Case Reports in Orthopedics The latest articles from Hindawi Publishing Corporation © 2017 , Hindawi Publishing Corporation . All rights reserved. Lumbar Scoliosis Combined Lumbar Spinal Stenosis and Herniation Diagnosed Patient Was Treated with “U” Route Transforaminal Percutaneous Endoscopic Lumbar Discectomy Thu, 19 Jan 2017 11:55:23 +0000 The objective was to report a case of a 63-year-old man with a history of low back pain (LBP) and left leg pain for 2 years, and the symptom became more serious in the past 5 months. The patient was diagnosed with lumbar scoliosis combined with lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH) at the level of L4-5 that was confirmed using Computerized Topography and Magnetic Resonance Imaging. The surgical team preformed a novel technique, “U” route transforaminal percutaneous endoscopic lumbar discectomy (PELD), which led to substantial, long-term success in reduction of pain intensity and disability. After removing the osteophyte mass posterior to the thecal sac at L4-5, the working channel direction was changed to the gap between posterior longitudinal ligament and thecal sac, and we also removed the herniation and osteophyte at L3-4 with “U” route PELD. The patient’s symptoms were improved immediately after the surgical intervention; low back pain intensity decreased from preoperative 9 to postoperative 2 on a visual analog scale (VAS) recorded at 1 month postoperatively. The success of the intervention suggests that “U” route PELD may be a feasible alternative to treat lumbar scoliosis with LSS and LDH patients. Binbin Wu, Shaobo Zhang, Qingquan Lian, Haibo Yan, Xianfa Lin, and Gonghao Zhan Copyright © 2017 Binbin Wu et al. All rights reserved. Scaphoid Fracture in a Patient with a Scaphotrapezial Synostosis: A Case Report and Literature Review Wed, 18 Jan 2017 00:00:00 +0000 Introduction. Scaphotrapezial synostosis has been rarely reported in the literature and only one case underwent surgical treatment for scaphoid fracture. Presentation of Case. A 15-year-old male presented with a painful left wrist following a fall. The initial radiographs showed a displaced scaphoid proximal pole fracture and a Scaphotrapezial synostosis. The fracture was then fixed percutaneously with satisfactory outcome. Discussion. Scaphotrapezial synostoses are very rare and most found in patients with multiple congenital anomalies or as part of a hereditary syndrome. They have previously been reported; however, we found only one case reporting a concomitant scaphoid fracture. Conclusion. This is the second case of its kind to report surgical treatment of scaphoid fracture associated with a congenital Scaphotrapezial synostosis. Soliman Noureldin, Mohammed Ali, Farshid Fallahi, and Thomas Dehler Copyright © 2017 Soliman Noureldin et al. All rights reserved. Neuromuscular Coordination Deficit Persists 12 Months after ACL Reconstruction But Can Be Modulated by 6 Weeks of Kettlebell Training: A Case Study in Women’s Elite Soccer Wed, 18 Jan 2017 00:00:00 +0000 The aim of the present single-case study was to investigate the effect of 6 weeks’ kettlebell training on the neuromuscular risk profile for ACL injury in a high-risk athlete returning to sport after ACL reconstruction. A female elite soccer player (age 21 years) with no previous history of ACL injury went through neuromuscular screening as measured by EMG preactivity of vastus lateralis and semitendinosus during a standardized sidecutting maneuver. Subsequently, the player experienced a noncontact ACL injury. The player was screened again following postreconstruction rehabilitation, then underwent 6-week kettlebell training, and was subsequently screened again at 6-week follow-up. Prior to and after postreconstruction rehabilitation the player demonstrated a neuromuscular profile during sidecutting known to increase the risk for noncontact ACL injury, that is, reduced EMG preactivity for semitendinosus and elevated EMG preactivity for vastus lateralis. Subsequently, the 6-week kettlebell training increased semitendinosus muscle preactivity during sidecutting by 38 percentage points to a level equivalent to a neuromuscular low-risk profile. An ACL rehabilitated female athlete with a high-risk neuromuscular profile changed to low-risk in response to 6 weeks of kettlebell training. Thus, short-term kettlebell exercise with documented high levels of medial hamstring activation was found to transfer into high medial hamstring preactivation during a sidecutting maneuver. Mette K. Zebis, Christoffer H. Andersen, Jesper Bencke, Christina Ørntoft, Connie Linnebjerg, Per Hölmich, Kristian Thorborg, Per Aagaard, and Lars L. Andersen Copyright © 2017 Mette K. Zebis et al. All rights reserved. An Interesting Case of Intramuscular Myxoma with Scapular Bone Lysis Tue, 17 Jan 2017 09:24:06 +0000 Introduction. Intramuscular myxoma is a rare benign primitive tumor of the mesenchyme founded at the skeletal muscle level; it presents itself like an unpainful, slow-growing mass. Myxomas with bone lysis are even more rare; only 7 cases have been reported in the English literature, but never at the shoulder level. Case Presentation. We describe an 83-year-old patient with a growing mass in the deltoid muscle with unique scapular lysis, without any symptom. Magnetic resonance imaging (MRI) and a biopsy were performed and the diagnosis of intramuscular myxoma has been retained. In front of this diagnosis of nonmalignant lesion, the decision of a simple follow-up was taken. One year after this decision, the patient was still asymptomatic. Conclusion. In the presence of an intramuscular growing mass with associated bone lysis, intramuscular myxoma as well as malignant tumor should be evoked. MRI has to be part of the initial radiologic appraisal but biopsy is essential to confirm the diagnosis. By consensus, the standard treatment is surgical excision but conservative treatment with simple follow-up can be an option. Jérôme Tirefort, Frank C. Kolo, and Alexandre Lädermann Copyright © 2017 Jérôme Tirefort et al. All rights reserved. Latissimus Dorsi Tendon Transfer with GraftJacket® Augmentation to Increase Tendon Length for an Irreparable Rotator Cuff Tear Tue, 17 Jan 2017 09:09:33 +0000 Massive irreparable rotator cuff tears can be reconstructed with latissimus dorsi tendon transfers (LDTT). Although uncommon, the natural length of the latissimus dorsi tendon (LDT) could be insufficient for transfer even after adequate soft tissue releases. Descriptions of cases where grafts were needed to lengthen the LDT are therefore rare. We located only two reports of the use of an acellular dermal matrix to increase effective tendon length in tendon transfers about the shoulder: (1) GraftJacket patch for a pectoralis major tendon reconstruction and (2) ArthroFlex® patch for LDTT. Both of these brands of allograft patches are obtained from human cadavers. These products are usually used to cover soft tissue repairs and offer supplemental support rather than for increasing tendon length. Extending the LDTT with GraftJacket to achieve adequate length, to our knowledge, has not been reported in the literature. We report the case of a 50-year-old male who had a massive, irreparable left shoulder rotator cuff tear that was reconstructed with a LDTT. The natural length of his LDT was insufficient for transfer. This unexpected situation was rectified by sewing two patches of GraftJacket to the LDT. The patient had greatly improved shoulder function at two-year follow-up. John G. Skedros and Tanner R. Henrie Copyright © 2017 John G. Skedros and Tanner R. Henrie. All rights reserved. Synovial Osteochondromatosis at the Carpometacarpal Joint of the Thumb Wed, 11 Jan 2017 13:12:11 +0000 Synovial osteochondromatosis (SOC) is a benign tumor characterized by synovial connective tissue metaplasia. SOC commonly affects major joints including the knee followed by the hip, elbow, and wrist. SOC cases in the hand are not reported as often as SOC of major joints. Particularly SOC of the carpometacarpal joint of the thumb is rare. We report on a 57-year-old female with primary SOC of the carpometacarpal joint of her left thumb. Surgical excision was performed and the patient had no symptoms with full range of motion of her left thumb. At 3 years of follow-up, there was no recurrence. Satoru Yonekura, Hiroyoshi Hagiwara, Takahiro Nishimura, Hiroshi Amagai, Mayu Yamamura, Osamu Miyamoto, and Sueo Nakama Copyright © 2017 Satoru Yonekura et al. All rights reserved. Scedosporium prolificans Septic Arthritis and Osteomyelitis of the Hip Joints in an Immunocompetent Patient: A Case Report and Literature Review Tue, 10 Jan 2017 00:00:00 +0000 Scedosporium prolificans, also known as Scedosporium inflatum, is a fungus widespread in soil, sewage, and manure. This species is highly virulent and is an emerging opportunistic pathogen found in penetrating injuries in immunocompromised patients. Here we report on an immunocompetent patient with bilateral hip S. prolificans-associated osteomyelitis and septic arthritis caused by intentional penetrating trauma. The condition was refractory to initial antimicrobial suppression and surgical irrigation and debridement. Successful outcome was achieved after incorporating a bilateral two-stage total-hip-arthroplasty with Voriconazole-loaded cement and spacer. Luca Daniele, Michael Le, Adam Franklin Parr, and Lochlin Mark Brown Copyright © 2017 Luca Daniele et al. All rights reserved. Valgus Slipped Capital Femoral Epiphysis in Patient with Hypopituitarism Thu, 05 Jan 2017 00:00:00 +0000 Slipped capital femoral epiphysis (SCFE) is a common disease of adolescent and the epiphysis is positioned more posteromedially in relation to the femoral neck shaft with varus SCFE; however, posterolateral displacement of the capital epiphysis, valgus SCFE, occurs less frequently. We report a case of valgus SCFE in a 17-year-old boy with hypopituitarism. After falling down, he experienced difficulty in walking. The radiographs were inconclusive; however three-dimensional computed tomography images showed lateral displacement of the epiphysis on the right femoral head. Valgus SCFE was diagnosed. The patient underwent in situ pinning of both sides. In situ pinning on the left side was performed as a prophylactic pinning because of endocrine abnormalities. At the 1-year follow-up, he could walk without any difficulty and there were no signs of pain. The epiphysis is commonly positioned more posteromedially in relation to the femoral neck shaft with most SCFE, but, in this case, the epiphysis slipped laterally. Differential diagnosis included femoral neck fracture (Delbet-Colonna type 1); however, this was less likely due to the absence of other clinical signs. Therefore, we diagnosed the patient as SCFE. When children complain of leg pain and limp, valgus SCFE that may not be visualized on anteroposterior radiographs needs to be considered. Yoshihiro Kotoura, Yasuhiro Fujiwara, Tatsuro Hayashida, Koji Murakami, Satoshi Makio, Yuichi Shimizu, Yoshinobu Oka, Wook-Choel Kim, Taku Ogura, and Toshikazu Kubo Copyright © 2017 Yoshihiro Kotoura et al. All rights reserved. A Subdermal Osteochondroma in a Young Girl Wed, 04 Jan 2017 09:28:41 +0000 Osteochondromas are common benign tumors of cartilage and bone. They are usually found as contiguous bone with a cartilage cap at the end of the growth plate of long bones. Similar to structure are extraskeletal osteochondromas. However, unlike typical osteochondromas, extraskeletal osteochondromas are noncontinuous with bone. To our knowledge, all reported extraskeletal osteochondromas have been contained within fascial compartments. Here we present the case of a 5-year-old female who had a slow growing mass of the anterior distal right thigh. Imaging studies revealed an ossified mass extending from dermal layer of the subcutaneous tissue with no connection to the underlying deep fascia. An excisional biopsy was performed and proved to be a subdermal extraskeletal osteochondroma. Heather A. Cole, Hernan Correa, and Jonathan G. Schoenecker Copyright © 2017 Heather A. Cole et al. All rights reserved. Myelopathy due to Spinal Extramedullary Hematopoiesis in a Patient with Polycythemia Vera Wed, 04 Jan 2017 08:57:21 +0000 Extramedullary hematopoiesis (EMH) occasionally occurs in patients exhibiting hematological disorders with decreased hematopoietic efficacy. EMH is rarely observed in the spinal epidural space and patients are usually asymptomatic. In particular, in the patients with polycythemia vera, spinal cord compression due to EMH is extremely rare. We report a case of polycythemia vera, in which operative therapy proved to be an effective treatment for myelopathy caused by spinal EMH. Shuhei Ito, Nobuyuki Fujita, Naobumi Hosogane, Narihito Nagoshi, Mitsuru Yagi, Akio Iwanami, Kota Watanabe, Takashi Tsuji, Masaya Nakamura, Morio Matsumoto, and Ken Ishii Copyright © 2017 Shuhei Ito et al. All rights reserved. Giant Baker’s Cyst Associated with Rheumatoid Arthritis Mon, 02 Jan 2017 07:18:13 +0000 We report a rare case of a “giant Baker’s cyst-related rheumatoid arthritis (RA)” with 95 × 26 mm dimensions originating from the semimembranosus tendon. The patient presented with chronic pain and a palpable mass behind his left calf located between the posteriosuperior aspect of the popliteal fossa and the distal third of the calf. In MRI cystic lesion which was located in soft tissue at the posterior of gastrocnemius, extensive synovial pannus inside and degeneration of medial meniscus posterior horn were observed. Arthroscopic joint debridement and partial excision of the cyst via biomechanical valve excision were performed. The patient continued his follow-up visits at Rheumatology Department and there was no recurrence of cyst-related symptoms in 1-year follow-up. Similar cases were reported in the literature previously. However, as far as we know, a giant Baker’s cyst-related RA, which was treated as described, has not yet been presented. Levent Adiyeke, Emre Bılgın, Tahir Mutlu Duymus, İsmail Emre Ketencı, and Meriç Ugurlar Copyright © 2017 Levent Adiyeke et al. All rights reserved. Preservation and Tissue Handling Technique on Iatrogenic Dural Tear with Herniated Nerve Root at Cauda Equina Level Thu, 29 Dec 2016 09:54:45 +0000 Iatrogenic or incidental dural tear is a relatively common complication in lumbar decompression surgery. Although mostly there are no changes that occurred in long-term result following an incidental durotomy, the sequelae are not always benign especially when the herniated nerve root is involved. Preservation and tissue handling is paramount in order to prevent further injury. Two cases of dural tear with herniated nerve root complicating the lumbar decompression surgery are presented. Direct watertight repair was performed using the preservation and tissue handling concept. Assessing the relative size between the dural tear and the root mass is the key in determining whether enlargement of tear is needed. Whenever feasible, the tear will not be enlarged. Opening the vent by using a suture anchor and manually repositioning the nerve root with a fine instrument is the key for an atraumatic handling of the herniated nerve root. Clinical and neurophysiology examination was performed postoperatively and no further neurologic deficit occurred despite the iatrogenic injury. Although some debate on a few intraoperative and postoperative details still persists, tissue handling and preservation concept should be applied in all cases. Ahmad Jabir Rahyussalim, Yoshi Pratama Djaja, Ifran Saleh, Ahmad Yanuar Safri, and Tri Kurniawati Copyright © 2016 Ahmad Jabir Rahyussalim et al. All rights reserved. A Method of Using a Pelvic C-Clamp for Intraoperative Reduction of a Zone 3 Sacral Fracture Thu, 22 Dec 2016 14:39:26 +0000 It is challenging to properly reduce pelvic ring injuries that involve a zone 3 sacral fracture. Several open and closed reduction methods have been described. Percutaneous reductions are challenging, and improper reductions can have poor long-term outcomes. The pelvic C-clamp is a tool designed to provide emergency stabilization to patients suffering from c-type pelvic ring injuries. We describe a case in which a patient’s open book pelvic ring injury with a zone three sacral fracture is reduced intraoperatively with the use of a pelvic C-clamp and stabilized with transsacral screws. Daniel H. Wiznia, Nishwant Swami, Chang-Yeon Kim, and Michael P. Leslie Copyright © 2016 Daniel H. Wiznia et al. All rights reserved. Superior Patellar Dislocation Misdiagnosed as Patellar Tendon Rupture: The Value of Ultrasonography Thu, 22 Dec 2016 13:52:02 +0000 Superior dislocation of the patella with intact patellar tendon is a rare condition. Most cases in literatures were diagnosed by clinical examination and plain radiography; however there are many cases that were misdiagnosed as patellar tendon rupture. In this case, we demonstrate the use of ultrasound for diagnosis of superior dislocation of the patella in the emergency department. We also include a literature review of similar cases and discuss the advantages of different types of imaging for diagnosis in this condition. Artit Boonrod, Sermsak Sumanont, Manusak Boonard, and Arunnit Boonrod Copyright © 2016 Artit Boonrod et al. All rights reserved. Successful Closed Reduction of a Lateral Elbow Dislocation Wed, 21 Dec 2016 10:36:03 +0000 In this report, we present a case of lateral elbow dislocation treated with closed reduction. Lateral elbow dislocation is rare, and a closed reduction is reported with even less frequency. The reduction can be hindered by swelling and soft tissue interposition, and we describe the use of a nonoperative reduction technique performed under mild sedation with early physiotherapy to avoid joint stiffness. No additional complication was observed, and the normal range of elbow movement and function was obtained by early physiotherapy. Kenya Watanabe, Takuma Fukuzawa, and Katsuhiro Mitsui Copyright © 2016 Kenya Watanabe et al. All rights reserved. An Unusual Traumatic Presentation: Luxatio Erecta Humeri and Concomitant Hip Dislocation Mon, 19 Dec 2016 07:54:57 +0000 Introduction. Inferior dislocation of the glenohumeral joint, known as luxatio erecta humeri, and posterior hip dislocation are both rare presentations in the emergency department. The most common aetiology is falling for luxatio erecta humeri. The aim of this manuscript was to present a unique case in terms of luxatio erecta humeri, which has a different aetiology, treatment method, and concomitant injury. Presentation of Case. We report a construction worker who was rescued from a collapsed building who presented with both luxatio erecta humeri and complex posterior hip dislocation. An orthopaedic surgeon reducted luxatio erecta humeri with a one-step reduction technique under procedural anaesthesia as soon as the patient’s vital signs were stable. Discussion. Different concomitant injuries and various injury mechanisms have been described in regard to inferior shoulder dislocation in the literature. However, posterior dislocation of the hip as a concomitant distant region injury and trapping as an injury mechanism for luxatio erecta humeri are being described for the first time in this case report. Two reduction manoeuvers, one-step and two-step, have been used for this dislocation. Some authors suggested that a two-step manoeuver can be more easy to apply. In our specific case, luxatio erecta was easily reducted by a single operator in a single attempt. Conclusion. Luxatio erecta humeri may occur from trapping and complex injuries can accompany luxatio erecta humeri in patients with multiple trauma. A one-step closed reduction can be easily applied by a single operator under procedural anaesthesia. Mehmet Demirel, Berkan Anarat, Mehmet Ersin, Ali Erşen, and Cengiz Şen Copyright © 2016 Mehmet Demirel et al. All rights reserved. A Rare Case of Pheohyphomycotic Lumbar Spondylodiscitis Mistreated as Koch’s Spine Sun, 18 Dec 2016 12:58:11 +0000 Pheohyphomycosis is an uncommon infection and its association in spondylodiscitis has not yet been reported. The purpose of this case report is to describe a rare case of Pheohyphomycotic spondylodiscitis and methods to diagnose and manage the patient with less invasive techniques. A 29-year-old male patient presented to the outpatient department with complaints of gradually increasing low back pain with bilateral lower limbs radicular pain since one and a half years. He had associated fever, weight loss, voice changes, and dry, scaly, erythematous skin with elevated ESR. The patient had been taking anti-Koch’s therapy since 1 year with little relief in pain and no radiological improvement. Percutaneous pedicle biopsy of L4 vertebra was taken under local anaesthesia and confirmed Pheohyphomycosis which was treated with antifungal medications. The patient showed sequential improvement with long term antifungal treatment. He was eventually able to walk independently without support. Shakti A. Goel, Hitesh N. Modi, Yatin J. Desai, and Harshal P. Thaker Copyright © 2016 Shakti A. Goel et al. All rights reserved. A Delayed Postoperative C5 Palsy due to Spinal Cord Lesion: A Typical Clinical Presentation but Unusual Imaging Findings Sun, 18 Dec 2016 06:20:52 +0000 Postoperative C5 palsy (C5 palsy) is a troublesome complication after cervical spine surgery and its etiology is still unclear. We experienced a case of C5 palsy after anterior decompression with fusion for cervical ossification of posterior longitudinal ligament with the typical clinical presentation of left deltoid and bicep weakness and left-arm pain without deterioration of myelopathy symptoms, albeit with the unusual imaging findings not shown preoperatively of a swelling in the spinal cord, and intramedullary high intensity change on T2-weighed MRI. The additional posterior surgery was carried out to decompress the swollen spinal cord. The abnormal findings disappear on MRI taken three weeks following the second surgery and the weakness improved fully within three months after the second surgery. This case report highlights the possibility of spinal cord lesion due to circulatory impairment as a cause of C5 palsy. Nobuaki Tadokoro, Yusuke Kasai, Katsuhito Kiyasu, Motohiro Kawasaki, Ryuichi Takemasa, and Masahiko Ikeuchi Copyright © 2016 Nobuaki Tadokoro et al. All rights reserved. Combined Isolated Laugier’s Fracture and Distal Radial Fracture: Management and Literature Review on the Mechanism of Injury Wed, 14 Dec 2016 07:55:18 +0000 Introduction. Isolated fracture of the trochlea is an uncommon condition requiring a particular mechanism of injury. Its association with a distal radial fracture is rare. We aimed through this case report to identify the injury mechanism and to assess surgical outcomes. Case Presentation. We report a 26-year-old female who was admitted to our department for elbow trauma following an accidental fall on her outstretched right hand with her elbow extended and supinated. On examination, the right elbow was swollen with tenderness over the anteromedial aspect of the distal humerus. The elbow range was restricted. Standard radiographs showed an intra-articular half-moon-shaped fragment lying proximal and anterior to the distal humerus. There was a comminuted articular fracture of the distal radius with an anterior displacement. A computed tomography revealed an isolated shear fracture of the trochlea without any associated lesion of the elbow. The patient was surgically managed. Anatomical reduction was achieved and the fracture was fixed with 2 Kirschner wires. The distal radial fracture was treated by open reduction and plate fixation. The postoperative course was uneventful with a good recovery. Conclusion. Knowledge of such entity would be useful to indicate the suitable surgical management and eventually to obtain good functional outcomes. Walid Osman, Meriem Braiki, Zeineb Alaya, Nader Naouar, and Mohamed Ben Ayeche Copyright © 2016 Walid Osman et al. All rights reserved. Cartilage Delamination Flap Mimicking a Torn Medial Meniscus Tue, 13 Dec 2016 11:38:54 +0000 We report a case of a chondral delamination lesion due to medial parapatellar plica friction syndrome involving the medial femoral condyle. This mimicked a torn medial meniscus in clinical and radiological presentation. Arthroscopy revealed a chondral delamination flap, which was debrided. Diagnosis of chondral lesions in the knee can be challenging. Clinical examination and MRI have good accuracy for diagnosis and should be used in tandem. Early diagnosis and treatment of chondral lesions are important to prevent progression to early osteoarthritis. Gan Zhi-Wei Jonathan, Hamid Rahmatullah Bin Abd Razak, and Mitra Amit Kanta Copyright © 2016 Gan Zhi-Wei Jonathan et al. All rights reserved. A Surgical Opinion in a 36-Week Pregnant with Tibia Fracture: Intramedullary Nailing Tue, 13 Dec 2016 07:18:10 +0000 The operative treatment of tibial fractures in late pregnancy is a controversial issue that is rarely discussed in the literature. Here we present a case of a tibial diaphyseal fracture in a woman that was 36 weeks pregnant, which was treated with intramedullary nails under noninvasive foetal monitoring with cardiotocography. The patient underwent a successful surgery, and no harm or adverse events to either the mother or the foetus were reported during or after the procedure. Following surgery, the mother had a comfortable pregnancy and a normal spontaneous vaginal delivery with a healthy newborn. Celal Bozkurt and Baran Sarikaya Copyright © 2016 Celal Bozkurt and Baran Sarikaya. All rights reserved. A Case of Penicillin-Resistant Veillonella Prosthetic Joint Infection of the Knee Mon, 05 Dec 2016 12:40:24 +0000 Veillonella sp. and V. dispar are emerging pathogens. This is the third case of a monomicrobial Veillonella sp. prosthetic joint infection (PJI) among knees and hips; this is the second prosthetic knee infection described. The infection was treated with a 2-stage procedural approach combined with 6 weeks of ceftriaxone with excellent clinical response. There was no relapse in 2 years of follow-up care. This case exemplifies the importance of incubating anaerobic cultures for at least 7 days to grow some anaerobic pathogens. Claudia R. Libertin, Joy H. Peterson, Mark P. Brodersen, and Tamara Huff Copyright © 2016 Claudia R. Libertin et al. All rights reserved. Interdigital Neuroma in the Second Intermetatarsal Space Associated with Metatarsophalangeal Joint Instability Thu, 24 Nov 2016 07:48:40 +0000 The entrapment theory is the most commonly accepted theory concerning the development of interdigital neuroma; it incriminates the deep transverse metatarsal ligament as the major causative factor of the condition. This report presents a patient with interdigital neuroma in the second intermetatarsal space, which was strongly suspected to be caused by the metatarsophalangeal joint instability due to plantar plate injury. Surgical intervention revealed that the neuroma was located more distally and dorsally than the deep transverse metatarsal ligament and was pinched between the adjacent metatarsal heads, suggesting the involvement of the metatarsophalangeal joint instability and chronic trauma as etiologies in this case. Takumi Matsumoto, Song Ho Chang, Naohiro Izawa, Yohei Ohshiro, and Sakae Tanaka Copyright © 2016 Takumi Matsumoto et al. All rights reserved. Unusual Presentation of Popliteal Cyst on Magnetic Resonance Imaging Wed, 23 Nov 2016 08:39:24 +0000 Popliteal cyst commonly presents as an ellipsoid mass with uniform low signal intensity on T1-weighted magnetic resonance images and high signal intensity on T2-weighted images. Here, we describe a popliteal cyst with unusual appearance on magnetic resonance imaging, including heterogeneous intermediate signal intensity on T2-weighted images. Arthroscopic cyst decompression revealed that the cyst was filled with necrotic synovial villi, indicative of rheumatoid arthritis. Arthroscopic enlargement of unidirectional valvular slits with synovectomy was useful for the final diagnosis and treatment. Tsuyoshi Ohishi, Masaaki Takahashi, Daisuke Suzuki, and Yukihiro Matsuyama Copyright © 2016 Tsuyoshi Ohishi et al. All rights reserved. Avulsion Fracture of the Coracoid Process at the Coracoclavicular Ligament Insertion: A Report of Three Cases Tue, 22 Nov 2016 14:08:11 +0000 Avulsion fracture at the site of attachment of the coracoid process of the coracoclavicular ligament (CCL) is extremely rare. We presented three adult cases of this unusual avulsion fracture associated with other injuries. Case  1 was a 25-year-old right-handed male with a left distal clavicular fracture with an avulsion fracture of the coracoid attachment of the CCL; this case was treated surgically and achieved an excellent outcome. Case  2 was a 39-year-old right-handed male with dislocation of the left acromioclavicular joint with two avulsion fractures: one at the posteromedial surface of the coracoid process at the attachment of the conoid ligament and one at the inferior surface of the clavicle at the attachment site of the trapezoid ligament; this case was treated conservatively, and unfavorable symptoms such as dull pain at rest and sharp pain during some daily activities remained. Case  3 was a 41-year-old right-handed female with a right distal clavicular fracture with an avulsion fracture of the coracoid attachment of the conoid ligament; this case was treated conservatively, and the distal clavicular fracture became typical nonunion. These three cases corresponded to type I fractures according to Ogawa’s classification as the firm scapuloclavicular connection was destroyed and also to double disruption of the superior shoulder suspensory complex. We recommend surgical intervention when treating patients with this type of acute or subacute injury, especially in those engaging in heavy lifting or overhead work. Takeshi Morioka, Kiyohisa Ogawa, and Masaaki Takahashi Copyright © 2016 Takeshi Morioka et al. All rights reserved. Delayed Reconstruction by Total Calcaneal Allograft following Calcanectomy: Is It an Option? Sun, 20 Nov 2016 10:48:52 +0000 Many options are available in literature for the management of delayed reconstruction following calcanectomy. In cases of low-grade tumor lesions, conservative surgery can be considered. We describe a case of delayed reconstruction by calcaneal allograft after calcanectomy for low-grade chondrosarcoma. At 12-month follow-up, the patient had no pain; MSTS score and AOFAS score were satisfactory. Subtalar nonunion was observed with no secondary displacement or graft necrosis. The aim of conservative treatment for this patient was to restore normal gait with plantigrade locomotion and function of the Achilles tendon. Calcaneal reconstruction by total allograft is an alternative approach following calcanectomy for calcaneal tumors. We also discussed other options of calcaneal reconstruction. Benjamin Degeorge, Louis Dagneaux, David Forget, Florent Gaillard, and François Canovas Copyright © 2016 Benjamin Degeorge et al. All rights reserved. Technical Innovation Case Report: Ultrasound-Guided Prolotherapy Injection for Insertional Achilles Calcific Tendinosis Tue, 15 Nov 2016 06:33:45 +0000 We describe the use of ultrasound guidance for hyperosmolar dextrose (prolotherapy) injection of the distal calcaneal tendon specifically just anterior to identified enthesophytes in patients with insertional Achilles calcific tendinosis refractory to conservative treatment. This specific technique has not to our knowledge been described or used in literature previously. Benjamin K. Buchanan, Jesse P. DeLuca, and Kyle P. Lammlein Copyright © 2016 Benjamin K. Buchanan et al. All rights reserved. Primary Ewing’s Sarcoma of the Spine in a Two-Year-Old Boy Tue, 08 Nov 2016 14:24:26 +0000 Ewing’s Sarcoma (ES) is a highly malignant bone tumour. It may involve any part of the skeleton but the most frequent parts are the ilium and diaphysis of femur and tibia (Alfeeli et al., 2005; Zhu et al., 2012). Primary ES of the spine is extremely rare (Yan et al., 2011). It accounts for only 3.5 to 14.9 percent of all primary bone sarcomas. The age of presentation ranges from 12 to 24 years (median 21 years) (Ferguson, 1999; Sharafuddin et al., 1992; Klimo Jr. et al., 2009). We report an unusual case of primary ES of the spine in a two-year-old boy, who presented to us with paraparesis and features of cauda equina syndrome. MRI scan showed a tumour mass arising from the pedicle of L4 vertebra invading the spinal canal. Tc-99 bone scan showed increased tracer uptake in L4 vertebra and normal tracer uptake elsewhere in the skeleton. After reaching the diagnosis of a space occupying lesion invading the lumber spinal canal, we performed a decompressive laminectomy and a biopsy was sent which confirmed the diagnosis of ES. Immunohistochemistry showed tumour cells staining positive for CD-99 (specific stain for ES). Gene testing showed an EWS-FLI 1 chimera. Surgery was followed by good improvement in motor signs. The child was then referred to a specialized oncotherapy centre for further treatment, radiation, and chemotherapy. To the best of our knowledge, we are the first to report primary ES of the spine at the age of two years. Ali J. Electricwala and Jaffer T. Electricwala Copyright © 2016 Ali J. Electricwala and Jaffer T. Electricwala. All rights reserved. An Unusual and Complicated Course of a Giant Cell Tumor of the Capitate Bone Tue, 25 Oct 2016 14:57:44 +0000 A 51-year-old female patient presented with a carpal giant cell tumor (GCT) of the right capitate bone. The lesion was initially misdiagnosed as having an osteomyelitis. First, the diagnosis of a benign GCT was confirmed by histological examination. Second, an intralesional curettage and packing of the cavity with cancellous iliac crest bone grafts combined with a fusion of the third carpometacarpal (CMC III) joint were carried out. Third, due to a secondary midcarpal osteoarthritis and a secondary scaphoid nonunion, the CMC III joint fusion plate was removed and the midcarpal joint completely excised. Fourth, in the absence of recurrence of GCT, a four-corner fusion (4CF) with a corticocancellous iliac crest bone graft and complete excision of the scaphoid bone had to be performed. Fifth, a total wrist arthroplasty (TWA) was performed due to hardware failure of 4CF with migration of a headless compression screw into radiocarpal joint which led to erosion of articular surface of the distal radius. At the 3-year follow-up that includes a 1-year follow-up after TWA, there was no recurrence of GCT, and the TWA was not failed. The patient reported that she would have the motion-preserving TWA again. Ingo Schmidt Copyright © 2016 Ingo Schmidt. All rights reserved. Neck of Femur Fracture in a Patient with a Chronic Osteomyelitis of the Ipsilateral Foot Mon, 24 Oct 2016 06:13:21 +0000 This case report describes a successful two-stage treatment in a 75-year-old male with a displaced neck of femur fracture, also suffering from an active chronic osteomyelitis of the ipsilateral calcaneus. In our case, a below-knee amputation was performed first, followed by total hip arthroplasty two weeks later. At 15-month follow-up, full recovery of the prefracture level of activities of daily living without significant impairment was obtained. Only a few cases of total hip arthroplasty in amputees have been published, but the indication for surgery was mainly traumatic or advanced osteoarthritis. Treating patients with this type of comorbidities is challenging; therapeutic dilemmas can be major. The management in cases like these requires a thorough evaluation and a clear surgical and medical treatment plan, preferably conducted by a multidisciplinary orthogeriatric team. Anne-Carolin Döring, Anne J. H. Vochteloo, Kees van Doorn, Rianne M. H. A. Huis in ’t Veld, and Anil Peters Copyright © 2016 Anne-Carolin Döring et al. All rights reserved.