Case Reports in Orthopedics The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Evaluation of Gait Performance of a Hemipelvectomy Amputation Walking with a Canadian Prosthesis Mon, 14 Apr 2014 12:44:01 +0000 Background. Hemipelvectomy amputation is a surgical procedure in which lower limb and a portion of pelvic are removed. There are a few studies in the literature regarding the performance of subjects with hip disarticulation during walking. However, there is no study on gait analysis of hemipelvectomy subject. Therefore, the aim of this paper was to evaluate the gait and stability of subject with hemipelvectomy amputation. Case Description and Methods. A subject with hemipelvectomy amputation at right side was involved in this study. He used a Canadian prosthesis with single axis ankle joint, 3R21 knee joint, and 7E7 hip joint for more than 10 years. The kinetic and kinematic parameters were collected by a motion analysis system and a Kistler force platform. Findings and Outcomes. There was a significant difference between knee, hip, and ankle range of motions and their moments in the sound and prosthesis sides. In the other side, the stability of the subject in the anteroposterior direction seems to be better than that in the mediolateral direction. Conclusions. There was a significant asymmetry between the kinetic and kinematic performance of the sound and prosthesis sides, which may be due to lack of muscular power and alignment of prosthesis components. M. T. Karimi, M. Kamali, H. Omar, and Javid Mostmand Copyright © 2014 M. T. Karimi et al. All rights reserved. Snapping Knee Caused by Medial Meniscal Cyst Sun, 13 Apr 2014 14:03:46 +0000 Snapping phenomenon around the medial aspect of the knee is rare. We present this case of snapping knee caused by the sartorius muscle over a large medial meniscal cyst in a 66-year-old female. Magnetic resonance images demonstrated a large medial meniscal cyst with a horizontal tear of the medial meniscus. Arthroscopic cyst decompression with limited meniscectomy resulted in the disappearance of snapping, and no recurrence of the cyst was observed during a 2-year follow-up period. Tsuyoshi Ohishi, Daisuke Suzuki, Kazufumi Yamamoto, Tomohiro Banno, Hiroki Ushirozako, Yoichi Koide, and Yukihiro Matsuyama Copyright © 2014 Tsuyoshi Ohishi et al. All rights reserved. Ossicle in Anterior Cruciate Ligament: A Rare Occurrence Sun, 13 Apr 2014 08:28:32 +0000 The occurrence of an intra-articular ossicle is not rare in the knee, with reports suggesting the existence of meniscal osscile. There are also reports describing the attachment of the posterolateral bundle of the anterior cruciate ligament (ACL) to an accessory ossicle. However, despite an extensive search of the English literature we did not find much written about an intrasubstance ossicle in the ACL. We present the case of a 13-year-old male with an intrasubstance ossicle in the anteromedial bundle of the ACL of his right knee. Ashish Devgan, Reetadyuti Mukhopadhyay, Amanpreet Singh, Paritosh Gogna, Rohit Singla, and Narender Kumar Magu Copyright © 2014 Ashish Devgan et al. All rights reserved. Skin Necrosis Associated with Thromboprophylaxis after Total Knee Replacement Sun, 06 Apr 2014 12:34:25 +0000 Thromboprophylaxis are routinely given to prevent venous thromboembolism (VTE) in patients after total hip and knee replacement surgeries. Low molecular weight heparin (LMWH) (fractioned heparin) is effective in the prevention and treatment of VTE. The predicable effect of LMWH has popularized it for routine clinical use. Although LMWH has lesser complication rate, compared to unfractioned heparin (UFH), sporadic clinical complication has been reported. We report a rare case of skin necrosis secondary to use of LMWH tinzaparin used for routine thromboprophylaxis after total knee replacement. S. V. Karuppiah and A. J. Johnstone Copyright © 2014 S. V. Karuppiah and A. J. Johnstone. All rights reserved. Bilateral Simultaneous Heterotopic Ossification of the Reflected Head of Rectus Femoris Muscle: A Case Report and Review of the Literature Thu, 03 Apr 2014 13:03:37 +0000 Lamellar bone formation in an abnormal location is defined as heterotopic ossification. It commonly occurs around the hip joint and most often involves the abductor muscles. It is a benign condition; however, its etiology remains largely unknown. Most previously reported cases have been due to trauma or intramuscular hemorrhage. In this paper, we present a case of bilateral heterotopic ossification of the reflected head of rectus femoris muscle without antecedent trauma or any other known cause, as the first and unique case in the literature. She was treated by excision of the right symptomatic bony mass via a modified Smith-Petersen approach. Postoperatively, she received 75 mg indomethacin daily for six weeks. She was pain-free and obtained full range of motion 3 weeks after the first intervention. Murat Tonbul, Seyma Ozen, and Ayse Tuba Tonbul Copyright © 2014 Murat Tonbul et al. All rights reserved. Missed Massive Morel-Lavallee Lesion Sun, 30 Mar 2014 12:15:02 +0000 A Morel-Lavallee lesion (MLL) involves posttraumatic fluid collection around the greater trochanter. Many cases of MLL are missed at the initial evaluation, and the treatment of MLL is not well established. We present two cases in which MLL was missed at the initial evaluation. Case 1. A 65-year-old man was run over by a parade float. There was subcutaneous hematoma around the left greater trochanter, and no fracture was found. We diagnosed this injury as MLL on the 7th day after the trauma. Although we performed percutaneous drainage, the injured area was infected. Case 2. A 57-year-old man was hit by a train in a factory. There was an iliac wing fracture, but an MLL was not initially recognized. On the 6th day after the trauma, when performing open reduction and internal fixation for the iliac fracture, we recognized the lesion and performed percutaneous drainage simultaneously. This lesion also became infected. In these two cases, the wounds finally healed after a long duration of treatment. We suggest that it is important to keep this injury in mind and debride the lesion early and completely in the treatment course. Shunsuke Takahara, Keisuke Oe, Hironori Fujita, Atsushi Sakurai, Takashi Iwakura, Sang Yang Lee, Takahiro Niikura, Ryosuke Kuroda, and Masahiro Kurosaka Copyright © 2014 Shunsuke Takahara et al. All rights reserved. Upper Extremity Thrombosis Presenting as Medial Elbow Pain after Shoulder Arthroscopy Wed, 19 Mar 2014 11:34:02 +0000 Deep vein thrombosis of the upper extremity is believed to be an uncommon complication of arthroscopic shoulder surgery. It most commonly presents with significant swelling and pain throughout the upper extremity. However the diagnosis can be easily missed when findings are more subtle and unrelated or the patient asymptomatic. In this study we report on 5 cases of postoperative upper extremity deep vein thrombosis (UEDVT). Each case was performed in the lateral decubitus position with an interscalene block and postoperative sling immobilization. All patients presented with a primary complaint of medial elbow pain and went on to require anticoagulation. Only one patient was found to have a heritable coagulopathy. The true incidence of thromboembolic phenomena after shoulder arthroscopy may be higher than that reported in the current literature. Therefore a high index of suspicion must be maintained when evaluating patients postoperatively to avoid misdiagnosis. Symptoms of medial elbow pain after immobilization in a sling should be considered an indication for duplex ultrasound evaluation. Ultimately, further prospective study is needed to better understand the prevalence, prevention, and management of this entity. Moiz I. Manaqibwala, Irene E. Ghobrial, and Alan S. Curtis Copyright © 2014 Moiz I. Manaqibwala et al. All rights reserved. Swellings over the Limbs as the Earliest Feature in a Patient with Osteogenesis Imperfecta Type V Tue, 18 Mar 2014 06:33:53 +0000 Swellings over the upper and lower limbs were encountered in a one-year-old child. Skeletal survey showed a constellation of distinctive radiographic abnormalities of osteoporosis, hyperplastic callus and ossification of the interosseous membrane of the forearm, femora, and to lesser extent the tibiae. Neither wormian bones of the skull nor dentinogenesis imperfecta was present. Genetic tests revealed absence of mutation in COL1A1 or COL1A2 genes, respectively. The overall phenotypic features were consistent with the diagnosis of osteogenesis imperfecta type V (OI-V). The aim of this paper is to distinguish between swellings because of intrinsic bone disorders and these due to child physical abuse. Ali Al Kaissi, Rudolf Ganger, Klaus Klaushofer, and Franz Grill Copyright © 2014 Ali Al Kaissi et al. All rights reserved. Pott’s Disease in a 2-Year-Old Child Treated by Decompression and Anterior-Posterior Instrumented Fusion Tue, 11 Mar 2014 08:49:57 +0000 Introduction. Paraplegia and kyphotic deformity are two major disease-related problems of spinal tuberculosis, especially in the early age disease. In this study a 2-year-old boy who underwent surgical decompression, correction, and 360° instrumented fusion via simultaneous anterior-posterior technique for Pott’s disease was reported. Case Report. A 2-year-and-9-month-old boy presented with severe back pain and paraparesis of one-month duration. Thoracic magnetic resonance imaging demonstrated destruction with a large paraspinal abscess involving T5-T6-T7 levels, compressing the spinal cord. The paraspinal abscess drained and three-level corpectomy was performed at T5-6-7 with transthoracic approach. Anterior instrumentation and fusion was performed with structural 1 autogenous fibula and rib graft using screw-rod system. In prone position pedicle screws were inserted at T4 and T8 levels and rods were placed. Six months after surgery, there was no weakness or paraparesis and no correction loss at the end of follow-up period. Discussion. In cases of vertebral osteomyelitis with severe anterior column destruction in the very early child ages the use of anterior structural grafts and instrumentation in combination with posterior instrumentation is safe and effective in maintenance of the correction achieved and allows efficient stabilization and early mobilization. Mehmet Nuri Erdem, Cem Sever, Mehmet Fatih Korkmaz, Sinan Karaca, Ferit Kirac, and Mehmet Tezer Copyright © 2014 Mehmet Nuri Erdem et al. All rights reserved. Treatment of Habitual Patellar Dislocation in an Adult by Isolated Medial Patellofemoral Ligament Reconstruction Tue, 04 Mar 2014 16:31:07 +0000 Habitual patellar dislocations are rare in adults. Treatment is difficult, and often associated with significant morbidity. A 30-year-old man, construction worker, presented a habitual patellofemoral dislocation which was caused by direct trauma to the knee as a child. Clinical examination showed a 3 cm leg-length discrepancy with no rotational deformities. The patient had a limp and loss of function; the patella was dislocated laterally and had locked at 20° of flexion with a range of motion of 0°/0°/30°. Open surgery was performed associating lateral retinacular release, reconstruction of the medial patellofemoral ligament with an ipsilateral gracilis tendon graft. The postoperative course was simple with no complications. Four months after surgery the patient has begun working normally. At the final 50-month clinical follow-up, knee range of motion was 0°/0°/130°, and functional results were excellent on clinical assessment scores of Kujala, Lysholm, and subjective IKDC. MPFL reconstruction alone seems effective in habitual posttraumatic patellar dislocation in adults without any associated bone anomalies. Yoann Bohu, Mathieu Thaunat, Nicolas Lefevre, Shahnaz Klouche, Serge Herman, and Yves Catonné Copyright © 2014 Yoann Bohu et al. All rights reserved. A Delayed and Rather Unusual Presentation of a Bladder Injury after Pelvic Trauma: 5 Years after a Road Traffic Accident Tue, 04 Mar 2014 08:59:38 +0000 Associated injuries frequently occur in patients who sustain fractures of the pelvis. Specifically, high-energy trauma resulting in pelvic fractures places the bladder and urethra at risk for injury, often resulting in significant complications. Timely identification and management of genitourinary injuries minimize associated morbidity. Prompt injury identification depends upon a systematic evaluation with careful consideration of the mechanism of injury. Physical examination is pertinent as well as analysis of the urine and appropriate diagnostic imaging. Despite such increased vigilance genitourinary injuries get missed and delayed presentations in the order of a few weeks have been well documented. To our knowledge, this is the first report of its kind in the literature showing such a particularly delayed (5 years) and rather unusual presentation of a bladder injury after pelvic trauma. Nikolaos Davarinos, John Thornhill, JP McElwain, and David Moore Copyright © 2014 Nikolaos Davarinos et al. All rights reserved. Adult Traumatic Atlantoaxial Rotatory Fixation: A Case Report Tue, 04 Mar 2014 08:58:39 +0000 We presented a very rare case of adult Fielding type I atlantoaxial rotatory fixation (AARF). We performed awake manual reduction of the dislocation without need for anesthesia, achieving excellent outcomes, and no previous reports have described awake reduction without the need for anesthesia. AARF in this case was attributed to excessive extension and rotation forces applied to the cervical spine. For the management of adult Fielding type I AARF, early diagnosis and early reduction may lead to excellent outcomes. Zaw Min Han, Nobuto Nagao, Toshihiko Sakakibara, Koji Akeda, Takao Matsubara, Akihiro Sudo, and Yuichi Kasai Copyright © 2014 Zaw Min Han et al. All rights reserved. Titanium Alloy Stem as a Cause for Adverse Reaction to Metal Debris after Bipolar Hemiarthroplasty Tue, 04 Mar 2014 08:42:11 +0000 A 68-year-old male with failure of bipolar hemiarthroplasty consistent with adverse reaction to metal debris (ARMD) who presented with a painful cystic lesion and lower extremity swelling was encountered. However, revision surgical findings showed no apparent cause of ARMD previously described in the literature, such as corrosion at the head-neck junction and articular abrasion. Therefore, it was difficult to make a definite diagnosis of failure secondary to ARMD, which consequently led to the decision to perform two-stage revision procedure, though the stem was firmly fixed. Postoperative analysis in the retrieval tissues showed that the metal debris mainly originated from the titanium alloy stem itself. Although this is a very rare case, one should be aware that even the well-fixed femoral components themselves have the potential to be the cause of ARMD. Masaaki Sakamoto, Hitoshi Watanabe, Hidetaka Higashi, and Hitoshi Kubosawa Copyright © 2014 Masaaki Sakamoto et al. All rights reserved. Localized Giant Cell Tenosynovial Tumor Seen in the Knee Joint Tue, 04 Mar 2014 07:36:10 +0000 Tenosynovial giant cell tumor is a locally aggressive tumor arising from the synovia of the fibrous tissue surrounding the joints, tendon sheaths, mucosal bursas, and tendons. Although it is often to be observed at the hand, localized form is very rare in the knee joint. In this case report, we aimed to present a very rare case of a surgically treated intra-articular giant cell tenosynovial tumor arising from the hoffa’s infrapatellar fat pad of a 19-year-old male patient, by reviewing the literature. The patient we have treated with marginal excision was asymptomatic at the 14th month in the controls and recurrence was not detected. Ozan Beytemür, Cem Albay, Ümit Seza Tetikkurt, Mehmet Öncü, Mehmet Ali Baran, Sever Çağlar, and Mehmet Akif Güleç Copyright © 2014 Ozan Beytemür et al. All rights reserved. Imaging Features of Periosteal Chondroma Manifesting as a Subcutaneous Mass in the Index Finger Sun, 23 Feb 2014 15:33:14 +0000 Periosteal chondroma is a rare benign hyaline cartilage neoplasm that occurs most commonly in the metaphases of long tubular bones. We present a unique case of periosteal chondroma arising in the proximal phalanx of the left index finger in a 12-year-old boy. Physical examination revealed a slightly protuberant, subcutaneous mass. Plain radiographs and computed tomography scans showed a periosteal lesion producing saucerization of the cortex and subjacent cortical sclerosis, without internal matrix calcification. On magnetic resonance imaging, the lesion exhibited intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images. Contrast-enhanced fat-suppressed T1-weighted images demonstrated peripheral and septal enhancement. The patient underwent a marginal excision with curettage of the underlying bone cortex. Histological examination confirmed the diagnosis of periosteal chondroma. There has been no evidence of local recurrence eight months after surgery. Periosteal chondroma can protrude into the subcutaneous soft tissue causing a palpable mass. Recognition of the typical radiological features can lead to an accurate diagnosis of this rare condition. Hidetomo Kosaka, Jun Nishio, Taiki Matsunaga, Mikiko Aoki, Hiroshi Iwasaki, and Masatoshi Naito Copyright © 2014 Hidetomo Kosaka et al. All rights reserved. Subacromial Impingement Syndrome Caused by a Voluminous Subdeltoid Lipoma Sun, 23 Feb 2014 11:28:00 +0000 Subacromial impingement syndrome is a clinical diagnosis encompassing a spectrum of possible etiologies, including subacromial bursitis, rotator cuff tendinopathy, and partial- to full-thickness rotator cuff tears. This report presents an unusual case of subdeltoid lipoma causing extrinsic compression and subacromial impingement syndrome. The patient, a 60-year-old man, presented to our institution with a few years' history of nontraumatic, posteriorly localized throbbing pain in his right shoulder. Despite a well-followed 6-months physiotherapy program, the patient was still suffering from his right shoulder. The MRI scan revealed a well-circumscribed 6 cm × 2 cm × 5 cm homogenous lesion compatible with a subdeltoid intermuscular lipoma. The mass was excised en bloc, and subsequent histopathologic examination confirmed a benign lipoma. At 6-months follow-up, the patient was asymptomatic with a complete return to his activities. Based on this case and a review of the literature, a subacromial lipoma has to be included in the differential diagnosis of a subacromial impingement syndrome refractory to nonoperative treatment. Complementary imaging modalities are required only after a failed conservative management to assess the exact etiology and successfully direct the surgical treatment. Jean-Christophe Murray and Stéphane Pelet Copyright © 2014 Jean-Christophe Murray and Stéphane Pelet. All rights reserved. Surgical Management of a Completely Avulsed Adductor Longus Muscle in a Professional Equestrian Rider Wed, 19 Feb 2014 16:01:45 +0000 Avulsion injuries of the adductor longus muscle tendon are rare and a challenge to manage especially in athletes. There has been little published literature on the outcome of conservative and operative treatment for these injuries. We report the first case of an acute adductor longus avulsion injury which was surgically repaired in a professional equestrian rider. Return to full preinjury function was achieved at 3 months with surgical repair using 3 suture anchors. Conal Quah, Andrew Cottam, and James Hutchinson Copyright © 2014 Conal Quah et al. All rights reserved. Reslip of a Previously Fixed Slipped Upper Femoral Epiphysis with an Associated Vitamin D Deficiency Mon, 17 Feb 2014 07:30:26 +0000 Slipped upper femoral epiphysis (SUFE) is a relatively common adolescent hip disorder that represents a biomechanical instability of the proximal femoral growth plate. A link between vitamin D deficiency and SUFE has emerged in recent years; however, we present a unique case of a 10-year-old girl who presented with a reslip of a previously fixed SUFE with an associated vitamin D deficiency. Aziz Ul Haque, Benjamin Bloch, and Alwyn Abraham Copyright © 2014 Aziz Ul Haque et al. All rights reserved. Synthetic Augmented Suture Anchor Reconstruction for a Complete Traumatic Distal Triceps Tendon Rupture in a Male Professional Bodybuilder with Postoperative Biomechanical Assessment Sun, 16 Feb 2014 13:58:12 +0000 Bodybuilding is a high-risk sport for distal triceps tendon ruptures. Management, especially in high-demanding athletes, is operative with suture anchor refixation technique being frequently used. However, the rate of rerupture is high due to underlying poor tendon quality. Thus, additional augmentation could be useful. This case report presents a reconstruction technique for a complete traumatic distal triceps tendon rupture in a bodybuilder with postoperative biomechanical assessment. A 28-year-old male professional bodybuilder was treated with a synthetic augmented suture anchor reconstruction for a complete triceps tendon rupture of his right dominant elbow. Postoperative biomechanical assessment included isokinetic elbow strength and endurance testing by using multiple angular velocities to simulate the “off-season” and “precompetition” phases of training. Eighteen months postoperatively and after full return to training, the biomechanical assessment indicated that the strength and endurance of the operated elbow joint was fully restored with even higher ratings compared to the contralateral healthy arm. The described reconstruction technique can be considered as an advisable option in high-performance athletes with underlying poor tendon quality due to high tensile strength and lack of donor site morbidity, thus enabling them to restore preinjury status and achieve safe return to sports. Maria-Elissavet Nikolaidou, Ingo J. Banke, Thomas Laios, Konstantinos Petsogiannis, and Anastasios Mourikis Copyright © 2014 Maria-Elissavet Nikolaidou et al. All rights reserved. Extremity Manifestations and Surgical Treatment for Nasu Hakola Disease Wed, 12 Feb 2014 07:32:51 +0000 Nasu-Hakola disease, which is also known as polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy (PLOSL), is a rare and mortal human genetic disorder (Verloes et al., (1997) and Bianchin et al., (2004)). Nasu-Hakola is a progressive disease characterized by early onset cognitive dementia and bone cysts (both evident by the third decade). The disease has a worldwide distribution, but most patients have been reported in Finland and in Japan (Montalbetti et al., (2004)). In the literature less than 200 cases are reported and only a few of them are about the surgical treatment for the extremity (Madry et al., (2007)). Most patients die by their fourth or fifth decade because of neurologic problems. Surgeons generally prefer conservative treatment modalities in the treatment of cystic lesions of the bone in this syndrome. In this case report, we presented a 42-year-old male with Nasu-Hakola disease having bilateral painful talar lipomembranous cystic lesions treated with curettage and iliac bone grafting. He is in the 3rd year of his followup after surgery and he has not any extremity complaints, but his neurological problems sustain. Our aim in this study is to show the beneficial aspect of surgical intervention in the cystic lesions of Nasu Hakola disease in the skeleton to obtain the patient a painless joint although surgery is rarely performed in this systemic and progressive disease. Murat Arıkan, Ahmet Yıldırım, Güray Togral, and Alp Burak Ekmekçi Copyright © 2014 Murat Arıkan et al. All rights reserved. Intravascular Glomus Tumor of the Forearm Causing Chronic Pain and Focal Tenderness Mon, 03 Feb 2014 00:00:00 +0000 Introduction. A glomus tumor is a benign vascular tumor derived from glomus cells and occurs mainly in the subcutaneous layer of the subungual or digital pulp. Extradigital glomus tumors have been reported within the palm, wrist, forearm, foot, bone, stomach, colon, cervix, and mesentery. Glomus tumors can originate from the intraosseous, intramuscular, periosteal, intravascular, and intraneural layers. However, a glomus tumor originating from the intravascular layer of the forearm is a rare condition. Case Report. A 44-year-old woman had a 7-year history of chronic pain and focal tenderness of the forearm. No hypersensitivity or sensory alterations were observed. Contrast magnetic resonance imaging (MRI) showed a mass measuring 5 × 3 × 2 mm leading to a vein. Surgical excision was performed, and the tumor was completely resected. Finding of gross examination revealed a dark-red, well-defined soft tissue tumor, and histologic examination confirmed that the mass was a glomus tumor. The patient’s symptoms were completely resolved postoperatively. Conclusion. Intravascular glomus tumors rarely occur in the forearm; therefore, a thorough physical exam, comprehensive medical history, in-depth imaging, and early surgical excision upon clinical suspicion may be helpful to prevent a delayed or incorrect diagnosis. Sang Ki Lee, Dae Geon Song, and Won Sik Choy Copyright © 2014 Sang Ki Lee et al. All rights reserved. The Cortical Step Sign Fails to Prevent Malrotation of a Nailed Femoral Shaft Fracture: A Case Report Wed, 29 Jan 2014 00:00:00 +0000 Intramedullary nailing has become the treatment of choice for diaphyseal femur fractures. Malrotation is a well-recognized complication of femoral nailing. Various techniques including the cortical step sign (CSS) have been described to minimize iatrogenic rotational deformity during femoral nailing. We present a case in which the use of the CSS resulted in a clinically significant malrotation requiring revision. Taranjit Tung and Ted Tufescu Copyright © 2014 Taranjit Tung and Ted Tufescu. All rights reserved. Agenesis of the Corpus Callosum and Skeletal Deformities in Two Unrelated Patients: Analysis via MRI and Radiography Wed, 29 Jan 2014 00:00:00 +0000 Purpose. Mental retardation, mild to severe epilepsy and cerebral palsy often of hemiplegic type are common accompaniments in patients with agenesis/hypoplasia of the corpus callosum. Skeletal deformities of bilateral radiohumeral synostosis, brachydactyly, bilateral elbow dislocation, talipes equinovarus, and juxtacalcaneal accessory bones have been encountered in two unrelated children with agenesis of the corpus callosum. Methods. We report on two unrelated children who presented with the full clinical criteria of agenesis of the corpus callosum. Strikingly, both presented with variable upper and lower limb deformities. The clinical features, radiographic and MRI findings in our current patients, have been compared with previously reported cases identified through a PubMed literature review. Results. Bilateral radiohumeral synostosis associated with pyruvate dehydrogenase deficiency has been encountered in one patient. The other patient manifested bilateral elbow dislocation, coxa valga, talipes equinovarus, and bilateral juxtacalcaneal accessory bones. Conclusion. The constellation of malformation complexes in our current patients have the hitherto not been reported and expanding the spectrum of skeletal deformities in connection with agenesis of the corpus callosum. Ali Al Kaissi, Herbert Kurz, Wolfgang Bock, Gerald Pärtan, Klaus Klaushofer, Rudolf Ganger, and Franz Grill Copyright © 2014 Ali Al Kaissi et al. All rights reserved. Anterior Hip Subluxation due to Lumbar Degenerative Kyphosis and Posterior Pelvic Tilt Tue, 28 Jan 2014 10:55:39 +0000 Nontraumatic anterior subluxation and dislocation of the hip joint are extremely rare. A 58-year-old woman presented to our outpatient clinic with left hip pain with a duration of 15 years. There was no history of trauma or other diseases. Her hip pain usually occurred only on walking and not at rest. Physical examinations demonstrated no tenderness in the hip joint. The range of motion of both hip joints was almost normal. Laxity of other joints was not observed. The bone mineral density of the lumbar spine and proximal femur confirmed a diagnosis of osteoporosis. A plain radiograph showed osteoarthritic changes of the hip joints, severe posterior pelvic tilt, and superior displacement of both femoral heads, especially in a standing position. Three-dimensional computed tomography (3DCT) revealed anterior subluxation of both femoral heads. Seven years after the initial visit, both hip joints showed progression to severe osteoarthritis. Although the exact cause remains unclear, lumbar kyphosis, posterior pelvic tilt, and a decrease in acetabular coverage may have influenced the current case. We should be aware of these factors when we examine patients with hip osteoarthritis. Hiroyuki Tsuchie, Shin Yamada, Hiroshi Tazawa, Hiroaki Kijima, and Yoichi Shimada Copyright © 2014 Hiroyuki Tsuchie et al. All rights reserved. Double Threaded Screw Fixation for Bilateral Stress Fracture of the Medial Malleolus Tue, 28 Jan 2014 07:37:21 +0000 An 18-year-old college basketball player presented with continued ankle pain. A radiographic examination showed bilateral medial malleolus stress fractures. Considering the prolonged history and refractory nature of this injury, surgery was adopted as a treatment option. At surgery, the fracture site was percutaneously fixed using two cannulated double threaded screws. Surgery for each side was sequentially performed two months apart. Prompt bony healing was attained after surgery, and the patient could return to his previous sports level six months after the first surgery without subsequent recurrence. Ryo Kanto, Shigeo Fukunishi, Takatoshi Morooka, Daisuke Seino, Takayuki Takashima, Shinichi Yoshiya, and Juichi Tanaka Copyright © 2014 Ryo Kanto et al. All rights reserved. Nontraumatic Fracture of the Femoral Condylar Prosthesis in a Total Knee Arthroplasty Leading to Mechanical Failure Thu, 23 Jan 2014 08:55:51 +0000 This paper reports a case of fatigue fracture of the femoral component in a cruciate-retaining cemented total knee arthroplasty (TKA). A 64-year-old man had undergone a primary TKA for osteoarthritis 10 years previously at another institution using the PFC-Sigma prosthesis. The patient recovered fully and was back to his regular activities. He presented with a history of sudden onset pain and locking of the left knee since the preceding three months. There was no history of trauma, and the patient was mobilizing with difficulty using crutches. Radiographs revealed fracture of the posterior condyle of the femoral prosthesis. Revision surgery was performed as an elective procedure revealing the broken prosthesis. The TC3RP-PFC revision prosthesis was used with a medial parapatellar approach. The patient recovered fully without any squeal. Mechanical failure of the knee arthroplasty prosthesis is rare, and nontraumatic fracture of the femoral metallic component has not been reported before. Girish N. Swamy, Conal Quah, Elmunzar Bagouri, and Nitin P. Badhe Copyright © 2014 Girish N. Swamy et al. All rights reserved. Surgical Treatment of Osteopetrosis-Related Femoral Fractures: Two Case Reports and Literature Review Tue, 21 Jan 2014 11:44:51 +0000 Osteopetrosis is a rare hereditary disease which is characterized by increased bone density. Bone resorption is insufficient or fails due to the osteoclast defect in osteopetrosis. Half of the patients are asymptomatic and diagnosed incidentally or based on the presence of fracture. Adult onset osteopetrosis usually presents with hip and proximal femoral fractures. Internal fixation can be performed; however, technical challenges may be experienced due to increased bone density. As in other fractures, nonunion or varus malunion of these fractures may occur. Although rare, osteopetrosis may complicate treatment of fractures in such patients. In this study, we aimed to present two new cases of ADO type II with an osteopetrotic femoral fracture along with the clinical and radiological findings in the light of a comprehensive literature review. Orthopaedics surgeons should be aware of intraoperative technical difficulties and possible postoperative complications during the follow-up period. Investigation would be beneficial for the diagnosis of osteopetrosis such the patient with fractures who has minor trauma history and increased bone density in radiography. Ahmet Aslan, Yakup Barbaros Baykal, Emin Uysal, Tolga Atay, Vecihi Kirdemir, Metin Lütfi Baydar, and Nevres Hürriyet Aydoğan Copyright © 2014 Ahmet Aslan et al. All rights reserved. Fracture of Two Moderately Cross-Linked Polyethylene Tibial Inserts in a TKR Patient Wed, 08 Jan 2014 13:53:25 +0000 Highly cross-linked polyethylene has become the gold standard in total hip replacement for its wear resistance. Moderately crosslinked polyethylene is now available for total knee replacement (TKR), although concerns about reduced mechanical strength have prevented widespread adoption. The purpose of this report is to describe an unusual case where a patient underwent cruciate retaining TKR using a moderately crosslinked polyethylene tibial insert that went on to fracture twice in the same location across the primary and first revision surgery. The first tibial insert was 10 mm thick and was implanted for 16 months. The second tibial insert was 15 mm thick and was implanted for 11 months. Both fractured along the posterior aspect of the medial articular surface. The lack of a specific event leading to these fractures and the fact that they occurred twice in the same location in the same patient suggest that caution is still necessary regarding the introduction of crosslinked polyethylene for TKR surgery. Matthew G. Teeter, James P. McAuley, and Douglas D. Naudie Copyright © 2014 Matthew G. Teeter et al. All rights reserved. Acute Compartment Syndrome of the Arm after Minor Trauma in a Patient with Optimal Range of Oral Anticoagulant Therapy: A Case Report Mon, 06 Jan 2014 14:05:24 +0000 Compartment syndrome of the arm is a rare event that can be subsequent to trauma or other pathological and physical conditions. At the arm the thin and elastic fascia may allow accumulation of blood more than in other districts, especially in patients undergoing anticoagulant therapy. We describe a rare case of an acute compartment syndrome of the arm after minor trauma with partial biceps brachii rupture in a patient with warfarin therapy and optimal value of INR. Prompt diagnosis and surgical decompression helped to avoid the occurrence of complications with a satisfying recovery of arm function. Paolo Titolo, Patrizia Milani, Bernardino Panero, Davide Ciclamini, Giulia Colzani, and Stefano Artiaco Copyright © 2014 Paolo Titolo et al. All rights reserved. Isolated Fracture of the Coracoid Process Mon, 06 Jan 2014 13:30:44 +0000 Coracoid fractures are rarely seen fractures. In the shoulder girdle, coracoid process fractures generally accompany dislocation of the acromioclavicular joint or glenohumeral joint, scapula corpus, clavicula, humerus fracture, or rotator cuff tear. Coracoid fractures can be missed and the treatment for coracoid process fractures is still controversial. In this paper, a 34-year-old male manual labourer presented to the emergency department with complaints of pain and restricted movement in the left shoulder following a traffic accident. On direct radiographs and computerised tomography images a fragmented fracture was observed on the base of the coracoid process. In addition to the coracoid fracture, a mandibular fracture was determined. The patient was admitted for surgery on both fractures. After open reduction, fixation was made with a 3.5 mm cannulated screw and washer. At the postoperative 6th week, bone union was determined. The patient returned to his previous occupation pain-free and with a full range of joint movement. In conclusion, in the current case of isolated fragmented coracoid process fracture showing minimal displacement in a patient engaged in heavy manual work, surgery was preferred as it was thought that nonunion might be encountered particularly because of the effect of forces around the coracoid. Ali Güleç, Harun Kütahya, Recep Gani Göncü, and Serdar Toker Copyright © 2014 Ali Güleç et al. All rights reserved.