Journal of Foot and Ankle Research
Recurring calcaneal osteochondroma
A calcaneal osteochondroma with recurrence in a skeletally mature patient: a case report
Introduction: Osteochondroma is the most common benign tumor of the skeleton. However, calcaneal osteochondroma is very rare. Osteochondromas grow during childhood through adolescence, but usually growing ends when the epiphyseal plates close. In an adult, growth of an osteochondroma suggests the diagnosis of malignant transformation to a chondrosarcoma. However, enlargement of an osteochondroma reported as benign after skeletal maturity is present in literature.
Case presentation: We report the clinical and radiologic findings of a calcaneal osteochondroma with an extremely rare placement and painfull, rapid reccurence following surgical excision in a skeletally mature female. The lesion showed growth the first-operation later and was re-operated. Histopathological examination did not show malignancy.
Conclusion: It should kept in mind that benign osteochondromas can show symptomatic growth in skeletally mature patients without malignant transformation.
Posted by Hylton Menz at 02:16 Comments (0)
Perniosis (chilblains) masquerading as CA-MRSA
Perniosis (chilblains) masquerading as CA-MRSA
Perniosis (chilblains) is a vasospastic, inflammatory disease that occurs when the skin is subjected to cold above the freezing point, under damp conditions. Erythematous (violaceous) blisters, ulcerations or pustules that sit on an edematous base, accompanied by pain, burning or itching, are usually evident. To the inexperienced clinician it may resemble community-associated methicillin-resistant Staphylococcus aureus and could lead to inappropriate treatment. Here we report such a case.Posted by Hylton Menz at 03:27 Comments (0)
Treatment of talar body fractures
The treatment of talar body fractures with compression screws: a case series
Fractures of talar body are rare and serious injuries and frequently seen in multiply injured and polytraumatised patients. The high variability of talar fractures, their relatively low incidence together with the high percentage of concomitant injuries makes treatment of these injuries a challenge to the surgeon.
We treated three patients with talus body fracture and multiple articular fractures of the distal tibia. The patients were male, aged 36, 34 and 40 years. All cases were treated by open reduction and internal fixation. All the fractures were united during an average follow-up of 13 months and there were neither non-union nor collapses due to avascular necrosis.
Posted by Hylton Menz at 05:03 Comments (0)
Manifestations of Ollier’s disease
Manifestations of Ollier’s disease in a 21-year-old man: a case report
Babak Fallahi, Morteza Bostani, Kianoush Ansari Gilani, Davood Beiki, Ali Gholamrezanezhad
Ollier's disease is a rare nonhereditary disorder characterized by multiple enchondromas with a predilection for unilateral distribution. Malignant changes in Ollier's disease may occur in adult patients. Radionuclide bone scanning is one method used to assess lesions depicted on radiographs or magnetic resonance images that are presumed to be enchondromas. Also, a bone scan may give a clue to the multifocal nature of the disease and it has been recommended that scintigraphy is useful in the monitoring of lesions and the development of any malignant transformation. A 21-year-old man with a history of pathologic fractures of the right tibia and multiple limb surgeries related to Ollier's disease was referred to our nuclear medicine department. Radiographic assessment showed multiple radiolucent expansile lesions, suggestive of multiple enchondromas. A whole-body bone (99mTc-MDP) scan showed multiple foci of increased activity involving the proximal and distal right femur and tibia, proximal right humerus, distal right ulna, right metacarpals, metatarsals and phalyngeal tubular bones, consistent with unilateral distribution of the lesions. The long bones of the left hemi-skeleton were unremarkable, representing unilateral involvement of the skeleton. In this case, the intensity of uptake in the lesions of the lower extremity was high, raising the possibility of malignant degeneration of the enchondromas. Hence, the patient underwent surgical excision of the suspected lesions. Pathology analysis revealed their benign nature. Although the malignant transformation of enchondromas is a well known phenomenon, it should be kept in mind that other etiologies can be considered as the cause of intensely increased uptake. Retrospective assessment of our patient revealed that the etiology of increased uptake in the lower limb lesions was due to previous insufficiency fractures and the possibility of malignant transformation was ruled out based on the pathology findings.
Posted by Hylton Menz at 04:51 Comments (0)
Mycobacterium ulcerans osteomyelitis
Successful treatment of Mycobacterium ulcerans osteomyelitis with minor surgical debridement and prolonged rifampicin and ciprofloxacin therapy: a case report
Daniel P O'Brien, Eugene Athan, Andrew Hughes and Paul D Johnson
Treatment for osteomyelitis-complicating Mycobacterium ulcerans infection typically requires extensive surgery and even amputation, with no reported benefit from adjunctive antibiotics.We report a case of an 87-year-old woman with M. ulcerans osteomyelitis that resolved following limited surgical debridement and 6 months of therapy with rifampicin and iprofloxacin. M. ulcerans osteomyelitis can be successfully treated with limited surgical debridement and adjunctive oral antibiotics.
Posted by Hylton Menz at 02:38 Comments (0)
Death following bilateral complete Achilles tendon rupture
Risk of tendon rupture, especially of the Achilles tendon, is one of the many potential side-effects of fluoroquinolone therapy. Achilles tendon rupture may be painful, debilitating or, as seen in our patient, devastating. While fluoroquinolone-induced tendon rupture typically accompanies other comorbidities (for example renal impairment) or concurrent steroid therapy, our case represents a medical 'first' in that there were no such comorbidities and no steroid therapy. Furthermore, our case is remarkable in that tendon rupture was bilateral, complete, and resulted in a devastating outcome. A healthy 91-year-old Caucasian man was placed on fluoroquinolone (levofloxacin) therapy for a presumed bacterial pneumonitis. Subsequently, he developed bilateral heel pain, edema, and ecchymoses leading to a diagnosis of bilateral complete Achilles tendon rupture. This drug's side-effect was directly responsible for his subsequent physical and psychologic decline and unfortunate death. Fluoroquinolones are a powerful and potent tool in the fight against bacterial infection. As a class, they are employed by primary care physicians as well as by subspecialty physicians in all areas of medical practice. However, as this case illustrates, the use of these drugs is not without risk. Attention must be paid to potential side-effects when prescribing any medication, and close follow-up with patients is a medical necessity to evaluate for these adverse reactions, especially with fluoroquinolones.
Posted by Hylton Menz at 02:08 Comments (0)
Congenital anterolateral tibial bowing and polydactyly
Congenital anterolateral tibial bowing and polydactyly: a case report
Edmond G Lemire
Congenital anterolateral bowing of the tibia is a rare deformity that may lead to pseudarthrosis and risk of fracture. This is commonly associated with neurofibromatosis type 1. In this report, we describe a 15-month old male with congenital anterolateral bowing of the right tibia and associated hallux duplication. This is a distinct entity with a generally favourable prognosis that should not be confused with other conditions such as neurofibromatosis type 1. Previously published cases are reviewed.
Posted by Hylton Menz at 02:04 Comments (0)
Bilateral giant femoropopliteal artery aneurysms
Bilateral giant femoropopliteal artery aneurysms: a case report
Popliteal artery aneurysms are the most common peripheral arterial aneurysms, and are frequently bilateral. Acute limb ischemia, rupture and compression phenomena can complicate these aneurysms when the diameter exceeds 2 cm.We report an 82-year-old male patient with two giant femoropopliteal aneurysms, 10.5 and 8.5 cm diameters, managed in our institution. Both aneurysms were resected and a polytetrafluoroethylene (PTFE) femoropopliteal interposition graft was placed successfully. Management and literature review are discussed. We believe this is the first report in the medical literature of bilateral giant femoropopliteal aneurysms.
Posted by Hylton Menz at 02:01 Comments (0)
Grade IV frostbite
Grade IV frostbite requiring bilateral below knee amputations: a case report
A rare case of grade IV frostbite is presented resulting in bilateral below knee amputations. This case highlights the importance of early versus late amputation as well as the importance of close collaboration between the rehabilitation, surgical, psychosocial, and public health disciplines in this rare and challenging problem that still may be encountered in the United Kingdom.
Posted by Hylton Menz at 01:55 Comments (0)
Bilateral open calcaneal fractures
Open calcaneal fractures are high morbidity injuries and the risk of complications depends on the concomitant injuries, on the size and the position of the traumatic wound. A 53-year-old male patient with bilateral open calcaneal fractures and associated concomitant lower extremity injuries such as subtalar dislocation, talonavicular dislocation and open distal tibial metaphyseal fracture was immediately operated by percutaneous Kirschner wire fixation combined with external fixators. He was able to walk with full weight bearing without any assistance at the end of the first postoperative year. Early aggressive debridement and irrigation followed by fixation with percutaneous Kirschner wires and external fixator can supply bony alignment in open comminuted calcaneal fractures associated with concomitant lower extremity injuries and should be considered for the healthy and active patients before primary arthrodesis.
Posted by Hylton Menz at 01:51 Comments (0)
Pneumatic compression devices for lymphedema
Pneumatic compression devices for in-home management of lymphedema: two case reports
The two patients in this case series had experienced long-term difficulty controlling lymphedema at home. Both patients had used numerous home therapies, including older-generation intermittent pneumatic compression devices, without success. The Flexitouch® system, an advanced pneumatic device, was prescribed to assist them with in-home efforts by providing therapy to their affected limbs in addition to the lower trunk area for the patient with lymphedema of the lower extremity; and the trunk, chest wall, and shoulder areas for the patient with lymphedema of the upper xtremity. Both patients achieved successful home maintenance of lymphedema, as judged by limb volume, clinical observations, and subjective patient impressions, after incorporating the Flexitouch® system. Neither patient experienced the deleterious effects (worsening genital edema; fibrotic cuff development) that they had experienced with the older-generation intermittent pneumatic compression devices they had previously used. Incorporating the Flexitouch® system as part of maintenance may improve success for lymphedema patients who have previously struggled with inhome management.
Posted by Hylton Menz at 01:48 Comments (0)
Silver-Russel syndrome
Silver-Russell Syndrome: A case report
A 15-year-old male boy with hemihypertrophy (left side) of the body was admitted in the hospital with the history of repeated attacks of convulsion. The patient was diagnosed as Silver-Russell syndrome on clinical ground. Silver-Russell syndrome (SRS) is a very rare genetic disorder that appears no later than early childhood. This is usually characterized by asymmetry in the size of the two halves or other parts of the body. Silver-Russell Syndrome occurs mostly in isolated cases because of sporadic genetic changes (mutations) for no apparent reason. For lack of facilities we were not able to do genetic study.
Posted by Hylton Menz at 01:41 Comments (0)
Necrotizing soft tissue infections
Diagnosis and misdiagnosis of necrotizing soft tissue infections: three case reports
Today, gas gangrene is rare, but still many of the patients die, despite having received timely treatment. This report highlights the cases of three different patients, who were transferred to our surgical department in 2006. The first patient (Patient_A), with the suspected diagnosis "femoral hematoma", a second patient (Patient_B) because of an "acute abdomen" and the third patient (Patient_C) with suspected gas gangrene of the right leg. The first two cases demonstrate gas gangrene should always be kept in mind, especially in high-risk-patients. Though, the third case shows that severe consequences because of a precipitate diagnosis can be avoided by careful evaluation.
Posted by Hylton Menz at 01:35 Comments (0)
Acroform type of enchondromatosis
Ali Al Kaissi, Katharina Roetzer, Klaus Klaushofer, Franz Grill
Enchondromatosis represent a heterogenous group of disorders. Spranger et al attempted a classification into 6 types: Ollier disease, Maffuci syndrome, metachondromatosis, spondyloenchondrodysplasia, enchondromatosis with irregular vertebral lesions, and generalized enchondromatosis. Halal and Azouz added 3 tentative categories to the 6 in the classification of Spranger et al. We report on a 15-year-old boy with acrofrom upper limbs and mixed appearance of radiolucency, cysts and striae of fibro-chondromatosis. Lower limbs (femoral, tibial and fibular dysplasia showed enlarged metaphyses near the knees bilaterally) were present. Additional features of short stature, macrocephaly, facial dysmorphism, and generalised platyspondyly have been encountered. These bone shortenings were associated with bone bending, curving and rhizomelia of the upper limbs with significant macrodactyly. Limitations in articular movements were present. The forearm deformities were similar to those observed in hereditary multiple exostosis. The acrofrom upper limbs with mixed appearances of radiolucencies, cysts and striae of fibro-chondromatosis are the basic features of type I1Spranger. The constellation of facial dysmorphic features and significant vertebral abnormalities in our present patient were not compatible with the above-mentioned type of enchondromatosis. Our report widens the knowledge of disorders characterised by enchondromatosis. Ascertainment of the mode of inheritance in our present patient was difficult because of insufficient family history and parents declined clinical/radiographic documentation.
Posted by Hylton Menz at 01:32 Comments (0)
Atypical periosteal osteoid osteoma
Atypical periosteal osteoid osteoma: a case report
Osteoid osteoma is a benign osteoblastic tumor usually seen in adolescent and young males. In the paediatric age group, since the history may be difficult to elicit, there are often problems in early diagnosis. The author reports an unusual presentation of osteoid osteoma in a ten-year-old girl, which could not be diagnosed by conventional X-rays and CT scan.
Posted by Hylton Menz at 01:28 Comments (0)