Case Reports in Orthopedics https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Surgical Hip Dislocation for Management of Acetabular Osteochondroma in an Adult Tue, 25 Jul 2017 07:19:49 +0000 http://www.hindawi.com/journals/crior/2017/8481563/ 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 http://www.hindawi.com/journals/crior/2017/3271026/ 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 http://www.hindawi.com/journals/crior/2017/9672126/ 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 http://www.hindawi.com/journals/crior/2017/8284548/ 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 http://www.hindawi.com/journals/crior/2017/8769369/ 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 http://www.hindawi.com/journals/crior/2017/8090721/ 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 http://www.hindawi.com/journals/crior/2017/1675654/ 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 http://www.hindawi.com/journals/crior/2017/1090245/ 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 http://www.hindawi.com/journals/crior/2017/7402570/ 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 http://www.hindawi.com/journals/crior/2017/2365808/ 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 http://www.hindawi.com/journals/crior/2017/4898057/ 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 http://www.hindawi.com/journals/crior/2017/4101346/ 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 http://www.hindawi.com/journals/crior/2017/5246080/ 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 http://www.hindawi.com/journals/crior/2017/5354298/ 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 http://www.hindawi.com/journals/crior/2017/3175765/ 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 http://www.hindawi.com/journals/crior/2017/8290804/ 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. 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 http://www.hindawi.com/journals/crior/2017/3025084/ 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 http://www.hindawi.com/journals/crior/2017/8908216/ 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 http://www.hindawi.com/journals/crior/2017/6936013/ 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 http://www.hindawi.com/journals/crior/2017/7195016/ 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 http://www.hindawi.com/journals/crior/2017/1704697/ 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 http://www.hindawi.com/journals/crior/2017/4823589/ 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 http://www.hindawi.com/journals/crior/2017/5012948/ 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 http://www.hindawi.com/journals/crior/2017/1650194/ 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 http://www.hindawi.com/journals/crior/2017/2865971/ 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 http://www.hindawi.com/journals/crior/2017/7409153/ 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 http://www.hindawi.com/journals/crior/2017/6354284/ 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. Fibroma of Tendon Sheath Presenting Limited Flexion of the Fingers Tue, 16 May 2017 00:00:00 +0000 http://www.hindawi.com/journals/crior/2017/4129714/ 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. Fracture of the Tibial Baseplate 16 Years after Miller-Galante II Total Knee Arthroplasty Tue, 16 May 2017 00:00:00 +0000 http://www.hindawi.com/journals/crior/2017/4080816/ 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. Safe and Effective Reduction Technique for Intertrochanteric Fracture with Ipsilateral Below-Knee Amputated Limb Sun, 14 May 2017 07:04:25 +0000 http://www.hindawi.com/journals/crior/2017/2672905/ 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.