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.

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.

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.

Meniscal bucket handle tears: a retrospective study of arthroscopy and the relation to MRI.

In this study, we aim to evaluate the arthroscopic findings of meniscal bucket handle tears and to correlate them with the proposed MR imaging signs of meniscal bucket handle tears suggested in the literature. Thirty-six patients who had a diagnosis of bucket handle tear in arthroscopy, in either medial or lateral meniscus, were included in our study (32 males and 4 females). Meniscal tears were evaluated in arthroscopy according to Dandy's classification. The MRIs were retrospectively analyzed regarding the following findings: absence of bow tie sign, presence of double posterior cruciate ligament (PCL) sign, double anterior horn sign, flipped meniscus sign, disproportional posterior horn sign, and fragment within the intercondylar region. Locked types I and II fragment of medial meniscus and half-length, whole-width and whole length-half-width fragment of lateral meniscus in arthroscopy were basically correlated with fragment within the intercondylar notch and absent bow tie signs in MRI. We did not find the double PCL sign in any of the patients with a lateral meniscal bucket handle tear. The most common signs in MR images of meniscal bucket handle tears were the fragment in the notch sign and the absent bow tie sign. They were observed with equal frequency of 88.8%. The presence of double PCL sign, double anterior horn sign, flipped meniscus sign, disproportional posterior horn sign were less common (41.66, 33, 25, and 27.7%, respectively). We conclude that the presence of at least two of the six MRI signs should be regarded as highly suggestive for bucket handle tears of menisci.