr 2015 11:21:20 +0000 Replantation of the lower extremity has controversial indications but nevertheless it may be considered in carefully selected patients who present early and are expected to show good functional recoveries. Here we present a successful replantation in a 3-year-old boy who has made excellent recovery with no functional deficit evident at 12 years of follow-up. He sustained a traumatic amputation at the level of distal tibia when he fell of a “Qing Qi” (motorcycle rickshaw). Replantation was attempted at 8 hours cold ischemia time with the tibia shortened 4 cm and all tendons, vessels, and nerves repaired. Patient required a second procedure during the same hospital stay for skin coverage. Patient made good recovery with ambulation without support at 6 months, less than 3 cm limb length discrepancy, plantar and dorsiflexion power 4/5, and recovery of sensation over the foot. Now at 12 years of follow-up patient has a normal gait and has integrated into society with no functional deficit. Considering the functional outcome of our case, replantation should be attempted whenever possible and feasible especially in children. Akbar Jaleel Zubairi and Pervaiz Mahmood Hashmi Copyright © 2015 Akbar Jaleel Zubairi and Pervaiz Mahmood Hashmi. All rights reserved. Extrinsic Subclavian Vein Compression after Osteosynthesis of a Midshaft Clavicular Fracture in an Athlete Wed, 01 Apr 2015 08:33:42 +0000 Clavicle fractures are common injuries. Traditionally, nonsurgical management has been favored; however, recent evidence has emerged indicating that operative fixation produces lower nonunion rates, better functional outcomes, improved cosmesis, and greater patient satisfaction. Although clavicle fixation has been considered a safe procedure, several complications related to plate fixation have been reported. We report a case of a 21-year-old basketball player that had a vascular complication associated with internal fixation of a clavicle fracture. An external compression of the subclavian vein was attributed to a long screw of a precontoured clavicular plate. Although vascular complications associated with clavicle fixation are rare, they may be limb and even life threating. It is advisable that surgeons take measures to avoid them especially when placing the medial screws. Luciano A. Rossi, Nicolas S. Piuzzi, Santiago L. Bongiovanni, Ignacio Tanoira, Gaston Maignon, and Maximiliano Ranalletta Copyright © 2015 Luciano A. Rossi et al. All rights reserved. Rotationplasty with Vascular Reconstruction for Prosthetic Knee Joint Infection Mon, 30 Mar 2015 13:59:36 +0000 Rotationplasty is used most often as a function-preserving salvage procedure after resection of sarcomas of the lower extremity; however, it is also used after infection of prosthetic knee joints. Conventional vascular management during rotationplasty is to preserve and coil major vessels, but recently, transection and reanastomosis of the major vessels has been widely performed. However, there has been little discussion regarding the optimal vascular management of rotationplasty after infection of prosthetic knee joints because rotationplasty is rarely performed for this indication. We reviewed four patients who had undergone resection of osteosarcomas of the femur, placement of a prosthetic knee joint, and rotationplasty with vascular reconstruction from 2010 to 2013. The mean interval between prosthetic joint replacement and rotationplasty was 10.4 years and the mean interval between the diagnosis of prosthesis infection and rotationplasty was 7.9 years. Rotationplasty was successful in all patients; however, in one patient, arterial thrombosis developed and necessitated urgent surgical removal and arterial reconstruction. All patients were able to walk independently with a prosthetic limb after rehabilitation. Although there is no consensus regarding the most appropriate method of vascular management during rotationplasty for revision of infected prosthetic joints, vascular transection and reanastomosis is a useful option. Masahide Fujiki, Shimpei Miyamoto, Fumihiko Nakatani, Akira Kawai, and Minoru Sakuraba Copyright © 2015 Masahide Fujiki et al. All rights reserved. Total En Bloc Spondylectomy for Locally Aggressive Vertebral Hemangioma Causing Neurological Deficits Mon, 30 Mar 2015 12:15:41 +0000 Vertebral hemangiomas are common; however, aggressive vertebral hemangiomas with extraosseous extensions causing neurological deficits are rare. The treatment for this subtype of hemangioma remains controversial, since there are few reports on long-term clinical outcomes or tumor recurrence rates. We describe a case of aggressive vertebral hemangioma treated by total en bloc spondylectomy, with a literature review focusing on long-term recurrence. A 52-year-old male with a two-month history of numbness in the bilateral lower extremities was referred to our hospital. Imaging studies showed a tumor originating in the T9 vertebra and extending to the T8 and T10 vertebrae, with extraosseous extension causing spinal-cord compression. Ten months after onset, the patient presented with progressive paraparesis and hypalgesia. Total en bloc spondylectomy was performed, and pathology was consistent with cavernous hemangioma. Motor and sensory deficits improved significantly, and no signs of recurrence are seen at 2.5 years after operation. A review of literature revealed a recurrence rate of 12.7% (10/79 cases). The available evidence indicates satisfactory long-term outcomes for total tumor resection without adjuvant radiotherapy. Ryo Ogawa, Tomohiro Hikata, Shuji Mikami, Nobuyuki Fujita, Akio Iwanami, Kota Watanabe, Ken Ishii, Masaya Nakamura, Yoshiaki Toyama, and Morio Matsumoto Copyright © 2015 Ryo Ogawa et al. All rights reserved. A Rare Case of Adductor Longus Muscle Rupture Mon, 30 Mar 2015 05:54:24 +0000 An adductor longus muscle rupture is a rare injury. This case report describes a 32-year-old patient with an adductor longus rupture. The trauma mechanism was a hyperabduction movement during a soccer game. Nonoperative treatment was initiated. After a follow-up of 4 years, the patient was without pain but a small swelling was still visible. This report describes the anatomy, pathophysiology, and evidence-based treatment of adductor longus rupture. R. J. L. L. van de Kimmenade, C. J. A. van Bergen, P. J. E. van Deurzen, and R. A. W. Verhagen Copyright © 2015 R. J. L. L. van de Kimmenade et al. 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.