Case Reports in Orthopedics The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. A Fatal Sepsis Caused by Hyaluronate Knee Injection: How Much the Medical History and the Informed Consent Might Be Important? Thu, 23 Feb 2017 00:00:00 +0000 The incidence of Osteoarthritis (OA) is gradually increasing worldwide due to two main reasons: longer life expectation and increased functional demand. Several treatment options have been proposed for this disease. Conservative treatment has the goal to improve the quality of life, reduce pain, and prevent the progression of the disease. Hyaluronate viscosupplementation is one of the most used infiltrative treatments for OA, but, despite its common use, clinical efficacy is still under question. Though adverse reactions for this medical option are actually rare, septic arthritis is a very scaring complication. We present a case report of a 59-year-old man who has been submitted to only one knee hyaluronate injection and consequently reported a severe septic arthritis and systemic sepsis, which lead to the death of the patient. We recommend producing correct guidelines for a clean aseptic procedure of injection to obtain proper consensus from the patient and to pay attention to his clinical history and comorbidities before acting any kind of invasive treatment, including joint injection. F. Manfreda, G. Rinonapoli, A. Nardi, P. Antinolfi, and A. Caraffa Copyright © 2017 F. Manfreda et al. All rights reserved. Open and Arthroscopic with Mini-Open Surgical Hip Approaches for Treatment of Pigmented Villonodular Synovitis and Concomitant Hip Pathology Thu, 23 Feb 2017 00:00:00 +0000 Background. Pigmented villonodular synovitis (PVNS) is a rare benign tumor affecting large joints and prompts excision to prevent local destruction of the joint. The purpose of this case report is to describe two differing surgical approaches for management of PVNS of the hip in patients requiring concomitant treatment for additional hip pathology. Methods. This report discusses the presentation, clinical and radiographic findings, and operative management of two contrasting cases of PVNS of the hip. Case describes a 31-year-old female with localized PVNS in addition to a labral tear treated with arthroscopic labral repair followed by tumor excision via a mini-open incision. Case describes a 29-year-old male with more diffuse PVNS in addition to a cam deformity managed with open surgical dislocation of the hip, tumor excision, and restoration of the femoral head/neck junction. Results. This report demonstrates two cases of successful excision of PVNS of the hip in addition to addressing concomitant hip pathology in both cases. Conclusions. Open surgical dislocation of the hip or arthroscopic surgery with a mini-open incision may be used in appropriately selected patients to successfully excise PVNS lesions in addition to addressing concomitant hip pathology. Bridget Ellsworth and Atul F. Kamath Copyright © 2017 Bridget Ellsworth and Atul F. Kamath. All rights reserved. Fixation of a Proximal Humeral Fracture Using a Novel Intramedullary Cage Construct following a Failed Conservative Treatment Wed, 01 Feb 2017 07:40:42 +0000 A majority of proximal humeral fractures are preferably treated conservatively. However, surgical management may be beneficial in proximal humeral fractures with significant displacement or angulation. Unfortunately, the complication rates associated with current surgical procedures for fracture fixation, ORIF and IM devices, can be unacceptably high. A new technology, termed the PH Cage, addresses the technical limitations associated with current technologies available for fixation of proximal humeral fractures. It allows for intramedullary fixation of a PH fracture and provides direct load bearing support to the articular surface and buttresses the medial column during healing. We are presenting our first experience with the PH Cage for the fixation of a PH fracture, which had previously failed conservative management. John Macy Copyright © 2017 John Macy. All rights reserved. Surgical Management of Multijoint Septic Arthritis due to Rat-Bite Fever in a Pediatric Patient: A Case Study Tue, 31 Jan 2017 09:25:39 +0000 In the United States, rat-bite fever is a rare systemic illness principally caused by Streptobacillus moniliformis, an organism found in the nasopharyngeal flora of rodents. Infection through direct exposure to rat excreta such as saliva, urine, or feces can lead to fever, rash, and an asymmetric migratory polyarthritis. As rodents are becoming more popular as pets, more pediatric cases are being documented. We report a pediatric case of delayed onset septic arthritis in the left wrist and right knee due to S. moniliformis from a rat bite. Previously reported pediatric case studies of suppurative arthritis due to S. moniliformis have only involved the hip. This case study demonstrates the importance of a thorough exposure history and consideration of zoonotic infections as a cause of septic arthritis in a pediatric patient that requires antibiotics and surgical intervention. Adam M. Wegner, Nicole Look, and Brian M. Haus Copyright © 2017 Adam M. Wegner et al. All rights reserved. Stenosing Tenosynovitis of the Flexor Hallucis Longus Tendon Associated with the Plantar Capsular Accessory Ossicle at the Interphalangeal Joint of the Great Toe Tue, 31 Jan 2017 00:00:00 +0000 This report presents a case of stenosing tenosynovitis of the flexor hallucis longus tendon associated with the plantar capsular accessory ossicle at the interphalangeal joint of the great toe, which was confirmed by intraoperative observation and was successfully treated with surgical resection of the ossicle. As the plantar capsular accessory ossicle was not visible radiographically due to the lack of ossification, ultrasonography was helpful for diagnosing this disorder. Song Ho Chang, Takumi Matsumoto, Masashi Naito, and Sakae Tanaka Copyright © 2017 Song Ho Chang et al. All rights reserved. Osteolysis of the Greater Trochanter Caused by a Foreign Body Granuloma Associated with the Ethibond® Suture after Total Hip Arthroplasty Tue, 31 Jan 2017 00:00:00 +0000 The present case shows a case of progression of osteolysis of the greater trochanter caused by a foreign body granuloma associated with the number 5 Ethibond suture in cementless THA with the direct lateral approach that was completely healed by removal of the Ethibond suture. A 55-year-old Japanese woman with secondary osteoarthritis caused by acetabular dysplasia underwent left cementless THA with the direct lateral approach. After setting of the total hip prosthesis, the gluteus medius muscle and vastus lateralis muscle were reattached to the greater trochanter through two bone tunnels using number 5 Ethibond EXCEL sutures. The left hip pain disappeared after surgery, but the bone tunnels enlarged gradually and developed osteolysis at 10 weeks. The removal of the Ethibond sutures and debridement improved the osteolysis. Histological examination showed the granuloma reaction to a foreign body with giant cell formation. The Ethibond suture has the lowest inflammatory tissue reaction and relatively high tension strength among nonabsorbable suture materials. However, number 5 Ethibond has the potential to cause osteolysis due to a foreign body granuloma, as in the present case. Keiji Kamo, Hiroaki Kijima, Koichiro Okuyama, Nobutoshi Seki, Shin Yamada, Naohisa Miyakoshi, and Yoichi Shimada Copyright © 2017 Keiji Kamo et al. All rights reserved. Difficulty in Fixation of the Volar Lunate Facet Fragment in Distal Radius Fracture Tue, 31 Jan 2017 00:00:00 +0000 Recent reports suggest the presence of a rare fracture type for which reduction and fixation cannot be achieved with volar locking plate (VLP). In particular, it is difficult to achieve reduction and fixation with volar lunate facet (VLF) fragments present on the volar ulnar aspect of the lunate facet, because of the anatomical structure and biomechanics in this region. Herein, we report two challenging cases of difficulty in fixation of the VLF fragment in distal radius fracture. For this fracture type, it is most important to identify the volar ulnar bone fragment before surgery; it may also be necessary to optimize distal placement of the VLP via a dual-window approach and to apply additional fixations, such as a small plate, anchor, and/or external fixation. Hiroyuki Obata, Tomonori Baba, Kentaro Futamura, Osamu Obayashi, Atsuhiko Mogami, Hideki Tsuji, Yoshiaki Kurata, and Kazuo Kaneko Copyright © 2017 Hiroyuki Obata et al. All rights reserved. Traumatic Rupture of an Intermediate Tendon in a Patient with Patellar Duplication Tue, 31 Jan 2017 00:00:00 +0000 Patellar duplication is a rare asymptomatic condition. The diagnosis is often made following a traumatic event associated with an injury to the knee extensor mechanism. The treatment is often surgical and consists in removal of the smaller part of the patella with tendon reinsertion. The presence and rupture of an intermediate tendon between the two parts of the patella have not been reported in the modern literature. We present a traumatic rupture of an intermediate tendon in a patient with horizontal patellar duplication. The surgical management consisted of tenorrhaphy protected with a figure-of-eight tension band wire approximating the two parts of the patella. The patient recovered full knee range of motion and quadriceps strength at the last 8-month follow-up. Stéphane Pelet, Mathieu Hébert, Amerigo Balatri, and Pierre-Alexandre LeBlanc Copyright © 2017 Stéphane Pelet et al. All rights reserved. Pectoralis Major Tear with Retracted Tendon: How to Fill the Gap? Reconstruction with Hamstring Autograft and Fixation with an Interference Screw Mon, 30 Jan 2017 00:00:00 +0000 Rupture of the pectoralis major tendon is considered an uncommon injury and a significant number of ruptures are missed or diagnosed late, leading to a chronic tear. We report an open reconstruction technique and its outcomes in a case of chronic and retracted PM tear. At the last follow-up (12 months), the patient was pain-free, with a visual analogic scale at 0 all the time. He was very satisfied concerning the cosmetic and clinical results. The constant score was 93%, the SST value 95%, and the Quick DASH score 4.5. MRI performed one year postoperatively confirmed the continuity between PM tendon and graft, even if the aspect of the distal tendon seemed to be thinner than normal PM tendon. The excellent clinical outcomes at one-year follow-up suggest that PM tear with major tendon retraction can be reliably reconstructed with hamstring autograft, using a bioabsorbable screw to optimize the fixation device. This technique has proven its simplicity and efficiency to fill the gap. L. Baverel, K. Messedi, G. Piétu, V. Crenn, and F. Gouin Copyright © 2017 L. Baverel et al. All rights reserved. Treating Early Knee Osteoarthritis with the Atlas® Unicompartmental Knee System in a 26-Year-Old Ex-Professional Basketball Player: A Case Study Thu, 26 Jan 2017 00:00:00 +0000 Knee osteoarthritis (OA) is a leading cause of disability among adults. Within the affected population, there exists a group of patients who have exhausted conservative treatment options and yet are not ideal candidates for current surgical treatments due to young age, early disease severity, or neutral mechanical knee alignment. For these patients, a new potential treatment option may be considered. We present an interesting case report of a young, ex-professional athlete treated with a minimally invasive load-altering implant (Atlas System) whose young age (26 years), disease status (tibiofemoral kissing lesions), and neutral mechanical limb alignment eliminated all traditional surgical treatment options such as high tibial osteotomy or arthroplasty. At 6 months after surgery, our patient demonstrated positive outcomes improvement in pain, function, and quality of life and had returned to high-impact athletic activity without symptoms. These initial results are promising, and longer follow-up data on the treatment will be necessary. Konrad Slynarski and Lukasz Lipinski Copyright © 2017 Konrad Slynarski and Lukasz Lipinski. 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. 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. 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. 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.