A novel technique to remove a broken tibiotalocalcaneal intramedullary nail using Moreland hip revision instrumentation.

Hindfoot intramedullary devices are increasingly used in tibiotalocalcaneal arthrodesis after failed total ankle arthroplasty or as a salvage procedure after complex trauma. Nail breakage is a well-described complication and numerous techniques for removal of broken parts can be found in the literature, especially for femoral and tibial nails. There is a relative paucity regarding techniques solving the challenge of removing a broken hindfoot intramedullary nail. We describe a novel technique using a curved thin hook from the Moreland hip revision set to remove the distal part of a broken tibiotalocalcaneal intramedullary nail.

Human pulmonary Dirofilariasis: one more case in Greece suggests that Dirofilaria is a rather common cause of coin lesions in the lungs in endemic areas of Europe.

Herein we describe a case of a 52 year-old male from Greece who presented with a coin lesion in the right lung, which proved to be an infection from Dirofilaria immitis. A careful review of the literature shows that, contrary to the common perception, humans may be frequently infected by Dirofilaria species. For this reason the authors suggest that in every case which presents with a coin lesion in the lung in endemic areas, dirofilariasis should always be considered, and excluded before any other intervention is decided.

Tumors of the ribs: experience with 47 cases.

OBJECTIVES: To emphasise the existing difficulties in differentiating benign from malignant rib tumours, and especially the problems that a clinical doctor encounters when dealing with a hyperplastic rib. METHODS: Forty-seven patients with rib tumour underwent surgery in a period of 12 years (1984-1996). In 40 cases (85%), the lesion was benign and in seven (15%) was malignant. Twenty-one benign tumours originated from cartilage and bone, seven were inflammatory, six originated from the bone marrow, and minor percentages (2.5-5%) had vascular, neurogenous, degenerative or miscellaneous origin. Three of the malignant tumours were primary chondrosarcomas and two were metastatic from kidney. The rest were metastatic from stomach (adeno-Ca), and skin (melanoma). The mean age in the benign group was 25.2 years and in the primary malignant group was 20.7 years. Related symptoms were pain (47%) and swelling (42.5%). One-third (32%) of the patients were asymptomatic and the lesion was accidentally found during routine chest radiography. All patients were treated surgically with wide excision of the tumour and the diagnosis was established histologically. RESULTS: Resection was complete and curative in all cases without recurrence. CONCLUSIONS: Since the likelihood of malignancy cannot be excluded, all rib tumours should be considered malignant until proven otherwise. Therefore, prompt intervention is necessary and wide and radical initial excision of the involved rib is advocated.

Salmonella osteomyelitis of the rib.

Salmonella rib osteomyelitis is extremely rare; we found only one previously reported case. A 33-year-old man presenting with a discharging sternal sinus was diagnosed by means of computed tomography and bone isotope scans and confirmed by excision of the affected portion of the rib. The operation was curative.

Gigantic primary lipoma of the diaphragm presenting with respiratory failure.

Primary diaphragmatic lipomas are rare. A 66-year-old female case is reported, with the unusual presentation of progressive dyspnoea leading to respiratory failure, mainly because of a large fatty mass occupying the base of the left hemithorax. The completely resected mass (16 x 14.5 x 5.5 cm) was a primary diaphragmatic lipoma. The literature is discussed. We recommend surgical exploration since the possibility of liposarcoma cannot be excluded.

Magnetic resonance imaging of blunt traumatic rupture of the right hemidiaphragm.

A patient suffering from blunt traumatic rupture of the right hemidiaphragm is presented. Chest radiography and computed tomography (CT) suggested the type of injury, but magnetic resonance imaging (MRI) established unequivocally the correct preoperative diagnosis.