A Rare Case of Patella Fracture in Osteopetrosis: A Case Report.

CASE: Fractures in patients with osteopetrosis pose unique technical challenges to the orthopaedic surgeon. We present a case of a 43-year-old man with osteopetrosis who underwent tension band wiring of a patella fracture. The intraoperative appearance of osteopetrotic bone, technical difficulties in passing wires through dense bone, and how this was overcome are presented. CONCLUSIONS: A simple transverse fracture of the patella in a patient with osteopetrosis can be fixed successfully using a standard tension band construct.

An unusual case of "locking" of the knee four years post fixation of an open supracondylar femur fracture.

UNLABELLED: The introduction of locking plate devices have increased the number of viable options for fracture fixation. An understanding of the indications and contraindications and technique limitations are important to minimise associated adverse events. We report the case of a patient who presented with a single broken screw head four years following fixation of a supracondylar femur fracture, resulting in symptoms of migratory knee pain and locking. He underwent implant and foreign body removal and made an unremarkable recovery postoperatively. With the increasing use of locking plate devices, we are likely to see more such complications. KEY WORDS: bone plates, bone screws, fractures.

The Anatomic Pattern of Injuries in Acute Inversion Ankle Sprains: A Magnetic Resonance Imaging Study.

BACKGROUND: There are little data on the incidence and patterns of injuries seen on magnetic resonance imaging (MRI) in acute inversion ankle sprains. This study may help in the understanding of the pathomechanics, natural history, and outcomes of this common injury. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: From June 2011 to June 2013, a total of 64 consecutive patients had MRI of the ankle performed for acute inversion injury to the ankle. All injuries/pathologies reported were recorded. RESULTS: Only 22% of patients had isolated lateral ligament complex injuries. Twenty-two percent of patients had other pathologies but no lateral ligament injury, and 53% had lateral ligament injuries in combination with other pathologies or injuries. The most common associated finding with lateral ligament injuries was bone bruising (76%) followed by deltoid ligament injury (50%). The overall incidence of bone bruising was 50%. Thirty percent of ankles had tendon pathology, 27% had deltoid ligament injury, and 22% had occult fractures. CONCLUSION: Isolated lateral ligament ankle injury is not as common as is believed. The pattern of injury seems complex, and most patients appear to have more injuries than expected. MRI reveals additional information that may have significance in terms of diagnosis, treatment, and prognosis in this common injury.

A systematic review of brain metabolite changes, measured with 1H magnetic resonance spectroscopy, in healthy aging.

BACKGROUND: (1)H MR spectroscopy (MRS) can identify metabolite abnormalities in age-related, neurological diseases. However, there is little information on how metabolites change with healthy aging. METHODS: We systematically reviewed the literature on MRS, from 1980 to 2006, for studies where healthy young subjects (<60 years) were compared to healthy older subjects (>60 years). We extracted metabolite data reported as "no change", "increase" or "decrease" for each metabolite by brain region and, where data were available, meta-analysed mean metabolite concentrations (mM) for young versus old subjects. RESULTS: Eighteen studies met the inclusion criteria (total n=703 subjects, 284 >60 years old). Most data came from the frontal region, and reported "no change" in older subjects; however, a meta-analysis revealed a decrease in frontal NAA (p=0.05) and increases in parietal choline (p=0.003) and creatine (p<0.001). DISCUSSION: These data suggest that NAA may decrease and choline and creatine increase with age. Therefore, more data are needed from older subjects to characterise age effects better and ratios in older subjects should be interpreted with caution.

A colonic submucosal lipoma presenting with recurrent intestinal obstruction attacks.

Colonic submucosal lipomas are rare benign tumours of the colon, which may be discovered incidentally at colonoscopy, through imaging such as CT or at autopsy. These tumours can cause complications such as bleeding, intussusception and bowel obstruction. We describe the case of a patient in whom a small submucosal lipoma was identified at the time of colonoscopy and who did not receive follow-up treatment. The patient presented 1 year later with intussusception and obstruction resulting from this polyp and required urgent surgery. With the increasing use of colonoscopy and CT, such lesions are likely to be discovered more often. As complications can ensue, guidelines should be developed to advise on the management of such polyps in order to prevent consequent complications.