Poster 213: A Case Report of Hypercoagulability Presenting as Acute Radiculopathy, Leading to an Above Knee Amputation: A Zebra in the Musculoskeletal and Electromyography Clinics

Mycetomas are chronic inflammatory pseudo-tumoral lesions caused by fungal or bacterial agents developing in subcutaneous soft tissues and bone. Mycetoma is frequently located in the foot, realizing the Madura foot. We report the case of a 42-year-old male farmer, who presented two years following an injury to the plant of the right foot. He already had two excisions elsewhere with recurrence and aggravation of the swelling. He had a large painless subcutaneous swelling of his right foot with plantar sinuses discharging pale white and yellow grains. A surgical biopsy with histological study confirmed the diagnosis of mycetoma. He received an antibiotic therapy consisting in penicillin G followed by amoxicillin then an association of penicillin G and co-trimoxazole during almost three years without any improvement. A below-knee amputation was performed complicated with necrosis and infection of the stump, which was resumed twice followed by an above-knee amputation. Through this case of unusual development of a Madura foot we discuss the diagnostic and especially therapeutic difficulties of this chronic infection.

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Successful management of femoral trauma in a through-knee amputee with a previous malunited fracture: Implications and functional outcome

Prosthetics and Orthotics International ◽

10.1177/0309364616683821 ◽

2017 ◽

Vol 41 (5) ◽

pp. 512-516

Author(s):

Beth Lineham ◽

Paul Harwood ◽

Peter Giannoudis

Keyword(s):

Case Report ◽

Poor Quality ◽

Residual Limb ◽

Case Description ◽

Successful Management ◽

Careful Planning ◽

Knee Amputation ◽

Shortening Osteotomy ◽

Limb Trauma ◽

Surgical Options

Background:After amputation patients are more likely to injure their residual limb. An injury of a previously amputated limb, especially if the residuum is not anatomically normal, poses a dilemma for management.Case Description and Methods:This case report discusses a femoral fracture sustained proximal to a through-knee amputation.Findings and outcomes:The fracture was at the site of a malunited fracture. A shortening osteotomy with bone graft was undertaken to improve alignment and prosthetic fit and remove poor-quality bone. This was stabilised using an intramedullary nail, supplemented with an anti-rotation plate. This fracture went on to uneventful union, and the patient was able to comfortably use a prosthesis with increased functionality compared with prior to the recent injury.Discussion:This management enabled quick healing of the fracture without the need to resort to a more proximal amputation.Conclusion:In these unusual cases, careful planning is necessary to ensure all aspects of the problem is dealt with. Each case should be treated on its own merits.Clinical relevanceThis case demonstrates the difficulty in care of complex limb trauma and offers a solution for management of similar cases. Excellent results are possible when all surgical options are considered.

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