Thyroid papillary carcinoma presenting with femoral neck metastasis: a case report

Thyroid carcinoma is relatively uncommon, accounting for 2% of all cancers. Although they usually present as a neck lump, occasionally they may be presented with a distant metastasis. In this study, a 65 year-old woman was referred to our clinic with a pain on her left hip at both rest and walking. A lytic area at the inferior femoral neck was found with plain radiography. To clarify the characteristics of the lesion, left hip magnetic resonance imaging (MRI) had been performed displaying 3×5 cm hyperintense lesion extending from medial part of the left femoral neck to the left femoral head. Laboratory findings were normal. An open biopsy had then been performed from the left femoral neck with a suspicion of a metastatic tumor. After Immunohistochemical assesment diagnosis was consistent with metastatic thyroid papillary cancer. Proximal femoral resection with clear margins were achieved by proximal femur tumor endoprosthesis.  In conclusion, papillary thyroid cancer have an excellent prognosis and doesn’t tend to metastese. But rarely, as seen in our case it can even present with syptoms of metastasic disease. Management strategy is the same as other solitary bone metastasis. Papillary thyroid cancer must be kept in mind as a differential diagnosis in solitary bone metatasis

Necrotizing leukocytoclastic vasculitis mimicking necrotizing fasciitis: a case report

There are several subtypes of necrotizing leukocytoclastic vasculitis, which are classified according to their morphological features in biopsy specimens using immunofluorescence microscopy. Necrotizing leukocytoclastic vasculitis is limited to the skin, predominantly that of the lower extremities, and usually spares the palms and soles. The most common skin manifestation is palpable purpura. Other skin manifestations include maculopapular rash, bullae, papules, nodules, ulcers and livedo reticularis. There is no specific laboratory test to determine the diagnosis. There are various diseases presenting with these nonspecific symptoms, and a rapid differential diagnosis must be conducted, because the appropriate differentiation and diagnosis markedly influence the treatment strategy and survival of patients. In this study, we report a case of necrotizing leukocytoclastic vasculitis presenting with internal organ involvement and symptoms of necrotizing fasciitis, with emphasis on the clinical differentiation

A biomechanical comparison of two cephalomedullary nails; one using a single lag screw with antirotator blade and a nail using two lag screws for unstable intertrochanteric fractures

Background: Implant choice for fixation of intertrochanteric fractures remains controversial despite being one of the most commonly performed operations. Although use of sliding hip screws is still considered a gold standard in treatment of these fractures, there is a wide tendency in using cephalomedullary nails because of their biomechanical superiority over sliding hip screws. This trial was initiated in order to compare the biomechanical properties of two different cephalomedullary nails, aPFN and the PROFIN under axial loading, based on the questions that can a single lag screw with an antirotator blade render better rotational stability? Is there a difference between one lag screw or two lag screws with respect to superior migration or cut-out of the screws? And do different nail designs cause different types of failure and what are the pros and cons of classical and new designs from the view point of biomechanical aspects?Methods: Ten pairs of third generation synthetic bone models simulating unstable intertrochanteric fracture were used for biomechanical testing.Results: No posterior displacement of screws was recorded in both groups suggesting rotational unstability.  There was not a significant difference between forces values loaded at the time of failure.Conclusions: Although there was no statistically significant difference between compressive strengths at the time of failure, aPFN may provide equal rigid fixation with less possible cut-out which may have an important consequences in real clinical applications

Mid-term radiological and clinical results of incomplete triple pelvic osteotomy

WOS: 000392918400013PubMed ID: 27923543Objective: The aim of this study was to assess clinical and radiological results of incomplete triple pelvic osteotomy in acetabular dysplasia. Patients and methods: Twenty-six hips of 24 patients (5 males, 19 females) treated with incomplete triple pelvic osteotomy by a single surgeon from February 1995 to October 2001 were retrospectively reviewed at an average follow-up time of 12 years. The mean age at the time of surgery was 21.6 years (range: 14-41). Radiological evaluation was based on the central edge angle, acetabular angle, acetabular index, acetabular head index and lateralisation. Clinical and radiological scoring was performed using the Harris scoring system, Omeroglu scoring system and the Tonnis criteria for osteoarthritis. Results: There was significant improvements in all of the radiological parameters with 88.5% good radiological results, 96.2% excellent clinical results, no significant progression to osteoarthritis and no need for conversion to total hip arthroplasty. The rate of major complication was 11%. Retroversion was seen in 15.4% of the hips. Conclusion: Our results support the use of incomplete triple pelvic osteotomy as a safe choice in the treatment of acetabular dysplasia as it offers clinical and radiological benefits and contributes to the prevention of osteoarthritis. (C) 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V

Lung Metastasis Mimicking Fingertip Infection

Metastasis fingers (acral metastasis) are finding a poor prognosis. Past medical history should be questioned and metastasis from primary tumor should be kept in mind in patients with pain, swelling, and hyperemia in fingers. Successful surgical treatment on acral metastasis does not extend the life expectancy; however, it reduces the patient's pain during his terminal period, saves the functions of the limb, and increases life comfort

Lung Metastasis Mimicking Fingertip Infection

Metastasis fingers (acral metastasis) are finding a poor prognosis. Past medical history should be questioned and metastasis from primary tumor should be kept in mind in patients with pain, swelling, and hyperemia in fingers. Successful surgical treatment on acral metastasis does not extend the life expectancy; however, it reduces the patient’s pain during his terminal period, saves the functions of the limb, and increases life comfort

Short-term results of surgical treatment with cephalomedullary nails for basicervical proximal femoral fractures

The treatment of basicervical femoral fractures remains controversial. The aim of this study was to examine the efficacy of intramedullary nail use in the surgical treatment of basicervical fractures. In total, 28 patients with basicervical fractures treated with proximal femoral nails were examined retrospectively. Fracture healing was observed in all patients, who were followed at least for 6 months. While the average radiological fracture healing timing was ~10.5 (8-14) weeks, clinical fracture healing occurred in 6 (5-9) weeks on average. Screw cut‑out, avascular necrosis, femur fracture, and surgical wound infections did not occur in any patient. Severe collapse (> 10%) was not noted in any patient. The postoperative mean Harris hip score was 81.2±21.3. Osteosynthesis application with a proximal femoral nail in basicervical proximal femur fractures is a surgical treatment that can be performed with minimally invasive techniques without open surgery. This is a rapid, sound, and simple treatment method with low morbidit

Clinical management of a challenging malignancy, osteoblastoma-like osteosarcoma: a report of four cases and a review of the literature

Osteoblastoma-like osteosarcoma, a rare form of osteosarcoma, is a malignant lesion associated with risks of both local recurrence and distant metastasis. The differential diagnosis of osteoblastoma-like osteosarcoma from osteoblastoma and aggressive osteoblastoma remains controversial and challenging. Previous studies suggest that these three types of tumor are distinct entities. However, working out a precise diagnosis may not always be possible immediately on the basis of initial clinical, radiological, and histopathological features. On the other hand, the importance of a correct diagnosis cannot be overemphasized since the treatment strategies change dramatically according to the nature of the lesion. In all of our cases, initial Tru-Cut biopsies revealed osteoblastic features with minimal atypia, but further biopsies confirmed malignancy. A high index of suspicion and considerable experience are prerequisites for accurate diagnosis in case of clinicopathological and radiological discordance

Use of provisional K wires instead of Poller screws for treatment of diametaphyseal fractures of the distal femur and proximal and distal tibia

There are several important technical points that need to be observed when using an intramedullary nail to fix diametaphyseal fractures of femur and tibia. We aimed to describe a technique using 3.0-mm K wires, which act like Poller screws, in conjunction with intramedullary nails to obtain alignment of diametaphyseal fractures of the femur and tibia, and present our results. 7 distal femoral, 2 proximal tibial, and 4 distal tibial diametaphyseal fractures  who were treated with this technique were identified. There was no case of nonunion at the last follow-up. In all, 12 of the 13 patients had postoperative fracture angulation that was less than 5° degrees in the coronal and sagittal planes. K wires function essentially as a Poller screw for centralization of the nail and help to ensure reduction. Locking the nail in different directions, appropriate reduction can be maintained until the bone heals and there is no need for additional fixation material