Arthroscopic decompression and notchplasty for long-standing anterior cruciate ligament impingement in a patient with multiple epiphyseal dysplasia: a case report

<p>Abstract</p> <p>Introduction</p> <p>Multiple epiphyseal dysplasia is a genetically and clinically heterogeneous osteochondroplasia with symmetrical involvement. It is characterized by joint pain in childhood and early adulthood with early onset of osteoarthritis, mainly affecting the hips.</p> <p>Case presentation</p> <p>We report the case of a 20-year-old man of Asian origin with multiple epiphyseal dysplasia presenting with bilateral knee pain, stiffness and instability found to be caused by bilateral anterior cruciate ligament impingement on abnormal medial femoral condyles. Bilateral staged arthroscopic notchplasty was performed successfully, resulting in subjective relief of pain, and improved range of movement and stability.</p> <p>Conclusion</p> <p>Care should be taken not to exclude a diagnosis of multiple epiphyseal dysplasia when few of the characteristic radiographic features are evident but clinical suspicion is high. This case highlights the scope for subjective symptomatic improvement following a minimum of surgical intervention. We recommend limiting early intervention to managing symptomatic features rather than radiographic abnormalities alone.</p

Initial management of closed fracture-dislocations of the ankle.

BACKGROUND: Immediate management of closed fracture-dislocations of the ankle requires urgent reduction and immobilisation of the ankle prior to definitive surgery. METHODS: The management of 23 patients attending the accident and emergency department of a district general hospital with this type of injury were reviewed retrospectively. RESULTS: Paramedic reduction was attempted in 1 of the 22 patients brought by ambulance. Triage categorisation was inappropriate in 14 patients. Unnecessary pre-reduction radiographs were obtained in 8 patients. Reduction was initially inadequate in 2 patients, and no post-reduction splintage was applied in a further 2 patients. Recording of skin and neurovascular status was inadequate in the majority of the patient's notes. CONCLUSIONS: The necessary urgent reduction and splintage is being delayed in some cases because of inadequate injury recognition, inappropriate triage categorisation and unnecessary radiographs

Giant cell arteritis presenting as a supraclavicular nodule

Letters to the editor: Sir: We read with great interest the article by Englert and colleagues on their experiences with sulphasalazine treatment in rheumatoid arthritis (RA).' They noted the disappearance of rheumatoid nodules in four patients with RA in eight to 12 weeks after the start of treatment, parallel with a decrease in disease activity