Case Reports in Orthopedics The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . 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. Unusual Closed Traumatic Avulsion of Both Flexor Tendons in Zones 1 and 3 of the Little Finger Tue, 30 Aug 2016 12:02:35 +0000 Closed tendon avulsion of both flexor tendons in the same finger is an extremely rare condition. We encountered the case of a patient who presented a rupture of the flexor digitorum profundus in zone 1 and flexor digitorum superficialis in zone 3 in the little finger. This occurrence has not been reported previously. We hereby present our case, make a review of the literature of avulsion of both flexor tendons of the same finger, and propose a treatment according to the site of the ruptures. Marie-Aimée Päivi Soro, Thierry Christen, and Sébastien Durand Copyright © 2016 Marie-Aimée Päivi Soro et al. All rights reserved. Thumb Reconstruction with Arthrodesis to the Second Metacarpal following Sarcoma Excision Mon, 29 Aug 2016 14:15:43 +0000 Primary sarcomas of the thumb metacarpal are rare malignant lesions. Surgical treatment involves amputation versus tumor resection with thumb reconstruction. If complete tumor resection is possible, thumb preservation may be considered, as the thumb is vital to hand function. Following tumor resection, previous reports have described graft reconstruction with fusion to the trapezium or scaphoid. We present two cases of sarcoma necessitating resection of the thumb metacarpal that were reconstructed with an arthrodesis of the proximal phalanx to the second metacarpal shaft. Arthrodesis to the second metacarpal allows robust bony contact for fusion as well as improved resting position of the thumb. At 2- and 4-year follow-up, both patients have a stable, pain-free thumb without evidence of local recurrence. Christopher Hein, Barry Watkins, and Lee M. Zuckerman Copyright © 2016 Christopher Hein et al. All rights reserved. Sacral Emphysematous Osteomyelitis Caused by Escherichia coli after Arthroscopy of the Knee Mon, 29 Aug 2016 11:01:08 +0000 Emphysematous osteomyelitis is a rare but serious condition which is often associated with a fatal outcome. The typical appearances of emphysematous osteomyelitis are clusters of small gas bubbles within the medullary cavity. We report a case of a 62-year-old male who presented with emphysematous osteomyelitis due to hematogenous spread of Escherichia coli from the knee after arthroscopy. Mirko Velickovic and Thomas Hockertz Copyright © 2016 Mirko Velickovic and Thomas Hockertz. All rights reserved. A Rare Case of Progressive Palsy of the Lower Leg Caused by a Huge Lumbar Posterior Endplate Lesion after Recurrent Disc Herniation Sun, 28 Aug 2016 14:21:48 +0000 A lesion of the lumbar posterior endplate is sometimes identified in the spinal canal of children and adolescents; it causes symptoms similar to those of a herniated disc. However, the pathology of the endplate lesion and the pathology of the herniated disc are different. We present a rare case of a 23-year-old woman who developed progressive palsy of the lower leg caused by huge lumbar posterior endplate lesion after recurrent disc herniation. Masatoshi Morimoto, Kosaku Higashino, Shinsuke Katoh, Tezuka Fumitake, Kazuta Yamashita, Fumio Hayashi, Yoichiro Takata, Toshinori Sakai, Akihiro Nagamachi, and Koichi Sairyo Copyright © 2016 Masatoshi Morimoto et al. All rights reserved. Simultaneous Bilateral Transient Osteoporosis of the Hip without Pregnancy Sun, 28 Aug 2016 08:43:04 +0000 Transient osteoporosis of the hip (TOH) is a rare disorder characterized by acute severe coxalgia and temporary osteopenia in the proximal femur. Although most cases were unilateral or staged bilateral TOH, some authors reported that the pregnant patients simultaneously had TOH in their bilateral hips. However, there has been no report of simultaneous bilateral TOH in the patient without pregnancy. A 25-year-old Japanese woman without pregnancy had acute simultaneous bilateral hip pain. Plain X-ray of the bilateral hips did not show a periarticular osteopenia. However, magnetic resonance image obtained one week after the onset demonstrated increased T2-weighted signal intensity and decreased T1-weighted signal intensity in the bilateral femoral heads. She was treated conservatively, and follow-up magnetic resonance image at seven weeks after the onset returned to normal bone marrow signal intensity. Her bilateral coxalgia subsided gradually. At one year after the onset, she had no sign of symptomatic flair. Our experience with this case indicates that recognizing the possibility of simultaneous bilateral TOH is important unless the patient is pregnant, and magnetic resonance image is predictable test to make a diagnosis of TOH, even in the absence of abnormal finding on plain X-ray. Yasuaki Okada, Sachiyuki Tsukada, Masayoshi Saito, and Atsushi Tasaki Copyright © 2016 Yasuaki Okada et al. All rights reserved. Metallosis after Exchange of the Femoral Head and Liner following Ceramic Acetabular Liner Dissociation in Total Hip Arthroplasty with a Modular Layered Acetabular Component Thu, 25 Aug 2016 16:29:38 +0000 The type of bearing material that should be used in revision surgery after the failure of ceramic-on-ceramic total hip arthroplasty (THA) remains controversial. In the case of ceramic fracture, the residual ceramic particles can cause consequent metallosis when metal implants are used for revision THA. On the other hand, in the case of THA failure without ceramic fracture, revision THA with a metal femoral head provides satisfactory results. We report an unusual case of progressive osteolysis due to metallosis that developed after revision THA for ceramic liner dissociation without a liner fracture performed using a metal femoral head and polyethylene liner. The residual metal debris and abnormal pumping motion of the polyethylene liner due to the breakage of the locking system or the aspherical metal shell being abraded by the ceramic head seemed to be the cause of the progressive osteolysis. Tomoya Takasago, Tomohiro Goto, Keizo Wada, Daisuke Hamada, Toshiyuki Iwame, Tetsuya Matsuura, Akihiro Nagamachi, and Koichi Sairyo Copyright © 2016 Tomoya Takasago et al. All rights reserved. Gait Analysis of Conventional Total Knee Arthroplasty and Bicruciate Stabilized Total Knee Arthroplasty Using a Triaxial Accelerometer Thu, 25 Aug 2016 16:28:43 +0000 One component of conventional total knee arthroplasty is removal of the anterior cruciate ligament, and the knee after total knee arthroplasty has been said to be a knee with anterior cruciate ligament dysfunction. Bicruciate stabilized total knee arthroplasty is believed to reproduce anterior cruciate ligament function in the implant and provide anterior stability. Conventional total knee arthroplasty was performed on the right knee and bicruciate stabilized total knee arthroplasty was performed on the left knee in the same patient, and a triaxial accelerometer was fitted to both knees after surgery. Gait analysis was then performed and is reported here. The subject was a 78-year-old woman who underwent conventional total knee arthroplasty on her right knee and bicruciate stabilized total knee arthroplasty on her left knee. On the femoral side with bicruciate stabilized total knee arthroplasty, compared to conventional total knee arthroplasty, there was little acceleration in the -axis direction (anteroposterior direction) in the early swing phase. Bicruciate stabilized total knee arthroplasty may be able to replace anterior cruciate ligament function due to the structure of the implant and proper anteroposterior positioning. Takenori Tomite, Hidetomo Saito, Toshiaki Aizawa, Hiroaki Kijima, Naohisa Miyakoshi, and Yoichi Shimada Copyright © 2016 Takenori Tomite et al. All rights reserved. Resection and Resolution of Bone Marrow Lesions Associated with an Improvement of Pain after Total Knee Replacement: A Novel Case Study Using a 3-Tesla Metal Artefact Reduction MRI Sequence Thu, 25 Aug 2016 13:27:50 +0000 We present our case report using a novel metal artefact reduction magnetic resonance imaging (MRI) sequence to observe resolution of subchondral bone marrow lesions (BMLs), which are strongly associated with pain, in a patient after total knee replacement surgery. Large BMLs were seen preoperatively on the 3-Tesla MRI scans in a patient with severe end stage OA awaiting total knee replacement surgery. Twelve months after surgery, using a novel metal artefact reduction MRI sequence, we were able to visualize the bone-prosthesis interface and found complete resection and resolution of these BMLs. This is the first reported study in the UK to use this metal artefact reduction MRI sequence at 3-Tesla showing that resection and resolution of BMLs in this patient were associated with an improvement of pain and function after total knee replacement surgery. In this case it was associated with a clinically significant improvement of pain and function after surgery. Failure to eradicate these lesions may be a cause of persistent postoperative pain that is seen in up to 20% of patients following TKR surgery. Thomas Kurien, Robert Kerslake, Brett Haywood, Richard G. Pearson, and Brigitte E. Scammell Copyright © 2016 Thomas Kurien et al. All rights reserved. Perforation of an Occult Carcinoma of the Prostate as a Rare Differential Diagnosis of Subcutaneous Emphysema of the Leg Thu, 11 Aug 2016 16:15:37 +0000 We report a case of subcutaneous emphysema caused by perforation of the rectum due to a carcinoma of the prostate. Although rare, an abdominal cause must always be considered as a rare differential diagnosis of subcutaneous emphysema. As a matter of fact adequate diagnostic with rapid treatment is essential for the outcome. Mirko Velickovic and Thomas Hockertz Copyright © 2016 Mirko Velickovic and Thomas Hockertz. All rights reserved. Metatarsal Shaft Fracture with Associated Metatarsophalangeal Joint Dislocation Thu, 11 Aug 2016 13:09:12 +0000 Metatarsophalangeal joint dislocations of lesser toes are often seen in the setting of severe claw toes. Traumatic irreducible dislocations have been reported in rare cases following both low-energy and high-energy injuries to the forefoot. In this case report, I present a previously unreported association of a metatarsal shaft fracture with metatarsophalangeal joint dislocation of a lesser toe. Taranjit Singh Tung Copyright © 2016 Taranjit Singh Tung. All rights reserved. Effect of Long-Term Use of Bisphosphonates on Forearm Bone: Atypical Ulna Fractures in Elderly Woman with Osteoporosis Wed, 10 Aug 2016 14:10:06 +0000 Osteoporosis is a common musculoskeletal disease of the elderly population characterized by decreased bone mineral density and subsequent fractures. Bisphosphonates are a widely accepted drug therapy which act through inhibition of bone resorption and prevent fractures. However, in long-term use, atypical bisphosphonate induced fractures may occur, particularly involving the lower weight bearing extremity. Atypical ulna fracture associated with long-term bisphosphonate use is rarely reported in current literature. We present a 62-year-old woman with atypical ulna due to long-term alendronate therapy without a history of trauma or fall. Clinicians should be aware of stress fracture in a patient who has complaints of upper extremity pain and history of long-term bisphosphonate therapy. Yusuf Erdem, Zafer Atbasi, Tuluhan Yunus Emre, Gülis Kavadar, and Bahtiyar Demiralp Copyright © 2016 Yusuf Erdem et al. All rights reserved. Multiple Giant Cell Tumors of Tendon Sheath Found within a Single Digit of a 9-Year-Old Wed, 10 Aug 2016 11:46:25 +0000 Giant cell tumor of tendon sheath is one of the most common soft tissue tumors of the hand. These tumors typically occur in the third or fourth decade of life and present as solitary nodules on a single digit. Currently, the greatest reported number of lesions found within a single digit is five. Although uncommon, giant cell tumor of tendon sheath does occur in the pediatric population. Herein we present a report of a rare case of GCTTS in a child in which seven lesions were identified within a single digit—the greatest number of lesions within a single digit reported to date. John S. Hwang, Valerie A. Fitzhugh, Peter D. Gibson, Jacob Didesch, and Irfan Ahmed Copyright © 2016 John S. Hwang et al. All rights reserved. Acute Pectoralis Major Rupture Captured on Video Wed, 10 Aug 2016 09:17:13 +0000 Pectoralis major (PM) ruptures are uncommon injuries, although they are becoming more frequent. We report a case of a PM rupture in a young male who presented with axillar pain and absence of the anterior axillary fold after he perceived a snap while lifting 200 kg in the bench press. Diagnosis of PM rupture was suspected clinically and confirmed with imaging studies. The patient was treated surgically, reinserting the tendon to the humerus with suture anchors. One-year follow-up showed excellent results. The patient was recording his training on video, so we can observe in detail the most common mechanism of injury of PM rupture. Alejandro Ordas Bayon, Enrique Sandoval, and María Valencia Mora Copyright © 2016 Alejandro Ordas Bayon et al. All rights reserved. Gluteal Compartment Syndrome Secondary to Pelvic Trauma Mon, 08 Aug 2016 16:31:17 +0000 Gluteal compartment syndrome (GCS) is extremely rare when compared to compartment syndrome in other anatomical regions, such as the forearm or the lower leg. It usually occurs in drug users following prolonged immobilization due to loss of consciousness. Another possible cause is trauma, which is rare and has only few reports in the literature. Physical examination may show tense and swollen buttocks and severe pain caused by passive range of motion. We present the case of a 70-year-old man who developed GCS after prolonged anterior-posterior pelvis compression. The physical examination revealed swelling, scrotal hematoma, and left ankle extension weakness. An unstable pelvic ring injury was diagnosed and the patient was taken to surgery. Measurement of the intracompartmental pressure was measured in the operating room, thereby confirming the diagnosis. Emergent fasciotomy was performed to decompress the three affected compartments. Trauma surgeons must be aware of the possibility of gluteal compartment syndrome in patients who have an acute pelvic trauma with buttock swelling and excessive pain of the gluteal region. Any delay in diagnosis or treatment can be devastating, causing permanent disability, irreversible loss of gluteal muscles, sciatic nerve palsy, kidney failure, or even death. Fernando Diaz Dilernia, Ezequiel E. Zaidenberg, Sebastian Gamsie, Danilo E. R. Taype Zamboni, Guido S. Carabelli, Jorge D. Barla, and Carlos F. Sancineto Copyright © 2016 Fernando Diaz Dilernia et al. All rights reserved. Spinous Process Osteochondroma as a Rare Cause of Lumbar Pain Thu, 04 Aug 2016 06:47:55 +0000 We present a case of a 5th Lumbar Vertebra (L5) spinous process osteochondroma as a rare cause of lumbar pain in an old patient. A 70-year-old male presented with progressive and disabling lower lumbar pain. Tenderness over the central and left paraspinal area of the lower lumbar region and a palpable mass were evident. CT scan showed a mass arising from the spinous process of L5. Marginal resection of the tumor was performed through a posterior approach. The histological study revealed an osteochondroma. After surgery, pain was completely relieved. After one year there was no evidence of local recurrence or symptoms. Osteochondromas rarely involve the spine, but when they do symptoms like pain, radiculopathy/myelopathy, or cosmetic deformity may occur. The imagiologic exam of election for diagnosis is CT scan. When symptomatic the treatment of choice is surgical resection. The most concerning complication of osteochondromas is malignant transformation, a rare event. Bárbara Rosa, Pedro Campos, André Barros, Samir Karmali, Esperança Ussene, Carlos Durão, João Alves da Silva, and Nuno Coutinho Copyright © 2016 Bárbara Rosa et al. All rights reserved. A Scaphoid Stress Fracture in a Female Collegiate-Level Shot-Putter and Review of the Literature Wed, 03 Aug 2016 14:38:22 +0000 Scaphoid stress fractures are rare injuries that have been described in young, high-level athletes who exhibit repetitive loading with the wrist in extension. We present a case of an occult scaphoid stress fracture in a 22-year-old female Division I collegiate shot-putter. She was successfully treated with immobilization in a thumb spica splint for 6 weeks. Loaded wrist extension activities can predispose certain high-level athletes to sustain scaphoid stress fractures, and a high index of suspicion in this patient population may aid prompt diagnosis and management of this rare injury. Jessica M. Kohring, Heather M. Curtiss, and Andrew R. Tyser Copyright © 2016 Jessica M. Kohring et al. All rights reserved. Synovial Lipomatosis of the Glenohumeral Joint Mon, 01 Aug 2016 09:49:17 +0000 Synovial lipomatosis (also known as lipoma arborescens) is a rare and benign lesion affecting synovium-lined cavities. It is characterized by hyperplasia of mature fat tissue in the subsynovial layer. Although the most commonly affected site is the knee joint, rarely additional locations such as tendon sheath and other joints are involved. We present a case of synovial lipomatosis of the glenohumeral joint in a 44-year-old man. The clinical data radiological studies and histopathologic results are described, as well as a review of the current literature. Shaul Beyth and Ori Safran Copyright © 2016 Shaul Beyth and Ori Safran. All rights reserved. Acute Failure of a Glenoid Component in Anatomic Shoulder Arthroplasty Sun, 31 Jul 2016 06:44:20 +0000 Glenoid loosening is the most common cause of failure in primary total shoulder arthroplasty (TSA) and often occurs years after the initial surgery. It is rare for a glenoid component to fail acutely. Several case reports of complete glenoid dissociation appear in the literature. It is important to report these failures to identify technical errors or component design flaws to improve outcomes in TSA. In this case report, we present an unrecognized acute failure of a cemented hybrid glenoid component at the time of surgery. William E. Daner, III and Norman D. Boardman, III Copyright © 2016 William E. Daner, III and Norman D. Boardman, III. All rights reserved. Delayed Axillary Artery Occlusion after Reverse Total Shoulder Arthroplasty Sun, 31 Jul 2016 06:23:13 +0000 Axillary artery injury has been associated with shoulder dislocation and surgery. We describe a case of delayed axillary artery occlusion after reverse total shoulder arthroplasty. The injury was confirmed by Doppler and angiography and was treated with angioplasty and stenting. Early recognition and treatment of this injury are mandatory for patients’ recovery. Omar M. Ghanem, Jana Sacco, Richard F. Heitmiller, and Seyed Mojtaba Gashti Copyright © 2016 Omar M. Ghanem et al. All rights reserved.