The New Normal: Coronavirus Pandemic Response Utilizing Microsoft SharePoint.

On March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus disease (COVID-19) a pandemic. Hospitals throughout the USA and the residency programs housed therein have drastically altered their standard operations to slow the spread of disease. Maintaining the educational mission of a residency program within the parameters of social distancing mandates is an unprecedented challenge to graduate medical education and will remain so for the near future. We evaluated resident perception of our efforts to transition educational activities within the residency to an online, remote format utilizing Microsoft SharePoint. Educational conferences were transitioned to a videoconferencing platform on March 13, 2020 in conjunction with the deployment of an intradepartmental Microsoft SharePoint site to provide educational resources, disseminate scheduling changes, and provide wellness resources in response to the COVID-19 pandemic. An 11-question survey available from 4 Jan 2020-4 Jun 2020 surveyed resident perceptions of the instituted changes. Twenty-six of 31 residents (83.8%) responded to the resident survey invitation. Twenty-four of 26 residents (92.3%) characterized the SharePoint as useful. Twenty of 26 residents (76.9%) desired attending guidance as to how to utilize the online resources for each resident rotation. A total of 92.3% (24/26) of residents felt that the program's response utilizing SharePoint engendered a greater sense of belonging to their work community. Resident perception of the transition to online learning utilizing Microsoft SharePoint as a distribution platform was generally positive, helping to mitigate untoward educational consequences of the COVID-19 pandemic.

Erdheim-Chester disease: an unusual presentation of an uncommon disease.

Erdheim-Chester disease (ECD) is a rare, non-Langerhans cell histiocytosis with classic radiographic findings of patchy or diffuse osteosclerosis predominantly involving the long bones in a bilaterally symmetrical pattern. A 49-year-old woman presented with diffuse lymphadenopathy, painful skin lesions, and constitutional symptoms. Recent history was significant for a nontraumatic fracture of the tibia 3 weeks prior to admission. Physical examination and laboratory studies were notable for lower extremity pain and swelling, nodular lesions on the skin, and normocytic, normochromic anemia. Plain radiographs showed a lytic pattern of destruction with a superimposed fracture in the left proximal tibia. MRI showed focal bone marrow replacement extending from the subchondral bone to the tibial diaphysis. Excisional lymph node and skin biopsies of the lesions demonstrated a CD-68 positive, S-100 variable, and CD1a-negative histiocytic cell proliferation filling the dermis and completely replacing the sampled lymph node with an accompanying chronic inflammatory infiltrate and fibrosis, pathognomonic for ECD. We report an unusual case of ECD presenting initially as diffuse, painful lymphadenopathy, and subsequently demonstrating a lytic lesion of the tibia underlying a nontraumatic fracture.

A rare case of chondroblastoma involving the distal phalanx of the ring finger.

Chondroblastoma, a rare benign bone tumor, is typically found in the epiphysis of long bones, with hand involvement being particularly uncommon. We present a case of an 11-year-old female with chondroblastoma involving the fourth distal phalanx of the hand. Imaging revealed a lytic, expansile lesion with sclerotic margins and no soft tissue component. A preoperative differential diagnosis included intraosseous glomus tumor, epidermal inclusion cyst, enchondroma, and chronic infection. The patient underwent open surgical biopsy and curettage for both diagnostic and treatment purpose. The final histopathologic diagnosis was chondroblastoma.

Recurrent chondroblastoma of the acetabulum in an adult.

Chondroblastoma is a rare, benign neoplasm of chondroblast cell origin, accounting for less than 1% of primary bone tumors. It is usually diagnosed in the second decade of life with most of the cases involving the long bones such as the femur and humerus. Furthermore, over 90% of cases are in individuals under 30 years of age. In older adults, chondroblastomas are typically found in bones in the foot, such as the talus and calcaneus. Treatment is usually local curettage of the lesion with a relatively low rate of recurrence. In this case report, we present a patient with an atypical age of initial presentation at 49 years, a rare location of the chondroblastoma in the acetabulum, and a recurrence 14 years after surgical resection in the same location. The lesion's radiographic findings of intralesional calcifications alongside the high-signal, heterogeneous composition on T2-weighted MRI were supportive of the atypical diagnosis of chondroblastoma in this patient.

Unusual chondroblastoma of the hand with large extraosseous soft tissue component.

Chondroblastoma is a rare, benign primary cartilaginous bone tumor that typically arises in the epiphyses of the long bones. Radiologically, a well-defined lytic lesion with thin sclerotic margins is commonly found. The tumor is characterized histologically as an admixture of chondroblasts and multinucleated giant cells with chondroid matrix and pericellular calcifications. We present a case of a chondroblastoma of the hand with an unusual large extraosseous soft tissue component. The mass demonstrated diffuse calcifications and radiolucent lesions in the dorsal aspect of the hamate and metacarpals. Differential diagnoses included synovial chondromatosis, soft tissue chondroma, and tenosynovial giant cell tumor. The patient underwent open biopsy of the mass with plans for excision. Final histopathologic diagnosis was of chondroblastoma of the hamate with a large soft tissue component. A marginal excision of the lesion with curettage and cementation was performed.

Venous tumor thrombus from a pelvic osteosarcoma.

We present a case of pelvic osteosarcoma in an 18-year-old woman with a tumor thrombus in the left iliac vein, extending to the inferior vena cava. Tumor thrombus has been rarely described with osteosarcoma, with only 14 cases in the literature.

Superficial acral fibromyxoma.

We present a case of a superficial acral fibromyxoma (SAFM) of the distal aspect of the thumb with radiographic evidence of extrinsic pressure erosion of the underlying cortex. This 47-year-old woman presented with a slow-growing mass over the distal aspect of the right thumb that proved to be SAFM on surgical pathology. This is a relatively rare mesenchymal neoplasm of the periungual and subungual regions of fingers and toes.

Bilateral triceps tendon tear.

Triceps tendon tear is one of the least commonly recognized major tendon tears. Bilateral triceps tendon tears are especially rare. We present a case of simultaneous complete tears of bilateral triceps tendons secondary to a fall. The anatomy, etiology, image findings, and current literature are discussed.

Coracoid fracture with recurrent AC joint separation after Tightrope repair of AC joint dislocation.

We present a case of failure of acromioclavicular joint (ACJ) reduction that was performed with low-profile, double-metallic button technique (Tightrope; Arthrex Inc). The patient presented with coracoid fracture and loss of reduction within eight weeks of surgery.