Case Reports in Orthopedics The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . 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. Metastatic Prostate Cancer of Hand Sun, 23 Oct 2016 09:08:50 +0000 Soft tissue metastases of prostate cancer to other sites are extremely rare, and, to our best knowledge, there have been no reports of metastasis to soft tissue of the hand. A 63-year-old man was diagnosed with prostatic cancer. During treatment, bone and soft tissue metastases to the right hand, appearing in the first web space, were observed. The tumor was resected, along with both the first and second metacarpal bones. The thumb was reconstructed by pollicization of the remaining index finger, enabling the patient to use the pollicized thumb for activities of daily living. This is the first case report of prostate cancer metastasizing to the soft tissue in hand. After wide resection, pollicization was able to reconstruct a functional hand and thumb. Akihito Nagano, Takatoshi Ohno, Koji Oshima, Daichi Ishimaru, Yutaka Nishimoto, Yoshiyuki Ohno, Akihiro Hirakawa, Tatsuhiko Miyazaki, and Haruhiko Akiyama Copyright © 2016 Akihito Nagano et al. All rights reserved. Bilateral Simultaneous Quadriceps Tendon Rupture in a 24-Year-Old Obese Patient: A Case Report and Review of the Literature Thu, 20 Oct 2016 05:57:34 +0000 Introduction. Simultaneous bilateral quadriceps tendon ruptures (SBQTR) are uncommon knee injuries and most frequently occur in male patients, over 50 years of age. It can be associated with one or more predisposing risk factors like obesity, steroids use, and hyperparathyroidism. The main focus of this paper is to review SBQTR in obese patients. Case Report. We are reporting the youngest patient in the literature to date, a 24-year-old obese male patient, who presented to the emergency department complaining of bilateral knee pain and inability to walk after a fall during a basketball game. His clinical examination revealed the presence of a palpable suprapatellar gap and loss of knee extension bilaterally. Magnetic resonance imaging (MRI) confirmed that both of his quadriceps tendons were ruptured. A day after his diagnosis, the patient underwent successful operative repair followed by rehabilitation. At the two-year follow-up, the patient had full strength of both quadriceps muscles with no extension lag. Conclusion. The diagnosis of SBQTR can be challenging. Early diagnosis and treatment are associated with better functional outcome compared to delayed treatment. Physicians should have a high index of clinical suspicion in order not to miss such an injury and achieve favourable outcomes. Fahad H. Abduljabbar, Abdulaziz Aljurayyan, Bayan Ghalimah, and Lawrence Lincoln Copyright © 2016 Fahad H. Abduljabbar et al. All rights reserved. Double-Layered Lateral Meniscus in an 8-Year-Old Child: Report of a Rare Case Wed, 19 Oct 2016 13:57:29 +0000 Reports of congenital abnormalities of the lateral meniscus include discoid meniscus, accessory meniscus, double-layered meniscus, and ring-shaped meniscus. Particularly, only a few cases of double-layered meniscus have been reported. We report a case of double-layered lateral meniscus, in which an additional semicircular meniscus was observed under the normal lateral meniscus. The accessory hemimeniscus was resected by means of arthroscopic surgery. This case demonstrates an interesting and extremely rare anatomical abnormality of the lateral meniscus. Susumu Araki, Mitsuhiko Kubo, Kosuke Kumagai, and Shinji Imai Copyright © 2016 Susumu Araki et al. All rights reserved. Magnesium-Based Absorbable Metal Screws for Intra-Articular Fracture Fixation Wed, 19 Oct 2016 12:51:00 +0000 MAGNEZIX® (Syntellix AG, Hanover, Germany) is a biodegradable magnesium-based alloy (MgYREZr) which is currently used to manufacture bioabsorbable compression screws. To date, there are very few studies reporting on a limited number of elective foot surgeries using this innovative implant. This case report describes the application of this screw for osteochondral fracture fixation at the humeral capitulum next to a loose radial head prosthesis, which was revised at the same time. The clinical course was uneventful. Degradation of the magnesium alloy did not interfere with fracture healing. Showing an excellent clinical result and free range-of-motion, the contour of the implant was still visible in a one-year follow-up. Roland Biber, Johannes Pauser, Markus Geßlein, and Hermann Josef Bail Copyright © 2016 Roland Biber et al. All rights reserved. First Case Report of a Late Onset Knee Periprosthetic Joint Infection Caused by Lactococcus garvieae Wed, 19 Oct 2016 11:17:56 +0000 Lactococcus garvieae is known as a Gram-positive, catalase-negative, and facultatively anaerobic fish pathogen. The association between Lactococcus spp. and human infectious diseases is described as being mainly associated with lumbar osteomyelitis, hepatic abscess, and infective endocarditis. In the literature of orthopedic post-prosthetic infections, L. garvieae was associated with a case of hip prosthetic infection in a fishmonger woman. We present the case of a 79-year-old male patient with multiple comorbidities, who is admitted to our center with a 5-day history of pain, swelling, and motility disorder of the right knee by the presence of a bicondylar knee replacement surgery, which was performed due to gonarthrosis 17 years ago. The radiographies of the right knee revealed no signs of displacement or loosening of the prothesis. After multiple radical debridements including VAC therapy and targeted antibiotic therapy we have managed to defeat the infection without exchange arthroplasty. Although we could not demonstrate the source of infection, we can only presume that in our case the source of infection was represented by the ingestion of possibly contaminated food. The patient had a habit of eating Nile perch fish (Lates niloticus) every 4 weeks. We illustrated once more the possibility of a late onset L. garvieae related orthopedic periprosthetic joint infection by multiple comorbidities. V.-I. Neagoe, S. Zytoun, and H.-J. Neuhaus Copyright © 2016 V.-I. Neagoe et al. All rights reserved. Low-Energy Traumatic Obturator Hip Dislocation with Ipsilateral Femoral Shaft Fracture in a Patient with Omolateral Knee Arthroplasty Mon, 17 Oct 2016 06:19:44 +0000 Ipsilateral obturator hip dislocation and femoral shaft fracture are rare. We report such a case in an older woman after a low-energy injury. She had a knee prostheses in the same limb. The patient was treated by open manipulative reduction of the luxation without opening joint and open reduction and internal fixation of the femur with angular stability plate and screws. We could not find a similar case in the literature. An early diagnosis of the dislocation is crucial in order to obtain good results. Great awareness and radiologic examination are fundamental to achieve precocious diagnosis of both these rare combined injuries, as treatment in these cases is considered an emergency. The first step was an attempt to reduce the dislocation by closed means but it failed. Then we performed a short approach at the trochanteric region and used Lambotte forceps to manoeuvre the proximal femur without opening the joint achieving reduction. Thereafter the femoral shaft fracture underwent open reduction and internal fixation with an angular stable plate. After a 2-year follow-up the outcome was very good. G. Gazzotti, L. Patrizio, S. Dall’Aglio, and E. Sabetta Copyright © 2016 G. Gazzotti et al. All rights reserved. Total Hip Arthroplasty for Implant Rupture after Surgery for Atypical Subtrochanteric Femoral Fracture Wed, 12 Oct 2016 14:05:43 +0000 Treatment methods for delayed union and nonunion of atypical femoral fracture are still controversial. Moreover, no treatment method has been established for implant rupture caused by delayed union and nonunion. We encountered a 74-year-old female in whom nonunion-induced implant rupture occurred after treatment of atypical subtrochanteric femoral fracture with internal fixation using a long femoral nail. It was unlikely that sufficient fixation could be obtained by repeating osteosynthesis alone. Moreover, the patient was elderly and early weight-bearing activity was essential for early recovery of ADL. Based on these reasons, we selected one-stage surgery with total hip arthroplasty and osteosynthesis with inverted condylar locking plate as salvage procedures. Bone union was achieved at 6 months after surgery. This case illustrated that osteosynthesis-combined one-staged total hip arthroplasty could be considered as one of the options for nonunion-induced implant rupture of atypical femoral subtrochanteric fracture. Yu Ozaki, Tomonori Baba, Hironori Ochi, Yasuhiro Homma, Taiji Watari, Mikio Matsumoto, and Kazuo Kaneko Copyright © 2016 Yu Ozaki et al. All rights reserved. Corrigendum to “Migration of the Anterior Spinal Rod to the Right Thigh, a Rare Complication of Anterior Spinal Instrumentations: A Case Report and a Literature Review” Tue, 11 Oct 2016 12:35:43 +0000 Gaston Camino Willhuber, Danilo Taype Zamboni, Guido Carabelli, Jorge Barla, and Carlos Sancineto Copyright © 2016 Gaston Camino Willhuber et al. All rights reserved. Leg Lengthening as a Means of Improving Ambulation Following an Internal Hemipelvectomy Sun, 09 Oct 2016 13:36:25 +0000 Reconstructive surgery following an internal hemipelvectomy for a malignant pelvic tumor is difficult due to the structural complexity of the pelvis and the massive extension of the tumor. While high complication rates have been encountered in various types of reconstructive surgery, resection without reconstruction reportedly involved fewer complications. However, this method often results in limb shortening with resultant instability during walking. We reported herein leg lengthening performed to correct lower limb shortening after an internal hemipelvectomy, which improved ambulatory stability and overall QOL. An 18-year-old male patient came to our hospital to correct a lower limb discrepancy resulting from a left internal hemipelvectomy. His left pelvis and proximal femur had been resected, and the femur remained without an acetabular roof. His left lower limb was about 8 centimeters shorter. The left tibia was lengthened 8 centimeters with an external fixator. After the lengthening, the patient was able to walk without support and his gait remarkably improved. Additionally he no longer required placing a wallet in his back pocket as a pad as a means of raising the left side of his torso while sitting. Leg lengthening was a useful method of improving ambulation after an internal hemipelvectomy. Wakyo Sato, Hiroshi Okazaki, and Takahiro Goto Copyright © 2016 Wakyo Sato et al. All rights reserved. A Case of Implant Failure in Partial Wrist Fusion Applying Magnesium-Based Headless Bone Screws Wed, 05 Oct 2016 09:38:25 +0000 This article presents a case of implant failure resulting in mechanical instability of a scaphotrapezotrapezoideal arthrodesis using magnesium-based headless bone screws. During revision surgery osteolysis surrounding the screws was observed as well as degraded screw threads already in existence at 6 weeks after implantation. The supposed osseous integration attributed to magnesium-based screws could not be reproduced in this particular case. Thus, it can be reasoned that the use of magnesium-based screws for partial wrist arthrodesis cannot be encouraged, at least not in dual use. Alice Wichelhaus, Judith Emmerich, and Thomas Mittlmeier Copyright © 2016 Alice Wichelhaus et al. All rights reserved. Surgical Treatment for Occipital Condyle Fracture, C1 Dislocation, and Cerebellar Contusion with Hemorrhage after Blunt Head Trauma Wed, 05 Oct 2016 06:10:15 +0000 Occipital condyle fractures (OCFs) have been treated as rare traumatic injuries, but the number of reported OCFs has gradually increased because of the popularization of computed tomography (CT) and magnetic resonance imaging (MRI). The patient in this report presented with OCFs and C1 dislocation, along with traumatic cerebellar hemorrhage, which led to craniovertebral junction instability. This case was also an extremely rare clinical condition in which the patient presented with traumatic lower cranial nerve palsy secondary to OCFs. When the patient was transferred to our hospital, the occipital bone remained defective extensively due to surgical treatment of cerebellar hemorrhage. For this reason, concurrent cranioplasty was performed with resin in order to fix the occipital bone plate strongly. The resin-made occipital bone was used to secure a titanium plate and screws enabled us to perform posterior fusion of the craniovertebral junction. Although the patient wore a halo vest for 3 months after surgery, lower cranial nerve symptoms, including not only neck pain but also paralysis of the throat and larynx, improved postoperatively. No complications were detected during outpatient follow-up, which continued for 5 years postoperatively. Shigeo Ueda, Nobuhiro Sasaki, Miyuki Fukuda, and Minoru Hoshimaru Copyright © 2016 Shigeo Ueda et al. All rights reserved. Knee-Extension Training with a Single-Joint Hybrid Assistive Limb during the Early Postoperative Period after Total Knee Arthroplasty in a Patient with Osteoarthritis Wed, 28 Sep 2016 09:47:33 +0000 The knee range of motion is an important outcome of total knee arthroplasty (TKA). According to previous studies, the knee range of motion temporarily decreases for approximately 1 month after TKA due to postoperative pain and quadriceps dysfunction following surgical invasion into the knee extensor mechanism. We describe our experience with a knee-extension training program based on a single-joint hybrid assistive limb (HAL-SJ, Cyberdyne Inc., Tsukuba, Japan) during the acute recovery phase after TKA. HAL-SJ is a wearable robot suit that facilitates the voluntary control of knee joint motion. A 76-year-old man underwent HAL-SJ-based knee-extension training, which enabled him to perform knee function training during the acute phase after TKA without causing increased pain. Thus, he regained the ability to fully extend his knee postoperatively. HAL-SJ-based knee-extension training can be used as a novel post-TKA rehabilitation modality. Tomokazu Yoshioka, Hisashi Sugaya, Shigeki Kubota, Mio Onishi, Akihiro Kanamori, Yoshiyuki Sankai, and Masashi Yamazaki Copyright © 2016 Tomokazu Yoshioka et al. All rights reserved. A Case of Bilateral Permanent Subluxation of the Lateral Meniscus Tue, 27 Sep 2016 13:29:41 +0000 We report a case of bilateral, permanent subluxation of the lateral meniscus. To our knowledge, the present case is the first reported description of bilateral irreducible anterior dislocation of the posterior segment of the lateral meniscus. This disorder is characterized by a flipped meniscus sign of the lateral meniscus on sagittal magnetic resonance images of the knee joint, with no history of trauma or locking symptoms. A detailed examination of serial magnetic resonance images of the lateral meniscus can help differentiate this condition from malformation of the lateral meniscus, that is, a double-layered meniscus. We recommend two-stage treatment for this disorder. First, the knee joint is kept in straight position for 3 weeks after the lateral meniscus is reduced to the normal position. Second, if subluxation of the lateral meniscus recurs, meniscocapsular suture is then performed. Although subluxation of the lateral meniscus without locking symptoms is rare, it is important to be familiar with this condition to diagnose and treat it correctly. Jun Suganuma, Tadashi Sugiki, and Yutaka Inoue Copyright © 2016 Jun Suganuma et al. All rights reserved. Two Extension Block Kirschner Wires’ Technique for Bony Mallet Thumb Tue, 27 Sep 2016 13:29:12 +0000 Mallet fingers with an avulsion fracture of the distal phalanx or rupture of the terminal tendon of the extensor mechanism is known as a common injury, while mallet thumb is very rare. In this paper, the case of a 19-year-old woman with a sprained left thumb sustained while playing basketball is presented. Plain radiographs and computed tomography revealed an avulsion fracture involving more than half of the articular surface at the base of the distal phalanx. Closed reduction and percutaneous fixation were performed using the two extension block Kirschner wires’ technique under digital block anesthesia. At 4 months postoperatively, the patient had achieved excellent results according to Crawford’s evaluation criteria and had no difficulties in working or playing basketball. Various conservative and operative treatment strategies have been reported for management of mallet thumb. We chose the two extension block Kirschner wires’ technique to minimize invasion of the extensor mechanism and nail bed and to stabilize the large fracture fragment. Yutaka Mifune, Atsuyuki Inui, Fumiaki Takase, Yasuhiro Ueda, Issei Shinohara, Ryosuke Kuroda, and Takeshi Kokubu Copyright © 2016 Yutaka Mifune et al. All rights reserved. Delayed Femoral Nerve Palsy Associated with Iliopsoas Hematoma after Primary Total Hip Arthroplasty Mon, 26 Sep 2016 09:49:55 +0000 Femoral nerve neuropathy after total hip arthroplasty is rare but catastrophic complication. Pain and quadriceps muscle weakness caused by this complication can significantly affect the functional outcome. Here we present a case report, describing delayed onset femoral nerve palsy associated with iliopsoas hematoma following pseudoaneurysm of a branch of profunda femoris artery after 3 months of primary total hip arthroplasty in an 80-year-old female patient with single kidney. Hip arthroplasty was done for painful primary osteoarthritis of left hip. Diagnosis of femoral nerve palsy was made by clinical examination and computed tomography imaging of pelvis. Patient was managed by surgical evacuation of hematoma and physiotherapy. The patient’s clinical symptoms were improved after surgical evacuation of hematoma. This is the first case report of its kind in English literature regarding delayed onset femoral nerve palsy after primary total hip arthroplasty due to pseudoaneurysm of a branch of profunda femoris artery without any obvious precipitating factor. Sandeep Kumar and Gerald Pflueger Copyright © 2016 Sandeep Kumar and Gerald Pflueger. All rights reserved. Entrapment of Common Peroneal Nerve by Surgical Suture following Distal Biceps Femoris Tendon Repair Thu, 15 Sep 2016 09:13:12 +0000 We describe entrapment of the common peroneal nerve by a suture after surgical repair of the distal biceps femoris tendon. Complete rupture of the distal biceps femoris tendon of a 16-year-old male athlete was surgically repaired. Postoperative common peroneal nerve palsy was evident, but conservative treatment did not cause any neurological improvement. Reexploration revealed that the common peroneal nerve was entrapped by the surgical suture. Complete removal of the suture and external neurolysis significantly improved the palsy. The common peroneal nerve is prone to damage as a result of its close proximity to the biceps femoris tendon and it should be identified during surgical repair of a ruptured distal biceps femoris tendon. Aki Fukuda, Akinobu Nishimura, Shigeto Nakazora, Ko Kato, and Akihiro Sudo Copyright © 2016 Aki Fukuda et al. All rights reserved. Solitary Spinal Epidural Metastasis from Gastric Cancer Wed, 14 Sep 2016 14:34:11 +0000 Solitary epidural space metastasis of a malignant tumor is rare. We encountered a 79-year-old male patient with solitary metastatic epidural tumor who developed paraplegia and dysuria. The patient had undergone total gastrectomy for gastric cancer followed by chemotherapy 8 months priorly. The whole body was examined for suspected metastatic spinal tumor, but no metastases of the spine or important organs were observed, and a solitary mass was present in the thoracic spinal epidural space. The mass was excised for diagnosis and treatment and was histopathologically diagnosed as metastasis from gastric cancer. No solitary metastatic epidural tumor from gastric cancer has been reported in English. Among the Japanese, 3 cases have been reported, in which the outcome was poor in all cases and no definite diagnosis could be made before surgery in any case. Our patient developed concomitant pneumonia after surgery and died shortly after the surgery. When a patient has a past medical history of malignant tumor, the possibility of a solitary metastatic tumor in the epidural space should be considered. Taisei Sako, Yasuaki Iida, Yuichirou Yokoyama, Shintaro Tsuge, Keiji Hasegawa, Akihito Wada, Tetsuo Mikami, and Hiroshi Takahashi Copyright © 2016 Taisei Sako et al. All rights reserved. Spontaneous Recurrent Hemarthrosis of the Knee: A Report of Two Cases with a Source of Bleeding Detected during Arthroscopic Surgery of the Knee Joint Wed, 14 Sep 2016 14:13:28 +0000 We report two cases of the spontaneous recurrent hemarthrosis of the knee. In these cases lateral meniscus was severely torn and a small tubular soft tissue with pulsation was identified on the synovium in the posterolateral corner during arthroscopic surgery of the knee joint. Gentle grasping of this tissue by forceps led to pulsating bleeding, which stopped by electrocoagulation. This soft tissue was considered a source of bleeding, since no recurrence of hemarthrosis was observed for more than four years after surgery. It was highly probable that this soft tissue was the ruptured end of the lateral inferior genicular artery or its branch. This case report strongly supports the theory that the bleeding from the peripheral arteries of the posterior portion of the lateral meniscus is the cause of spontaneous recurrent hemarthrosis of the knee. Eisuke Nomura, Hisatada Hiraoka, and Hiroya Sakai Copyright © 2016 Eisuke Nomura et al. All rights reserved. A Case of Successful Foraminotomy for Severe Bilateral C5 Palsy following Posterior Decompression and Fusion Surgery for Cervical Ossification of Posterior Longitudinal Ligament Thu, 08 Sep 2016 17:32:22 +0000 We report a very rare (5~7%) case of bilateral C5 palsy after cervical surgery. A 71-year-old male patient with cervical ossification of posterior longitudinal ligament (OPLL) with foraminal stenosis at bilateral C4/5 underwent posterior decompression and fusion surgery. After surgery, muscle weakness in his both deltoid and biceps was detected and gradually deteriorated to complete paralysis. Postoperative MRI showed sufficient decompression of the spinal cord and posterior shifting. Subsequently, an additional bilateral foraminotomy at C4/5 was performed, with a suspicion that bilateral foraminal stenosis at C4/5 may have been the cause of the paresis. After foraminotomy, muscular contraction was seen in both deltoid and biceps. Finally, complete motor recovery was achieved in a year. Although the gold standard procedure for the prevention and treatment of postoperative C5 palsy has not yet been established, an additional foraminotomy may be recommended for severe C5 palsy in cases of foraminal stenosis even after the occurrence of palsy. Yoshifumi Kudo, Tomoaki Toyone, Toshiyuki Shirahata, Tomoyuki Ozawa, Akira Matsuoka, Yoichi Jin, and Katsunori Inagaki Copyright © 2016 Yoshifumi Kudo et al. All rights reserved. Traumatic Testicular Dislocation Associated with Lateral Compression Pelvic Ring Injury and T-Shaped Acetabulum Fracture Thu, 08 Sep 2016 07:47:41 +0000 We report a case of a unilateral testicular dislocation to the superficial inguinal region associated with a lateral compression type pelvic ring injury (OTA classification 61-C3.3a2, b2, c3) and left T-shaped acetabulum fracture (OTA classification 62-B2) in a 44-year-old male who was in a motorcycle accident. The testicular dislocation was noted during the emergency department primary survey, and its location and viability were verified with ultrasound. The testicle was isolated during surgical stabilization of the left acetabulum through a Pfannenstiel incision and modified-Stoppa approach and returned through the inguinal canal to the scrotum. In follow-up, the patient did not suffer urologic or sexual dysfunction. All motorcycle collision patients presenting with pelvic ring injuries or acetabulum fractures should be worked up for possible testicular dislocation with a scrotal exam. Advanced imaging and a urologic consult may be necessary to detect and treat these injuries. Daniel Howard Wiznia, Mike Wang, Chang Yeon-Kim, Paul Tomaszewski, and Michael P. Leslie Copyright © 2016 Daniel Howard Wiznia et al. All rights reserved. Bilateral Diabetic Knee Neuroarthropathy in a Forty-Year-Old Patient Wed, 07 Sep 2016 16:41:42 +0000 Diabetic osteoarthropathy is a rare cause of neuropathic joint disease of the knee; bilateral involvement is even more exceptional. Diagnosis is often made late due to its unspecific symptoms and appropriate surgical management still needs to be defined, due to lack of evidence because of the disease’s low incidence. We report the case of a forty-year-old woman with history of diabetes type I who developed bilateral destructive Charcot knee arthropathy. Bilateral total knee arthroplasty was performed in order to achieve maximal functional outcome. Follow-up was marked by bilateral tibial periprosthetic fractures treated by osteosynthesis with a satisfactory outcome. The diagnosis of Charcot arthropathy should always be in mind when dealing with atraumatic joint destruction in diabetic patients. Arthroplasty should be considered as an alternative to arthrodesis in bilateral involvement in young patients. Patrick Goetti, Nicolas Gallusser, and Olivier Borens Copyright © 2016 Patrick Goetti et al. All rights reserved. Symptomatic Bilateral Torn Discoid Medial Meniscus Treated with Saucerization and Suture Tue, 30 Aug 2016 14:22:59 +0000 Discoid meniscus is an anatomical congenital anomaly more often found in the lateral meniscus. A discoid medial meniscus is a very rare anomaly, and even more rare is to diagnose a bilateral discoid medial meniscus although the real prevalence of this situation is unknown because not all the discoid medial menisci are symptomatic and if the contralateral knee is not symptomatic then it is not usually studied. The standard treatment of this kind of pathology is partial meniscectomy. Currently the tendency is to be very conservative so suture and saucerization of a torn discoid meniscus when possible are gaining support. We present the case of a 13-year-old patient who was diagnosed with symptomatic torn bilateral discoid medial meniscus treated by suturing the tear and saucerization. To the best of our knowledge this is the first case reported of bilateral torn discoid medial meniscus treated in this manner in the same patient. Enrique Sevillano-Perez, Alejandro Espejo-Reina, and María Josefa Espejo-Reina Copyright © 2016 Enrique Sevillano-Perez et al. All rights reserved.