Intraosseous ganglion cysts (IGC) of the carpal bones are frequently reported in the literature, involving at most two carpal bones of the same wrist. Only one case recently described the presence of multiple intraosseous ganglion lesions in the capitate, lunate, and triquetrum, resulting in chronic wrist pain. The following study reports the first case of multiple IGCs causing a unilateral carpal tunnel syndrome (CTS), in a 56-year-old woman, with no previous history of trauma. Failure of conservative management prompted carpal tunnel release and the surgical excision of the ICGs, followed by autologous bone grafting to fill in the defects. Consequently, IGCs must be considered in the differential diagnosis of unilateral CTS due to the expansile nature of the bone lesions.

Raymonde Dahdouh

Dany Aouad

Elyssa Kiwan

Georges Sakhat

Mohammad Daher

Rabih Kortbawi

Joseph Wehbe

Multiple Intraosseous Cysts of the Carpal Bones Presenting as Unilateral Carpal Tunnel Syndrome

Medial tibial plateau fractures generally present as simple metaphyseal fractures; however, certain cases may present as comminuted articular fractures. Medial and posteromedial anatomical plates have traditionally been used for their management; nevertheless, not all cases can be successfully managed using these implants. We present a comminuted posteromedial Schatzker type VI tibial plateau fracture case. Direct visualization and subsequent fixation using a posteromedial rim plate were achieved through a posteromedial approach and submeniscal arthrotomy. The adequate joint reduction and the obtained stability allowed satisfactory clinical and radiological outcomes. This variation of the classic posteromedial approach and the use of a posteromedial rim plate provide an alternative when facing comminuted medial tibial plateau fractures.

Nicolás Franulic

Tomás Pineda

José Laso

Diego Valiente

Nicolás Gaggero

Posteromedial Submeniscal Arthrotomy and Fixation with a Posteromedial Rim Plate in a Comminuted Medial Tibial Plateau Fracture

Background. Traumatic hip dislocation (THD) is an orthopaedic emergency that requires rapid reduction. THD is generally encountered in high-energy trauma. THD with low-energy trauma is extremely rare, even more so in the elderly. Methods/Results. We report the case of a 72-year-old woman who presented to the emergency department with anterior superior left hip dislocation after a low-energy trauma. Results. The patient was initially treated with closed reduction. Because of recurring dislocation, closed reduction was performed a second time. Magnetic resonance imaging showed no soft tissue interposition. At 12 week follow-up, the patient complained of intractable hip pain and was treated with total hip arthroplasty. The post-operative course was uneventful with a return to pre-injury functional mobility. We also conducted a review of the literature with regard to anterior hip dislocation in the population aged 70 years or more. Conclusion. THD can be associated with significant morbidity. Time to reduction is considered essential in improving functional outcomes. In the case of poor functional outcomes, total hip arthroplasty should be considered.

Quentin Schopfer

Roland Strasser

Eric Ngassom Leumessi

Aurélien Traverso

Traumatic Anterior Hip Dislocation in the Elderly: Description and Review of a Rare Trauma

Introduction. Tumor-induced osteomalacia (TIO) is a rare paraneoplastic disorder where patients present with hypophosphatemia, chronic diffuse bone pain, and occasionally fractures. Benign phosphaturic mesenchymal tumors (PMT) are responsible for the TIO and are largely soft tissue tumors. Cases. Two male patients with TIO secondary to PMT were reported—one in the bony scapula and the other in the plantar foot soft tissue. The first case describes a 63-year-old Caucasian male, who sustained an intertrochanteric proximal femur stress fracture and approximately two years of diffuse bone pain and hypophosphatemia. Wide excision of a left scapula boney lesion resulted in immediate resolution of his electrolyte abnormalities and bone pain. Case 2 describes a 58-year-old male with four years of multifocal bone pain and atraumatic fractures. A 68Ga-DOTATATE-positron emission tomography/computed tomography (PET/CT) scan identified a soft tissue tumor in his plantar foot, which was ultimately excised. He also experienced near immediate resolution of his pain and no additional fractures. Conclusion. TIO is a rare condition presenting with chronic multifocal bone pain, stress fractures, and hypophosphatemia. These two cases highlight that the causative tumor may originate in soft tissue or bone. Furthermore, a high index of suspicion, along with fibroblast growth factor-23 testing and DOTATATE-PET/CT localization, can help with diagnosis and minimize treatment delays.

Stephanie M. Clegg

Emily S. Eiel

Sara Fine

Rachel I. Gafni

Mathew J. Most

Atypical Fragility Fractures due to Bony or Soft Tissue Phosphaturic Mesenchymal Tumors: A Report of Two Cases

There is widespread use of matrix-induced autologous chondrocyte implantation. Initial use of autologous bone grafting in combination with the matrix-induced autologous chondrocyte implantation procedure has shown efficacy in small- to medium-sized osteochondral lesions. This case report demonstrates use of the “Sandwich” technique in a large, deep osteochondritis dissecans lesion of the medial femoral condyle. Technical considerations that are key to containment of the lesion and outcomes are reported.

Bhumit Desai

Graylin Jacobs

Deryk Jones

MACI “Sandwich” Technique for a Large Osteochondritis Dissecans Lesion: A Case Report

Fractures of the anterior tibial tuberosity are uncommon, ranging from 0.4% to 2.7% of all epiphyseal lesions reported. Bilateral sequential fractures are even rarer, with less than twenty-eight cases described to date and, as such, there is very little consensus data on their treatment as a whole. We report the first two documented cases of bilateral tibial tuberosity avulsions of the anterior tubercle in Switzerland, treated by open reduction and internal fixation. Both cases were 14-year-old healthy males with no previous medical history, who both suffered extra-articular fractures after falling from a height. The first case was treated in 2012 with a four-year long clinical follow-up and full recovery. The second, treated in 2019, was clinically followed for one year with a complete recovery and has returned to sporting activity at a pre-injury level. Due to the rarity of the condition, a lack of consensus on the optimal therapy, we believe the documentation of these two cases treated by the same team may be of clinical relevance.

Dario Giunchi

Jorge Gonzalez

Marco Odorizzi

Mario Sagaon Mendoza

Vincenzo De Rosa

Simultaneous Bilateral Avulsion of Tibial Anterior Tubercle in Adolescent: Two Case Reports and Narrative Review of the Literature

Background. Limb lengthening and deformity correction in patients with abnormal bone associating fragility often require an approach combining methods of external and internal fixation. This study demonstrates results of simultaneous application of external fixator, and telescopic rod for femoral lengthening and deformity correction in three children with osteogenesis imperfecta or severe form of Ollier’s disease. Materials and Methods. Three patients (two boys with Ollier’s disease and a girl with osteogenesis imperfecta, type I) were operated on for femoral lengthening with combined technique associating Ilizarov frame and titanium telescopic intramedullary rodding. Results. Planned amount of lengthening and deformity correction were achieved for all patients. We found neither rod bending nor pull out of threaded tips. There was no difficulty of expanding of telescopic intramedullary rods made of titanium alloy during distraction phase of lengthening procedure. Conclusion. This short series proved feasibility of performing one-stage surgery with external frame and telescopic rodding in limb lengthening. The technique of telescopic rods in lengthening procedure is promising method requiring meticulous insertion of rod in centralized positioning in epiphysis. Acute alignment of the segment been elongating should be achieved at surgery. No any progressive angular deformity correction in postoperative period is authorized in order to avoid bending of telescopic rod. This combined approach does not affect bone healing.

Eduard Mingazov

Nikita Gvozdev

Arnold Popkov

Pierre Journeau

Dmitry Popkov

Preliminary Results of Bone Lengthening over Telescopic Titanium Intramedullary Rod

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Case Reports in Orthopedics publishes case reports and case series related to arthroplasty, foot and ankle surgery, hand surgery, joint replacement, limb reconstruction, pediatric orthopaedics, sports medicine, trauma etc.

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Case Reports in Orthopedics - Table of contents 2023

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Case Reports in Orthopedics publishes case reports and case series related to arthroplasty, foot and ankle surgery, hand surgery, joint replacement, limb reconstruction, pediatric orthopaedics, sports medicine, trauma etc.

Case Reports in Orthopedics