The prevalence and risk factors for delayed union of the superior pubic ramus at one year after curved periacetabular osteotomy: its risk factor and outcome.

PURPOSE: Curved periacetabular osteotomy (CPO) has been developed for the treatment of acetabular dysplasia. While several studies have reported its good clinical results, the complications of CPO include delayed union and nonunion of the superior pubic ramus. The purpose of this study is to investigate the prevalence of delayed union of the pubis one year after CPO, and to determine the risk factors for this complication. METHODS: The study examined 113 hips that underwent CPO between 2008 and 2012. Delayed union was assessed based on the anteroposterior radiography one year after CPO. A superior pubic ramus union group (U group) and a delayed union group (D group) were retrospectively compared regarding patient characteristics, clinical evaluations, and radiographic parameters. RESULTS: Delayed union rate was 16.8%. The D group contained a significantly greater proportion of smokers (p < 0.001). The gap at the pubic osteotomy site on CT coronal images was significantly larger in the D group (p < 0.001), and the cut-off value for the risk of nonunion was larger than 5.1 mm. Multivariate regression analysis indicated that smoking (OR 10.7, 95% CI 2.1-55.4) and a gap at the superior pubic ramus >5.1 mm (OR 16.5, 95% CI 3.7-73.7) were significantly associated with delayed union as independent risk factors. CONCLUSION: The prevalence of delayed union one year after CPO was 16.8%. Smoking and a gap larger than 5.1 mm at the pubic osteotomy site are risk factors for delayed union after CPO.

Three-dimensional computed tomography analysis on bony birth canal after bilateral periacetabular osteotomy.

BACKGROUND: Curved periacetabular osteotomy (CPO) is one of the joint preserving procedures for developmental dysplasia of the hip. CPO requires osteotomy of the medial wall of the acetabulum, which may cause narrowing of the bony birth canal and this step may result in increased risk of cesarean delivery. We analyzed the narrowest part of the bony birth canal using three-dimensional computed tomography (3D-CT) before and after bilateral CPO. METHODS: Between February 2007 and March 2014, there were 29 cases of bilateral CPO in which both pre- and post-operative 3D-CT were available. Transverse diameters of the pelvic inlet, contraction, outlet, expansion, and teardrop were analyzed. Among them, the narrowest part of the bony birth canal was investigated, which being smaller than the normal lower threshold value for vaginal delivery (95 mm) was considered as a risk for cesarean delivery. RESULTS: The transverse diameters of both pelvic expansion and teardrop significantly decreased after CPO (both p < 0.01), while other diameters showed no significant changes. Among these two diameters, the narrowest diameter of the bony birth canal was the pelvic teardrop in all 29 cases. That in 24 patients (82.8%) was greater than 95 mm, while that in five patients (17.2%) showed less than 95 mm. CONCLUSIONS: Based on 3D-CT analysis, the narrowest part of the bony birth canal after bilateral CPO was the pelvic teardrop. In this study, 82.8% of the patients showed pelvic teardrop diameter greater than 95 mm, while that of the other patients (17.2%) were less than 95 mm.

Re-dislocation after revision total hip arthroplasty for recurrent dislocation: a multicentre study.

PURPOSE: Although most case of dislocations after total hip arthroplasty (THA) can be managed with conservative treatment, recurrent dislocation may require surgical intervention. This multicentre study was conducted to evaluate the re-dislocation rate after revision THA for recurrent dislocation, and to determine the risk factors for re-dislocation. METHODS: We retrospectively reviewed the 88 hips in 88 patients who underwent revision THA for recurrent dislocation at five institutions between 1995 and 2014. The mean patient age at surgery was 68.5 years and the mean follow-up period was 53.1 months. Multivariate logistic regression was performed to identify risk factors for re-dislocation. RESULTS: Sixteen hips in 16 patients (18.2 %) re-dislocated at a mean of 25.5 months (range, 1-83 months) after revision THA. Multivariate analysis identified osteonecrosis of the femoral head (odds ratio [OR] = 5.62 vs. osteoarthritis) and a femoral head size < 32 mm (OR = 3.86) as independent risk factors for re-dislocation. Eight hips required additional revision THA for re-dislocation. CONCLUSION: The re-dislocation rate after revision THA for recurrent dislocation remains high, suggesting the need for prevention measures. We recommend the use of a femoral head size ≥ 32 mm.

Polyethylene Wear Associated With 26- and 32-mm Heads in Total Hip Arthroplasty: A Multicenter, Prospective Study.

BACKGROUND: Although there were many clinical studies of highly cross-linked polyethylene (XLPE) wear among different femoral head diameters, few referred to thickness of XLPE in case larger femoral heads were used because smaller sockets were frequently used for Asian population. METHODS: This prospective study included 240 hips that underwent primary total hip arthroplasty using XLPE combined with 26-mm (group S) or 32-mm (group L) cobalt-chromium head with maximum follow-up of 10 years. We measured 3-dimensional (3-D) linear penetration rate of XLPE among same implant design groups except head diameter and estimated the validity of thinner XLPE. RESULTS: Our study demonstrated comparable 3-D linear penetration rates, which were 0.06 ± 0.07 mm/y for group S and 0.03 ± 0.02 mm/y for group L at 10 years after surgery and penetration rates seemed to be almost constant with no significant difference after 3 years. Minimum liner thickness (5.3 mm for 48-mm socket in combination with 32-mm femoral head) and the second thinnest XLPE (6.3 mm in case of socket from 50 mm to 54 mm combined with 32-mm femoral head) was distributed in 25% and 72% with group L, respectively, and there were no significant differences in penetration rates between 5.3-mm- and 6.3-mm-thickness groups. CONCLUSION: Our study suggested that whether to select 26- or 32-mm diameters of femoral head does not affect XLPE wear in combination with this type of articulation.

Usefulness of ultrasonography for detection of pseudotumors after metal-on-metal total hip arthroplasty.

We retrospectively analyzed 83 metal-on-metal total hip arthroplasties in 74 patients. Ultrasonography and magnetic resonance imaging (MRI) of each hip were performed to detect abnormal patterns and pseudotumors. We examined the reliability of ultrasonography for detecting pseudotumors in comparison with MRI. We also compared the acetabular component inclination between patients with and without pseudotumors. The mean positive and negative predictive values for pseudotumor detection by ultrasonography were 65% and 91%, respectively. The mean positive and negative likelihood ratios were 5.78 and 0.32, respectively. There was no clear association between pseudotumor presence and acetabular component inclination. We concluded that ultrasonography is a suitable technique to screen for the presence of pseudotumors. We also need to distinguish between bearing-related and taper junction corrosion-related complications.

The relationship between the lesion-to-ankle articular length ratio and clinical outcomes after bone marrow stimulation for small osteochondral lesions of the talus.

PURPOSE: The purpose of this study was to determine the relationship between the defect-to-ankle articular length ratio and clinical outcomes after arthroscopic bone marrow stimulation. METHODS: Seventeen male and 24 female patients (mean age 36.0 years, height 160.7 cm, weight 62.5 kg, body mass index 24.0) with an osteochondral lesion of the talus were treated with arthroscopic bone marrow stimulation and assessed using the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale, Berndt and Harty scales and clinical outcome criteria. The lengths of the tibial and talar articular surfaces were defined from the anterior tip to posterior tip of the articular cartilage on sagittal magnetic resonance imaging scans. The size of the defect area was defined and determined for each patient on magnetic resonance images using coronal length, sagittal length, and area. The relationship between clinical outcome and sagittal tibia ratio (sagittal length of defect/length of tibia articular cartilage) and sagittal talus ratio (sagittal length of defect/length of talus articular cartilage) were assessed. RESULTS: The mean lesion length was 11 mm (range 6-14 mm), lesion size was 67 mm(2) (range 19-134 mm(2)), sagittal tibia ratio was 0.42 (range 0.21-0.75), and sagittal talus ratio was 0.32 (range 0.16-0.58). The mean JSSF scale improved from 74 (range 18-90) to 89 (range 67-100) postoperatively. Lesion area was not associated with the JSSF scale (r = -0.10, P = 0.52). Talus articular length (r = 0.64, P < 0.0001) and tibia articular length (r = 0.64, P < 0.0001) were correlated with patient height. The sagittal talus ratio and sagittal tibia ratio were not associated with the JSSF scale (r = -0.10, P = 0.55; r = -0.02, P = 0.90). CONCLUSION: Arthroscopic bone marrow stimulation provides good clinical outcomes in small osteochondral lesions of the talus (<15 mm). For small lesions, the lesion size is not a prognostic factor. LEVEL OF EVIDENCE: IV: Retrospective Case Series.

Outcome of peri-acetabular osteotomy for hip dysplasia in teenagers.

PURPOSE: Peri-acetabular osteotomy, especially curved peri-acetabular osteotomy, is an effective surgical procedure for re-orientating the acetabulum. However, there have been few reports on this procedure in teenagers. The purpose of this study was to investigate the treatment outcomes of curved peri-acetabular osteotomy in teenagers. METHODS: We retrospectively reviewed 33 hips in 27 teenage patients with acetabular dysplasia who underwent curved peri-acetabular osteotomy between 1995 and 2012. The mean age was 17.0 years (range, 14-19 years). The mean follow-up duration at the most recent physical examination was 33.3 months (range, 24-96 months). All hips were evaluated in terms of the Harris hip score, radiographic measurements, and complications. RESULTS: The mean Harris hip score improved from 80.1 points pre-operatively to 95.4 points post-operatively (p < 0.001). There were significant differences in all of the radiographic measurements between the pre-operative and post-operative values (p < 0.001). One major complication occurred (symptomatic ischial nonunion) and required subsequent surgery. Nine hips had minor complications, including nonunion of the superior ramus osteotomy (four hips), superficial stitch abscess (two hips), and transient lateral femoral cutaneous nerve palsy (three hips). CONCLUSIONS: Satisfactory results can be obtained clinically and radiographically after curved peri-acetabular osteotomy in adolescents. Osteotomy for acetabular dysplasia is effective in teenagers.

Simultaneous use of lateral calcaneal ostectomy and subtalar arthroscopic debridement for residual pain after a calcaneal fracture.

Inadequate primary treatment of calcaneal fractures frequently results in persistent, residual pain. This can be caused by subtalar arthritis, an increased calcaneal width, and/or calcaneal fibular impingement of the peroneal tendons. Many patients experience multiple disorders simultaneously, requiring a combination of procedures to treat the injury. The purpose of the present study was to evaluate the clinical outcomes of arthroscopic debridement with lateral calcaneal ostectomy for residual pain after a calcaneal fracture. Four feet (4 patients) were treated with arthroscopic debridement and lateral calcaneal ostectomy. The patients were 3 males and 1 female, with a mean age of 55.3 ± 14.1 years. The mean follow-up duration was 33.5 ± 10.5 months postoperatively. Three patients received worker's compensation as a result of their condition. The patients were examined for improvement in pain levels using the numeric pain intensity scale and healing was assessed using the Japanese Society of Surgery of the Foot score. The mean Japanese Society of Surgery of the Foot score improved from 64.5 ± 13.8 preoperatively to 82.5 ± 7.1 postoperatively. The mean postoperative numeric pain intensity scale score was 2.3 ± 1.9. No complications, such as deep infection or problems with wound healing, were observed in any of the patients. The simultaneous use of arthroscopic subtalar debridement and lateral calcaneal ostectomy is a valuable intervention for the treatment of residual pain after a calcaneal fracture in patients who present with increased calcaneal width and mild or no degenerative changes in the subtalar joint.

Soft tissue perineurioma of the foot with 10q24 rearrangements: unique MRI features with histopathologic correlation.

Perineurioma is an uncommon benign peripheral nerve sheath tumor with advanced perineurial differentiation. Two distinct subtypes are recognized: intraneural and soft tissue. We herein present a unique case of soft tissue perineurioma in the right foot of a 43-year-old man. Radiographs showed a non-specific soft tissue mass. On computed tomography scan, the mass was iso- to slightly hypodense relative to muscle. On T1- and T2-weighted images, the mass exhibited iso- to slightly low signal intensity relative to muscle with foci of high signal intensity. Slight contrast enhancement was noted on enhanced T1-weighted images with fat suppression. A marginal excision of the tumor was performed and histopathologic examination confirmed the diagnosis of soft tissue perineurioma. The clinicopathologic, radiologic, and cytogenetic findings are described, and the relevant literature is reviewed.

Does the addition of computed tomography to computed radiography provide more value to final outcomes and treatment decisions in displaced intra-articular calcaneal fractures?

BACKGROUND: Little is known about the additional prognostic value of computed tomography (CT) in addition to computed radiography in displaced intra-articular calcaneal fractures. Thepresent study was undertaken to examine and compare the final radiographic outcomes and the prevalence of treatment methods of displaced intra-articular calcaneal fractures in patients with preoperative computed radiography alone vs. a combination ofcomputed radiography and computed tomogra- phy. MATERIAL AND METHOD: Thirty-four patients with 38 displaced intra-articular calcaneal fractures were divided into two groups: a group that was evaluated with computed tomography and computed radiography (17 patients; 20 fractures) and a group that was evaluated with computed radiography alone (17 patients; 18 fractures). Patient demographics, pre- operative and postoperative Bohler's angles, and fracture classifications were recorded. Postoperative outcomes were evaluated using calcanealfracture radiographic scores (modified Zwipp score). RESULTS: The mean age ofour patients in the present study was 43.3 ± 12.3 years. The mean age ofthe patients in the computed tomography group (48.4 ± 11.6 years) was significantly higher than that of the non-computed tomography group (37.6 ± 10.7 years, p = 0.005). The mean follow-up time was 17.4 ± 9.8 months. There was a significantly higher prevalence of open reduction and internalfixation in the computed tomography group versus the non-computed tomography group (p = 0.019). However there was no significant difference observed for the mean radiographic scores. Postoperatively, outcomes were satisfactory in both groups, although intra-articular alignment was significantly better in the computed tomography group (p = 0.020). CONCLUSION: The overall outcomes were comparable between the patient groups with computed tomography vs. those without computed tomography, exceptfor the superiority of postoperative intra-articular alignment in patients with computed tomography. Open reduction and internal fixation were more frequently performed in the patients with computed tomography than patients without computed tomography.

Critical three-dimensional factors affecting outcome in osteochondral lesion of the talus.

PURPOSE: This study aimed to investigate the relationship between clinical outcomes, patient demographics and the 3D-geometric profiles of the osteochondral lesion of the talus (OLT) following arthroscopic debridement and bone marrow stimulation. METHODS: Between 2005 and 2011, arthroscopic debridement and bone marrow stimulation were performed on 50 ankles with OLT mean age of 36.0 (19.1) years and mean follow-up time of 35.5 (20.2) months. Clinical data were assessed using validated Japanese Society of Surgery of the Foot scoring. An outcome was deemed unsatisfactory if the JSSF score was less than 80. Magnetic resonance imaging and X-rays were used to assess the 3D-geometric profiles of the OLT. RESULTS: The mean preoperative and postoperative scores were 73.4 (13.6) and 89.6 (11.5), respectively (p < 0.001). Unsatisfactory outcomes were identified in 12 % of patients. Linear regression analyses showed that lesion depth and patient age were significantly negatively correlated with postoperative scores (p < 0.001). High prognostic significances were attributed to defect depth and age of patient, and cut-off values of 7.8 mm and 80 years, respectively, were recommended to avoid a postoperative score less than 80. No significant correlations between poor clinical outcome and the other lesion profiles or demographic factors were identified. CONCLUSION: Using 3D-geometric and demographic profiles, defect depth and age of patient are essential prognostic factors in OLT and may act as a basis for preoperative surgical decisions. A lesion depth ≥ 7.8 mm and age ≥ 80 years predict an unsatisfactory outcome following arthroscopic debridement and bone marrow stimulation.

Assessing the safe direction of instruments during posterior ankle arthroscopy using an MRI model.

BACKGROUND: The safety of posterior ankle arthroscopy is still the subject of debate. The purpose of this study was to evaluate the anatomical relationship between the posterior portals and the neurovascular structures using magnetic resonance imaging (MRI) to determine the safety of posterior portals in posterior ankle arthroscopy. METHODS: Forty ankles from 38 patients who had undergone MRI scanning for ankle disorders were assessed (18 males, 20 females). For each ankle, the angles of the presumed position of the portals to the posterior neurovascular structures and the malleoli were measured on 4-mm proximal slices from the anterior tip of the fibula. The shortest distance from the sural nerve and the tibialis posterior neurovascular bundle to the position of the posterior portals was measured. RESULTS: The average distance between the posteromedial portal and the tibialis posterior neurovascular bundle was 18 ± 3 mm, whereas the average distance between the posterolateral portal and the sural nerve was 15 ± 3 mm. In 100% of ankles, there were no neurovascular structures lying within the region between the anterior tip of fibula and the posteromedial portal or between the posterior tip of fibula and the posteromedial portal. In 32 ankles (80%), the medial neurovascular structures were present on the medial side of the line running between the anterior tip of medial malleolus and the posteromedial portal. CONCLUSION: The posterior neurovascular structures were not in immediate proximity to where we estimated the posteromedial and posterolateral portals to be located. CLINICAL RELEVANCE: The findings of the present MRI-based study suggest that arthroscopic instruments oriented toward the fibula may be safely introduced into the posterior ankle without injuring the neurovascular structures.

Minimally invasive distal linear metatarsal osteotomy for correction of hallux valgus: a preliminary study of clinical outcome and analytical radiographic results via a mapping system.

PURPOSES: To date, actual results of a minimally invasive distal linear metatarsal osteotomy (DLMO) via more explicit radiographic delineation are poorly understood and radiographic findings and clinical results have not been systematically correlated. Purposes of this study were (1) to evaluate the effectiveness of DLMO using a precise radiographic mapping system; and (2) to determine the relationship between radiographic outcomes and clinical results. MATERIALS AND METHODS: In 2008-2011, DLMO was performed in 30 patients (36 feet) who had reducible symptomatic hallux valgus. Clinical data were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographs were reviewed at preoperative and final follow-up for delineations of first ray construct, hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle, and other radiographic profiles. Correlation between postoperative AOFAS score and degree of malalignment was also analyzed. RESULTS: A total of 36 feet had predominantly moderate hallux valgus (26 feet with HVA: 21-39°; 23 feet with IMA: 12-17°). Mean preoperative and postoperative AOFAS scores were 70.2 ± 11.3 and 95 ± 6.4, respectively (p < 0.001). Mapping system revealed improvements of first ray construct deformity (p < 0.05). Significant reductions in all angular measurements were observed at final follow-up period (p < 0.001) and correlated significantly with changes in AOFAS score (p < 0.001). Nine feet (25 %) were observed with recurrence of deformity which showed HVA >15°. Significant sesamoid lateralization was observed (p < 0.05). Twenty-four feet (66.7 %) showing overall sagittal malunions were found with significant plantar angulation (p = 0.026) and non-significant plantar displacement compared with preoperative reference (p = 0.43). These radiographic abnormalities were not related to clinical outcomes including postoperative AOFAS scores (p > 0.05). CONCLUSION: DLMO is an acceptable procedure to correct reducible hallux valgus in most patients with moderate level of severity. Sagittal malunion, recurrence, and sesamoid lateralization are possibly radiographic abnormalities but are not associated with clinical impairments.

Surgical treatment of an osteochondral lesion associated with stress fracture of the tarsal navicular: a case report.

We surgically treated an osteochondral lesion associated with a stress fracture of the tarsal navicular. The surgical procedure involved the confirmation and complete resection of the lesion under direct vision, followed by the transplantation of block-shaped iliac bone grafts. The postoperative computed tomography scan showed that the lesions had disappeared, the grafted bone had fused, and the stress fracture had healed. However, the tarsal navicular joint surface was slightly irregular. The patient was able to resume her sports activities 15 weeks after surgery. We have described a novel method to reconstruct the tarsal navicular after osteochondral lesion resection.

FDG PET/CT and MR imaging of intramuscular myxoma in the gluteus maximus.

Intramuscular myxoma is a rare benign soft tissue tumor which may be mistaken for other benign and low-grade malignant myxoid neoplasms. We present the case of a 63-year-old woman with an asymptomatic intramuscular myxoma discovered incidentally on a whole-body F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography. PET images showed a mild FDG uptake (maximum standardized uptake value, 1.78) in the left gluteus maximus. Subsequent magnetic resonance (MR) imaging revealed a well-defined ovoid mass with homogenous low signal intensity on T1-weighted sequences and markedly high signal intensity on T2-weighted sequences. Contrast-enhanced MR images showed heterogeneous enhancement throughout the mass. The diagnosis of intramuscular myxoma was confirmed on histopathology after surgical excision of the tumor. The patient had no local recurrence at one year follow-up. Our case suggests that intramuscular myxoma should be considered in the differential diagnosis of an oval-shaped intramuscular soft tissue mass with a mild FDG uptake.

The effect of screw position and number on the time to union of arthroscopic ankle arthrodesis.

PURPOSE: This study aimed to investigate the factors that influence the time to union after arthroscopic ankle arthrodesis. METHODS: From June 2005 to October 2010, 46 patients (50 ankles) underwent arthroscopic ankle arthrodesis with 6.0-mm cannulated cancellous screws. There were 22 men and 24 women (mean age, 63 years). Medical records and radiographs were retrospectively reviewed. Screw configurations used were as follows: 3 transmedial and translateral malleolar screws (ML3) in 12 ankles (24%), 2 transmedial and translateral malleolar screws (ML2) in 4 ankles (8%), 3 transmedial malleolar screws (M3) in 23 ankles (46%), and 2 transmedial malleolar screws (M2) in 11 ankles (22%). RESULTS: Radiographic fusion was achieved in 46 (92%) of the 50 ankles. The mean time to fusion was 11.0 ± 4.5 weeks for ML3, 13.1 ± 3.3 weeks for ML2, 9.7 ± 2.7 weeks for M3, and 12.5 ± 3.5 weeks for M2 (P < .05). The mean American Orthopaedic Foot & Ankle Society scores were 81.3 ± 2.2 for ML3, 83.5 ± 4.4 for ML2, 88.3 ± 1.5 for M3, and 85.3 ± 2.2 for M2. The mean time until radiographic fusion was 10.2 ± 3.4 weeks for correction angles of less than 10° and 13.2 ± 3.4 weeks for angles of 10° or greater (P < .01). In obese patients a significant difference in ankle fusion time was observed (12.6 ± 3.5 weeks for patients with body mass index ≥25 v 9.4 ± 2.9 weeks for patients with body mass index <25, P < .01). CONCLUSIONS: Overall, this study showed that arthroscopic ankle arthrodesis achieves a high rate of union, with fastest union achieved with 3 parallel screws placed medially from the distal tibia into the talus. Care should be taken when one is designing treatment strategies for obese patients and/or patients with large correction angles. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Arthroscopic removal of an intra-articular osteoid osteoma of the radial styloid.

We describe a case of intra-articular osteoid osteoma arising in the radial styloid of a 21-year-old man. Plain radiographs were not diagnostic, but computed tomography, gadolinium-enhanced magnetic resonance imaging, and bone scintigraphy suggested the possibility of an osteoid osteoma. We arthroscopically removed the lesion; histological examination confirmed the diagnosis. The patient's symptoms disappeared immediately after surgery.

Elastofibroma dorsi: diagnostic and therapeutic algorithm.

BACKGROUND: Elastofibroma typically occurs in the subscapular region of elderly individuals and has a high incidence in Kyushu and the surrounding islands in southern Japan. The treatment of this lesion is somewhat controversial. PATIENTS AND METHODS: Eleven patients with a diagnosis of elastofibroma dorsi were identified from the unit's database. The clinical presentation, diagnosis, and treatment options were evaluated. RESULTS: There were 6 men and 5 women, with a mean age of 66.7 years (range, 49-82 years). Bilateral lesions were found in 2 patients. The mean lesion size was 6.6 cm in greatest dimension (range, 5-9 cm). The mean follow-up of both surgically and conservatively managed patients was 16.4 months (range, 2-69 months). All were diagnosed by magnetic resonance imaging, and early in the series, 1 also underwent an open biopsy to confirm the diagnosis. Five patients underwent marginal excision of the lesion. No recurrence was observed at last follow-up. CONCLUSIONS: Magnetic resonance imaging can be used as a first-line investigation of the lesion, and biopsy is not necessary in most cases. We suggest that a conservative "wait-and-watch" attitude is reasonable and may be considered even when patients are symptomatic.

Subcutaneous rupture of the flexor hallucis longus tendon: a case report.

It is well known that rupture of the flexor hallucis longus tendon can be associated with open injuries and that closed rupture of the flexor hallucis longus tendon is rare. Tendon injuries of the foot can occur secondary to direct, indirect, or repetitive injury. Repetitive tendon injuries can cause tendinitis or stenosing tenosynovitis. Tendinitis is associated with internal tendon injury that can present with tendon thickening, mucinoid degeneration, nodule development, or in situ partial tears. Stenosing tenosynovitis is the development of tendon adhesions within the tendon sheath that interfere with tendon gliding, known as trigger toe. The flexor hallucis longus tendon is susceptible to injury along its entire course. A total of 35 cases of complete or partial closed ruptures of the flexor hallucis longus tendon have been reported. We present the case of complete subcutaneous rupture of the flexor hallucis longus tendon associated with trauma at the proximal phalangeal head.

Myxoid liposarcoma of the ankle: a case report.

Myxoid liposarcoma occurs predominantly in the deep soft tissues of the extremities, and tends to metastasize to a wide range of soft tissue or bone locations. We report a case of myxoid liposarcoma arising in the ankle of a 19-year-old man. A diagnosis of myxoid liposarcoma was made by open biopsy, and a wide resection requiring plastic surgical reconstruction was performed. Cytogenetic analysis of the resected tumor exhibited a reciprocal translocation t(12;16)(q13;p11) as the sole anomaly, which is found in more than 90% of myxoid liposarcoma cases. The patient had no evidence of local recurrence or metastasis within 7 years of follow-up. Although myxoid liposarcoma is rare in the ankle, it should be considered in the differential diagnosis of a painless soft tissue mass in this region.