Tibial torus and toddler's fractures misdiagnosed as transient synovitis: a case series

<p>Abstract</p> <p>Introduction</p> <p>The high incidence of transient synovitis in early childhood makes it the first suspected pathology in a limping child. Trauma, which has long been regarded as a causative factor for transient synovitis, may be underestimated in a non-cooperative toddler.</p> <p>After excluding most serious conditions, such as septic arthritis, a speculative diagnosis of transient synovitis can be made, and this can easily mask a subtle musculoskeletal injury.</p> <p>Case presentations</p> <p>We report the cases of three Caucasian patients (two boys, aged 20-months- and three-years-old, and one girl, aged two-years-old), with tibial torus and toddler's fractures which were late-diagnosed due to an initial misdiagnosis of transient synovitis of the hip.</p> <p>Conclusion</p> <p>In a non-cooperative child musculoskeletal trauma can be mistaken as a simple causative factor for transient synovitis of the hip and this can easily prevent further investigation for a possible subtle musculoskeletal injury of the lower extremities.</p> <p>Our experience with the presented cases suggests the need to be more vigilant in the differential diagnosis of transient synovitis in young children.</p

Arthroscopic Removal of Intraosseous and Intratendinous Deposits in Calcifying Tendinitis of the Rotator Cuff

Purpose: The purpose of this study was to evaluate the surgical outcome of arthroscopic removal of intraosseous deposits in calcifying tendinitis of the rotator cuff. Methods: We studied the results of arthroscopic treatment in 30 shoulders in 28 patients with calcifying tendinitis (mean age, 48.3 years; age range, 26 to 83 years), with a mean follow-up of 38 months. According to the localization of calcification, the patients were divided into 2 groups: those with pure tendinous/soft-tissue involvement (n = 25) (group I) and those with tendinous/soft-tissue and osseous involvement (n = 5) (group II). After routine tendon debridement, debridement and curettage of the bone lesion were also performed in patients with bone involvement. Clinical outcome was evaluated by use of the pain score on a visual analog scale and the Constant score, and a special inquiry was used for self-assessment. Results: The pain scores and functional Constant scores improved significantly after the operation in both groups (P=.043 for pain score and P=.0001 for Constant score in group I and P=.042 for pain score and P=.0001 for Constant score in group 11). The median Constant score increased from 42 (range, 22 to 65) preoperatively to 100 (range, 80 to 100) postoperatively in group 1 and from 40 (range, 25 to 55) to 100 (range, 85 to 100) in group II. The mean pain score was 6.5 +/- 1.4 (range, 4 to 9) before treatment and 0.2 +/- 0.5 (range, 0 to 2) at follow-up in group 1, and it was 6.2 +/- 1.48 (range, 4 to 8) and 0.4 +/- 0.55 (range, 0 to 1), respectively, in group II. There was no significant difference between the 2 groups in terms of the final Constant (P=.85) and pain scores (P=.26). Conclusions: Arthroscopic removal of intraosseous and intratendinous deposits to treat calcifying tendinitis with osseous involvement seems to be as safe and effective a treatment method as the arthroscopic removal of intratendinous deposits in cases of tendinous involvement only

An unusual cause of shoulder pain: stress fracture of the clavicle

We report a case of stress fracture of the clavicle in which diagnosis was delayed due to the unusual localization of pain and absence of predisposing risk factors. A 34-year-old woman presented with severe right-sided pain in the shoulder, arm, neck, and hemithorax, and numbness in her right upper extremity. Systemic radiographs, cervical and brachial plexus magnetic resonance imaging (MRI) and thorax computed tomography (CT) did not show any pathology. In a retrospective review of the shoulder MRI sections, an edematous appearance was noted in the right clavicle and adjacent soft tissues, suggesting a stress fracture of the clavicle. The patient was followed-up with activity limitation and analgesic treatment and her complaints subsided gradually. Control radiographs obtained 10 months later showed fracture healing with atypical callus formation. Stress fractures of the clavicle must be kept in mind in the differential diagnosis of shoulder pain presenting as an atypical severe arm pain radiating to the upper extremity and hemithorax. In suspected cases, it may be helpful to obtain CT and MRI sections parallel to the long axis of the clavicle

Anconeus arthroplasty: a salvage procedure in recurrent heterotopic ossification

Anconeus interpositional arthroplasty has been used in the treatment of radiocapitellar and radioulnar joint problems occurring after trauma. We performed anconeus interposition arthroplasty in a 31-year-old male patient who developed heterotopic ossification (HTO) in the elbow following surgical treatment of an isolated radial neck fracture. Treatment with implant removal and excision of the radial head resulted in recurrent HTO and a stiff elbow. The patient underwent excision of the heterotrophic new bone and mobilization of the proximal radius. The anconeus muscle was mobilized and interposed between the proximal radius and ulna. Sixteen months after the operation, forearm rotation, elbow flexion and extension increased by 80 degrees, 45 degrees, and 60 degrees, respectively. Control X-rays showed maintenance of the radiohumeral gap without any signs of HTO

Anconeus arthroplasty: a salvage procedure in recurrent heterotopic ossification

Ankoneus interpozisyon artroplastisinin travma sonrası oluşan radikapitellar ve radioulnar eklem sorunlarının tedavisinde kullanılabileceği bildirilmiştir. Bu yazıda, ankoneus interpozisyon artroplastisi ile tedavi edilen 31 yaşında bir erkek hasta sunuldu. Hastada radius boyun kırığı osteosentezi sonrasında heterotopik ossifikasyon (HTO) gelişmişti. Ossifikasyon odakları temizlenip radius başı eksize edildikten sonra HTO ve dirsek sertliği tekrarlayan hastaya, tekrar ossifikasyon eksizyonu sonrasında ankoneus kası ile interpozisyon artroplastisi uygulandı. Ameliyattan 16 ay sonraki kontrolde, önkol supinasyonu, dirsek fleksiyonu ve ekstansiyonunda sırasıyla 80, 45 ve 60 derece kazanım sağlandığı görüldü. Kontrol radyografilerinde HTO’nun tekrarlamadığı ve radioulnar ve radiokapitellar eklemlerin açık olduğu izlendi.Anconeus interpositional arthroplasty has been used in the treatment of radiocapitellar and radioulnar joint problems occurring after trauma. A 31-year-old male patient developed heterotopic ossification (HTO) in the elbow following surgical treatment of an isolated radial neck fracture. Treatment with implant removal and excision of the radial head resulted in recurrent HTO and a stiff elbow. We performed anconeus interposition arthroplasty with excision of the heterotrophic new bone and mobilization of the proximal radius. The anconeus muscle was mobilized and interposed between the proximal radius and ulna. Sixteen months after the operation, forearm rotation, elbow flexion and extension increased by 80&deg;, 45&deg;, and 60&deg;, respectively. Control X-rays showed maintenance of the radiohumeral gap without any signs of HTO

An unusual complication after syndesmotic injury: retrotibial heterotopic ossification

A 27-year-old male patient sustained an isolated syndesmotic injury in the right ankle following a fall. His complaints subsided gradually within the first six weeks of conservative treatment. At the end of the third month, he returned to follow-up with posterior ankle pain. Radiological examinations revealed heterotopic ossification adjacent to the posterior inferior tibiofibular ligament and posterior capsule. His complaints disappeared only after local excision of the ossification. Heterotopic ossification may be a cause of persistent pain after ankle ligament injuries

Tumoral calcinosis: Clinical and biochemical aspects of a patient treated with vinpocetine

We describe a tumoral calcinosis (TC) patient with a calcified mass around the hip joint. Once diagnosed, she was followed up with vinpocetine [14-ethoxycarbonyl-(3 alpha,16 alpha-ethyl)/14,15-eburnamenine] treatment, which was reported to be effective in eliminating TC in a previous study. We think that vinpocetine contributed, at least in part, to the process of TC elimination. Although there are many reports about the surgical excision of calcified masses in TC, local recurrences are not uncommon. Our success with conservative treatment has encouraged us to refrain from surgical procedures in patients with TC. (C) 2006 European Federation of Internal Medicine. Published by Elsevier B.V All rights reserved

A Two-Portal Posterior Endoscopic Approach in the Treatment of a Complex Talus Fracture A Case Report

The two-portal hindfoot endoscopy is a relatively new technique that is becoming increasingly popular. It gives excellent access to the posterior ankle compartment, the subtalar joint, and extra-articular structures. We report a 24-year-old man with a complex talus fracture involving the posterior part of the talar body and posterolateral process. He was treated endoscopically, with a two-portal posterior approach to the hindfoot. This approach allowed a better visualization and treatment of accompanying pathologies. Combined excision of the posterolateral process and fixation of the fracture was performed with the two-portal hindfoot endoscopy, which has not been previously described to our knowledge. The two-portal posterior endoscopic approach can be an attractive treatment alternative for the posterior part fractures of the talus, which can in turn, be a new indication for this technique. (J Am Podiatr Med Assoc 99(5): 443-446, 2009

Functional results of the parallel-plate technique for complex distal humerus fractures

Objectives: We evaluated functional results of patients treated with open reduction and internal fixation with the parallel-plate technique for complex distal humerus fractures