Complete avulsion of the extensor mechanism of a finger with simultaneous dislocation of the proximal interphalangeal joint.

We report a rare case of open dislocation of the proximal interphalangeal (PIP) joint, associated with simultaneous avulsion of the central band and distal insertion of the extensor mechanism, rapture of the proximal volar plate, and rapture of the ulnar collateral ligament of the PIP joint.Although isolated IP joint injuries are common, they rarely occur simultaneously in a single finger. Even more rarely are they accompanied by a complete avulsion of the extensor mechanism. Operative restoration of the injured structures is a necessity in order to achieve a good functional outcome.An initial forceful flexion of the finger resulting to rapture of the extensor apparatus and then followed by finger hyperextension and PIP joint dislocation is our perception of the possible mechanism of this extremely rare injury.

Total Dislocation of the Talus without a Fracture. Open or Closed Treatment? Report of Two Cases and Review of the Literature.

Complete dislocation of the talus not accompanied by a fracture is a very rare injury. The injury is encountered as a closed one even more rarely. Reviewing the literature we found that proposed treatments for total talus dislocation varied from primary talectomy or arthodesis (to avoid complications) to closed reduction and an under knee cast. Most importantly, there was no agreement among authors about the method of reduction (open/closed). We report our experience with two cases of closed total talus dislocation not accompanied by a fracture, and review the literature to retrieve evidence on whether a closed or open treatment should be preferred for this type of injury.

Bilateral transient bone marrow edema or transient osteoporosis of the knee in pregnancy.

Transient osteoporosis or transient bone marrow edema is an uncommon self-limiting condition of unknown etiology. The most commonly affected joint is the hip, followed by the knee, ankle, and the foot. Simultaneous involvement of both hips has been reported exclusively in pregnant women. Bilateral knee involvement during pregnancy seems to be extremely rare. We present a case of bilateral transient bone marrow knee edema during pregnancy with complete resolution of symptoms and radiological findings after 10 months.

Simultaneous dislocation of the radial head and distal radio-ulnar joint. A case report.

Isolated dislocation of the distal radio-ulnar joint and isolated dislocation of the radial head in adults are not common injuries. A simultaneous dislocation of the radial head and distal radio-ulnar joint with no other injury seems to be extremely rare since only one report was found in the English literature. A similar case, but with some differences in presentation and treatment is reported.

Maggot infestation (myiasis) of external fixation pin sites in diabetic patients.

Diabetic patients, and especially elderly patients in a low-nutritional or immunocompromised state, are prone to a variety of opportunistic infections. 'Myiasis' is a term that refers to non-iatrogenic infestation of tissues by larvae, commonly known as maggots, of dipterous flies. Myiasis as a complication of fracture treatment by means of external fixation of long bones has not been reported. We present three diabetic patients, who suffered maggot infestation of their external fixation pin holes, and their outcome. Diabetes, immobilization, poor hygiene and low immune status are predisposing factors for developing myiasis, an extremely rare complication for external fixation of fractures.

Multifocal infection after hip fracture fixation: a case report.

We present the case of a seventy five year old female diabetic patient, who sustained an inter-trochanteric fracture of her left hip and was treated by dynamic hip screw fixation on the same day. The patient developed multifocal infection with three different and unusual types of bacteria isolated in blood and wound cultures. In spite of aggressive and repeated wound debridement, infection and blood sugar levels were impossible to control until metal removal, which led to fracture malunion. The patient denied further hip reconstruction surgery and ended up mobilizing with a walker and a limp.Multifocal infection is possible even after a routine Orthopaedic procedure on a patient with precipitating factors no more than diabetes mellitus. It is important to be aware of the possibility of simultaneous wound infection and septicemia by different agents.

Are two screws enough for fixation of femoral neck fractures? A case series and review of the literature.

There is still a controversy in literature regarding the treatment of subcapital fractures of the hip with internal fixation. Different methods have been tested and studies such as in cadavers mainly prejudge the three cannulated screws application. We present a series of 20 patients in which percutaneous fixation with two parallel cannulated screws under specific technical conditions has led to an uneventful fracture union. No complications were observed at a one year follow-up. Reviewing the literature we found no previous clinical studies on the subject.

Ulnar nerve dislocation at the elbow: review of the literature and report of three cases.

Ulnar nerve instability without compression at the cubital tunnel is not common and even more rare is a dislocating nerve. We review the literature regarding the etiology of instability, its incidence and treatment. Snapping around the medial humeral epicondyle can also be caused by a subluxing medial head of the triceps. This pathology may be accompanied by symptoms from the ulnar nerve. Differential diagnosis even intraoperatively is therefore essential if effective treatment is to be given. We also present our own experience on the subject consisting of three cases, one of them with bilateral instability. In only one case there were clinical findings suggesting nerve compression. All laboratory and screening tests were normal, except for the nerve conduction studies in this one case. The main symptom was strong pain, especially during manual activities. Only two of the four subluxing nerves required surgical treatment which in our case was by anterior submuscular or subcutaneous transposition of the ulnar nerve. As diagnosis is not always easy and is usually made on clinical grounds, we also present a clinical test that we believe to be diagnostic for the situation.

Malunion of the ulnar styloid as a cause of ulnar wrist pain.

We present a case of ulnar wrist pain that had been wrongly attributed to non-union of the ulnar styloid. Surgical exploration revealed an ulnar styloid malunion that had caused pain by impinging on the triquetrum and a triangular fibrocartilage complex (TFC) lesion. There was no fracture of the distal radius and no associated carpal instability or disruption of the distal radio-ulnar joint. Treatment by resection of the ulnar styloid and re-attachment of the TFC provided a satisfactory outcome.

Non rheumatoid closed rupture of extensor carpi ulnaris tendon. Report of a case in a professional athlete.

A rare case of closed, non-rheumatoid rupture of the extensor carpi ulnaris tendon, that occurred in a professional tennis player, is presented. The authors describe the diagnostic problems and the treatment. They discuss the anatomical particularities of the area, the probable pathological mechanisms that lead to the lesion and the best ways of dealing with the problem.

Osteoblastoma of the carpal scaphoid frequency and treatment.

A rare case of osteoblastoma of the carpal scaphoid is presented. Review of the literature revealed two more cases that have been previously reported. The authors present the diagnostic difficulties and the treatment which was applied: proximal row carpectomy and tendon transfers for wrist stabilization. Treatment options, according to the literature, also include scaphoidectomy and tumor curettage with bone grafting.