A Patient with Fixed Flexion Deformity of Hip and Knee

Abstract A 17 years old female patient presented to PMR OPD with fixed flexion deformity of left hip and knee and cachexia. Five years back a severe pain was suddenly developed in her left knee and thigh which was investigated for juvenile inflammatory arthropathy and rheumatic arthritis. At that time all the serological markers (ANA, RF, ASO titre) and x-ray of knee were normal. Subsequently left hip pain and restricted ROM were developed which made it clear that the knee pain was actually referred from hip. A plain x-ray of hip was done to rule out Perthe's disease which was reported as avascular necrosis of femur. When the patient was examined at PMR OPD, a CT scan of hip, routine hemogram, CXR, Manteux test was advised considering a provisional diagnosis of infective pathology like TB hip with a differential of neoplaia in or around hip keeping in mind about cachexia and weight loss. Surprisingly CT scan showed a big mass originating from glutei muscles evading back of the thigh and even left sphincter ani muscle. Fortunately patient was continent at that time. Interestingly the pathological report suggested a relatively rare diagnosis which practically made the patient bedridden with commonly featured fixed flexion deformity.

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Heterotopic Ossification of Brachialis Muscle

The Scientific World JOURNAL ◽

10.1100/tsw.2005.104 ◽

2005 ◽

Vol 5 ◽

pp. 834-834

Author(s):

Jacob George

Keyword(s):

Alkaline Phosphatase ◽

Heterotopic Ossification ◽

Flexion Deformity ◽

Range Of Movement ◽

Middle Segment ◽

X Ray ◽

Anterior Aspect ◽

Brachialis Muscle ◽

History Of ◽

Fixed Flexion Deformity

A 13-year-old girl with seizure disorder presented with 90º fixed flexion deformity of right elbow. She had history of encephalitis, 2 years ago, from which she recovered completely except for the deformity of the elbow. Plain X-ray revealed extensive ossification of the brachialis muscle from its origin at the lower anterior aspect of the humerus to its insertion at the coronoid process of the ulna. The alkaline phosphatase value was 500 IU. The middle segment of the ossified mass was surgically excised. The mobility of the elbow was restored and she achieved a range of movement between 45–120º.

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Iliopsoas Abscess in Children – A Forgotten Diagnosis

International Journal of Paediatric Orthopaedics ◽

10.13107/ijpo.2021.v07i02.107 ◽

2021 ◽

Vol 7 (2) ◽

Keyword(s):

Ct Scan ◽

Correct Diagnosis ◽

Atypical Presentation ◽

Imaging Studies ◽

Incision And Drainage ◽

Iliopsoas Abscess ◽

Invasive Techniques ◽

High Degree ◽

Rare Diagnosis ◽

Fixed Flexion Deformity

Iliopsoas abscess is a rare diagnosis in children. We recently encountered two cases which were managed at our institution. A 11-year female presented with thigh and inguinal swelling while 3-year male child presented with limp and fixed flexion deformity of right leg. Due to the differing presentation, imaging studies are often important before management is planned. Ultrasound scan is the most common investigation followed by computerized tomography (CT) scan in a selected few. The girl underwent a CT scan followed by incision and drainage (I&D) of the iliopsoas abscess while the boy underwent ultrasound-guided pigtail catheter insertion. Both cases were successfully treated. Atypical presentation of iliopsoas abscess makes the diagnosis difficult and requires a high degree of clinical suspicion for making correct diagnosis. Imaging studies help with diagnosis in such cases. Less invasive techniques like image-guided aspiration and catheter drainage can be helpful in carefully selected cases. Keywords: Iliopsoas abscess, Atypical presentation, Percutaneous drainage, Pediatric.

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Requesting physicians’ knowledge of X-radiation exposure from computed tomography scan examinations: A case study of two Nigerian tertiary hospitals

Calabar Journal of Health Sciences ◽

10.25259/cjhs_9_2019 ◽

2020 ◽

Vol 3 ◽

pp. 36-39

Author(s):

Samson O. Paulinus ◽

Benjamin E. Udoh ◽

Bassey E. Archibong ◽

Akpama E. Egong ◽

Akwa E. Erim ◽

...

Keyword(s):

Computed Tomography ◽

Ionizing Radiation ◽

Ct Scan ◽

Radiation Exposure ◽

Work Experience ◽

Radiation Risk ◽

Radiological Protection ◽

X Ray ◽

Tertiary Hospitals ◽

Medical Exposure

Objective: Physicians who often request for computed tomography (CT) scan examinations are expected to have sound knowledge of radiation exposure (risks) to patients in line with the basic radiation protection principles according to the International Commission on Radiological Protection (ICRP), the Protection of Persons Undergoing Medical Exposure or Treatment (POPUMET), and the Ionizing Radiation (Medical Exposure) Regulations (IR(ME)R). The aim is to assess the level of requesting physicians’ knowledge of ionizing radiation from CT scan examinations in two Nigerian tertiary hospitals. Materials and Methods: An 18-item-based questionnaire was distributed to 141 practicing medical doctors, excluding radiologists with work experience from 0 to >16 years in two major teaching hospitals in Nigeria with a return rate of 69%, using a voluntary sampling technique. Results: The results showed that 25% of the respondents identified CT thorax, abdomen, and pelvis examination as having the highest radiation risk, while 22% said that it was a conventional chest X-ray. Furthermore, 14% concluded that CT head had the highest risk while 9% gave their answer to be conventional abdominal X-ray. In addition, 17% inferred that magnetic resonance imaging had the highest radiation risk while 11% had no idea. Furthermore, 25.5% of the respondents have had training on ionizing radiation from CT scan examinations while 74.5% had no training. Majority (90%) of the respondents were not aware of the ICRP guidelines for requesting investigations with very little (<3%) or no knowledge (0%) on the POPUMET and the IR(ME)R respectively. Conclusion: There is low level of knowledge of ionizing radiation from CT scan examinations among requesting physicians in the study locations.

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