Proximal Tibiofibular Joint Ganglion Cyst: A Rare Cause of Calf Pain.

Intramuscular cysts are rare at the proximal calf. However, their etiology is varied, making accurate diagnosis and treatment really difficult. Ganglion cyst (GC) of the proximal tibiofibular (PTF) joint is a very rare entity with an estimated prevalence of 0.76%. Intramuscular extension of the GC arising from the PTF joint is an even rarer lesion, and only a few cases have been published in the literature. Hereby, we report an infrequent case of a GC arising from the PTF joint with a sizable pedicle and intramuscular (lateral head of gastrocnemius) extension to the posterolateral aspect of the right calf.

An Intrathoracic Meningocele in a Neurofibromatosis Type I Patient Mimicking Severe COVID-19 Disease.

Intrathoracic meningoceles (IM) are quite rare; they are commonly associated with neurofibromatosis type 1 (NF-1). We report a case of a 55-year-old lady who was admitted to our emergency department with a sore throat, mild fever, cough, and right-sided chest pain, and tested positive for coronavirus disease 2019 (COVID-19). Ιmaging revealed a meningocele in the right upper pulmonary area, attributed to her NF-1. Clinicians should be aware that patients with NF-1 can develop IM, and they should be included in the differential diagnosis of patients with an intrathoracic mass.

Characteristics, Management, and Outcomes of Inferior Scapula Angle Fractures: A Systematic Review of the Literature.

Fractures of the inferior angle of the scapula represent a rare entity, with few cases published in the literature to date. Their optimal management is still unclear. A systematic literature search was conducted in PubMed and Google Scholar of reports published between 1977 and 2022. Inclusion criteria were cases presenting inferior scapula angle fractures (ISAF) and reporting management and outcomes. Extracted data included patient demographics (age, sex), mechanism of injury, associated injuries, management, procedures performed, and outcomes. Seventeen studies (22 cases; 19 males and three females) were included. The mean age was 33 years (15 adult and seven pediatric cases). High energy injuries were the most common mechanism of injury (77%). Displacement of the fragment was reported in 64%. The most common initial treatment was conservative (77%); of these cases, more than half failed initial treatment (53%). Of the displaced ISAF cases, 89% failed conservative treatment, contrary to 83% of the nondisplaced cases that were successfully treated conservatively. Surgery yielded 100% success both as initial treatment and after failed conservative management. Displaced fractures should be approached surgically, while conservative management should be reserved for nondisplaced fractures.

Management and Outcomes of Bilateral Acetabular Fractures: A Critical Review of the Literature.

Background: Bilateral acetabular fractures constitute a rare entity, and their optimal management is unknown. Materials and Methods: A systematic literature search was conducted in PubMed, Embase and Cochrane Library between 1995 and 2020. Inclusion criteria were studies presenting cases of bilateral acetabular fractures and reporting outcomes. Extracted data included patient demographics, injury mechanism, fracture classification, associated injuries, management and outcomes. Results: Thirty-seven studies (47 cases; 35 males vs 12 females) were included. Mean age was 46 years old (range 13-84) and mean follow-up was 19.8 months (range 1.5-56). High-energy injuries (49%) and seizures (45%) were the most common injury mechanisms. Fracture type distribution differed according to injury mechanism. Treatment was surgical in 70% of cases (75% open reduction and internal fixation vs 25% acute total hip arthroplasty). Outcomes were excellent/good in 58% of patients. Complications included heterotopic ossification (11%), nerve injury (11%), degenerative arthritis (6%), DVT (6%), and infection (3%). Conclusions: Bilateral acetabular fractures most commonly occur either after trauma or seizures and are commonly managed operatively. They are not devoid of complications, however, more than half (58%) achieve complete functional recovery.

Late-Onset Hematoma Due to Bleeding of a Small Branch of the Lateral Circumflex Femoral Artery Following Proximal Femur Intramedullary Nailing.

Intramedullary nailing of proximal femur fracture is not deprived of complications, although vascular complications are very rare and a high index of suspicion is required for timely diagnosis. This case report describes how a late-onset hematoma formation and bleeding of a small branch of the lateral circumflex femoral artery can complicate intramedullary nailing after a pertrochanteric fracture. To the best of our knowledge, this complication has never been reported and should be considered among the possible vascular complications of intramedullary nailing. Orthopedic surgeons should be aware of the vascular complications that can occur even with late-onset presentation and even from small vessels, while administration of anticoagulants is an aggravating factor. Elderly patients with proximal femur fractures are more susceptible to vascular injury due to the structure of their vessels and the vicinity of the fracture to the arterial supply of the hip.

Tibia Tuberosity Fracture and Patellar Tendon Rupture Combination in a Pediatric Patient: Case Report and Narrative Review.

A combination of tibial tuberosity (TT) fracture (TTF) along with patellar tendon (PT) rupture (PTR) is rare. We report a 15-year-old male who presented to our ED with acute knee pain and an inability to actively extend the knee after jumping during a basketball game. Diagnosis of simultaneous PTR is crucial as it changes clinical management. It is, therefore, important to maintain a high index of suspicion for the combination of TTF and PT injury.

Sigmoid Sinus Thrombosis As Complication of Otitis Media in a 3-Year-Old Boy: Case Report and Review of the Literature.

Sigmoid sinus thrombosis is a relatively rare, but severe complication of acute otitis media and mastoiditis among other conditions. We report a case of a 3-year-old boy with a history of recurrent acute otitis media which was initially partially treated with antibiotics for 1 month before his admission to our department for high fever and headache. Although initially, no signs of central nervous system (CNS) involvement were present, clinical suspicion for CNS pathology led our whole work-up to conclude the diagnosis of sigmoid sinus thrombosis. The patient was subsequently treated with intravenous antibiotics, anticoagulation therapy and also underwent myringotomy, bilateral tympanostomy tube placement, and mastoidectomy. Cerebral sinus thrombosis is a life-threatening condition that usually complicates the neglected acute otitis media or mastoiditis. Optimal treatment includes antibiotic therapy, hydration, and pain management, with the debatable role of anticoagulation therapy and mastoidectomy.

Horizontal (Transverse) Intraarticular Metacarpal Head Fracture in a Young Adult.

Metacarpal head fractures are rare injuries that usually occur during trauma. These fractures are classified into 10 groups, with horizontal (transverse) being the rarest type of fractures. To our knowledge, very few cases have been reported in the literature to date. Here, we present the case of a 21-year-old male who sustained multiple ipsilateral hand injuries accompanied by a horizontal (transverse) fracture of the fourth metacarpal. He underwent open reduction and fixation with Kirschner wires followed by intensive rehabilitation. He finally regained complete active range of motion and grip strength three months after the operation. However, at nine months postoperatively, he developed avascular necrosis, which was asymptomatic and did not need any intervention. Therefore, it is important to maintain a high index of suspicion for possible complications and follow patients regularly, probably even for as long as 12 months after the initial injury.

A Smart Technique to Remove Ruptured Inflatable Bone Tamp From the Vertebral Body in Balloon Kyphoplasty.

Accidental rupture of the inflatable bone tamp is a rare but possible complication during balloon kyphoplasty. We describe an easy and minimal invasive technique to remove this foreign body from fractured vertebra. A 62-year-old female patient with severe osteoporosis had a low energy trauma and sustained burst fracture of the 12th thoracic (Th12) vertebra. The inflated bone tamp was not possible to be fully deflated and during the maneuvers to withdraw the balloon, it was disassembled and trapped under the distal end of working cannula, remaining within the bone cavity formed by balloon. Since no standard recommendation for this complication exists in current literature, we faced the dilemma of either leaving ruptured bone tamp in situ or removing it with a more extensive approach. We decided to use an alternative minimal invasive technique and managed to remove it through the right pedicle using a small size straight pituitary rongeur forceps under biplane continuous image intensifier and neuromonitoring. Subsequently, balloon kyphoplasty (BK) was performed through the left cannula accompanied with pedicle screw fixation of the adjacent vertebrae. The patient was followed up to our outpatient department for one year without complications. This extremely rare complication during BK consists of a challenge for spine surgeons and interventional radiologists. The described technique is relatively easy, safe, minimal invasive, time-saving and avoids further complications related with trapping of foreign bodies within the vertebral body.

Os Vesalianum Pedis in a Young Adult: A Case Report and Literature Review.

Os vesalianum pedis is a rare accessory foot ossicle. It is usually asymptomatic, however, it can be an infrequent cause of lateral foot pain. We present the case of a 19-year-old healthy male with lateral foot pain after an inversion-type injury. Initial X-rays were mistaken for fracture of the fifth metatarsal, however, a high index of suspicion for the presence of the os vesalianum led us to perform imaging of the contralateral foot; a mirror image with contralateral os vesalianum was revealed. The patient was treated conservatively and had an excellent outcome. In the context of trauma, os vesalianum must be differentiated from other causes of lateral foot pain, such as Iselin's disease, avulsion fracture of the fifth metatarsal, Jones fracture, and others. Os vesalianum pedis is characterized as a rounded ossicle, with smooth edges, surrounded by cortical bone. Prompt diagnosis is essential as it changes the management.

Simultaneous Combined Major Arterial and Lumbar Plexus Injury During Primary Extra Lateral Interbody Fusion: Case Report and Review of the Literature.

Extra lateral interbody fusion (XLIF) has been established in recent years as an effective approach to address degenerative lumbar disc disease (DLDD). Although neurological and vascular complications during XLIF have been reported, to our knowledge, a combination of simultaneous vascular and neurovascular complication during XLIF has not been reported to date. A 72-year-old female patient was admitted to our orthopaedic department because of back pain associated with severe neuropathic radicular pain to her both lower extremities, incomplete paraplegia and low back fistula with serous secretion for several weeks. She had been wheel-chair bound since nine years before her admission in our department when she had her initial XLIF operation in another institution. Intraoperatively, an aorta lesion occurred, which was emergently addressed, along with lumbar plexus injury. Since then, she had an extensive history of subsequent operations that ended with a T10-S1 posterior lumbar fusion, with no improvement of her neurological condition, complicated by hardware-induced infection. She underwent her last operation in our department; removal of the posterior lumbar construct and extensive debridement of the posterior lumbar spine. We present this rare case and we perform an extensive literature review. Although XLIF has been established in recent years, the report of major vascular injuries, although rare, has questioned its safety profile. Spine surgeons should be aware of catastrophic major neurovascular complications associated with this procedure and be prepared to address them.

Pubic Bone Aplasia as an Incidental Finding in the Adult Population: Case Report and Review of the Literature.

Pubic bone aplasia is a rare finding that is either diagnosed as incidental finding or associated with various clinical syndromes. It is usually discovered in early childhood, however, there are few reported cases of late discovery during adulthood. We present a case of a 64-year-old male with unilateral superior pubic rami aplasia, discovered incidentally during workup for sustained trauma. Our patient reported treatment for unilateral hip dislocation in his early childhood and had a history of operated undescended testes ipsilaterally. This exact constellation of pubic rami aplasia, undescended testes and hip dysplasia is unique in the available literature. Even though our patient had a normal life and the pubic aplasia was discovered incidentally, it is important to always assess these patients for systemic involvement, either from the musculoskeletal system or other organs, in order to provide better treatment for them.