Case Reports in Orthopedics The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma Developed in a Patient with Progressive Muscular Dystrophy: A Case Report and Review of the Literature Mon, 29 May 2017 08:25:46 +0000 Background. Atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDLS) is an intermediate or locally aggressive form of adipocytic soft tissue sarcoma. Muscular dystrophy (MD) is characterized by progressive muscle atrophy and its replacement by adipose and fibrous tissue. Recently, some authors have reported that MD genes are related to neoplastic formation, but there have been no detailed clinical reports of ALT associated with MD. Case Presentation. A 73-year-old woman with a diagnosis of limb-girdle MD visited our department for recurrence of a huge tumor in her left thigh. She had undergone resection of a lipoma at the same site more than 20 years earlier. Imaging studies revealed a lipomatous tumor in her left thigh. We performed marginal resection including the adjacent muscles. Histological diagnosis was atypical lipomatous tumor. The postoperative course was uneventful, with no recurrence at 36 months of follow-up. Conclusion. We encountered a huge atypical tumor in a patient with MD. This is the first detailed report to describe an association between ALT and MD. We hypothesize that degenerative changes occurring in adipose tissue during muscle atrophy can cause lipomatous neoplasms and moreover that the mutation of MD-related genes may lead to the proliferation of tumor cells or to malignancy. Ryo Miyagi, Toshihiko Nishisho, Shinjiro Takata, Yoshimitsu Shimatani, Shunichi Toki, and Koichi Sairyo Copyright © 2017 Ryo Miyagi et al. All rights reserved. A Simple Bone Cyst in Cervical Vertebrae of an Adolescent Patient Sun, 28 May 2017 09:10:32 +0000 Introduction. Spinal simple bone cysts, also known as solitary cysts, are extremely unusual benign primary bone tumors with few cases reported in the literature. Case Presentation. Incidental Magnetic Resonance Imaging (MRI) finding of a C2 Simple bone cyst in a 13-year-old female patient is reported. Complementary studies suggested the benign nature of the lesion. Patient underwent cervical curettage followed by tumor excision. A lateral submandibular approach to the upper cervical spine was used and careful bone resection was possible with a radiofrequency assisted burr and no instrumentation or fixation was required. The stability of the defect was ensured by filling it with bone allograft and by prescribing a postsurgical plastic cervical collar to maintain neck immobilization. Histological examination supported the diagnosis of simple bone cyst. At 6–12-month follow-up the patient presented no recurrence or symptomatology. Conclusions. Solitary bone cysts are infrequent entities in the cervical vertebrae and preservation of spine stability without instrumentation to avoid neurological complications is often challenging. In this case, the proximity of the cyst to the right vertebral artery and the risk of injury were high; however the surgical approach used was successful and no recurrence or instability was evidenced on postoperative MRI. Adriana Bruges Boude, Lina González Vásquez, Fernando Alvarado-Gomez, María Constanza Bedoya, Andrés Rodríguez-Múnera, and Luis Carlos Morales-Saenz Copyright © 2017 Adriana Bruges Boude et al. All rights reserved. A Case of Trapezium Avascular Necrosis Treated Conservatively Thu, 25 May 2017 07:31:58 +0000 Introduction. Avascular necrosis (AVN) of the bones of the wrist most commonly involves the lunate followed by the proximal pole of the scaphoid and the capitate. Trapezium avascular necrosis is extremely rare with only two cases reported in the literature, both of which were treated surgically. In this article, we report a unique case of trapezium avascular necrosis treated conservatively. Case Presentation. A 38-year-old man complaining of a 4-month history of mild pain on the base of his right thumb. MRI scan was performed. The clinical presentation and the imaging findings indicated avascular osteonecrosis of the trapezium. The patient was treated with immobilization of the wrist joint for a period of six weeks. Three months later, the patient was free of symptoms and the MRI scan revealed a normal trapezium. Conclusion. AVN of trapezium is extremely rare. Our case shows that immobilization of an early stage avascular necrosis of the trapezium might be a treatment option. Evangelos Petsatodis, Konstantinos Ditsios, Panagiotis Konstantinou, Iosafat Pinto, Lazaros Kostretzis, Ioannis Theodoroudis, and Mayia Pilavaki Copyright © 2017 Evangelos Petsatodis et al. All rights reserved. Diffuse B Cell Non-Hodgkin’s Lymphoma Presenting Atypically as Periprosthetic Joint Infection in a Total Hip Replacement Wed, 24 May 2017 07:42:20 +0000 The occurrence of extranodal primary B cell non-Hodgkin’s lymphoma is rare. Total hip replacement is one of the most common orthopaedic procedures performed. There has been an increased incidence of primary lymphomas involving periprosthetic sites. Chronic inflammation due to metal debris arising from the prosthetic implants has been evidenced as one of the causes for the development of soft tissue lymphomas albeit rarely. We describe a case report of a 77-year-old patient who had underwent a cemented total hip replacement in the past who further developed large B cell primary non-Hodgkin’s lymphoma. She presented initially with signs and symptoms highly suggestive of underlying periprosthetic infection. The radiological imaging was also indicative of periprosthetic infection. The diagnosis was eventually confirmed after an open biopsy. This case underlines the importance of considering and including soft tissue malignancy in the differential diagnosis of suspected chronic periprosthetic infection. Aysha Rajeev, Angela Ralte, Nameer Choudhry, Faizan Jabbar, and Paul Banaszkiewicz Copyright © 2017 Aysha Rajeev et al. All rights reserved. Suprascapular Nerve Entrapment Caused by Protrusion of an Intraosseous Ganglion of the Glenoid into the Spinoglenoid Notch: A Rare Cause of Posterior Shoulder Pain Tue, 23 May 2017 10:04:19 +0000 We describe a case of suprascapular nerve entrapment caused by protrusion of an intraosseous ganglion of the glenoid into the spinoglenoid notch. A 47-year-old man with left shoulder pain developed an intraosseous cyst in the left glenoid, which came into contact with the suprascapular nerve. The area at which the patient experienced spontaneous shoulder pain was innervated by the suprascapular nerve, and 1% xylocaine injection into the spinoglenoid notch under ultrasonographic guidance relieved the pain. Therefore, we concluded that the protrusion of an intraosseous cyst of the glenoid into the spinoglenoid notch was a cause of the pain, and performed curettage. Consequently, the shoulder pain was resolved promptly without suprascapular nerve complications, and the cyst was histologically diagnosed as an intraosseous ganglion. This case demonstrated that the intraosseous ganglion of the glenoid was a benign lesion but could be a cause of suprascapular nerve entrapment syndrome. Curettage is a useful treatment option for a ganglion inside bone and very close to the suprascapular nerve. Daichi Ishimaru, Akihito Nagano, Nobuo Terabayashi, Yutaka Nishimoto, and Haruhiko Akiyama Copyright © 2017 Daichi Ishimaru et al. All rights reserved. Proximal Tibial Epiphysis Fracture in a 13-Year-Old Male Athlete Sun, 21 May 2017 00:00:00 +0000 Fractures of the proximal epiphysis of the tibia are rare, representing 0.5 to 3.0% of all epiphyseal injuries. These injuries can damage the popliteal vessels and their bifurcation, affecting the blood supply of the lower limb, as well as the nerves below the knee. Epiphyseal growth arrest is also a potential complication, leading to various angular deformities. We present a case of a 13-year-old male athlete with a posteriorly displaced Salter-Harris type II fracture of the proximal epiphysis of the left tibia who was treated conservatively with closed reduction and cast immobilization. Ioannis M. Stavrakakis, Pavlos E. Katsoulis, and Maria S. Katsafarou Copyright © 2017 Ioannis M. Stavrakakis et al. All rights reserved. Ipsilateral Rupture of Quadriceps Tendon with Distal Tibia Fracture: A Case Report and Review of the Literature Sun, 21 May 2017 00:00:00 +0000 Traumatic rupture of the quadriceps tendon by itself is not an uncommon clinical condition. However, its association with concurrent ipsilateral closed distal tibia oblique fracture is exceedingly rare with only one previously reported case in English literature. The dual diagnosis of this atypical combination of injury may be masked by pain and immobilization of the more obvious fracture and may be missed, unless the treating physician maintains a high index of suspicion. Suprapatellar knee pain with or without a palpable gap in the quadriceps tendon and inability to straight leg raise in the setting of a distal tibia fracture should raise concern, but if initial treatment employs a long-leg splint the knee symptoms may be muted. In this report, we describe this unusual combination of injury in a 67-year-old male patient who sustained a trivial twisting injury to the leg. The aim of this report is to raise awareness and emphasize the importance of thorough and repeated clinical examinations in the presence of distracting injuries. Despite the complexity of the problem, standard techniques for quadriceps tendon repair using transpatellar bone tunnels following locked intramedullary rodding of the tibia fracture may lead to optimal outcomes. Samik Banerjee, Timothy P. Dooley, and James R. Parkinson Copyright © 2017 Samik Banerjee et al. All rights reserved. Use of Nonvascularized Autologous Fibular Strut Graft in the Treatment of Major Bone Defect after Periprosthetic Knee Fracture Thu, 18 May 2017 09:44:17 +0000 We present the case of a patient who suffered a comminuted supracondylar periprosthetic femur fracture. The patient was an 86-year-old lady who suffered a minor fall at home and presented at our hospital with a right comminuted distal femur fracture around a total knee arthroplasty. The patient was submitted to a cruciate-sacrificing total knee replacement 6 years before at the same institution. Despite severe metaphyseal fragmentation and short distal fragment, the prosthesis was stable; thus, open fracture reduction and stabilization with internal fixation were performed. The surgical technique included the use of a nonvascularized autologous fibular strut graft as an augmentation technique in conjunction with double plating fixation. Clinically, patient presented a painless aligned knee 12 months after femur fixation, although she was not able to return to an independent level of activity. No pain involving the donor graft site was reported at the time of the most recent follow-up examination. This case study demonstrates the use of free nonvascularized autogenous fibular strut bone graft as an option to bridge major bone defects. This proved to be a relatively simple, not expensive procedure that can be done percutaneously and does not need high-quality training. Vincenzo Giordano, Bruno Parilha Coutinho, Mateus Kenji Miyahira, Felipe Serrão Mendes de Souza, and Ney Pecegueiro do Amaral Copyright © 2017 Vincenzo Giordano et al. All rights reserved. Pseudoaneurysm of the Anterior Tibial Artery following Ankle Arthroscopy in a Soccer Player Thu, 18 May 2017 00:00:00 +0000 Ankle arthroscopy carries a lower risk of vascular complications when standard anterolateral and anteromedial portals are used. However, the thickness of the fat pad at the anterior ankle affords little protection for the thin-walled anterior tibial artery, rendering it susceptible to indirect damage during procedures performed on the anterior ankle joint. To our knowledge, only 11 cases of pseudoaneurysm involving the anterior tibial artery after ankle arthroscopy have been described in the literature. Here we reported a rare case of a 19-year-old soccer player who presented with pseudoaneurysm of the anterior tibial artery following ankle arthroscopy using an ankle distraction method and underwent anastomosis for the anterior tibial artery injury. Excessive distraction of the ankle puts the neurovascular structures at greater risk for iatrogenic injury of the anterior tibial artery during ankle arthroscopy. Surgeons should look carefully for postoperative ankle swelling and pain after ankle arthroscopy. Ichiro Tonogai, Tetsuya Matsuura, Toshiyuki Iwame, Keizo Wada, Tomoya Takasago, Tomohiro Goto, Daisuke Hamada, Yohei Kawatani, Eiki Fujimoto, Tetsuya Kitagawa, Shyoichiro Takao, Seiji Iwamoto, Moriaki Yamanaka, Masafumi Harada, and Koichi Sairyo Copyright © 2017 Ichiro Tonogai et al. All rights reserved. A Case of Fracture-Redislocation of the Hip Caused by a Depressed Fracture of the Femoral Head Similar to a Hill-Sachs Lesion Thu, 18 May 2017 00:00:00 +0000 The present case shows a case of fracture-redislocation of the hip caused by a depressed fracture of the femoral head similar to a Hill-Sachs lesion. A 59-year-old man fell from a roof and his left hip joint was dislocated posteriorly. He was admitted to a nearby hospital, and he was referred to our hospital more than 24 hours after injury. Computed tomography (CT) suggested a bone chip from the posterior wall of the acetabulum roof and a depressed femoral head that cut into the posterior margin of the acetabulum roof. Immediate manual repositioning was performed under general anesthesia on the same day. He left our hospital to go home on day 26 after repositioning, but his left hip joint was dislocated again when he went down the stairs. It was thought that this patient’s redislocation occurred due to a femoral head depressed fracture involving the same mechanism as the Hill-Sachs injury seen with dislocation of the shoulder. The remplissage method for the Hill-Sachs injury is difficult for the femoral head. Therefore, total hip replacement was performed, and the patient’s postoperative course was good. We conclude that total hip arthroplasty should be considered as one of the best treatment methods for such cases. Yoshihiko Okudera, Hiroaki Kijima, Shin Yamada, Natsuo Konishi, Hitoshi Kubota, Hiroshi Tazawa, Takayuki Tani, Norio Suzuki, Keiji Kamo, Ken Sasaki, Tetsuya Kawano, Yosuke Iwamoto, Naohisa Miyakoshi, and Yoichi Shimada Copyright © 2017 Yoshihiko Okudera et al. All rights reserved. Elastic Intramedullary Nailing of a Medial Clavicle Fracture in a Pediatric Patient Tue, 16 May 2017 07:54:27 +0000 Introduction. Injuries to the medial clavicle in pediatric patients typically involve the physis and/or sternoclavicular joint. Clavicle fractures are one of the most common injuries in children, but ones at its medial end are rare. Most medial clavicle fractures are treated nonoperatively, but surgery is indicated in some cases. This original case report is unique in describing the use of an elastic intramedullary nail for fixation of a completely displaced medial clavicle fracture in a pediatric patient. Case Presentation. A pediatric patient sustained a completely displaced fracture of the medial clavicle. The fracture was lateral to the medial physis of the clavicle and did not involve the sternoclavicular joint. Internal fixation was achieved in an anatomic position with an elastic intramedullary nail. The postoperative course was unremarkable and resulted in complete healing of the fracture in an anatomic position. The patient returned to full activities without any pain or dysfunction. Conclusion. The use of elastic intramedullary nails is a viable option for internal fixation of displaced medial clavicle fractures. Knowledge of the surgical anatomy, potential implant complications, and rehabilitation principles is essential to a successful outcome. Michael J. Stark and Michael J. DeFranco Copyright © 2017 Michael J. Stark and Michael J. DeFranco. All rights reserved. Fracture of the Tibial Baseplate 16 Years after Miller-Galante II Total Knee Arthroplasty Tue, 16 May 2017 00:00:00 +0000 We report a rare case of tibial baseplate fracture of Miller-Galante II (MG II) prosthesis. We examine the factors that may cause such late fracture and review the literature on radiographic analysis and retrieval studies. A 76-year-old woman, who had undergone bilateral MG II total knee arthroplasty due to rheumatoid arthritis 16 years earlier, presented to our department with a 3-month history of left knee pain. Plain radiographs revealed severe distortion of the medial tibial component. During revision knee arthroplasty, we observed severe metallosis in the knee joint, polyethylene insert deformation, and posteromedial coronal baseplate fracture. After removal of the fractured tray, a bone deficit due to osteolysis was noted. The revision prosthesis (LCCK, Zimmer-Biomet) was implanted uneventfully. Four months after revision surgery, the patient was ambulating and had no complications. The implants on the right side had survived without complications for 17 years. We speculate that the primary causative factor of the fatigue fracture of the base plate due to loss of bony support most likely secondary to osteolysis was varus malalignment at primary implantation. This case highlights the importance of paying close attention to the correct alignment of each component at primary implantation. Kazuaki Mineta, Masahiko Okada, Soshi Matsumoto, Daisuke Hamada, Tomohiro Goto, and Koichi Sairyo Copyright © 2017 Kazuaki Mineta et al. All rights reserved. Fibroma of Tendon Sheath Presenting Limited Flexion of the Fingers Tue, 16 May 2017 00:00:00 +0000 A 35-year-old Japanese man presented with a 1-month history of limited flexion and radiating pain in the left middle and ring fingers. A physical examination revealed a hard nodular mass in his left palm. Magnetic resonance imaging showed a 2 × 1.5 × 1 cm mass of low intensity on T1-weighted images and high intensity on T2-weighted images and gadolinium enhancement. The tumor was marginally resected, adhering to the flexor digitorum profundus of both the third and fourth fingers. The histological diagnosis was fibroma of tendon sheath. After the surgery, the range of motion and hand function were improved. No recurrence has been observed. Fibroma of tendon sheath usually arises on the fingers and hands with strong attachment to the tendon or tendon sheath. The tumor in the present case probably limited the range of flexion of the fingers by obstruction of the transverse carpal ligament. Kazuhiro Maeda, Nokitaka Setsu, Yoshiharu Kato, Akira Kawai, and Eisuke Kobayashi Copyright © 2017 Kazuhiro Maeda et al. All rights reserved. Safe and Effective Reduction Technique for Intertrochanteric Fracture with Ipsilateral Below-Knee Amputated Limb Sun, 14 May 2017 07:04:25 +0000 The positioning of the patient on the fracture table is critical for the successful reduction and operative fixation of intertrochanteric hip fractures. However, this manipulation is challenging with patients who have undergone amputations of their legs. A 97-year-old man presented to the emergency department with symptom of right hip pain following a mechanical fall. He had a below-knee amputation on his right leg following a traffic accident as a 19-year-old and had a below-knee patellar tendon bearing prosthesis fitted to his lower limb for mobility. Radiographs of his pelvis revealed a displaced intertrochanteric fracture of the right side femur. The patient was positioned on a fracture table, as in the standard procedure. The method of inverting the traction boot to accommodate the flexed knee and stump described by Al-Harthy could be used to provide traction and rotational control. Internal fixation was performed using a short femoral nail. Postoperatively, the patient could walk with full weight bearing using a prosthesis on his affected limb. The method of inverting the traction boot to accommodate the flexed knee and stump can be used safely and effectively to achieve and maintain fracture reduction during fixation of intertrochanteric fractures for patients with a below-knee amputated limb. Hironori Ochi, Tomonori Baba, Takahiro Hamanaka, Yu Ozaki, Taiji Watari, Yasuhiro Homma, Mikio Matsumoto, and Kazuo Kaneko Copyright © 2017 Hironori Ochi et al. All rights reserved. Review and Long-Term Outcomes of Cruciate Ligament Reconstruction versus Conservative Treatment in Siblings with Congenital Anterior Cruciate Ligament Aplasia Sun, 14 May 2017 00:00:00 +0000 There is no consensus on the best treatment for anterior cruciate ligament hypoplasia or aplasia. To our knowledge, no comparative study between operative and conservative treatment of this condition has ever been performed. Conservative treatment is a viable alternative to surgery for ACL aplasia. Two siblings were examined at our outpatient clinic. The male patient underwent bilateral ACL reconstruction, while his sister was treated conservatively. Our results show a worse long-term outcome for the operative patient. At her last follow-up, the female patient treated conservatively showed subjective improvement in stability and gait. A review of the literature shows inconsistent outcomes after reconstruction in contrast to reports with cruciate ligament agenesis that did not undergo reconstruction with acceptable to good outcomes. Cruciate reconstruction should be reserved for cases of impaired articular instability, objectively manifest in the frequency of giving-way episodes. Treatment depends on the patient’s condition and expectations. Surgery should therefore only be suggested after proper patient counseling. Diego Davanzo, Paolo Fornaciari, Geoffroy Barbier, Mauro Maniglio, and Daniel Petek Copyright © 2017 Diego Davanzo et al. All rights reserved. Denosumab Therapy for Giant Cell Tumor of Bone Pulmonary Metastasis Wed, 10 May 2017 06:24:45 +0000 Case. A 68-year-old female was diagnosed with giant cell tumor of bone (GCTB) metastatic to her lungs. The patient was treated with IV denosumab for the course of 4.5 years for these metastases. The metastatic tumor burden decreased significantly after only 3 months of therapy. The size of the metastases has been stable for over 4 years. Conclusion. Denosumab therapy has promise in the treatment of GCTB, including pulmonary metastasis. However, the long-term role of denosumab for pulmonary metastases is yet to be determined. Ryan Carlisle Egbert, Ryan Folsom, Jeff Bell, and Rajiv Rajani Copyright © 2017 Ryan Carlisle Egbert et al. All rights reserved. Intra-Articular Osteoid Osteoma as a Cause of Anteromedial Knee Pain Tue, 02 May 2017 08:58:14 +0000 A 32-year-old male patient presented to our clinic with chronic left knee pain that was ongoing for about 1.5 years. The patient visited several times our clinic and the other clinics; conservative treatment (including rest, knee brace, and ice application with NSAIDs) was recommended by various different doctors. The anamnesis, physical examination, and plain radiography were nonspecific. Early MRI findings mislead us to believe it is bone marrow edema. One and half years with noneffective treatment, the knee pain persisted. At the latest visit intra-articular osteoid osteoma was suspected and the knee MRI with CT was employed. Even though the diagnosis of intra-articular osteoid osteoma often presents a challenge for the surgeons, with a present awareness of intra-articular osteoid osteomas which lack the characteristic sclerotic lesions and nidus on plain X-rays and the aid of multislice CT, a correct diagnosis which warrants proper treatment can be achieved. The possibility of osteoid osteomas, especially in young adults with persistent knee pain with unknown reasons that show normal plain radiographs results, must not be overlooked. The treatment method of these lesions should be customized depending on the location of the lesion, experience of the surgeon, and cost of method. Ergin Sagtas, Kemal Gokkus, and Ahmet Turan Aydin Copyright © 2017 Ergin Sagtas et al. All rights reserved. Retained Surgical Drains in Orthopedics: Two Case Reports and a Review of the Literature Wed, 19 Apr 2017 10:03:34 +0000 Though a relatively rare event, retained surgical drains are preventable and can lead to significant consequences. Two case reports from our institution are discussed as examples for the challenging management of this problem as well as an overview of techniques for the prevention and removal of retained drains based on the current literature. John S. Cox and Darin Friess Copyright © 2017 John S. Cox and Darin Friess. All rights reserved. Osteomyelitis of the Patella in a 10-Year-Old Girl: A Case Report and Review of the Literature Tue, 18 Apr 2017 00:00:00 +0000 The incidence of osteomyelitis constantly declines. While the disease most commonly affects the long bones, involvement of the patella is rarely seen. Due to this rarity and the variable clinical presentation, diagnosis is often delayed. The present case report describes a 10-year-old female patient with a delayed diagnosis of patella osteomyelitis. The diagnostic procedures and the treatment regimen are described. Additionally, a detailed literature review of the available publications reporting osteomyelitis of the patella in children is presented. Matthias Sperl, Michael Novak, Daniela Sperl, Martin Svehlik, Georg Singer, and Tanja Kraus Copyright © 2017 Matthias Sperl et al. All rights reserved. Anterior Interosseous Nerve Neuropraxia Secondary to Shoulder Arthroscopy and Open Subpectoral Long Head Biceps Tenodesis Sun, 16 Apr 2017 08:34:16 +0000 Arthroscopic rotator cuff tendon repair is a common elective procedure performed by trained orthopaedic surgeons with a relatively low complication rate. Specifically, isolated neuropraxia of the anterior interosseous nerve (AIN) is a very rare complication of shoulder arthroscopy. An analysis of peer-reviewed published literature revealed only three articles reporting a total of seven cases that describe this specific complication following standard shoulder arthroscopic procedures. This article reports on three patients diagnosed with AIN neuropraxia following routine shoulder arthroscopy done by a single surgeon within a three-year period. All three patients also underwent open biceps tenodesis immediately following completion of the arthroscopic procedures. The exact causal mechanism of AIN neuropraxia following shoulder arthroscopy with biceps tenodesis is not known. This case report reviews possible mechanisms with emphasis on specific factors that make a traction injury the most likely etiology in these cases. We critically analyze our operating room setup and patient positioning practices in light of the existing biomechanical and cadaveric research to propose changes to our standard practices that may help to reduce the incidence of this specific postoperative complication in patients undergoing elective shoulder arthroscopy with biceps tenodesis. Jeremiah T. Steed, Kathlyn Drexler, Adam N. Wooldridge, and Matthew Ferguson Copyright © 2017 Jeremiah T. Steed et al. All rights reserved. Primary Meningococcal Type C Arthritis: A Case Report and Literature Review Mon, 10 Apr 2017 07:02:28 +0000 Acute septic arthritis is a common clinical problem in emergency departments. Primary meningococcal arthritis (PMA) is very rare and few cases are reported in literature. D. B. M. consulted the emergency department for knee pain and fever; analysis showed that the cause was a Neisseria meningitidis type C infection. He received a treatment consisting of 2 arthroscopies and 5 weeks of antibiotics. At five weeks he returned to work and at 2 months he resumed sports (jogging and soccer) without complaints. Primary arthritis of the knee caused by Neisseria meningitidis is very rare. It has a very good response to antibiotics and arthroscopy procedure. Short-term follow-up and functional results are often good or excellent. Maximiliano Barahona, Jaime Catalan, Yoshiro Sato, and Jaime Hinzpeter Copyright © 2017 Maximiliano Barahona et al. All rights reserved. A Combined Bony and Soft Tissue, Thoracic Chance Fracture: Late Displacement following Conservative Treatment Mon, 10 Apr 2017 06:42:33 +0000 We report the first case of a combined bony and soft tissue Chance fracture in the thoracic spine, with late presenting displacement following conservative management. Chance fractures are flexion-distraction injuries to the spine. They consist of disruption and longitudinal separation of the posterior elements of the vertebra, with the fracture extending through the pedicles and into the vertebral body. Both bony and soft tissue Chance fractures of the lumbar spine have been reported, as well as bony Chance fractures in the thoracic spine. This case suggests that this type of fracture is unstable and is an indication for operative management. It is also important to note that the displacement of the fracture occurred at more than eight weeks after injury, suggesting that instability may not present immediately. James Thomas Bourne, Alexander David Laing Baker, and Manoj Khatri Copyright © 2017 James Thomas Bourne et al. All rights reserved. Atraumatic Acromioclavicular Dislocation: A Case Report and Review of the Literature Wed, 05 Apr 2017 09:05:44 +0000 Acromioclavicular dislocation (AC dislocation) is a common injury of the shoulder. In contrast to a traumatic cause, nontraumatic dislocation is very rare. We report on a 17-year-old female that presented with voluntary recurrent dislocation of the right AC joint followed by recurrent pain without instability of the ipsilateral shoulder. Clinical examination showed crepitation as well as palpitation pain and dislocation of the AC joint. There were no symptoms of Marfan or Ehlers-Danlos syndrome as other joint examinations were also negative for hypermobility. Considering age as well as minor complaints, nonoperative treatment by postural therapy without taping was recommended. After one year, the patient experienced fewer symptoms and she was able to participate in daily activities. Nasrat Sadeghi, Pieter Stijn Haen, and Ron Onstenk Copyright © 2017 Nasrat Sadeghi et al. All rights reserved. Ischiospinal Dysostosis in a Child with Pierre-Robin Syndrome Mon, 03 Apr 2017 00:00:00 +0000 Ischiospinal Dysostosis (ISD) is a complex and very rare medical entity. It is associated with kyphoscoliosis, dysplasia or aplasia of the ischial rami, segmental anomalies of the bony vertebrae, and peculiar facial morphologies. In this case report, we present a child with Ischiospinal Dysostosis and Pierre-Robin Syndrome. This case report is unique as we followed the patient for 13 years in which he had multiple spinal procedures to treat his kyphoscoliosis. In this paper, we elucidated the number of case reports with documented follow-up regarding spinal cord injury or other complications of ISD and its management. Mahmoud Almasri, Waleed Kishta, Fahad H. Abduljabbar, Vincent Arlet, Neil Saran, and Jean Oullet Copyright © 2017 Mahmoud Almasri et al. All rights reserved. Surgical Fixation of Bilateral Simultaneous Avulsion Fractures of the Proximal Tibia in a 12-Year-Old with History of Conservatively Managed Unilateral Tibial Avulsion Fracture Mon, 03 Apr 2017 00:00:00 +0000 Fractures of the proximal tibial epiphysis are rare, representing less than 3% of all epiphyseal and 1% of all physeal injuries in adolescents. Bilateral injuries are extremely rare. The specific anatomical and histological features of the proximal tibial epiphysis make it vulnerable to a specific fracture pattern that occurs when the tensile force of the quadriceps is greater than the fibrocartilaginous tissue underlying the tibial tuberosity. We report the first case to our knowledge of a 12-year-old boy who sustained simultaneous bilateral tibial avulsion fractures on the background of a previous conservatively managed unilateral tibial tuberosity avulsion fracture. We report this case for its uniqueness and as an educational review of the anatomy, the mechanism of injury, and the development of classifying these fractures and discussion of the stages of the growing physis that determine the treatment approach. Christopher Newman, Dharsh Musiienko, and Samuel Law Copyright © 2017 Christopher Newman et al. All rights reserved. Mobile Bearing Total Knee Arthroplasty for Valgus Knee Osteoarthritis with Permanent Patellar Dislocation: A Case Report and Review of the Literature Wed, 29 Mar 2017 00:00:00 +0000 Permanent patellar dislocation with tibiofemoral joint osteoarthritis is a relatively rare condition. To treat this condition, total knee arthroplasty with proximal or distal realignment of the extensor mechanism has been reported. We report a challenging case of an 80-year-old woman diagnosed with permanent patellar dislocation with tibiofemoral joint osteoarthritis treated by a mobile bearing total knee arthroplasty utilizing navigation system. Lateral retinaculum release was performed to improve patellar tracking; other proximal or distal realignment of the extensor mechanism was not necessary. Postoperative radiographs show stable patellar tracking and recurrent patellar dislocation was not observed. This clinical case indicates that the implant’s precise alignment and rotation during total knee arthroplasty could settle anatomical abnormalities of permanent patellar dislocation and the mobile bearing insert could contribute to stabilizing patellar tracking. Kohei Kamada, Tomoyuki Matsumoto, Koji Takayama, Daisuke Araki, Shingo Hashimoto, Shinya Hayashi, Takehiko Matsushita, and Ryosuke Kuroda Copyright © 2017 Kohei Kamada et al. All rights reserved. Anterior Impingement Syndrome of the Ankle Caused by Osteoid Osteoma in the Talar Neck Treated with Arthroscopy and 3D C-Arm-Based Imaging Tue, 28 Mar 2017 08:22:59 +0000 Osteoid osteoma in periarticular lesions tends to have an unusual presentation that likely leads to a delayed or missed diagnosis compared with a typical osteoid osteoma in the metaphysis or diaphysis of the long bone. In cases that are unresponsive to conservative treatment, surgical interventions including en bloc resection, computed tomography-guided percutaneous treatment, and arthroscopic resection have been performed; however, these methods frequently result in inadequate tumor resection and recurrence. Here we present a case of a 16-year-old girl with osteoid osteoma in the talar neck presenting as anterior impingement syndrome due to marked synovitis in the ankle joint which was successfully treated without complications by arthroscopic synovectomy and tumor resection followed by intraoperative 3D C-arm-based imaging confirming complete tumor lesion removal. Her pain was relieved immediately after the surgery, and there was no recurrence at 12 months of follow-up. This is the first case report of the surgical treatment of the osteoid osteoma in the talar neck with the combination methods of arthroscopy and 3D C-arm-based imaging. Masachika Ikegami, Takumi Matsumoto, Song Ho Chang, Hiroshi Kobayashi, Yusuke Shinoda, and Sakae Tanaka Copyright © 2017 Masachika Ikegami et al. All rights reserved. Osteochondritis Dissecans of the Capitellum: A Case Report of Successful Arthroscopic Treatment Sun, 26 Mar 2017 07:11:55 +0000 Introduction. Osteochondritis dissecans (OCD) of the capitellum is a localized disorder of the subchondral bone, in a region with limited healing capacity. Although its aetiology is still unknown, it has been associated with repetitive microtrauma. The natural history of this disease involves the evolution for degenerative joint disease in approximately half of the patients, with early identification and treatment being critical to optimizing the outcome. Case Presentation. We present a rare case in our practice, illustrating a capitellar OCD in a fifteen-year-old White male without an identified cause of repetitive microtrauma. Conclusion. In this case prompt diagnosis and arthroscopic-assisted treatment led to a successful result. J. Ribeiras Cabral, R. Henriques, J. Arvela Matoso, S. Martins, and M. Sarmento Copyright © 2017 J. Ribeiras Cabral et al. All rights reserved. Aggressive Digital Papillary Adenocarcinoma of the Hand Presenting as a Felon Tue, 21 Mar 2017 07:39:33 +0000 Aggressive digital papillary adenocarcinoma is a rare eccrine sweat gland malignancy that is frequently misdiagnosed at initial presentation. Histologically, this tumor is similar in appearance to many adenocarcinomas and as such may be diagnosed as a metastatic lesion. We present the case of a patient with digital papillary adenocarcinoma, which was initially diagnosed as a felon. No consensus has been published regarding the treatment of this disease. A review of the diagnosis, pathology, treatment, and adjunctive treatments of aggressive digital papillary adenocarcinoma are also included. Justin R. Bryant, Preston Gardner, Matthew Yousif, John C. Pui, Raymond T. Hajjar, and E. Aron Haass Copyright © 2017 Justin R. Bryant et al. All rights reserved. Arthroscopy-Assisted Reduction and Fixation of a Transversal Glenoid Fracture: About a Case Sun, 12 Mar 2017 00:00:00 +0000 An articular glenoid fracture is an uncommon injury. Usually significantly displaced intra-articular glenoid fractures are treated with open reduction surgery. Conventional open surgery techniques involve high morbidity. Here we describe an arthroscopy-assisted reduction and fixation method of an Ideberg type III glenoid fracture. This method provides good articular reduction without extensive exposure or soft tissue dissection and without nerve and/or vascular lesion. David Zbili, Eric Sali, Julien Serane, Edouard Lefèvre, and Lior Amsallem Copyright © 2017 David Zbili et al. All rights reserved.