Intra-articular knee haemangioma originating from the anterior cruciate ligament: a case report

<p>Abstract</p> <p>Introduction</p> <p>Synovial haemangioma is a rare intra-articular benign tumour, which may arise from any synovium-lined surface, but particularly in the knee joint. Synovial haemangioma originating from the anterior cruciate ligament has not been reported previously.</p> <p>Case presentation</p> <p>A 34-year-old man presented with a history of intermittent knee pain, locking and swelling.</p> <p>Conclusion</p> <p>Knee intra-articular haemangioma, a very rare benign tumour, is often misdiagnosed. Magnetic resonance imaging is effective in detecting this lesion and should be performed in cases of persistent knee swelling and pain.</p

Case Report Traumatic Floating Clavicle: A Case Report and Literature Review

Bipolar fracture dislocations of the clavicle are rare injuries, usually the result of high-energy direct trauma. Since the original description by Porral in 1831, only a handful of individual case reports and case series by Beckman and Sanders have been reported in the literature. Management of these injuries has remained controversial ranging from nonoperative to aggressive surgery. We report on the case of a young army cadet who had a fracture of the lateral end of the clavicle, with an anterior dislocation of the sternoclavicular joint. Despite being planned for surgery, at the patients request, it was decided to manage the lesion conservatively with graded physiotherapy. At one-year follow-up, he had full pain-free, functional range of movement of the shoulder. This young high demand patient had a good outcome with conservative management, despite going against the current trend towards surgical treatment. We present this case with a review of the literature, highlighting the various management options for this rare lesion

Surgical preferences of patients at risk of hip fractures: hemiarthroplasty versus total hip arthroplasty

BACKGROUND: The optimal treatment of displaced femoral neck fractures in patients over 60 years is controversial. While much research has focused on the impact of total hip arthroplasty (THA) and hemiarthroplasty (HA) on surgical outcomes, little is known about patient preferences for either alternative. The purpose of this study was to elicit surgical preferences of patients at risk of sustaining hip fracture using a novel decision board. METHODS: We developed a decision board for the surgical management of displaced femoral neck fractures presenting risks and outcomes of HA and THA. The decision board was presented to 81 elderly patients at risk for developing femoral neck fractures identified from an osteoporosis clinic. The participants were faced with the scenario of sustaining a displaced femoral neck fracture and were asked to state their treatment option preference and rationale for operative procedure. RESULTS: Eighty-five percent (85%) of participants were between the age of 60 and 80 years; 89% were female; 88% were Caucasian; and 49% had some post-secondary education. Ninety-three percent (93%; 95% confidence interval [CI], 87-99%) of participants chose THA as their preferred operative choice. Participants identified several factors important to their decision, including the perception of greater walking distance (63%), less residual pain (29%), less reoperative risk (28%) and lower mortality risk (20%) with THA. Participants who preferred HA (7%; 95% CI, 1-13%) did so for perceived less invasiveness (50%), lower dislocation risk (33%), lower infection risk (33%), and shorter operative time (17%). CONCLUSION: The overwhelming majority of patients preferred THA to HA for the treatment of a displaced femoral neck fracture when confronted with risks and outcomes of both procedures on a decision board

Analgesic effect of femoral nerve block on postoperative pain and ambulation after total knee arthroplasty

Objectives: Determine the analgesic effect of a single injection femoral nerve block on postoperative pain and ambulation, after total knee arthroplasty. Methods: In a prospective study, 84 patients undergoing total knee arthroplasty were randomly assigned to receive: either one single injection femoral nerve block and 100mg paracetamol combined with lornoxicam 4 mg administrated twice intravenously for 5 days (group 1, n=42) or only the aforementioned analgesics without nerve block for the same period (group 2, n=42). Distance walked on 5 first postoperative days and VAS pain score during first 5 days were reported. Patients with bilateral osteoarthritis, previous leg injury or serious cardiovascular disease were excluded. Statistical analysis was performed by statistical packet STATA 8.0 and significance was set at p-value &lt;0.05. Results: Patients of group 1 walked longer distance than patients of group 2 on postoperative day 1, 2 and 3 (p&lt;0.05).The VAS pain score decreased significantly from 7.8/10 to 4.1./10 in Group 1 (P&lt;0.05) and from average 8.1/10 to 5.9/10 in Group 2 (p&lt;0.05) at 5 days after surgery. Patients of group 1 experienced less pain than patients of group2 at 5 days after surgery according to VAS pain score (p&lt;0.05). Conclusion: Single shot of femoral nerve block provides efficient pain relief on early postoperative period after total knee arthroplasty. This is associated with better ambulatory performance. © The Author(s) 2014

Changes of bone turnover markers after marathon running over 245 km

We evaluated bone turn over markers, cortisol and parathyroid hormone (PTH) levels in male athletes after 245 km of marathon running. Sixteen athletes were studied five days before, immediately after, and 1, 3, and 5 days after the run. We used t-test and Pearson correlation for statistical analysis. Osteocalcin levels were significantly decreased from 4.6 μg/lit to 3.8 μg/lit (p &lt; 0.05). Activity of b-ALP was significantly decreased from 66 U/lit to 61.5 U/lit (p &lt; 0.05). PICP levels were also significantly decreased from 168 μg/lit to 153 μg/lit (p &lt; 0.05). Hydroxyproline levels decreased after the run from 70 mmol/min to 65 mmol/min (p &lt; 0.05). ICTP levels increased after the run but without being statistically significant, from 6.62 μg/lit to 7.0 μg/lit. Urine calcium decreased significantly by 68%, immediately after the run. Cortisol increased from 212 ng/ml to 455 ng/ml, and PTH levels increased from 12 pg/lit to 16 pg/lit immediately after the race (p &lt; 0.05). Cortisol levels were significantly negatively correlated with osteocalcin (r = -0.61, p &lt; 0.05) and b-ALP (r = -0.98, p &lt; 0.05). PTH levels were significantly negatively correlated only with serum osteocalcin (r = -0.8, p &lt; 0.05). These findings suggest a transient suppression in osteoblast function during the marathon run probably due to cortisol and PTH levels elevation. © Georg Thieme Verlag KG Stuttgart