Case Reports in Orthopedics The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Sciatic Nerve Palsy following Total Hip Replacement via Direct Anterior Approach after Recommencement of Warfarin for Prophylaxis in Atrial Fibrillation Wed, 17 Dec 2014 06:28:15 +0000 The occurrence of sciatic nerve palsy following posterior and anterolateral approaches to the hip has been well documented and is about 1-2%. To our knowledge, however, there are no reports of sciatic nerve palsy occurring secondary to the anterior approach to the hip for arthroplasty. We describe a case of sciatic nerve palsy secondary to haematoma formation following total hip replacement through the anterior approach. The recommencement of warfarin for prophylaxis against atrial fibrillation is thought to have been a contributing factor. Full recovery is rare following delayed diagnosis and early recognition of the signs of pain, parasthesia, and gradual loss of dorsiflexion and prompt drainage may reverse the condition. We advise caution with restarting warfarin following total hip arthroplasty. Vipin Asopa, Shafic Al-Nammari, Tony Spriggins, Tony Menz, and Adrian Bauze Copyright © 2014 Vipin Asopa et al. All rights reserved. Knee Lymphocutaneous Fistula Secondary to Knee Arthroplasty Mon, 15 Dec 2014 00:10:36 +0000 Lower limb lymphorrhea secondary to a surgical procedure is a rare but difficult-to-solve complication. In lower limb, this entity is frequently associated with vascular procedures around the inguinal area. We report on a case of a knee lymphocutaneous fistula secondary to a knee revision arthroplasty. To our knowledge, no previous reports regarding this complication have been published. T. Pérez-de la Fuente, E. Sandoval, A. Alonso-Burgos, L. García-Pardo, C. Cárcamo, and O. Caballero Copyright © 2014 T. Pérez-de la Fuente et al. All rights reserved. Symphysis Pubis Osteomyelitis with Bilateral Adductor Muscles Abscess Sun, 14 Dec 2014 00:10:58 +0000 Osteomyelitis of the pubis symphysis is a rare condition. There have been various reports in the literature of inflammation and osteomyelitis as well as septic arthritis of pubic symphysis. However, due to the fact that these conditions are rare and that the usual presenting symptoms are very nonspecific, osteomyelitis of the pubic symphysis is often misdiagnosed, thus delaying definitive treatment. We present a case that to our knowledge is the first case in literature of osteomyelitis of the pubic symphysis in a 17-year-old boy with juvenile idiopathic arthritis (JIA), which was initially misdiagnosed and progressed to bilateral adductor abscesses. A high suspicion of such condition should be considered in a JIA patient who presents with symphysis or thigh pain. Saad M. Alqahtani, Fan Jiang, Bardia Barimani, and Marie Gdalevitch Copyright © 2014 Saad M. Alqahtani et al. All rights reserved. Bilateral Distal Femoral Nailing in a Rare Symmetrical Periprosthetic Knee Fracture Sun, 14 Dec 2014 00:10:56 +0000 The authors report a case of a 78-year-old polytrauma patient, with severe thoracic trauma and bilateral symmetrical periprosthetic femoral fractures after a violent car accident. After the primary survey, with the thoracic trauma stabilized, neurovascular lesions excluded, and provisional immobilization applied, both fractures were classified as OTA: 33-A3, Rorabeck Type II, and closed reduction and internal fixation with distal femoral nails were performed. At 5 months of follow-up, the patient was able to walk with crutches and clear radiologic signs of fracture consolidation could be seen. At 24 months, the patient walked without any walking aid and had recovered her previous functional status. This surgical option allowed the authors to achieve relative stability using an intramedullary technique, preserving fracture hematoma in an osteopenic patient, and was found to be successful in recovering the patient’s previous functional status and satisfaction after major trauma. Marcos Carvalho, Ruben Fonseca, Pedro Simões, André Bahute, António Mendonça, and Fernando Fonseca Copyright © 2014 Marcos Carvalho et al. All rights reserved. Haemorrhagic Lumbar Juxtafacet Cyst with Ligamentum Flavum Involvement Sun, 14 Dec 2014 00:10:53 +0000 Juxtafacet cysts are an uncommon cause of radiculopathy. They occur most frequently in the lumbar region, and their distribution across the spine correlates with mobility. Haemorrhagic complications are rare and may occur in the absence of any provocation, although there is some association with anticoagulation and trauma. We present a case of acute radiculopathy due to an L5/S1 juxtafacet cyst with unprovoked haemorrhage which was found to extend into ligamentum flavum. The patient underwent uncomplicated microscope assisted decompression with excellent results. The demographics, presentation, aetiology, and management of juxtafacet cysts are discussed. Finn Ghent, Trent Davidson, and Ralph Jasper Mobbs Copyright © 2014 Finn Ghent et al. All rights reserved. Delaying Shoulder Motion and Strengthening and Increasing Achilles Allograft Thickness for Glenoid Resurfacing Did Not Improve the Outcome for a 30-Year-Old Patient with Postarthroscopic Glenohumeral Chondrolysis Sun, 14 Dec 2014 00:10:51 +0000 Although interposition soft-tissue (biologic) resurfacing of the glenoid with humeral hemiarthroplasty has been considered an option for end-stage glenohumeral arthritis, the results of this procedure are highly unsatisfactory in patients less than 40 years old. Achilles tendon allograft is popular for glenoid resurfacing because it can be made robust by folding it. But one reason that the procedure might fail in younger patients is that the graft is not initially thick enough for the young active patient. Most authors report folding the graft only once to achieve two-layer thickness. We report the case of a 30-year-old male who had postarthroscopic glenohumeral chondrolysis that was treated with Achilles tendon allograft resurfacing of the glenoid and humeral hemiarthroplasty. An important aspect of our case is that the tendon was folded so that it was 50–100% thicker than most allograft constructs reported previously. We also used additional measures to enhance allograft resiliency and bone incorporation: (1) multiple nonresorbable sutures to attach the adjacent graft layers, (2) additional resorbable suture anchors and nonresorbable sutures in order to more robustly secure the graft to the glenoid, and (3) delaying postoperative motion and strengthening. However, despite these additional measures, our patient did not have an improved outcome. John G. Skedros, Tanner R. Henrie, and Chad S. Mears Copyright © 2014 John G. Skedros et al. All rights reserved. Retrograde Intramedullary Nailing with a Blocking Pin Technique for Reduction of Periprosthetic Supracondylar Femoral Fracture after Total Knee Arthroplasty: Technical Note with a Compatibility Chart of the Nail to Femoral Component Thu, 11 Dec 2014 06:47:27 +0000 Periprosthetic fractures after total knee arthroplasty (TKA) present a clear management challenge, and retrograde intramedullary nails have recently gained widespread acceptance in treatment of these fractures. In two cases, we found a blocking screw technique, first reported by Krettek et al., was useful in the reduction of the fractures. Both patients attained preinjury mobility after intramedullary nailing. Moreover, we present a chart summarizing the notch designs of various femoral components because some prosthetic knee designs are not amenable to retrograde nailing. We hope this will be helpful in determining indications for retrograde nailing in periprosthetic fractures after TKA. Ichiro Tonogai, Daisuke Hamada, Tomohiro Goto, Tomoya Takasago, Takahiko Tsutsui, Naoto Suzue, Tetsuya Matsuura, and Koichi Sairyo Copyright © 2014 Ichiro Tonogai et al. All rights reserved. Chondroblastoma of the Knee Treated with Resection and Osteochondral Allograft Reconstruction Mon, 08 Dec 2014 12:39:43 +0000 Case. This case report describes the operative management of 16-year-old male with a symptomatic chondroblastoma of the distal femur with breach of the chondral surface. Following appropriate imaging and core needle biopsy, the diagnosis was confirmed histologically. The patient then underwent intralesional curettage and osteochondral allograft reconstruction of the defect. At one-year follow-up the patient was pain-free and has obtained excellent range of motion. There is radiographic evidence of allograft incorporation and no evidence of local recurrence. Conclusion. Osteochondral allograft reconstruction is an effective option following marginal resection and curettage of chondroblastoma involving the chondral surface of the distal femur. Judd Fitzgerald, Cory Broehm, David Chafey, and Gehron Treme Copyright © 2014 Judd Fitzgerald et al. All rights reserved. Familial Discoid Medial Meniscus Tear in Three Members of a Family: A Case Report and Review of Literature Mon, 08 Dec 2014 11:51:56 +0000 Background. A discoid meniscus is a thickened variant of the normal C-shaped meniscus prone to injury. Discoid medial meniscal tears have rarely been reported within families and may suggest familial or developmental origins. Methods. We report the cases of two Caucasian brothers with symptomatic discoid medial meniscus tears. A literature review was conducted addressing discoid medial meniscus and cases of familial meniscus tears. Case Presentation. Physically active brothers presented with progressively worsening knee pain. MRI revealed medial meniscus tears in both brothers. The family history of medial meniscus tears in their mother and the discoid medial meniscus injuries found on arthroscopy suggested evidence for familial discoid medial meniscus tears. Conclusions. Discoid medial meniscus tears within a family have not been previously reported. Two cases of families with discoid lateral meniscus tears have been reported. Discoid medial meniscus is rare relative to the discoid lateral meniscus and predisposes children to symptomatic tears. Raheel Ahmed Ali and Scott McKay Copyright © 2014 Raheel Ahmed Ali and Scott McKay. All rights reserved. Isolated Pulmonary Embolism following Shoulder Arthroscopy Sun, 07 Dec 2014 00:10:41 +0000 Pulmonary embolism (PE) following shoulder arthroscopy is a rare complication. We present a unique case report of a 43-year-old right-hand dominant female who developed a PE 41 days postoperatively with no associated upper or lower extremity DVT. The patient had minimal preoperative and intraoperative risk factors. Additionally, she had no thromboembolic symptoms postoperatively until 41 days following surgery when she developed sudden right-hand swelling, labored breathing, and abdominal pain. A stat pulmonary computed tomography (CT) angiogram of the chest revealed an acute PE in the right lower lobe, and subsequent extremity ultrasounds showed no upper or lower extremity deep vein thrombosis. After a thorough review of the literature, we present the first documented isolated PE following shoulder arthroscopy. Although rare, sudden development of an isolated PE is possible, and symptoms such as sudden hand swelling, trouble breathing, and systemic symptoms should be evaluated aggressively with a pulmonary CT angiogram given the fact that an extremity ultrasound may be negative for deep vein thrombosis. Nicole H. Goldhaber and Christopher S. Lee Copyright © 2014 Nicole H. Goldhaber and Christopher S. Lee. All rights reserved. Distal Clavicle Osteolysis after Modified Weaver-Dunn’s Procedure for Chronic Acromioclavicular Dislocation: A Case Report and Review of Complications Tue, 02 Dec 2014 07:23:20 +0000 Distal clavicle osteolysis after acromioclavicular joint stabilization has only been described after the use of hardware for clavicle stabilization or synthetic graft causing a foreign body reaction. This paper reports a very rare case of distal clavicle osteolysis after modified Weaver-Dunn procedure for the treatment of chronic acromioclavicular joint dislocation. The paper also provides a comprehensive review of complications of this surgical technique and discusses a potential vascular etiology and preventive strategies aimed at avoiding clavicle osteolysis. Eduard Alentorn-Geli, Fernando Santana, Felipe Mingo, Ignasi Piñol, Albert Solano, Lluís Puig-Verdié, and Carles Torrens Copyright © 2014 Eduard Alentorn-Geli et al. All rights reserved. Vertebral Osteomyelitis Caused by Mycobacterium abscessus Surgically Treated Using Antibacterial Iodine-Supported Instrumentation Tue, 02 Dec 2014 07:00:50 +0000 Mycobacterium abscessus infections rarely develop in healthy individuals, and mostly they occur in immunocompromised hosts. Vertebral osteomyelitis due to Mycobacterium abscessus is very rare and only three previous cases of spinal infection caused by Mycobacterium abscessus have been reported. Mycobacterium abscessus isolates are uniformly resistant to antituberculous agents and can display a virulent biofilm-forming phenotype. The patient was a 67-year-old woman with vertebral osteomyelitis of the L1-2. She was healthy without immune-suppressed condition, history of trauma, or intravenous drug use. The smear examination of the specimen harvested by CT-guided puncture of the paravertebral abscess revealed Mycobacterium abscessus. Her disease condition did not abate with conservative treatment using antimicrobial chemotherapy. Radical debridement of the vertebral osteomyelitis and anterior reconstruction from T12 to L2 using antibacterial iodine-supported instrumentation were performed. Chemotherapy using clarithromycin, amikacin, and imipenem was applied for 6 months after surgery as these antibiotics had been proven to be effective to Mycobacterium abscessus after surgery. Two years after surgery, the infected anterior site healed and bony fusion was successfully achieved without a recurrence of infection. Satoshi Kato, Hideki Murakami, Satoru Demura, Katsuhito Yoshioka, Hiroyuki Hayashi, Noriaki Yokogawa, Xiang Fang, and Hiroyuki Tsuchiya Copyright © 2014 Satoshi Kato et al. All rights reserved. Hypertrophic Nonunion Humerus Mimicking an Enchondroma Sun, 30 Nov 2014 07:56:23 +0000 Introduction. Although fractures of humeral shaft show excellent results with conservative management, nonunion does occur. Case Report. We bring forth the case of a young male with a 1.5-year-old hypertrophic nonunion of the humerus mimicking an enchondroma. The initial X-ray images of the patient appeared to be an enchondroma, which only on further evaluation and histopathological analysis was diagnosed conclusively to be a hypertrophic nonunion. Discussion. Enchondromas are often incidentally diagnosed benign tumours. It is however not common to misdiagnose a hypertrophic nonunion to be an enchondroma. We present this case to highlight the unique diagnostic dilemma the treating team had to face. N. K. Magu, Amanpreet Singh, Reetadyuti Mukhopadhyay, Jitendra Wadhwani, Paritosh Gogna, Rohit Singla, Sahil Arora, and Pragnashree Mukhopadhyay Chatterjee Copyright © 2014 N. K. Magu et al. All rights reserved. Traumatic Dislocation of the Hip in a Child Caused by Trivial Force for Age Wed, 26 Nov 2014 07:14:04 +0000 Traumatic hip dislocation in children has a relatively rare occurrence. There are some residual complications, such as avascular necrosis of the femoral head, growth disturbance caused by premature fusion, neurological injury, recurrent dislocation, and posttraumatic arthritis. There is no consensus in the literature about the period of non-weight bearing after reduction. A rare case of a 13-year-old boy of hip dislocation caused by trivial force for age is reported followed by review of the pediatric literatures with treatment recommendation. Hiroyuki Furuya, Yoshio Shimamura, Kazuo Kaneko, Hiroshi Sakuramoto, Kazuhiro Hirata, and Yasuhisa Arai Copyright © 2014 Hiroyuki Furuya et al. All rights reserved. An Unusual Metallic Foreign Body inside the Knee Medial Femoral Condyle Sun, 23 Nov 2014 08:30:33 +0000 Foreign bodies in the knee joint are uncommon, particularly those not related to surgical procedures. In this paper, we present a case of an intraosseous metallic foreign body situated in the medial femoral condyle for one year, causing pain, which was removed with complete resolution of the symptoms. Camilo Partezani Helito, Carlos Eduardo Nunes Faria, Marcelo Batista Bonadio, Jose Ricardo Pecora, Gilberto Luis Camanho, and Marco Kawamura Demange Copyright © 2014 Camilo Partezani Helito et al. All rights reserved. Bilateral Simultaneous Femoral Neck Fracture Mimicking Abdominal Pain in a Cerebral Palsy Patient Sun, 23 Nov 2014 00:00:00 +0000 Simultaneous bilateral femoral neck fractures are unusual lesions, generally associated with an underlying condition which causes impaired bone mineralization, triggered by an increased bone stress. We present a 24-year-old cerebral palsy patient, who was previously evaluated in another institution due to inability to walk, interpreted as abdominal pain. No alteration in blood analysis or abdominal X-rays was found. As no response to treatment was observed, a new abdominal X-ray was taken, which incidentally depicted bilateral medial femoral neck fracture. He was referred to our practice after a resection arthroplasty was offered in another institution. After admission, bilateral one-stage THA was performed. Several reports emphasize bone disease as a major precipitating factor, and there is an increased incidence of hip fractures in chronic epilepsy, renal osteodystrophy, and chronic steroid use. Femoral head resection has been proven to be effective in immobilized patients, whereas this was not a reasonable option in this patient who presented walking ability. Despite the treatment election, primary care physicians should be aware of and alert to the possibility of fractures in patients with neurological disorders and calcium metabolism alterations. Late diagnosis of orthopedic injuries in this type of patients may lead to permanent disability. P. Mariani, M. Buttaro, F. Comba, E. Zanotti, P. Ali, and F. Piccaluga Copyright © 2014 P. Mariani et al. All rights reserved. Two Patients with Osteochondral Injury of the Weight-Bearing Portion of the Lateral Femoral Condyle Associated with Lateral Dislocation of the Patella Tue, 18 Nov 2014 10:47:35 +0000 Complications of patellar dislocation include osteochondral injury of the lateral femoral condyle and patella. Most cases of osteochondral injury occur in the anterior region, which is the non-weight-bearing portion of the lateral femoral condyle. We describe two patients with osteochondral injury of the weight-bearing surface of the lateral femoral condyle associated with lateral dislocation of the patella. The patients were 18- and 11-year-old females. Osteochondral injury occurred on the weight-bearing surface distal to the lateral femoral condyle. The presence of a free osteochondral fragment and osteochondral injury of the lateral femoral condyle was confirmed on MRI and reconstruction CT scan. Treatment consisted of osteochondral fragment fixation or microfracture, as well as patellar stabilization. Osteochondral injury was present in the weight-bearing portion of the lateral femoral condyle in both patients, suggesting that the injury was caused by friction between the patella and lateral femoral condyle when the patella was dislocated or reduced at about 90° flexion of the knee joint. These findings indicate that patellar dislocation may occur and osteochondral injury may extend to the weight-bearing portion of the femur even in deep flexion, when the patella is stabilized on the bones of the femoral groove. Shuji Nakagawa, Yuji Arai, Hiroaki Inoue, Satoru Atsumi, Shohei Ichimaru, Kazuya Ikoma, Hiroyoshi Fujiwara, and Toshikazu Kubo Copyright © 2014 Shuji Nakagawa et al. All rights reserved. Fourth Primary Malignant Tumor in a Patient with Possible Li-Fraumeni Syndrome: Synchronous Diagnosis of Postirradiation Sarcoma, Cutaneous Relapse of a Previous Soft Tissue Sarcoma, and Lung Adenocarcinoma Tue, 18 Nov 2014 08:00:53 +0000 We present a 46-year-old female patient who is diagnosed with synchronous postirradiation sarcoma, cutaneous relapse of a previous soft tissue sarcoma, and lung adenocarcinoma. More than one malignant tumor at the same time with an accompanying relapse of a previous malignant tumor is a rare entity. A relatively young patient diagnosed with adenocarcinoma of the urethra before age 40, which is an unusual tumor for that age, later three more different malignant tumors being diagnosed, two of which are synchronous, causes the suspicion of Li-Fraumeni syndrome. Feridun Yumrukçal, Yalin Dirik, Arda Çinar, and Levent Eralp Copyright © 2014 Feridun Yumrukçal et al. All rights reserved. Traumatic Fracture in a Patient with Osteopoikilosis Sun, 16 Nov 2014 10:17:05 +0000 We report a case of traumatic humeral neck fracture occurring in a patient with osteopoikilosis after a motorcycle accident. The radiograph revealed the fracture but also multiple bone lesions. A few years before, the patient had been operated for a maldiagnosed chondrosarcoma of the humeral head. Osteopoikilosis is a rare benign hereditary bone disease, whose mode of inheritance is autosomal dominant. It is usually asymptomatic and discovered incidentally on radiograph that shows the presence of multiple osteoblastic lesions. It can mimic other bone pathologies, in particular osteoblastic metastases. Osteopoikilosis is a diagnosis that should be kept in mind to avoid misdiagnosis, particularly with regard to cancer metastasis. This disorder does not require any treatment and complications are rare. However, there may be associated anomalies that require follow-up. Adeline Du Mortier and Pierre-Louis Docquier Copyright © 2014 Adeline Du Mortier and Pierre-Louis Docquier. All rights reserved. A Case of Femoral Fracture in Klippel Trenaunay Syndrome Wed, 12 Nov 2014 09:37:01 +0000 We present a case of Klippel Trenaunay syndrome (KTS) who presented with severe bilateral knee osteoarthritis (OA). Preoperative planning was commenced for a total knee replacement (TKR). Whilst on the waiting list the patient suffered a fall and sustained a complete femoral diaphysis fracture. Conservative management in the form of skin traction was initially chosen as significant extra- and intramedullary vascular malformations posed an increased risk of perioperative bleeding. This failed to progress to union, and so open reduction and internal fixation was performed. This subsequently resulted in on-going delayed union, which was subsequently managed with low intensity pulsed ultrasound (LIPUS, otherwise known as Exogen (Bioventus. exogen. Secondary exogen, 2012)). There are only two previous documented cases of femoral fracture in KTS. This is the first report of a patient with this rare syndrome receiving this treatment. We discuss the management of fracture in this challenging group of patients. Sam Nahas, Fabian Wong, and Diane Back Copyright © 2014 Sam Nahas et al. All rights reserved. Ground-Level Geriatric Falls: A Not-So-Minor Mechanism of Injury Thu, 06 Nov 2014 13:27:03 +0000 Introduction. Ground-level falls are typically regarded as a minor mechanism of injury that do not necessitate trauma team activation; however, they represent a significant proportion of hospitalised trauma and can result in multisystem injury. Case Presentation. A 79-year-old nursing home resident was brought to the emergency department following an unwitnessed fall. She suffered dementia and had a seizure in the department resulting in a reduced GCS, making history and examination difficult. She was diagnosed with a right proximal humerus fracture and admitted under joint orthopedic and medical care. Following orthopedic review, further X-rays were requested which showed bilateral neck of femur fractures. The following day she had bilateral hip hemiarthroplasties and K-wire stabilisation of the right shoulder. Several days later, when cognition had improved, she was noted to be avoiding use of the left arm and was found to also have a left proximal humerus fracture which was managed conservatively. Conclusion. Trauma patients with reduced cognitive function should undergo full ATLS assessment, and a prospective trial is required to see if age should be incorporated as a criteria for trauma team activation. More liberal use of advanced imaging such as a full body CT-scan may be beneficial. Simon Parker and Arash Afsharpad Copyright © 2014 Simon Parker and Arash Afsharpad. All rights reserved. Severe Heterotopic Ossification following Total Knee Replacement Wed, 05 Nov 2014 11:14:52 +0000 Although the incidence of minor heterotopic ossification is probably higher than what is usually expected, severe heterotopic ossification (HO) is an extremely rare event following total knee replacement surgery. We present the case of a 66-year-old woman who initially had achieved an excellent range of motion following bilateral uncemented rotating platform total knee replacement, before presenting with pain and loss of range of motion at 2 months after surgery. Severe HO was diagnosed on X-rays. Treatment consisted of nonoperative measures only, including physiotherapy with hydrotherapy and anti-inflammatories. She eventually regained her range of motion when seen at 8 months after operation. This case illustrates that nonoperative treatment without the use of radiotherapy or surgery can be used to safely resolve stiffness caused by HO after total knee replacement. Alexander L. Dodds and Gregory C. R. Keene Copyright © 2014 Alexander L. Dodds and Gregory C. R. Keene. All rights reserved. A Case Report of Herpetic Whitlow with Positive Kanavel’s Cardinal Signs: A Diagnostic and Treatment Difficulty Tue, 04 Nov 2014 09:35:08 +0000 Herpetic whitlow is an acute viral infection of the hand caused by either herpes simplex virus (HSV) 1 or 2. Its characteristic findings are significant pain and erythema with overlying nonpurulent vesicles. The differential diagnosis includes flexor tenosynovitis. We present a case of recurrent infection of the middle finger in an immunocompetent 19-year-old girl. Multiple painful pustules with tracking cellulitis were partially treated by oral antibiotics. A recurrence with positive Kanavel’s signs suggested flexor tenosynovitis at seven months. Her symptoms improved transiently following emergent surgical open flexor sheath exploration and washout however, she required two further washouts; at eleven and thirteen months to improve symptoms. Viral cultures were obtained from the third washout as HSV infection was disclosed from further history taking. These were positive for HSV2. Treatment with acyclovir at thirteen months after presentation led to a complete resolution of her symptoms with no further recurrences to date. This rare case highlights the similarity in presentation between flexor sheath infection and herpetic whitlow which can lead to diagnostic confusion and mismanagement. We emphasise the importance of careful past medical history taking as well as considering herpetic whitlow as a differential diagnosis despite the presence of strongly positive Kanavel’s signs. Milos Brkljac, Samer Bitar, and Zafar Naqui Copyright © 2014 Milos Brkljac et al. All rights reserved. Proximal Row Carpectomy for Coexisting Kienböck’s Disease and Giant Intraosseous Ganglion of the Scaphoid: A Case Report and Review of the Literature Mon, 03 Nov 2014 07:12:06 +0000 The etiologies of Keinböck’s disease and intraosseous ganglion remain unknown. Both entities are rare and the coexistence of these two pathologies in the same patient and hand is even less frequent. We report the case of a 40-year-old man with a longstanding history of martial arts practice (karate) who developed an avascular necrosis of the lunate concomitant with a giant intraosseous ganglion of the scaphoid bone successfully managed by proximal row carpectomy. We review the literature of these two diseases. Miguel Morón, Florian Oellig, and Tomás Sánchez Copyright © 2014 Miguel Morón et al. All rights reserved. The Utility and Limitations of the Transfibular Approach in Ankle Trauma Surgery Thu, 30 Oct 2014 11:13:53 +0000 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 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 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 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 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 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.