Case Reports in Orthopedics http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. The Utility and Limitations of the Transfibular Approach in Ankle Trauma Surgery Thu, 30 Oct 2014 11:13:53 +0000 http://www.hindawi.com/journals/crior/2014/234369/ The commonly used extensive approaches to the distal tibia include the posteromedial and anterolateral approaches. The current report describes several cases performed using this technique establishing a rationale and safe zone for performing a transfibular approach to the distal tibia. The advantages of such approach are the excellent visualization of the lateral tibia and the articular space. The utilization of this approach involves the risk of injury to the anterior tibial vessels and to the superficial peroneal nerve as well as a requirement for syndesmosis reconstruction. The recommendation is to utilize this approach in cases of severe comminution of the lateral tibia with a relatively intact medial tibia. Mustafa Yassin, Avraham Garti, Muhammad Khatib, Moshe Weisbrot, Uzi Ashkenazi, Edward Ram, and Dror Robinson Copyright © 2014 Mustafa Yassin et al. All rights reserved. Tug-of-War Injuries: A Case Report and Review of the Literature Tue, 28 Oct 2014 13:39:59 +0000 http://www.hindawi.com/journals/crior/2014/519819/ We report a case of a 10-year-old boy presenting with radial nerve palsy due to injury during a tug-of-war game. Patient was managed nonoperatively and regained radial nerve function. Tug-of-war is a globally popular noncontact sport. Injuries during this game are inevitable and may range from simple sprains to life and limb threatening trauma. Combined hip and knee injuries and soft-tissue injuries involving the back are most frequent. Most injuries occur when tug-of-war was played in an informal setting and where the tug-of-war International Federation rules were less likely to be followed. Measures should be taken to increase the awareness about these safety rules and prevention of consequent injuries. Sports physicians, pediatricians, orthopedic surgeons, general physicians, and athletic trainers should be aware of potential injuries resulting from this game while caring for these athletes, so as to be well prepared for apt management of the injuries associated with TOW. Pranit N. Chotai and Amr A. Abdelgawad Copyright © 2014 Pranit N. Chotai and Amr A. Abdelgawad. All rights reserved. Rapid Hip Osteoarthritis Development in a Patient with Anterior Acetabular Cyst with Sagittal Alignment Change Mon, 27 Oct 2014 00:00:00 +0000 http://www.hindawi.com/journals/crior/2014/523426/ Rapidly destructive coxarthrosis (RDC) is rare and develops unusual clinical course. Recent studies suggest multiple possible mechanisms of the development of RDC. However the exact mechanism of RDC is still not clear. The difficulty of the study on RDC is attributed to its rareness and the fact that the data before the onset of RDC is normally unavailable. In this report, we presented the patient having the radiographic data before the onset who had rapid osteoarthritis (OA) development after contralateral THA, which meets the current criteria of RDC. We thought that the increased posterior tilt of the pelvis after THA reinforced the stress concentration at pre-existed anterior acetabular cyst, thereby the destruction of the cyst was occurred. As a result the rapid OA was developed. We think that there is the case of rapid osteoarthritis developing due to alternating load concentration by posterior pelvic tilt on preexisting anterior acetabular cyst such as our patient among the cases diagnosed as RDC without any identifiable etiology. The recognition of sagittal alignment changes and anterior acetabular cyst may play important role in prediction and prevention of the rapid hip osteoarthritis development similar to RDC. Yasuhiro Homma, Tomonori Baba, Nobuhiko Sumiyoshi, Hironori Ochi, Hideo Kobayashi, Mikio Matsumoto, Takahito Yuasa, and Kazuo Kaneko Copyright © 2014 Yasuhiro Homma et al. All rights reserved. 35 m Vertical Free Fall: How Impact Surface Influences Survival Thu, 23 Oct 2014 13:39:47 +0000 http://www.hindawi.com/journals/crior/2014/805213/ We describe the accidental free fall of a 23-year-old construction worker, who fell 13 stories (approximately 35 meters) from a false work landing on a toilet container. On impact he broke through the roof of the container, which attenuated his fall and made his survival possible. The patient sustained a central spleen rupture, liver laceration, subdural hematoma, blunt thoracic trauma with a left-sided hematothorax and right-sided pneumothorax with serial bilateral rib fractures, and an unstable fracture of the 10th thoracic vertebra. Two thoracic drainages were inserted in the emergency department before the patient underwent emergency surgery for the management of his intra-abdominal injuries. On the third day after trauma the unstable fracture of the 10th thoracic vertebra was stabilized with an internal fixator. Following extubation on day 8 after trauma the patient did not show any peripheral neurological deficits but cerebral affection with a general slowdown. After only 21 days, the patient was discharged from the hospital to a rehabilitation center where work specific rehabilitation was started. Although the patient is not suffering from physical afflictions from the injury his daily life abilities are still limited due to cerebral damage. C. Ehrnthaller and F. Gebhard Copyright © 2014 C. Ehrnthaller and F. Gebhard. All rights reserved. Miniopen Oblique Lateral L5-S1 Interbody Fusion: A Report of 2 Cases Tue, 21 Oct 2014 13:55:06 +0000 http://www.hindawi.com/journals/crior/2014/603531/ Extreme lateral interbody fusion (XLIF) has been widely used for minimally invasive anterior lumbar interbody fusion (ALIF), but an approach to L5-S1 is difficult because of the iliac crest. In the current study, we present 2 cases using minimally invasive oblique lateral interbody fusion (OLIF) of L5-S1. The patients showed foraminal stenosis between L5 and S1 and severe low back and leg pain. The patients were placed in a lateral decubitus position and underwent OLIF surgery (using a cage and bone graft from the iliac crest) without posterior decompression. Posterior screws were used in the patients. Pain scores significantly improved after surgery. There was no spinal nerve, major vessel, peritoneal, or urinary injury. OLIF surgery was minimally invasive and produced good surgical results without complications. Keijiro Kanno, Seiji Ohtori, Sumihisa Orita, Kazuyo Yamauchi, Yawara Eguchi, Yasuchika Aoki, Junichi Nakamura, Masayuki Miyagi, Miyako Suzuki, Gou Kubota, Kazuhide Inage, Takeshi Sainoh, Jun Sato, Yasuhiro Shiga, Koki Abe, Kazuki Fujimoto, Hiroto Kanamoto, Tomoaki Toyone, Gen Inoue, Eiji Hanaoka, and Kazuhisa Takahashi Copyright © 2014 Keijiro Kanno et al. All rights reserved. Chondrosternal Arthritis in Infant: An Unusual Entity Sun, 19 Oct 2014 00:00:00 +0000 http://www.hindawi.com/journals/crior/2014/652539/ Primary arthritis of chondrosternal joint is very rare and occurs in infants less than 18 months of age. Presentation is most often subacute but may be acute. Child presents with a parasternal mass with history of fever and/or local signs of infection. Clinical symptoms vary from a painless noninflammatory to a painful mass with local tenderness and swelling, while fever may be absent. Laboratory data show low or marginally raised levels of white blood cells and C-reactive protein, reflecting, respectively, the subacute or acute character of the infection. It is a self-limiting affection due to the adequate immune response of the patient. Evolution is generally good without antibiotherapy with a progressive spontaneous healing. A wait-and-see approach with close follow-up in the first weeks is the best therapeutic option. Athina Nikolarakou, Dana Dumitriu, and Pierre-Louis Docquier Copyright © 2014 Athina Nikolarakou et al. All rights reserved. Radiograms Obtained during Anterior Cervical Decompression and Fusion Can Mislead Surgeons into Performing Surgery at the Wrong Level Thu, 16 Oct 2014 11:35:15 +0000 http://www.hindawi.com/journals/crior/2014/398457/ A 68-year-old woman who suffered from C5 nerve palsy because of a C4-5 disc herniation was referred to our hospital. We conducted anterior cervical decompression and fusion (ACDF) at the C4-5 level. An intraoperative radiogram obtained after exposure of the vertebrae showed that the level at which we were going to perform surgery was exactly at the C4-5 level. After bone grafting and temporary plating, another radiogram was obtained to verify the correct placement of the plate and screws, and it appeared to show that the plate bridged the C5 and C6 vertebrae at the incorrect level. The surgeon was astonished and was about to begin decompression of the upper level. However, carefully double-checking the level with a C-arm image intensifier before additional decompression verified that the surgery was conducted correctly at C4-5. Cautiously double-checking the level of surgery with a C-arm image intensifier is recommended when intraoperative radiograms suggest surgery at the wrong level. Chikato Mannoji, Masao Koda, Takeo Furuya, Yuzuru Okamoto, Tamiyo Kon, Kazuhisa Takahashi, Masashi Yamazaki, and Masazumi Murakami Copyright © 2014 Chikato Mannoji et al. All rights reserved. Subcutaneous Rupture of the Extensor Pollicis Longus Tendon after Corticosteroid Injections for DeQuervain’s Stenosing Tenovaginitis Sun, 12 Oct 2014 00:00:00 +0000 http://www.hindawi.com/journals/crior/2014/934384/ DeQuervain’s stenosing tenovaginitis is a common condition. Nonsurgical treatment by corticosteroid injection has significantly improved the management of this disease. The authors describe a case of subcutaneous rupture of the extensor pollicis longus tendon at the wrist, three months after two corticosteroid injections for DeQuervain’s stenosing tenovaginitis. The etiological history has not found any trauma history of the wrist. The aim of our work is to draw attention to this rare complication and discuss its therapeutic management. Our functional results were excellent. Hassan Boussakri and Amara Bouali Copyright © 2014 Hassan Boussakri and Amara Bouali. All rights reserved. Dual ACL Ganglion Cysts: Significance of Detailed Arthroscopy Wed, 08 Oct 2014 00:00:00 +0000 http://www.hindawi.com/journals/crior/2014/236902/ Intra-articular ganglion cysts of the knee joint are rare and most frequently are an incidental finding on MRI and arthroscopy. Most of the previous studies have reported a single ganglion cyst in the knee. There have been previous reports of more than one cyst in the same knee but not in the same structure within the knee. We are reporting a case of dual ACL (anterior cruciate ligament) ganglion cysts one of which was missed on radiological examination but later detected during arthroscopy. To the best of our knowledge, no such case has been reported in the indexed English literature till date. Samarth Mittal, Amit Singla, H. L. Nag, Sanjay Meena, Ramprakash Lohiya, and Abhinav Agarwal Copyright © 2014 Samarth Mittal et al. All rights reserved. An Atypical Presentation of Myopericytoma in Palmar Arch and Review of the Literature Thu, 02 Oct 2014 08:49:34 +0000 http://www.hindawi.com/journals/crior/2014/759329/ Introduction. Myopericytoma is a very rare perivascular tumor that can be presented with painful mass in lower extremities. We aimed to present an atypical presentation and location of myopericytoma. Presentation of Case. An 18-year-old otherwise healthy individual was admitted to outpatient clinic with complaints of numbness and pain in his right hand. He has had no trauma. On volar aspect of his right hand, a well-circumscribed, painful mass was palpated. MRI results were related to hemangioma. Surgical excision was planned and performed. Pathological investigation revealed the mass is myopericytoma. Discussion. This case demonstrates a rare location and presentation of myopericytoma. Reviewing the literature, discussion was made to expand the horizon for diagnosis and treatment of patients with similar symptoms. Conclusion. Myopericytoma can rarely present with numbness and pain in affected region. Surgical excision is helpful for definitive diagnosis and symptom relief. Adnan Kara, Mert Keskinbora, Mahmut Enes Kayaalp, Ali Şeker, Mehmet Erdil, and Murat Bülbül Copyright © 2014 Adnan Kara et al. All rights reserved. Ocular Infection Preceding Major Epidural Abscess Tue, 30 Sep 2014 11:41:23 +0000 http://www.hindawi.com/journals/crior/2014/245013/ Staphylococcal bacteremia is an important clinical entity. A 74-year-old lady presented with an isolated staphylococcal ocular infection; this was treated with a short course of antibiotics, a prolonged course of steroids, and discharge from hospital with outpatient clinic followup. She represented three weeks later to the emergency department with back pain, raised inflammatory markers, and positive blood cultures. On magnetic resonance imaging (MRI), an extensive epidural collection was seen. This was surgically decompressed, and she was treated with appropriate intravenous antibiotics. Despite a complicated postoperative course, she made an excellent recovery. This case reviews the important clinical and radiological features of the presentation of a major epidural abscess and it also suggests a potentially unusual primary source. The clinician is reminded to always have a high index of suspicion regarding staphylococcal bacteremia and the potential for seeding to the epidural space. Liam Dunbar and Ryan Johnstone Copyright © 2014 Liam Dunbar and Ryan Johnstone. All rights reserved. Total Hip Arthroplasty Using a Short-Stemmed Femoral Component in the Presence of a Long Dynamic Condylar Screw Osteosynthesis Plate Tue, 30 Sep 2014 11:34:27 +0000 http://www.hindawi.com/journals/crior/2014/725403/ We present a potential indication of a short-stemmed femoral component in a patient with multiple comorbidities presenting with hip posttraumatic osteoarthritis and a long dynamic condylar screw osteosynthesis plate. Removal of the plate and implantation of a long stem would have been related to a much longer operative time and potential local or systemic complications. Martin Buttaro, Nicolas Piuzzi, Fernando Comba, Gerardo Zanotti, and Francisco Piccaluga Copyright © 2014 Martin Buttaro et al. All rights reserved. Osteoid Osteoma of Distal Phalanx of Toe: A Rare Cause of Foot Pain Wed, 24 Sep 2014 06:47:01 +0000 http://www.hindawi.com/journals/crior/2014/560892/ Osteoid osteoma is an uncommon benign tumor and causes severe pain, being worse at night, that responds dramatically to nonsteroidal anti-inflammatory medications. An osteoid osteoma of the toe is very rare and arising in a pedal phalanx may be difficult to diagnose. A 34-year-old male has local swelling and tenderness but there were no hyperemia, temperature increase, or clubbing. There was a 2-month history of antibiotic treatment with suspicion of soft tissue infection in another clinic. The osteoid osteoma was completely excised by curettage and nidus removal with open surgical technique. The patient was followed up for 63 months with annual clinical and radiographic evaluations. There was no relapse of the pain and no residual recurrent tumour. Osteoid osteoma may be difficult to distinguish from chronic infection or myxedema. The patients may be taken for unnecessary treatment. The aim of the treatment for osteoid osteoma is to remove entire nidus by open surgical excision or by percutaneous procedures such as percutaneous radiofrequency and laser ablation. Osteoid osteomas having radiologic and clinical features other than classical presentation of osteoid osteoma are called atypical osteoid osteomas. Atypical localized osteoid osteomas can be easily misdiagnosed and treatment is often complicated. Hakan Başar, Osman Mert Topkar, and Bülent Erol Copyright © 2014 Hakan Başar et al. 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.