Case Reports in Orthopedics The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Triplane Fracture of the Proximal Tibia: A Case Report and Literature Review Mon, 18 Sep 2017 00:00:00 +0000 Background. The triplane fracture, a unique transitional physeal injury, is classically described in the distal tibia. A small number of additional anatomic locations are documented in the orthopaedic literature. Methods. Available literature surrounding triplane fractures was reviewed. We describe a rare case of a proximal tibial triplane fracture in a thirteen-year-old girl, suffered during a skiing accident. Results. Using arthroscopically assisted percutaneous reduction techniques an anatomic reduction was achieved. Conclusion. We outline the surgical and postoperative techniques for management of this unique injury. Jason Strelzow, Alexander Aarvold, and Christopher W. Reilly Copyright © 2017 Jason Strelzow et al. All rights reserved. A Case of C5 Vertebral Chordoma in a 73-Year-Old Patient with More Than 8 Years of Follow-Up after Total Piecemeal Spondylectomy Tue, 12 Sep 2017 00:00:00 +0000 Chordoma arising from the cervical spine is rare and the traditional long-term prognosis is typically poor. Total en bloc spondylectomy with a wide margin is generally accepted to be the most appropriate management for thoracic and lumbar malignant tumors. However, this method is still challenging for the cervical spine because of the proximity of the tumor to the vertebral arteries and neural elements. Here, we report a 73-year-old man with a C5 vertebral chordoma treated with total piecemeal spondylectomy. Histological examination revealed pathognomonic physaliphorous cells with mucus-filled cytoplasm in the tumor, and the ratio of Ki-67-positive cells within the tumor was high (19.0%), showing active proliferation rate. Local recurrences were found at 9 months, 4 years and 2 months, and 6 years after the initial surgery. All the recurrences were encapsulated and isolated and treated with an additional en bloc resection successfully at each stage. Eight years after the initial total piecemeal spondylectomy, the patient maintained his intact neurological status without local recurrence or metastasis. The prognosis of cervical chordoma depends on the patient’s age, surgical procedures, and histological features. In this report, we present that piecemeal spondylectomy is an alternative management for aged patients with cervical chordoma, even for those with high MIB-1 index. Keigo Tanaka, Harutoshi Sakakima, Kazutoshi Hida, Kanako Hatanaka, and Kosei Ijiri Copyright © 2017 Keigo Tanaka et al. All rights reserved. Successful Treatment of a 15-Year-Old Nonunion of a Midshaft Clavicle Fracture Causing Brachial Plexus Compression Sun, 10 Sep 2017 00:00:00 +0000 A 49-year-old man with a 15-year-old nonunion of a midshaft clavicle fracture suffered from progressive tingling in his entire arm and fingers for two years, due to irritation of the brachial plexus in the costoclavicular space, especially upon elevation of the arm. After open reduction and internal plate fixation, all symptoms were resolved and complete consolidation of the fracture was achieved at one-year follow-up. This case demonstrates two things: brachial plexus compression can occur even many years after a nonunion of a clavicle fracture and union can be still achieved, even in a longstanding nonunion. Annemarijn Teunis, Rianne M. H. A. Huis In ’t Veld, Vincent E. J. A. de Windt, Sjoerd van Raak, and Anne J. H. Vochteloo Copyright © 2017 Annemarijn Teunis et al. All rights reserved. Ligament Augmentation and Reconstruction System Failures in Repair of Grade V Acromioclavicular Joint Dislocation Wed, 06 Sep 2017 07:20:23 +0000 The Ligament Augmentation and Reconstruction System® (LARS®) represents a popular synthetic anatomical reduction method for acromioclavicular joint dislocation by means of coracoclavicular ligament reconstruction. To our knowledge, no early failure has been documented in the literature. We present two unusual cases of LARS failure, one at four months after implant and the other at three weeks, without obvious causes, requiring re-do reconstruction, and discuss potential contributory factors. Martin K.-H. Li and David Woods Copyright © 2017 Martin K.-H. Li and David Woods. All rights reserved. Reverse Fosbury Flop Tear of the Rotator Cuff Tue, 05 Sep 2017 09:45:20 +0000 Introduction. “Fosbury flop” tear is an avulsion of the posterosuperior rotator cuff from the bone with reversal healing on its medial bursal-side. This case report describes a unique variant of Fosbury flop tear with a lesion of the musculotendinous junction that healed, for its tendon part, on the anterior humerus and coracoid process. Case Presentation. A 62-year-old man developed a posttraumatic painful shoulder with active loss of range of motion. Magnetic resonance arthrography demonstrated a lesion of the musculotendinous junction of the supraspinatus with healing of the tendon on the above-mentioned structures (reverse Fosbury flop). During arthroscopic evaluation, tendon repair was not possible and a debridement to avoid subacromial and anterior impingement associated with a tenotomy of the long head of the biceps were carried out. One year postoperatively, the patient had complete range of motion and was satisfied with the clinical results. Discussion and Conclusion. Different Fosbury flop tears exist. Radiologists and orthopedic surgeons should be aware of these tear patterns as failure to recognize them may lead to inadequate treatment. Jérôme Tirefort, Gregory Cunningham, and Alexandre Lädermann Copyright © 2017 Jérôme Tirefort et al. All rights reserved. Volar Distal Radioulnar Joint Dislocation Associated with Acute Median Nerve Neuropathy and a Distal Radius Fracture Wed, 30 Aug 2017 09:15:57 +0000 Volar distal radioulnar (DRUJ) dislocations are uncommon and can easily be missed. We present a rare case of an irreducible volar DRUJ dislocation associated with a distal radius fracture and acute median nerve neuropathy at the wrist. An attempt to reduce the DRUJ dislocation in the emergency department had failed. The patient was then taken to the operating room requiring a carpal tunnel release, as well as an open reduction and internal fixation of the distal radius fracture and repair of the volar distal radioulnar ligament. We also review some of the volar DRUJ case reports in the literature. Naser Alnusif, Sultan Aldebeyan, and Rudolf Reindl Copyright © 2017 Naser Alnusif et al. All rights reserved. Reverse Total Shoulder Arthroplasty as Treatment for Rotator Cuff-Tear Arthropathy and Shoulder Dislocations in an Elderly Male with Parkinson’s Disease Tue, 29 Aug 2017 07:47:28 +0000 We report the case of a 70-year-old male with Parkinson’s disease (PD) and recurrent traumatic left shoulder dislocations. This case is rare because (1) he had a massive irreparable rotator cuff tear and end-stage arthritis (i.e., rotator cuff-tear arthropathy) of the same shoulder and (2) his shoulder was ultimately reconstructed with a reverse total shoulder arthroplasty (RTSA). His first dislocation occurred after a fall. Recurrent shoulder dislocations occurred despite successful closed reduction and physical therapy. Initial surgical treatment included an open capsular-labral reconstruction; RTSA was not an ideal option because of the presumed risk of failure from PD-related dyskinesias. However, the capsular-labral reconstruction failed after he lost balance and stumbled but did not fall. A RTSA was then done which restored the patient’s shoulder stability and greatly improved his pain. At final follow-up two years later, he reported pain relief and improved function. This was partially attributed to the fact that he had moved to an assisted living center. He also began using an electric wheelchair one year after the RTSA. We report this case because of the unusual set of conditions and circumstances, namely, the implantation of a RTSA in a patient with PD and shoulder instability. John G. Skedros, James S. Smith, Tanner D. Langston, and Micheal G. Adondakis Copyright © 2017 John G. Skedros et al. All rights reserved. Reverse Segond Fracture Associated with Anteromedial Tibial Rim and Tibial Attachment of Anterior Cruciate Ligament Avulsion Fractures Tue, 29 Aug 2017 00:00:00 +0000 Reverse Segond fracture is an uncommon avulsion fracture of the tibial attachment of the deep portion of the medial collateral ligament of the knee. We report a reverse Segond fracture associated with anterior cruciate ligament tibial avulsion fracture and anteromedial tibial rim fracture. Unlike previous reports, the combination of reverse Segond fracture, anteromedial tibial rim fracture, and anterior cruciate ligament avulsion fracture was not associated with posterior cruciate ligament injury, posterolateral corner injury, or tibial plateau fracture. This new combination of injuries provides better understanding of the mechanisms of ligamentous injuries of the knee and highlights the importance of meticulous assessment of these injuries for accurate diagnosis and subsequent management. Yehia H. Bedeir Copyright © 2017 Yehia H. Bedeir. All rights reserved. Fatal Cobalt Toxicity after a Non-Metal-on-Metal Total Hip Arthroplasty Sun, 27 Aug 2017 00:00:00 +0000 This case illustrates the potential for systemic cobalt toxicity in non-metal-on-metal bearings and its potentially devastating consequences. We present a 71-year-old male with grinding sensations in his right hip following ceramic-on-ceramic total hip arthroplasty (THA). After diagnosing a fractured ceramic liner, the hip prosthesis was revised into a metal-on-polyethylene bearing. At one year postoperatively, X-rays and MARS-MRI showed a fixed reversed hybrid THA, with periarticular densities, flattening of the femoral head component, and a pattern of periarticular metal wear debris and pseudotumor formation. Before revision could take place, the patient was admitted with the clinical picture of systemic cobalt toxicity, supported by excessively high serum cobalt and chromium levels, and ultimately died. At autopsy dilated cardiomyopathy as cause of death was hypothesized. A third body wear reaction between ceramic remnants and the metal femoral head very likely led to excessive metal wear, which contributed systemic cobalt toxicity leading to neurotoxicity and heart failure. This case emphasizes that fractured ceramic-on-ceramic bearings should be revised to ceramic-on-ceramic or ceramic-on-polyethylene bearings, but not to metal-on-polyethylene bearings. We aim to increase awareness among orthopedic surgeons for clinical clues for systemic cobalt intoxication, even when there is no metal-on-metal bearing surface. Rinne M. Peters, Pax Willemse, Paul C. Rijk, Mels Hoogendoorn, and Wierd P. Zijlstra Copyright © 2017 Rinne M. Peters et al. All rights reserved. Chronic Osteomyelitis of the Distal Femur Treated with Resection and Delayed Endoprosthetic Reconstruction: A Report of Three Cases Tue, 15 Aug 2017 00:00:00 +0000 Chronic osteomyelitis involving the distal femur often results in amputation or arthrodesis. This article presents three cases of chronic osteomyelitis treated with a staged approach culminating in endoprosthetic reconstruction. Stage one involved resection of infected bone and placement of an intramedullary nail spanning the bony defect between proximal femur and tibia, with antibiotic cement packed around the nail. Patients were then placed on long-term IV +/− oral antibiotics to clear the infection. A “cooldown” period was then used between stages where patients were off antibiotics and inflammatory markers were monitored for signs of remaining infection. Stage two then involved reconstruction of the distal femur and knee with an endoprosthesis. In the appropriate patient, this treatment strategy offers another option in this challenging population. Sean Ryan, William Eward, Brian Brigman, and Robert Zura Copyright © 2017 Sean Ryan et al. All rights reserved. Acute Traumatic Patellar Tendon Rupture at the Tibial Tuberosity Attachment without Avulsion Fracture Thu, 10 Aug 2017 09:34:18 +0000 Patellar tendon rupture in children is especially rare. The fact that the area of traumatic rupture has wide variations makes surgical treatment difficult. We present an 11-year-old boy with acute traumatic patellar tendon rupture at the tibial tuberosity attachment without avulsion fracture. Primary end-to-end repair and reinforcement using 1.5 mm stainless steel wires as a surgical strategy were undertaken. Early range of motion began with a functional knee brace and the reinforced stainless wire was removed 3 months after surgery. Knee function at the final follow-up was satisfactory. We suggest that this strategy may provide a useful option for surgical treatment. Shuichi Miyamoto, Makoto Otsuka, Fumio Hasue, Takayuki Fujiyoshi, Koushirou Kamiya, Hitoshi Kiuchi, Ken Ohara, Atsushi Yunde, Yasunori Toki, Tadashi Tanaka, Junichi Nakamura, and Seiji Ohtori Copyright © 2017 Shuichi Miyamoto et al. All rights reserved. The Training Effect of Early Intervention with a Hybrid Assistive Limb after Total Knee Arthroplasty Thu, 10 Aug 2017 00:00:00 +0000 After total knee arthroplasty (TKA), it is important for patients to show early improvements in knee joint function and walking to regain independence in performing the activities of daily life. We conducted for 4 weeks an intervention one week after TKA using a hybrid assistive limb (HAL: unilateral leg type) as an exoskeleton robotic device to facilitate knee joint function and walking. The intervention improved the range of knee extension movement safely and without pain compared to preoperation. In addition, we found that training with the HAL improved walking ability, speed, and rate, as well as the time taken to perform the timed up and go (TUG) test compared to preoperation. The strength of the quadriceps muscle did not improve with training; however, the patient was able to induce a knee extensor moment during the initial stance phase, as measured by kinetics and kinematics, and these actions could be performed without pain. HAL training soon after TKA improved knee joint function in a 76-year-old patient who presented with OA of the knee. The improvements in knee extension lag and knee extensor moment allowed the patient to walk without pain and regain ADL in comparison with preoperation. Takashi Fukaya, Hirotaka Mutsuzaki, Kenichi Yoshikawa, Ayumu Sano, Masafumi Mizukami, and Masashi Yamazaki Copyright © 2017 Takashi Fukaya et al. All rights reserved. Recalcitrant Lateral Premalleolar Bursitis of the Ankle Associated with Lateral Ankle Instability Thu, 03 Aug 2017 00:00:00 +0000 Lateral premalleolar bursitis of the ankle is a rarely reported disorder in the English literature although it is not uncommon in Asian countries where people commonly sit on their feet. Here, we present the case of a 66-year-old woman with recalcitrant lateral premalleolar bursitis associated with lateral ankle instability which was successfully treated with surgical resection of the bursa and repair of the anterior talofibular ligament. Operative findings revealed a communication between the bursa and articular cavity of the ankle joint via the sheath of the extensor digitorum longus tendon, which was considered to act as a check valve leading to a large and recalcitrant bursitis. This report provides a novel concept about the etiology of recalcitrant lateral premalleolar bursitis of the ankle. Masashi Naito, Takumi Matsumoto, Song Ho Chang, Masachika Ikegami, Jun Hirose, and Sakae Tanaka Copyright © 2017 Masashi Naito et al. All rights reserved. Vertebral Artery Caught in the Fracture Gap after Traumatic C2/3 Spondylolisthesis Tue, 01 Aug 2017 06:34:05 +0000 Background Context. Patient with a C2 fracture and entrapment of the right vertebral artery in the fracture gap. Purpose. Presentation of a case with follow-up until end of treatment. Study Design. Case report. Methods. A 25-year-old woman was brought into our emergency room after falling while riding a horse. She complained of pain in the cervical spine. Clinical examinations showed local tenderness at the upper cervical spine and painful impairment of the mobility of the neck, with no signs of neurological impairment. Radiological diagnostics revealed a traumatic C2/3 spondylolisthesis. A computer tomography (CT) angiographic scan showed a dislocation of the right vertebral artery into the fracture gap without injury to the artery. Open reduction and osteosynthesis were considered of too high risk. Therefore, we conducted fracture treatment with closed reduction and halo fixation. After removal of the halo fixator, the patient was given a soft cervical collar and was advised to rest for additional 6 weeks before beginning gradual activity. Results. Conventional follow-up revealed osseous consolidation and a CT angiographic scan showed consistent blood flow to the artery. Conclusion. Halo fixation was a safe and effective therapy strategy in the case of vertebral artery entrapment after traumatic C2 spondylolisthesis. Ralf Henkelmann, Christoph Josten, Stefan Glasmacher, Christoph-Eckhard Heyde, and Ulrich Josef Albert Spiegl Copyright © 2017 Ralf Henkelmann et al. All rights reserved. Surgical Hip Dislocation for Management of Acetabular Osteochondroma in an Adult Tue, 25 Jul 2017 07:19:49 +0000 The purpose of this study is to report a rare case of acetabular osteochondroma with a unique clinical presentation occurring in an adult with normally developed hips. The distinctive size and location of the lesion required an open approach with surgical dislocation of the hip for complete resection. Alexandre H. Nehme, Georges F. Haidamous, Hicham G. Abdelnour, Jad N. BouMounsif, Joseph W. Wehbe, and Ramzi C. Moucharafieh Copyright © 2017 Alexandre H. Nehme et al. All rights reserved. The Dorsoulnar Artery Perforator Adipofascial Flap in the Treatment of Distal Radioulnar Synostosis Mon, 24 Jul 2017 09:37:56 +0000 Posttraumatic radioulnar synostosis (RUS) is a rare event following forearm fractures. Consequences are disabling for patients who suffer from functional limitation in forearm pronosupination. Distal RUS are even more rare and more difficult to treat because of high recurrence rates. The patient we describe in this paper came to our attention with a double distal RUS recurrence and a Darrach procedure already performed. We performed a radical excision of RUS and interposition with a vascularized dorsoulnar artery (DUA) adipofascial perforator flap. Four years after surgery, the patient shows the same complete range of motion in pronosupination, and MRI confirms that the flap is still in place with signs of vascularization. Simple synostosis excision has been proven ineffective in many cases. Interposition is recommended after excision, and biological material interposition seems to be more effective than foreign material. Surgeons are increasingly performing vascularized interposition, and the results are very encouraging. Alessia Pagnotta, Giorgio Antonietti, and Iakov Molayem Copyright © 2017 Alessia Pagnotta et al. All rights reserved. Combined Bone Transportation and Lengthening Techniques for the Treatment of Septic Nonunion of the Forearm Followed by Tendon Transfer Thu, 20 Jul 2017 07:03:29 +0000 Infected nonunion of a forearm fracture complicated by a considerable skin-muscle defect poses a great challenge to orthopaedic surgeons. The treatment strategy comprises eradication of the infection, ensuring bony union and soft tissue coverage along with functional restoration. We report a case of a 23-year-old man with an open Gustilo-Anderson IIIb fracture complicated by infected nonunion after internal fixation. After thorough surgical debridement, a considerable soft tissue defect, extensor muscle loss, and posterior interosseous nerve laceration had to be addressed. He was finally treated with bone transportation and bone lengthening followed by tendon transfers. Konstantinos Ditsios, Eirini Iosifidou, Lazaros Kostretzis, Panagiotis Konstantinou, Iosafat Pinto, Ioannis Theodoroudis, and Ippokratis Hatzokos Copyright © 2017 Konstantinos Ditsios et al. All rights reserved. Treatment of Knee Osteochondral Lesions Using a Novel Clot of Autologous Plasma Rich in Growth Factors Mixed with Healthy Hyaline Cartilage Chips and Intra-Articular Injection of PRGF Mon, 17 Jul 2017 00:00:00 +0000 Knee cartilage or osteochondral lesions are common and challenging injuries. To date, most symptomatic lesions warrant surgical treatment. We present two cases of patients with knee osteochondral defects treated with a one-step surgical procedure consisting of an autologous-based matrix composed of healthy hyaline cartilage chips, mixed plasma poor-rich in platelets clot, and plasma rich in growth factors (PRGF). Both patients returned to playing soccer at the preinjury activity level and demonstrated excellent defect filling in both magnetic resonance imaging and second-look arthroscopy (in one of them). The use of a clot of autologous plasma poor in platelets with healthy hyaline cartilage chips and intra-articular injection of plasma rich in platelets is an effective, easy, and cheap option to treat knee cartilage injuries in young and athletic patients. Ramón Cugat, Eduard Alentorn-Geli, Gilbert Steinbacher, Pedro Álvarez-Díaz, Xavier Cuscó, Roberto Seijas, David Barastegui, Jordi Navarro, Patricia Laiz, and Montserrat García-Balletbó Copyright © 2017 Ramón Cugat et al. All rights reserved. Subclinical Partial Attritional Rupture of the Flexor Digitorum Profundus as an Etiology of Atraumatic Trigger Finger Wed, 12 Jul 2017 09:52:23 +0000 Background. Trigger finger is a relatively common clinical entity. The etiology is most often attributable to stenosing tenosynovitis though traumatic cases have been described. When trigger finger is associated with an underlying flexor tendon rupture, previous cases have reported a clear association with overt laceration or previous trauma. Methods. We present the case of a 23-year-old male active duty military service member who presented with a characteristic history and clinical exam consistent with trigger finger. The symptomatic onset was gradual, with no history of inciting trauma. Results. Given symptomatic persistent triggering following failure of conservative management to include cortisone injections, the patient was taken for open A1 pulley release. Intraoperatively, the triggering was found to be attributable to a partial attritional rupture of the small finger flexor digitorum profundus tendon. Tendon debridement, tubularization, and A1 and partial A2 pulley releases were performed with subsequent resolution of triggering. Conclusion. We present the rare case of subclinical atraumatic attritional rupture of the FDP tendon to the small finger as a cause of clinically apparent trigger finger. This is an important consideration as the hand surgeon must be prepared to address more atypical pathologies. D. Anthony Bastian, Nicholas Kusnezov, John C. Dunn, Justin S. Mitchell, and Miguel Pirela-Cruz Copyright © 2017 D. Anthony Bastian et al. All rights reserved. Lateral Subtalar Dislocation with Tarsometatarsal Dislocation: A Case Report of a Rare Injury Thu, 06 Jul 2017 00:00:00 +0000 Dislocation of the fourth and fifth tarsometatarsal joints in conjunction with lateral subtalar dislocation is a rare occurrence. Little is known about the mechanism of injury, the appropriate treatment for this condition, and its ultimate prognosis. In this report, we describe this atypical presentation in a middle aged, otherwise healthy male who sustained a trivial twisting injury to the ankle when he slipped and fell on ice. Open reduction and K-wire fixation were necessary to affix the lateral tarsometatarsal and talonavicular joints. At one year postoperatively, he was able to return to his preinjury occupation with mild to moderate pain with prolonged walking. His Foot and Ankle Disability Index and American Orthopaedic Foot and Ankle Society scores were 64 and 65 points, respectively. Surgical intervention resulted in a stable plantigrade foot; however, the patient had early radiographic evidence of posttraumatic arthritis in the midfoot joints at one-year follow-up. Samik Banerjee, Mostafa M. Abousayed, Douglas J. Vanderbrook, and Kaushik Bagchi Copyright © 2017 Samik Banerjee et al. All rights reserved. A Case of an Insufficiency Fracture of the Medial Proximal Tibia Secondary to Osteomalacia Associated with Long-Term Saccharated Ferric Oxide Administration Tue, 04 Jul 2017 00:00:00 +0000 This article presents a case of insufficiency fracture of medial proximal tibia caused by long-term administration of saccharated ferric oxide (SFO) in a 77-year-old female. In this case, 2-year administration of SFO for iron deficit anemia induced hypophosphatemic osteomalacia and finally resulted in an insufficiency fracture of medial proximal tibia. Hypophosphatemia and pain due to the insufficiency fracture were recovered promptly by withdrawing SFO administration and rest. This case represented varus deformity of the knee associated with osteoarthritis, which may also cause the insufficiency fracture of medial proximal tibia in addition to osteomalacia due to long-term administration of SFO. Long-term SFO administration should be avoided because of a definitive risk of osteomalacia and fragile fracture. Daichi Ishimaru and Hiroshi Sumi Copyright © 2017 Daichi Ishimaru and Hiroshi Sumi. All rights reserved. “Monocept”: A Brief Report of Congenital Absence of the Long Head of the Biceps Tendon and Literature Review Sun, 02 Jul 2017 07:34:13 +0000 The long head of the biceps tendon plays an important role in shoulder stability and its functional absence has been shown to contribute to glenohumeral instability. Congenital absence of the long head to the biceps tendon is rare, although described in the literature. We report the case of an 18-year-old recreational athlete with recurrent shoulder instability and congenital absence of the long head of the biceps tendon (which we term “monocept”) and mild ipsilateral upper extremity hemimelia. The patient was treated surgically with posterior capsular shift with anterior Bankart repair without complication. At 16-month follow-up the patient has returned to recreational activity and has had an 11.37-point improvement in his DASH score. The authors suggest that patients with this uncommon anatomic anomaly and clinical shoulder instability are more likely to require surgical treatment. Benjamin A. Winston, Katlyn Robinson, and Dennis Crawford Copyright © 2017 Benjamin A. Winston et al. All rights reserved. Limb Amputation after Multiple Treatments of Tenosynovial Giant Cell Tumour: Series of 4 Dutch Cases Wed, 28 Jun 2017 08:27:27 +0000 In Tenosynovial Giant Cell Tumours (TGCT), previously named Pigmented Villonodular Synovitis (PVNS), a distinction is made between a single nodule (localized-type) and multiple nodules (diffuse-type). Diffuse-type is considered locally aggressive. Onset and extermination of this orphan disease remain unclear. Surgical resection is the most commonly performed treatment. Unfortunately, recurrences often occur (up to 92%), necessitating reoperations and adjuvant treatments. Once all treatments fail or if severe complications occur, limb amputation may become unavoidable. We describe four cases of above-knee amputation after TGCT diagnosis. Monique J. L. Mastboom, Floortje G. M. Verspoor, Hans Gelderblom, and Michiel A. J. van de Sande Copyright © 2017 Monique J. L. Mastboom et al. All rights reserved. Radical Surgery of Only the Anterior Elements of the Spine at the Posterior Element Fusion Level due to Metastatic Thyroid Cancer Tue, 27 Jun 2017 00:00:00 +0000 Spinal metastasis of differentiated thyroid cancer can have a favorable prognosis if radical surgery is performed. We encountered a case of spinal metastasis involving three anterior vertebral bodies at the posterior element fusion level and successfully achieved adequate stability by radical surgery involving only the anterior elements. A 67-year-old woman who had numbness and muscle weakness in the lower limbs caused by metastatic spinal tumor at the posterior element fusion level of L1–L3 vertebrae was treated with radical surgery of only the anterior element to gain stability. Similar situations may occur in cases involving other malignant tumor metastases or spinal primary tumors. If such a case occurs, this method could be useful in preventing metastasis to the posterior element. Ryuto Tsuchiya, Kazuki Fujimoto, Kazuhide Inage, Sumihisa Orita, Yasuhiro Shiga, Hiroto Kamoda, Kazuyo Yamauchi, Miyako Suzuki, Jun Sato, Koki Abe, Hirohito Kanamoto, Masahiro Inoue, Hideyuki Kinoshita, Masaki Norimoto, Tomotaka Umimura, Masao Koda, Takeo Furuya, Junichi Nakamura, Kazuhisa Takahashi, and Seiji Ohtori Copyright © 2017 Ryuto Tsuchiya et al. All rights reserved. Autologous Concentrated Bone Marrow Grafting for the Treatment of Osteonecrosis of the Humeral Head: A Report of Five Shoulders in Four Cases Tue, 20 Jun 2017 00:00:00 +0000 Five shoulders in four patients affected by advanced osteonecrosis of the humeral head were treated with autologous concentrated bone marrow grafting. Bone marrow sample was aspirated from the iliac crests, concentrated by a centrifugation technique, and injected into the necrotic site. The shoulders were evaluated radiologically with X-ray scoring and clinically with measurement of range of motion and pain score (visual analogue scale, VAS). The mean follow-up period was 49.4 (range, 24–73) months. The concentration ratio of nucleated cells was calculated and the number of transplanted mesenchymal stem cells (MSC) was estimated by a colony-forming assay. All four shoulders with stage 3 disease achieved joint sparing. One shoulder with stage 4 disease required replacement surgery. Clinical evaluation of the spared joints showed improvement in range of motion in two cases and deterioration in two cases. VAS scores were 0 after surgery in three cases. The mean concentration ratio was 2.73, and the mean number of transplanted MSC was 1125. The outcomes of autologous concentrated bone marrow grafting for advanced osteonecrosis of the humeral head were varied. Further research is needed to determine the effectiveness and the indications of the present surgery. Takeshi Makihara, Tomokazu Yoshioka, Hisashi Sugaya, Masashi Yamazaki, and Hajime Mishima Copyright © 2017 Takeshi Makihara et al. All rights reserved. A Patient-Matched Entire First Metacarpal Prosthesis in Treatment of Giant Cell Tumor of Bone Thu, 15 Jun 2017 08:04:14 +0000 Giant cell tumor of the bones occurring in the first metacarpals frequently requires entire metacarpal resection due to the aggressive nature and high rate of recurrence. Bone reconstruction can be performed with autogenous bone grafts. Here we describe a new technique of reconstruction using a patient-matched three-dimensional printed titanium first metacarpal prosthesis. This prosthesis has a special design for ligament reconstruction in the proximal and distal portions. Good hand function and aesthetic appearance were maintained at a 24-month follow-up visit. This reconstructive technique can avoid donor-site complications and spare the autogenous bone grafts for revision options. Thipachart Punyaratabandhu, Boonrat Lohwongwatana, Chedtha Puncreobutr, Arkaphat Kosiyatrakul, Puwadon Veerapan, and Suriya Luenam Copyright © 2017 Thipachart Punyaratabandhu et al. All rights reserved. Proximal Femoral Fracture in Hip Arthrodesis Treated with Double Reconstruction Plates Sun, 11 Jun 2017 08:04:28 +0000 We present a rare clinical case of a 90-year-old female who sustained a proximal femoral neck fracture following long-standing hip arthrodesis. Since the fracture occurred relatively proximally and involved the pelvis, double-plate fixation was chosen to achieve rigid fixation. The reconstruction plate was placed at the posterior and anterior columns individually through single vertical incision. She was treated successfully, and she attained preinjury activity level. Proximal femoral fractures in arthrodesed hips need to be recognized as a fracture between the pelvis and femur. Rotational stress from the trunk and lower extremity requires rigid fixation to minimize the increase of displacement and the risk for nonunion. Shunsuke Asakawa, Takeo Mammoto, and Atsushi Hirano Copyright © 2017 Shunsuke Asakawa et al. All rights reserved. A Large Rice Body-Containing Cyst Mimicking Infection following Total Hip Arthroplasty: A Case Report Mon, 05 Jun 2017 08:38:11 +0000 Introduction. Soft tissue mass following total hip arthroplasty raises several differential diagnoses not limited to infection, hematoma, wear debris, malignancy, and bursitis. Rice body formation in the hip region is an uncommon process denoting a chronic inflammation. We report here the second case of its kind in the medical literature of a wide symptomatic rice-like body cyst complicating a total hip arthroplasty. Case Presentation. This is the case of an 82-year-old white female, presenting with a warm, red, and inflated groin five years after revision of right total hip arthroplasty. Surgical intervention reveals a large well circumscribed cyst containing well-organized rice-like bodies. This eventuality was never reported in differential diagnosis of hip periprosthetic soft tissue masses before. Conclusion. This case report helps widening the array of the differential diagnosis in patients presenting with a slow growing soft tissue mass following total hip arthroplasty, making rice-like bodies cyst a valid one to consider. Wael Bayoud, Maroun Rizkallah, Samuel Georges, Tonine Younan, and Gaby Haykal Copyright © 2017 Wael Bayoud et al. All rights reserved. Arthroscopic Treatment of 2 Consecutive Cases of Dysplasia Epiphysealis Hemimelica of the Ankle: A 5-Year Follow-Up Report Tue, 30 May 2017 00:00:00 +0000 The dysplasia epiphysealis hemimelica (DEH) is a rare disease of unknown etiology consisting in an abnormal osteocartilaginous growth at the epiphysis, usually hemimelic with histological findings similar to benign osteochondroma. In this case series, we described the results of the arthroscopic treatment of 2 consecutive cases of intra-articular ankle localization of DEH in 2 patients aged 9 and 10 years. The good result obtained, persistent at the 5-year follow-up, leads us to consider the arthroscopic approach as a reliable treatment in patient affected by intra-articular ankle DEH. Cosma Calderaro, Carlo Iorio, Francesco Turturro, Federico Morelli, Luca Labianca, Antonello Montanaro, and Andrea Ferretti Copyright © 2017 Cosma Calderaro et al. All rights reserved. Custom-Made Alumina Ceramic Total Talar Prosthesis for Idiopathic Aseptic Necrosis of the Talus: Report of Two Cases Mon, 29 May 2017 09:54:36 +0000 Two women aged 65 years and 78 years presented to our center with idiopathic necrosis of the talus. In both cases, imaging examinations showed collapse and sclerotic changes of the talar body caused by the necrosis. Both women underwent resection and placement of a third-generation custom-made alumina ceramic total talar prosthesis. Immobilization of the ankle in a short-leg cast for 3 weeks was followed by early rehabilitation. One year and 6 months after surgery, both women were able to walk without pain. Their Japanese Society for Surgery of the Foot ankle-hindfoot scale scores improved from 22 and 29/100 points to 90 and 95/100 points, respectively. To the best of our knowledge, the successful treatments of these two rare cases of idiopathic necrosis of the talus are among only a few reported cases of using a third-generation alumina ceramic prosthesis. Ichiro Tonogai, Daisuke Hamada, Yuhei Yamasaki, Keizo Wada, Tomoya Takasago, Takahiko Tsutsui, Tomohiro Goto, and Koichi Sairyo Copyright © 2017 Ichiro Tonogai et al. All rights reserved.