Pseudotumor - Cysticercosis of the Flexor Digitorum Profundus Mimicking Volkmanns Contracture.

Introduction: Cysticercosis leads to a cyst formation known to occur due to the Taenia solium parasite. Patients normally present with seeding and formation of the cysts in the central nervous system (CNS) as neurocysticercosis (NCC). Intramuscular cysts are rare presentations and are mostly incidental findings in NCC patients. We present a rare case of a rapidly progressing isolated cysticercosis of the flexor digitorum profundus (FDP) muscle leading to a pseudotumor and presenting with pseudo-Volkmanns contracture and a positive Volkmanns sign. Case Report: A 26-year-old right-hand dominant vegetarian female presented with a 3-month-old progressive swelling on her right forearm with no antecedent trauma history. A positive Volkmann's sign was present. Radiographs were normal, and ultrasonography showed a cysticercus cyst in the FDP muscle belly with a multiseptated abscess around the tendons of the middle, ring, and little fingers at the musculotendinous junction. Bones and nerves were spared. After ruling out CNS involvement and providing oral antiparasitic cover, she underwent a successful surgical exploration with cyst excision, debridement, and freeing of the involved tendons. Immediately post-operatively, she was able to completely extend the three involved fingers without flexion at the wrist joint (resolving Volkmann's sign). She reported significant improvements in the functions of daily life. She was protected with a splint for 2 weeks. There was no recurrence, and the swelling subsided. Histo-pathology reports depicted cysts with visible scolices. Conclusion: It is important to consider the possibility of 'Myoparasitism' in atraumatic cases showing contractures. Clinching the right diagnosis is essential and best done with a multidisciplinary approach with ultrasonography, magnetic resonance imaging, electromyography, and nerve conduction velocity studies. It is essential to rule out life-threatening NCC beforehand and offer prophylaxis. Surgical exploration is generally indicated to regain normal function and free the involved structures.

Does Intra-operative Fluoroscopy Significantly Improve Component Position in a Primary Total Hip Arthroplasty? Our Experience in a Tertiary Care Hospital.

Background: Optimal component placement, equalization of leg lengths, and recreation of offset are important surgical objectives during total hip arthroplasty (THA). Historically, many surgeons have aimed for the Lewinnek's " safe zone," which is defined as 30°-50° of abduction and 5°-25° of anteversion. Methods for optimizing cup position include anatomic landmarks, room landmarks, acetabular cup coverage, and ischial or pubis palpation. Malposition of the acetabular component after total hip arthroplasty (THA) is related to dislocation of the prosthetic femoral head, increased polyethylene liner wear, and limited range of motion. The orientation of the acetabular component comprises inclination and anteversion. Although the inclination of the acetabular component can be easily measured on plain radiographs, the calculation of the anteversion is difficult. This study evaluates the effect of intra-operative fluoroscopy on component position, mainly anteversion and inclination of the acetabular cup, during a total hip arthroplasty. Methods: 106 hips undergoing total hip arthroplasty were assessed, and the decision to use fluoroscopy assistance was randomized based on a simple randomization technique. A total of 48 patients were operated on with fluoroscopy assistance and 58 patients without fluoroscopy assistance. All patients were evaluated postoperatively for version of component on anteroposterior radiographs of the hip using the method of Liaw et al. and for inclination of component on anteroposterior radiographs using the method of Woo and Morrey. Results: The mean version for the non-fluoroscopy (NF) group was 15.62° and the mean inclination was 44.22°, with 15.5% (9 out of 58) of the patients who did not fit into Lewinnek's safe zone for version and 25.9% (15 out of 58) of the patients who were outliers for inclination of the acetabular cup position. The mean version for the fluoroscopy group (F) was 11.80° and the mean inclination was 47.05°, with 0% (0 out of 48) of the patients who did not fit into Lewinnek's safe zone for version and 12.5% (6 out of 48) of the patients who were outliers for inclination of the acetabular cup position. Conclusion: While the mean version and inclination of the acetabular component were comparable for both groups, outliers for version and inclination were far more common in the group of patients who underwent surgery without intra-operative fluoroscopic assistance. Therefore, intra-operative fluoroscopy imaging confirms appropriate inclination (abduction) and version of acetabular cup position according to Lewinnek's safe zone and prevents undesirable component position during a total hip arthroplasty while adding a maximum of 5 min to the operative time.

Surgical Repair of Traumatic Rupture of Tibialis Posterior Tendon in 32-Year-Old Male.

Introduction: This article reports a case of surgical repair of traumatic rupture of tibialis posterior (TP) tendon in a young healthy male after alleged history of grinder (heavy machine) injury over the foot, with the help of a suture anchor and running whip stitch followed by immobilization in a below knee slab postoperatively. The acute rupture of the TP tendon (TPT), compared to an acute rupture of the Achilles tendon, is a quite uncommon disease to be diagnosed in the emergency department setting. In most cases symptoms related to a TP dysfunction, like weakness, pain along the course of the tendon, swelling in the region of the medial malleolus, and the partial or complete loss of the medial arch with a flatfoot deformity precede the complete rupture of the tendon. Case Report: A 32-year-old healthy male presented to the outpatient clinic with a history of pain and swelling in the right foot for 10 months after alleged history of sustaining a grinder (heavy machine) injury to the medial aspect of the right foot 10 months ago. Anteroposterior and oblique radiographs of the right foot suggestive of no skeletal pathology and patient was managed conservatively with analgesic, anti-inflammatory, and compression bandaging. A magnetic resource imaging of the right foot was advised after no relief of symptoms and was suggestive of high-grade tear of the distal tibialis posterior tendon from the level of medial malleolus to its insertion. Surgical repair of the TPT was planned with a suture anchor placed in the navicular bone. The procedure was carried out under spinal anesthesia and there were no complications in the intraoperative or post-operative period. Patient was given a below knee slab with the foot in inversion postoperatively which was revised into a below knee cast with foot in inversion. Six-week post-operative follow-up, cast was removed and physiotherapy was started for the patient that included Active Ankle ROM and Gait Training, patient had a Modified Olerud and Molander Score of 45/100. Six-month post-operative follow-up, patient was relieved of chronic pain and was able walk and stand on his toes without pain and showed significant improvement in gait with Modified Olerud and Molander Score 90/100. Conclusion: The TPT is the main dynamic stabilizer of the medial longitudinal arch of the foot. With appropriate surgical technique, adequate post-operative immobilization followed by physiotherapy surgical repair of the TPT helped alleviate the chronic pain experienced by the patient during weight bearing activities.