Heterotopic Ossification of the Triceps Muscle after Internal Fixation of Proximal Ulna Fracture: A Case Report

Introduction: Unilateral isolated ulna fracture secondary to trauma are common but the bilateral nightstick fractures are quite rare in the clinical scenario. These are managed conservatively or surgically depending upon the degree of displacement, location of the fracture, fracture pattern and associated injury to other bones. Proper management of these fractures helps in getting a better outcome. The purpose of the study was to present a case of bilateral traumatic isolated ulna fracture and its management. Case Report: A 33-year-old male presented to the emergency department with complaints of pain and swelling over the dorsum of both forearms with a history of assault with a bamboo stick. The mechanism of the injury was, the patient placed his both the forearms in front of the face as a defense during the assault and sustained injury to both forearms. On examination, the patient had bilateral forearm swelling with tenderness. Bony crepitus was present over both the ulna on palpation. X-ray of both forearms (radius and ulna) revealed the fracture of both right and left ulna without any associated fractures/injuries. The patient was managed surgically with open reduction and internal fixation using a 3.5 mm locking compression plate. At present, 1-year follow-up, the patient is having complete wrist, elbow ROM and supination, pronation without any pain. Conclusion: Bilateral traumatic Nightstick fractures of the ulna are rare and this is the first reported case of traumatic bilateral isolated ulna fracture according to author’s best knowledge and literature review. Open reduction and stable internal fixation using the principles of fracture fixation along with early mobilization helps in getting better functional outcome and prevents further complications and secondary procedures. This case is unique as it helps in identifying the mode of trauma in medico legal cases like assault in cases of bilateral ulna fracture. The mode and the mechanism of injury are differe

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Radial Head Dislocation with Ipsilateral Proximal Shaft of Radius Fracture: A Case Report

Journal of Nepal Medical Association ◽

10.31729/jnma.4991 ◽

2020 ◽

Vol 58 (226) ◽

Author(s):

Ayush Adhikari ◽

Subi Acharya ◽

Ravi Bhandari

Keyword(s):

Case Report ◽

Radial Head ◽

Shaft Fracture ◽

Radius Fracture ◽

Radial Head Dislocation ◽

Proximal Ulna ◽

Ulna Fracture

Radial head dislocations are uncommon in adults. They are commonly seen in children and aregenerally associated with proximal ulna fracture. Radial head dislocation with associated proximalradial shaft fracture is rarer than isolated radial head dislocation in adults. Due to the rarity of thiscomplex injury, in the absence of keen observation and meticulous attention, the correct diagnosismight be missed leading to unsatisfactory management and related complications. Here, a similarcase of radial head dislocation with associated proximal radial shaft fracture has been presented.

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Heterotopic ossification in lymph node metastasis after rectal cancer resection: a case report and literature review

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02098-x ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Hideki Nagano ◽

Tamotsu Togawa ◽

Takeshi Watanabe ◽

Kenji Ohnishi ◽

Toshihisa Kimura ◽

...

Keyword(s):

Rectal Cancer ◽

Case Report ◽

Lymph Node ◽

Heterotopic Ossification ◽

Tumor Cells ◽

Digestive Tract ◽

Histological Examination ◽

Metastatic Lesion ◽

Axillary Lymph ◽

The Brain

Abstract Background Heterotopic ossification (HO) is the formation of osseous tissue outside the skeleton. HO in malignant tumors of the digestive tract is extremely rare, as is ossification in metastatic lesions from HO-negative digestive tract tumors. Regarding the pathogenesis of HO, two theories have been proposed. The first is that the osteoblastic metaplasia of tumor cells (driven by the epithelial-mesenchymal transition, EMT) results in HO, and the second is that factors secreted by cancer cells lead to the metaplasia of stromal pluripotent cells into osteoblasts. However, the osteogenic mechanisms remain unclear. Case presentation An 83-year-old Japanese woman underwent low anterior rectal resection for rectal cancer before presentation at our institution, in June 2018. The final diagnosis was stage IIB rectal adenocarcinoma (T4aN0M0). Histological examination did not reveal HO in the primary tumor. Thirteen months after the operation, a solitary metastatic lesion in the brain 20 mm in size and a solitary metastatic lesion in a right axillary lymph node 20 mm in size were diagnosed. The patient was treated with gamma-knife therapy for the brain metastasis. One month later, she was referred to our institution. She underwent lymph node resection. Histological examination revealed that most portions of the affected lymph node were occupied by metastatic tumor cells and that central necrosis and four small ossified lesions without an osteoblast-like cell rim were present in the peripheral region. Immunohistochemical analysis showed tumor cells positive for BMP-2, osteonectin, osteocalcin, AE1/AE3, TGF-β1, Gli2, Smad2/3, and CDX2 and negative for nestin, CD56, and CK7. Conclusion This is the first English case report of HO in a metachronous metastatic lymph node after the curative resection of HO-negative rectal cancer. Unlike HO lesions in past reports, the HO lesion did not show peripheral osteoblast-like cells, and the immunohistochemical findings indicated that the present case resulted from the EMT.

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Combined Ipsilateral Humeral Shaft and Galeazzi Fractures Creating a Floating Elbow Variant

Case Reports in Orthopedics ◽

10.1155/2018/7430297 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Patrick Lee ◽

Allison Z. Piatek ◽

Michael J. DeRogatis ◽

Paul S. Issack

Keyword(s):

Internal Fixation ◽

Range Of Motion ◽

Open Reduction ◽

Humeral Fracture ◽

Humeral Shaft ◽

Proximal Ulna ◽

Elbow Injury ◽

Anatomic Reduction ◽

Elbow Injuries ◽

Floating Elbow

“Floating elbow” injuries of the arm traditionally represent a combination of humeral shaft and forearm fractures which require anatomic rigid open reduction and internal fixation of all fractures to allow for early range of motion exercises of the elbow. There are published variants of the floating elbow injury which include ipsilateral diaphyseal humeral fracture, proximal ulna fracture with proximal radioulnar joint disruption, and ipsilateral diaphyseal humeral fracture with elbow dislocation and both bones forearm fracture. We present the case of a 21-year-old woman whose left arm became caught between the side of a waterslide and adjacent rocks at a park. She sustained a torsional and axial loading injury to her left upper extremity resulting in ipsilateral humeral shaft and Galeazzi fractures. The combination of ipsilateral humeral shaft and Galeazzi fractures resulted in a rare floating elbow variant. Prompt open reduction and internal fixation of both fractures and early range of motion of the elbow and wrist resulted in an excellent clinical and radiographic result. Floating elbow injuries and their variants should be promptly recognized as early anatomic reduction, and rigid internal fixation can allow for good elbow function with minimization of stiffness.

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