Open posteromedial dislocation of ankle without associated fractures

<p class="abstract">Dislocation of ankle without associated malleoli or talar fractures is a rare presentation. There is no established standard treatment for this condition. Most of them are treated by immediate reduction followed by immobilisation for 6-9 weeks. Majority of them recover without any complications. Here we reported a case of 33 year old man who was injured due to fall from a height, His ankle was deformed with a laceration over lateral side of ankle. Plain radiograph revealed posteromedial tibiotalar dislocation without any associated fractures. Immediate reduction and suturing was performed. At 5 months postoperative review patient was able to perform his daily routine without any instability or complaints.</p>

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Ipsilateral Fractures of the Talus and Calcaneus

Foot & Ankle International ◽

10.1177/107110079601701110 ◽

1996 ◽

Vol 17 (11) ◽

pp. 701-705 ◽

Cited By ~ 15

Author(s):

Paul Gregory ◽

Thomas DiPasquale ◽

Dolfi Herscovici ◽

Roy Sanders

Keyword(s):

Standard Treatment ◽

Talus Fracture ◽

Treatment Regimens ◽

Combined Injury ◽

Joint Surfaces ◽

Articular Damage ◽

Talar Fractures ◽

Level I ◽

Both Bones

Nine ipsilateral fractures of the talus and calcaneus were treated at Tampa General Hospital between 1991 and 1994 and entered into the trauma registry of this level I trauma center. During this same period, a total of 78 talar fractures and 334 calcaneal fractures were entered into the registry. The patients who sustained this rare combined injury were studied retrospectively to characterize the fractures that occurred, examine the treatments instituted, and determine outcomes. Four patients had severe intra-articular damage of the subtalar joint surfaces and underwent either primary or delayed arthrodesis. This subgroup of patients was followed for an average of 39 months (range, 25–45 months), and all had excellent or good outcome as assessed by the Maryland Foot Score. Three patients had nondisplaced or avulsion-type fractures of both bones, which were treated with immobilization. These all healed well. One patient had a Hawkins type 2 talus fracture with an extra-articular avulsion fracture of the Achilles tendon. This patient did well with open reduction and internal fixation of both fractures. The final patient had a crushed lower extremity in association with her hindfoot injury, which resulted in primary below-knee amputation. In general, we believe each individual fracture in this combined injury can be addressed with standard treatment regimens.

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THUMB TUBERCULOSIS: A CASE REPORT

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00068 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0006

Author(s):

Yunus R. Mohd ◽

A.A. Ahmad ◽

A.R. Ahmad

Keyword(s):

Mycobacterium Tuberculosis ◽

Range Of Motion ◽

Active Form ◽

Plain Radiograph ◽

Proximal Phalanx ◽

Diagnostic Delay ◽

Joint Space ◽

Rare Presentation ◽

Wound Debridement ◽

Limited Range Of Motion

Tuberculosis is caused by Mycobacterium tuberculosis, occurs in about 2 billion people. Approximately 8 million people/year develop the active form.1,2 Tuberculosis in the hand is manifested as osteomyelitis in carpals, metacarpals and phalanges.1 Musculoskeletal tuberculosis occurs, in most cases, through haematogenous dissemination from the primary focus. In immunosuppression circumstances, it is reactivated. Methods: 47 years old lady, who had underlying pulmonary tuberculosis on anti-TB medications since June 2018, presented to us for swelling over right thumb. Associated with tender, erythematous skin and limited range of motion of right thumb. Results: Plain radiograph demonstrated soft tissue swelling, joint space narrowing, mottled lucency of the proximal phalanx and cystic degenerative changes. MRI shows osteomylities proximal phalanx of right thumb. Patient underwent wound debridement of right thumb, culture and sensitivity shows Mycobacterium tuberculosis infections. Post debridement, range of motion of MCP joint of right thumb was improved and anti-TB medications to restart. Discussions: Tuberculosis involvement of the metacarpals and phalanges is a rare presentation of extrapulmonary TB. The radiographic features of osseous tuberculosis are present in conditions such as inflammatory arthritis, pyogenic osteomyelitis, osteopenia, softtissue swelling with minimal periosteal reaction, narrowing of the joint space, cysts in bone adjacent to joints, and subchondral erosions. The gold standard to diagnose is culture of Mycobacterium tuberculosis from bone tissue. Current treatment is a 2 month initial phase of isoniazid, rifampin, pyrazinamide, and ethambutol followed by a 6 to 12 month regimen of isoniazid and rifampin. Conclusion: Finger swelling is a rare presenting sign of disseminated tuberculosis. Early biopsy and appropriate microbiologic testing can avoid diagnostic delay. References: Malaviya AN, et al. Best Pract Res Clin Rheumatol. 2003;17:319–43. Fortún J, et al. Mycobacterium tuberculosis infection? Medicine. 2010;10:3808–19. DOI: 10.1016/S0304-5412(10)70119-0.

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Central nervous system metastases: a rare presentation of nasopharyngeal carcinoma

BMJ Case Reports ◽

10.1136/bcr-2021-243892 ◽

2021 ◽

Vol 14 (8) ◽

pp. e243892

Author(s):

Sehrish Abrar ◽

Nasir Ali ◽

Bilal Mazhar Qureshi ◽

Rabia Tahseen

Keyword(s):

Nasopharyngeal Carcinoma ◽

Standard Treatment ◽

Systemic Disease ◽

Lumbar Region ◽

Rare Presentation ◽

Limb Weakness ◽

Cervical Lymph Nodes ◽

Bilateral Lower Limb ◽

Thoracic Cord ◽

The Brain

We report a case of a male patient. He presented with nasal obstruction and epistaxis. The MRI of the brain showed a mass in the nasopharynx and enlarged cervical lymph nodes. Besides this, there was an extra-axial, dural-based lesion in brain and subcentimetre nodules in both lungs. He received induction chemotherapy followed by chemoradiation therapy to the primary site and dural-based metastatic deposit. He re-presented with bilateral lower limb weakness. The MRI of the spine showed metastatic deposits within the thoracic cord parenchyma and meningeal deposits at the lumbar region. Palliative radiation was used to treat spinal cord and meningeal metastases. He died a few months later because of systemic disease progression. Considering the rarity of this presentation in nasopharyngeal carcinoma and lack of clear guidelines for standard treatment, we report this case to share our experience of management.

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Splenic hydatidosis with abdominal pain – a rare presentation in a developing nation

European Journal of Clinical and Experimental Medicine ◽

10.15584/ejcem.2020.1.10 ◽

2020 ◽

Vol 18 (1) ◽

pp. 45-48

Author(s):

Kafil Akhtar ◽

◽

Saquib Alam ◽

Atia Zaka-ur Rab ◽

Rana K Sherwani ◽

...

Keyword(s):

Abdominal Pain ◽

Standard Treatment ◽

Conservative Surgery ◽

Enzyme Linked Immunosorbent Assay ◽

Hydatid Cysts ◽

Computed Tomography Imaging ◽

Rare Presentation ◽

Left Hypochondrium ◽

Splenic Involvement ◽

End Stage

Introduction. Primary extrahepatic hydatid cysts are rare, and primary splenic hydatid cysts even rarer. Splenic hydatidosis constitutes 2% to 3.5% of all hydatid cysts. Aim. To present a case report of splenic hydatidosis with abdominal pain. Description of the case. We report here a case of isolated splenic hydatid cysts in a 23 year old female, who presented with dull dragging pain in the left hypochondrium. Diagnosis was made on computed tomography imaging of the abdomen and microscopic examination of the laminated hydatid cyst wall and supplemented with positive enzyme linked immunosorbent assay for hydatid antibodies. Conclusion. The incidence of splenic involvement by hydatid cysts is very low. Man is an accidental intermediate host, as entry of the larval forms into humans represents an end stage in its life cycle. Until recently the gold standard treatment for splenic hydatidosis was splenectomy, as medical therapy seems to be ineffective. However, the last two decades have shown a tendency towards splenic conservative surgery in suitable cases, to reduce opportunistic post splenectomy infection.

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The Comprehensive AOCMF Classification System: Mandible Fractures- Level 2 Tutorial

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0034-1389557 ◽

2014 ◽

Vol 7 (1_suppl) ◽

pp. 15-30 ◽

Cited By ~ 9

Author(s):

Carl-Peter Cornelius ◽

Laurent Audigté ◽

Christoph Kunz ◽

Randal Rudderman ◽

Carlos H. Buitrago-Téllez ◽

...

Keyword(s):

Classification System ◽

Lateral Side ◽

Mandibular Fractures ◽

Daily Routine ◽

Case Examples ◽

Body Regions ◽

Topographical Distribution ◽

Definition Of ◽

Mandible Fractures ◽

Level 2

This tutorial outlines the details of the AOCMF image-based classification system for fractures of the mandible at the precision level 2 allowing description of their topographical distribution. A short introduction about the anatomy is made. Mandibular fractures are classified by the anatomic regions involved. For this purpose, the mandible is delineated into an array of nine regions identified by letters: the symphysis/parasymphysis region anteriorly, two body regions on each lateral side, combined angle and ascending ramus regions, and finally the condylar and coronoid processes. A precise definition of the demarcation lines between these regions is given for the unambiguous allocation of fractures. Four transition zones allow an accurate topographic assignment if fractures end up in or run across the borders of anatomic regions. These zones are defined between angle/ramus and body, and between body and symphysis/parasymphysis. A fracture is classified as “confined” as long as it is located within a region, in contrast to a fracture being “nonconfined” when it extents to an adjoining region. Illustrations and case examples of mandible fractures are presented to become familiar with the classification procedure in daily routine.

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WBCT of Hallux Valgus Deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00290 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0029

Author(s):

Ji-Beom Kim ◽

Woo-Chun Lee ◽

Chihoon Ahn

Keyword(s):

Hallux Valgus ◽

Weight Bearing ◽

Plain Radiograph ◽

Valgus Deformity ◽

Dorsal Side ◽

Metatarsal Bone ◽

Lateral Side ◽

Axial Image ◽

Hallux Valgus Deformity ◽

The Mean

Category: Bunion Introduction/Purpose: Distal metatarsal articular angle (DMAA) is important for the treatment of hallux valgus deformity, because high DMAA is a cause of recurrence and stiffness after surgery. However, the DMAA is not commonly measured on plain radiograph, because of its low reliability. The reliability would be increased, if we clearly understand anatomical structure of the DMAA in hallux valgus deformity. In the WBCT, we found that the DMAA was different between dorsal side and plantar side. The purposes of this study were to compare the degree of the DMAA between dorsal side and plantar side in hallux valgus deformity, to identify which side of the DMAA is more correlated with the hallux valgus deformity, and to define standards for the DMAA measurement on plain radiograph. Methods: We retrospectively evaluated patients who underwent surgery for hallux valgus deformity in our clinic from April, 2017 to July, 2017. All patients underwent WBCT and plain weight-bearing radiograph preoperatively. The WBCT was performed using a cone-beam CT scanner (Planmed, Verity). For measuring the DMAA on axial plane image of the WBCT, we set axial plain parallel to sagittal axis of the 1st metatarsal bone. We determined dorsal and plantar axial WBCT images that located immediately below dorsal cortex and immediately over plantar cortex in the 1st metatarsal bone respectively. (Fig.1-A) We measured the DMAA on these dorsal and plantar axial WBCT images. (Fig.1-B) On the plain weight-bearing foot anteroposterior radiograph, we measured hallux valgus angle (HVA) and the DMAA. For measuring the DMAA on the plain radiograph, we defined the distal articular surface from sagittal groove at medial side to sharp edge at lateral side. (Fig. 1-C) Results: Thirty feet from 30 patients were included in this study. The mean age of patients was 55.6 years (range: 21-77). The mean of HVA was 34.9° (range: 22-52). The mean of the DMAA on the dorsal and the plantar axial WBCT images were 12.5°(0.7- 24.1) and 39.0°(16.7 – 57.6), respectively. Paired t test resulted that the DMAA on the plantar axial image was significantly higher than the DMAA on the dorsal axial image (P=0.000). Correlation analysis resulted that only the DMAA on the plantar coronal image was significantly correlated with the HVA (Pearson correlation coefficient:0.380, P=0.038). The intraclass coefficient indicated that the DMAA on the plain radiograph which defined in this study was highly reliable with the DMAA on the plantar coronal WBCT image.(ICC = 0.811) Conclusion: The present study showed that the plantar side DMAA is 27° higher than the dorsal side DMAA. We believed that this difference made confusion to define the DMAA on plain radiograph and decreased reliability for the measurement of the DMAA on the plain radiograph. Because the plantar side DMAA is more correlated with the HVA than the dorsal side DMAA, it is important to measure the plantar side DMAA on the plain radiograph. The present study proved that our definition of the DMAA on plain radiograph was appropriate for measuring the plantar side DMAA.

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A rare case of spontaneous gastric perforation in an adolescent

International Surgery Journal ◽

10.18203/2349-2902.isj20183743 ◽

2018 ◽

Vol 5 (9) ◽

pp. 3171 ◽

Cited By ~ 1

Author(s):

Vasuki R. ◽

Arun P. S. ◽

Rajesh Menon Moothedath

Keyword(s):

Children And Adolescents ◽

Gastric Perforation ◽

Plain Radiograph ◽

Young Patients ◽

Peptic Ulcer Perforation ◽

Rare Presentation ◽

Midline Laparotomy ◽

Young Adult Patient ◽

Perforated Appendix ◽

H Pylori

Incidence of Peptic ulcer perforation in children and adolescents are very rare. Perforated gastric ulcer is extremely rare with only handful of cases reported worldwide in the same age group. Pneumoperitoneum and peritonitis due to gastric perforation is a very rare presentation in children and adolescents and it can often be overlooked with disastrous consequences. Even though in young patients, peptic ulcerations can happen in association with H. pylori infection, secondary to medications like non-steroidal anti-inflammatory agents, corticosteroids, rarely due to Zollinger Ellison syndrome, related to stress, post burns or head trauma it is seldom common. Among perforations gastric perforation is very rare. Here we discuss a case of 15-year-old school student who presented with acute abdominal pain and features of peritonitis which we initially thought probably due to perforated appendix but turned out to be a gastric perforation. Plain radiograph of the abdomen showed pneumoperitoneum. When an emergency midline laparotomy was performed, we found a perforation in gastric antrum anteriorly with peritonitis which was treated by thorough decontamination and Graham's live omental patch closure. H. Pylori tests were negative. At a time when acute presentation of peptic ulcerations or perforation as its complication is decreasing in incidence worldwide, this case has come as an eye opener. Thus, perforated gastric/duodenal ulcer in pediatric and young adult patient should not be overlooked in a young patient presenting with acute abdomen. Many times, there is no clear etiology and then it is spontaneous perforation. Emergency surgical management is the preferred mode of treatment.

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