Intra-articular osteoid osteoma in the femoral neck of an 18-year-old man: a case report.

OBJECTIVE: This case study presents the delayed diagnosis, surgical management, and postsurgical follow-up of an intra-articular osteoid osteoma of the left femoral neck in an 18-year-old male patient with special emphasis on discussing the confusing clinical and imaging characteristics of the lesion often associated with delayed diagnosis and increased morbidity. CLINICAL FEATURES: The patient initially complained of left knee and hip pain at which time conventional radiographs were reported as normal. In magnetic resonance imaging studies, the diagnosis of intra-articular osteoid osteoma of the femoral neck was suggested; however, working diagnoses also included old posttraumatic injury, hip infection, juvenile chronic arthritis, and posttraumatic arthritis. The correct diagnosis was made 31 months after presentation based on computed tomography depiction of the lesion. INTERVENTION AND OUTCOME: Pain associated with the tumor was alleviated after surgical removal with minimal loss of motion and muscle atrophy 19 months after tumor excision. CONCLUSION: Clinicians and radiologists should be aware of the potentially confusing clinical and imaging findings associated with intra-articular osteoid osteoma of the hip. Early correlation between juvenile joint pain and imaging abnormalities as well as the use of thin slice computed tomography imaging could reduce the time to diagnose the lesion and prevent unnecessary morbidity.

Rehabilitation after total femur replacement: a report of 2 cases.

We describe the rehabilitation of 2 patients who underwent total femur replacement after neoplastic involvement of the bone. In the past, patients with cancer of the femur were generally advised to undergo a hip disarticulation or transfemoral amputation. It is now feasible to salvage the limb in selected patients, by excising the entire femur together with any contiguous soft tissue tumor and replacing it with an endoprosthesis. The surgical literature contains a number of reports on total femur replacement, which mention the rehabilitation aspects only briefly, but we found nothing on this relatively uncommon form of surgery in the rehabilitation literature. Physiotherapy techniques such as active assisted exercises, isometric exercises, and hydrotherapy are extremely useful during the early phase of rehabilitation to facilitate a graduated strengthening program. Certain exercises, such as active hip abduction or knee flexion, may not be permitted for several weeks to protect muscles that have been reattached to the prosthesis. Partial weight bearing may be required to allow incorporation of bone allograft around the prosthetic hip joint. Because of these factors patients with total femur replacement may need a longer period of rehabilitation (6-8wk) than patients with total hip or knee replacement. Patients with total femur replacement can, however, achieve full independence with an appropriate rehabilitation program.

Unresolving hip tendonitis leads to discovery of malignant tumor.

OBJECTIVE: To discuss a case of malignant bone tumor in the left hip of a patient who sought treatment following a tennis injury. CLINICAL FEATURES: A 27-year-old male patient visited a chiropractic clinic 6 months after a twisting injury to his left hip which occurred while playing tennis. His pain had remained moderate in intensity and intermittent to frequent in frequency since it originated but became more intense the week prior to his visit. INTERVENTION AND OUTCOME: The patient was diagnosed with a tendonitis/bursitis and received 3 weeks of treatment. Care consisted of various forms of passive modalities to reduce pain and inflammation, as well as hip mobilization and tissue stretching. Plain film examination was then performed, due to lack of progress, and revealed a possible chondroblastoma of the femoral head. The patient was referred to his primary care physician (PCP) for follow-up imaging. Surgical resection of the lesion occurred approximately 2 months later. Biopsy of the resected cells confirmed a new diagnosis of clear cell chondrosarcoma. A computed tomography (CT) scan of the chest was performed to rule out metastasis to the lungs. Regular follow-up care and imaging continued and revealed, 9 months following, that the femoral head lesion had returned and hip replacement surgery would be needed. CONCLUSION: Tendonitis, bursitis, and sprains commonly occur following sports-related trauma to the appendicular skeleton. A conservative trial of care should be performed on suspected soft tissue injuries. However, when lack of improvement occurs within the first month, further examination, special studies, or referral are warranted to ensure a proper diagnosis and to rule out a pathological condition.

Childhood chondrosarcoma: MR imaging with gadolinium-DTPA.

The radiologic, CT, MR, and histological features of a case of chondrosarcoma of the femur presenting in childhood are reported. This case emphasizes the use of correlative imaging in establishing the diagnosis as well as the value of MR supplemented by Gadolinium-DTPA enhancement in disclosing abundant necrosis within the tumor.

[Oncogenic hypophosphatemic osteomalacia]. / Onkogene hypophosphatätmische Osteomalazie.

In the courses of six years a severe hypophosphataemic osteomalacia, painful motor impairment and multiple rib fractures developed in a 51-year-old man. The symptoms gradually improved within one year under treatment with 3 micrograms daily of 1,25-dihydroxycholecalciferol, 3 g phosphorus and 3 g calcium, and biochemical parameters and the bone scintigram became normal. Ultimately, computed tomography, scintigraphy and digital subtraction angiography revealed a highly vascularized tumour in the condylar aspect of the right femur, and it was chiselled out. Histologically it was a mesenchymal phosphaturic tumour of haemangiopericytoma type of questionable benignity. After the operation the patient was symptom-free for some weeks without any drug treatment, but the latter was then resumed because of renewed bone pain. By now, two years later, he is essentially without pain and has full mobility. However, repeat scintigraphy and angiography revealed renewed tumour growth in the right femoral condyle.

Maqua (therapeutic burn) as an indicator of underlying disease.

The origin and nature of the maqua (the Arabic therapeutic burn) is presented together with our clinical experience of patients previously treated by this traditional method. Maquas are small deep burns inflicted in areas either in proximity to a diseased organ or in points related traditionally to the original basic problem. These relationships may be rooted in historical ties between old Arab medicine and traditional Oriental, antique Egyptian, and Greco-Roman medicines. Maquas alone only rarely present a threat to the patient, but in many cases they may serve as an indicator of the original underlying disease. This and other folklore treatment modalities, together with the healers themselves, should be acknowledged by us, as markers for health problems or maybe for potential healing methods and doctor-patient relationships.