Physiotherapeutic Approach for Osteochondroma of 4th And 5th Ribs - A Case Report

The most frequent benign bone tumor is osteochondroma, which account for 45 percent of all benign bone tumours. Although not a real neoplasm, osteochondroma (exostosis) is the most common lesion and is often classed as a tumour. The majority of them develop in the metaphyseal region of long bones like the femur and tibia. A 21-year-old female presented to the orthopedic OPD with complaints of pain and swelling over dorsal spine since 2 years with left upper limb radiculopathy since 1 month. Pain was insidious in onset which started 1 month back and it aggravated ever since. On inspection swelling present over paraspinal region of approximately 5cm in length and 4cm in width. On palpation swelling was not adherent to skin, immobile and firm in consistency. Osteochondroma represent the most common bone tumor accounting for 20 to 50% of all benign osseous tumors. In osteochondroma maintaining mobility is important for activities of daily living and to maintain the quality of life. Physiotherapy plays a significant role in maintaining the mobility and improving the quality of life.

Brodie’s Abscess of the Proximal Humerus Metaphysis: A Case Report

Introduction:Primary subacute pyogenic osteomyelitis, or Brodie’s abscess was initially documented by Sir Benjamin Brodie in 1832. We present a case report with a 6-months follow-up period, demonstrating the successful diagnosis and surgical treatment of a focal lesion of the proximal metaphysis of the right humerus in a 21-years-old female. The pathology of hematologic osteomyelitis and its role in the development of a subacute abscess along with a review of literature and an in detail description of the pathogenesis of Brodie’s abscess is discussed and submitted. Case Report:A 21- years -old healthy female with a history of fall sustaining injury to the right shoulder one 1 year back followed by which she presented to the outpatient clinic with a swelling over her right shoulder. The patient was managed conservatively with analgesics and was relieved of pain over a course of one 1 week of medications, the patient now presents with pain and swelling in the right shoulder joint on and off since the episode of fall one 1 year back, which had increased over a period of past one 1 week. A week before the most recent presentation she started experiencing some discomfort and pain in her right shoulder. No recent trauma was reported. A mild swelling appeared over the proximal part of the humerus. There were no constitutional symptoms of fever or any illness reported. On examination, there was noted a painful restriction of ROM at the right shoulder joint with no rotator cuff injury. Laboratory investigations were suggestive of raised inflammatory markers. Radiograph of the right shoulder taken in the true antero-posterior view with the shoulder in the neutral rotation was suggestive of an oval lucency with surrounding sclerosis in the proximal metaphyseal region of the humerus. Magnetic resonance imaging MRI of the right shoulder joint showed features consistent with Brodie’s abscess in the proximal metaphyseal region of the humerus. Surgical debridement of the abscess w

Ewing's Sarcoma: A Case Report

Ewing’s sarcoma is a bone tumor, considered one of the most aggressive, for its great capacity of metastasizing. Higher incidence in men, appears almost exclusively in the first three decades of life. Affects the long bones in the metaphyseal region, at its proximal end; the most affected are the femur, iliac, tibia, humerus, fibula and ribs; however, there are atypical locations such as in the hands, feet and extraosseous. The clinical case of a 13‐year‐old male adolescent patient, who two months before his medical attention presented a mass at the level of the second and third right costal arches that increased vertiginously. After routine and laboratory examinations performed at a third level complexity hospital, he was diagnosed with Ewing's Sarcoma, where 3 chemotherapy sessions were performed; however, despite the treatment, he presented brain and bone metastases. Ewing's tumor was highly aggressive and has a bleak prognosis. Keywords: sarcoma, ewing, tomography, morbid metastasis. RESUMEN El Sarcoma de Ewing es un tumor óseo, considerado uno de los más agresivos, por su gran capacidad de metástasis. Tiene mayor incidencia en hombres, se presentan de forma casi exclusiva en las tres primeras décadas de vida, afecta a los huesos largos en la región metafisodiafisaria, en su extremo proximal, los más afectados son el fémur, el iliaco, la tibia, el humero, el peroné y las costillas. Sin embargo, existen localizaciones atípicas como en los pies manos y extraóseas. Se presentación el caso de un paciente adolescente masculino de 13 años, que dos meses antes de la atención médica presenta una masa a nivel de segundo y tercer arco costal derecho que aumenta de tamaño de forma vertiginosa. Posterior a exámenes de gabinete y laboratorio realizados en Hospital de Tercer Nivel de Complejidad, es diagnosticado de Sarcoma de Ewing en donde se realizan 3 sesiones de quimioterapia, sin embargo, pese el tratamiento presenta metástasis cerebrales y óseas, El tumor de Ewing es altamente agresivo y tiene un pronóstico sombrío Palabras claves: sarcoma de ewing, tomografía, metástasis mórbida.

Metaphyseal Osteopathy in a Caucasian Shepherd Crossbred Dog

A six-month old, 24 kg, intact male Caucasian Shepherd crossbred dog was presented at the Sokoine University of Agriculture Teaching Animal Hospital with a history of difficulty standing and walking, and bilateral swelling of the distal antebrachial and crural metaphyeal region. The owner also reported prior calcium supplementation in form of dietary tablets. Upon physical examination; the animal was lethargic with fever, bilateral ocular discharge, tachypnea and reduced appetite. Hard painful bilateral swelling of the distal antebrachial and crural metaphyseal region was observed. Differential cell count showed neutrophilia and monocytosis. Sclerosis and paracortical cuffing of the distal antebrachial and crural metaphyseal region were seen on radiographic examination. Similar changes were also visualised in the proximal crural metaphyseal region. Further, cranial bowing of the radius with lateral deviation of the foot (carpal valgus) were also observed. Metaphyseal osteopathy was diagnosed based on the history, clinical and radiographic findings. The exact cause of metaphyseal osteopathy is unknown, however there have been reports linking it to breed predisposition and mineral over supplementation. Administration of corticosteroids and supportive care are recommended in dogs with metaphyseal osteopathy. However, a bony change that is paracortical cuffing requires several months for resorption.

Hoffa’s Osteochondroma - Para-articular Extrasynovial Infrapatellar Fat Pad Osteochondroma: A Case Report

Osteochondroma usually arises from the metaphyseal region of growing bones. The occurrence of extraskeletal osteochondroma is rare with very few case reports. Para-articular osteochondroma is a type of extraskeletal osteochondroma. It frequently occurs around the knee, usually at infrapatellar Hoffa’s fat pad. It is usually intracapsular but extrasynovial and arises from the capsule and connective tissues due to osteocartilaginous metaplasia. We present a case of 19-years male with anterior knee pain for 3 years, swelling, and deformity of the knee with flexion limitation for one year. Radiography revealed ovoid, corticated lesion free from adjoining bones. Mass interpreted as benign, so planned for excision. Well circumscribed nodule excised from the medial parapatellar approach. Histology revealed cartilaginous tissues surrounded by fibrous tissues with scattered enchondral ossification.Postoperatively and subsequent follow-up resulted in pain-free joint, complete recovery of range of motion with no clinicoradiological evidence of recurrence.

Exostosis of Rib: Case Report of an Extremely Rare Giant Osteochondroma at an Unusual Site, Radiopathological Correlation with Brief Review of Literature

Osteochondromas are common benign tumors developing as an abnormal bony growth in the metaphyseal region. Being more of a developmental anomaly rather than a true neoplasm, they are usually found around the growth plates of long bones such as the knee, hip, and shoulder. These are typically managed conservatively if they are asymptomatic; however, they require excision in symptomatic patients. A 38-year-old woman presented with a huge swelling causing disfigurement measuring 16 × 16 cm on the left side of chest wall. Radiographs and computed tomography scan showed a bony outgrowth at costochondral junction of second rib which was in continuity with the periosteum. Excision via mediastinal sternotomy and left thoracotomy was done. Histopathological features corroborated with the radiological diagnosis of osteochondroma. Osteochondroma should be considered in the differential diagnosis of chest wall tumors. Rib is an extremely rare site of presentation. The cartilaginous cap becomes fully ossified and is lost in longstanding lesions. Huge tumors at such a location can cause irritation of adjacent viscera which can lead to pleural effusion or hemothorax; therefore, a cautious and logical approach to diagnosis is warranted for appropriate therapeutic management.

Giant cell tumour of the scapula treated by partial scapulectomy

Giant cell tumour is a benign, but locally aggressive tumour. It most commonly affects the epiphysial-metaphyseal region of long bones, but rarely in flat bones. We present you a case of 26-year-old man with a large giant cell tumour of the inferior angle of the scapula. The patient was treated with partial scapulectomy with complete resection of tumour. There was excellent retention of shoulder function postoperatively.

Patient-specific design process and evaluation of a hip prosthesis femoral stem

Introduction: There are several commercially available hip implant systems. However, for some cases, custom implant designed based on patient-specific anatomy can offer the patient the best available implant solution. Currently, there is a growing trend toward personalization of medical implants involving additive manufacturing into orthopedic medical implants’ manufacturing. Methods: This article introduces a systematic design methodology of femoral stem prosthesis based on patient’s computer tomography data. Finite element analysis is used to evaluate and compare the micromotion and stress distribution of the customized femoral component and a conventional stem. Results: The proposed customized femoral stem achieved close geometrical fit and fill between femoral canal and stem surfaces. The customized stem demonstrated lower micromotion (peak: 21 μm) than conventional stem (peak: 34 μm). Stress results indicate up to 89% increase in load transfer by conventional stem than custom stem because the higher stiffness of patient-specific femoral stem proximally increases the custom stem shielding in Gruen’s zone 7. Moreover, patient-specific femoral stem transfers the load widely in metaphyseal region. Conclusion: The customized femoral stem presented satisfactory results related to primary stability, but compromising proximo-medial load transfer due to increased stem cross-sectional area increased stem stiffness.

Giant Cell Tumor of Bone: Review of Current Literature, Evaluation, and Treatment Options

Giant cell tumor of bone is a benign albeit aggressive tumor commonly affecting the bones of the knee. Patients with these tumors present with pain, swelling, and inability to bear weight on the involved extremity. These destructive tumors typically arise in the metaphyseal region of the long bones in individuals in the second, third, and fourth generations of life. Histologically, the multinucleated giant cells are the hallmark of the lesion, easily recognized on histological review, which recently have become therapeutic targets for medical management of the disease. For decades, surgical management has been the primary treatment for giant cell tumor of the bone. Some tumors can be treated with excision and filling of the osseous void with bone cement or allograft. This is an effective treatment option with a low to moderate risk of local recurrence while preserving limb function. For more destructive tumors, wide excision and reconstruction with prosthetic, structural allograft or combined allograft prosthetic components are utilized. Advances in medical management of the disease have also demonstrated promise as an effective treatment; however, its use has usually been limited to the treatment of metastatic disease, recurrent disease or when advanced local disease would require surgical treatment felt to be overly morbid.

Akin osteotomy as an adjunct to hallux MTPJ fusion

Category: Midfoot/Forefoot, Hallux MTP fusion Introduction/Purpose: It is not uncommon to note residual valgus at the hallux interphalangeal joint when performing a hallux MTPJ fusion. On occasion, despite optimum positioning of hallux MTPJ for fusion, we found that in some cases the hallux was still abutting the second toe. We noted that these cases had either a high hallux interphalangeus valgus angle or the proximal phalanx had a shorter, concave lateral border due to eccentric wear. These two variables were difficult to correct despite optimum positioning of the hallux MTPJ. Consequently the hallux abuts the second toe causing irritation. We have used Akin osteotomy as an adjunct to hallux MTPJ fusion to address this intraoperative problem Methods: Between 2013 to 2016 this technique was utilised in 16 patients in whom residual hallux valgus interphalangeus was noted once the hallux MTPJ was stabilised in the appropriate position. We used two 4.0 mm AO cannulated partially threaded screws inserted in a crossed configuration for MTPJ fusion and a 8 mm x 90 degree varisation staple for the Akin osteotomy. The Akin osteotomy was performed in the mid to distal diaphyseal region of the proximal phalanx to avoid the screw position. Postoperatively, patients were given a toe spica plaster cast and were advised to walk in a heel weight bearing wedge shoe for six weeks. Results: Despite the osteotomy not being in the metaphyseal region, we have not encountered any immediate post-operative complications. We accept that this technique may not be suitable when using plates and screws for fusion but would be suitable for use with screws or staples. We have not encountered any postoperative complications. All hallux MTPJ joints have fused and Akin osteotomies have healed uneventfully Conclusion: This technique has not been reported before. Akin osteotomy is commonly used as an adjunct to corrective hallux valgus surgery. It is a relatively quick and reproducible technique with minimal incidence of complications. We suggest that this technique be considered when carrying out a hallux MTPJ fusion, although may not be required in all cases.