ABSTRACT
Marjolin's squamous cell carcinoma (SCC) affecting the toe is rare. Due to resemblance with benign conditions it can often result in misdiagnosis. We report a case of Marjolin's SCC affecting the proximal hallux in a patient with recurrent ingrown toenail infections. A 58-year-old woman with a background of wedge resections for ingrown toenail and distal phalanx amputation for osteomyelitis presented with pain and hyperkeratotic raised ulcer around the proximal phalanx. MRI scan revealed soft tissue mass infiltrating the proximal phalanx with biopsies confirming a SCC. The patient underwent first ray amputation and made a good clinical recovery and remains disease free. Due to clinical similarities with benign conditions, awareness of Marjolin's SCC as a potential diagnosis when treating patients with recurrent ingrown toenail is imperative. We recommend patients with recurrent ingrown toenail or ulceration with a background of chronic infection have biopsies performed to exclude potential malignancy.
Subject(s)
Carcinoma, Squamous Cell/diagnosis , Hallux , Nails, Ingrown , Skin Neoplasms/diagnosis , Tinea Pedis , Amputation, Surgical , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Skin Neoplasms/diagnostic imaging , Skin Neoplasms/pathology , Skin Neoplasms/surgeryABSTRACT
Protrusio acetabuli is an uncommon complication of total hip arthroplasty, which results in intrapelvic implant migration after erosion of medial acetabular wall. We present a case of severe prosthetic migration with the formation of haematoma and impingement on iliac vessels leading to thrombosis and subsequent pulmonary embolus. This is the first reported case of protrusio acetabuli as a cause of pulmonary embolus.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Foreign-Body Migration/complications , Hip Prosthesis/adverse effects , Pelvis , Pulmonary Embolism/etiology , Acetabulum , Aged , Constriction, Pathologic/diagnostic imaging , Constriction, Pathologic/etiology , Female , Foreign-Body Migration/diagnostic imaging , Humans , Iliac Artery , Iliac Vein , Multimodal Imaging , Prosthesis Failure/adverse effects , Pulmonary Embolism/diagnostic imaging , Reoperation , Tomography, X-Ray Computed , UltrasonographyABSTRACT
Stress fractures occurring within the lower limbs are relatively common in athletes and military personnel. The specific bones affected are often predictable when the patient's activities are considered. We present an unusual case of bilateral distal tibial stress fractures sustained while playing as a goalkeeper in field hockey, in an otherwise healthy 46-year-old woman.
Subject(s)
Fractures, Stress/diagnostic imaging , Hockey/injuries , Tibial Fractures/diagnostic imaging , Female , Fractures, Stress/pathology , Humans , Magnetic Resonance Imaging , Middle Aged , Prognosis , Radiography , Tibial Fractures/pathologyABSTRACT
Transstyloid, transscaphoid, transcapitate fractures are uncommon. We report the case of a 28-year-old man who sustained this fracture following direct trauma. The patient was successfully treated by open reduction internal fixation of the scaphoid and proximal capitate fragment, with a good clinical outcome at 1-year follow-up. This pattern is a new variant of scaphocapitate fracture as involves a fracture of the radial styloid as well.
Subject(s)
Capitate Bone/injuries , Fractures, Bone/surgery , Scaphoid Bone/injuries , Adult , Fracture Fixation, Internal , Fractures, Bone/diagnostic imaging , Humans , Male , RadiographyABSTRACT
Bisphosphonate use has been identified as a contributory factor in atypical subtrochanteric fracture of the femur. These fractures are commonly treated with an intramedullary device. We present a case of implant failure of an intrameduallary device caused by non-union of an atypical subtrochanteric fracture.
Subject(s)
Alendronate/adverse effects , Bone Density Conservation Agents/adverse effects , Femoral Fractures/surgery , Fracture Fixation, Intramedullary , Hip Fractures/surgery , Prosthesis Failure/etiology , Device Removal , Female , Femoral Fractures/diagnostic imaging , Hip Fractures/diagnostic imaging , Humans , Middle Aged , Radiography , ReoperationABSTRACT
We report a case of a 73-year-old lady with transitional cell carcinoma and no evidence of metastatic disease presenting with gradual weight loss, pretibial swelling and painful weightbearing. Investigations revealed a lesion of the right tibial diaphysis. The radiological and clinical appearance was that of primary osteosarcoma. Biopsy results revealed metastatic transitional cell carcinoma of the tibia. Intramedullary nailing was performed which relieved pain on weightbearing. The patient declined radiotherapy and was started on a palliative care regimen. This case illustrates the importance of histological diagnosis in the treatment of diaphyseal lesions.
Subject(s)
Bone Neoplasms/secondary , Carcinoma, Transitional Cell/secondary , Osteosarcoma/diagnostic imaging , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/surgery , Aged , Biopsy, Needle , Bone Neoplasms/diagnosis , Bone Neoplasms/surgery , Carcinoma, Transitional Cell/surgery , Diagnosis, Differential , Female , Fracture Fixation, Intramedullary/methods , Humans , Immunohistochemistry , Magnetic Resonance Imaging/methods , Osteosarcoma/diagnosis , Positron-Emission Tomography/methods , Radiography , Risk Assessment , Tibia/diagnostic imaging , Tibia/pathology , Tibia/surgery , Treatment OutcomeABSTRACT
We present a 23-year-old man who sustained an isolated fracture of the lateral process of the talus (LPT) in a head-on vehicle collision at a combined speed of 200 km/h. The driver of the other vehicle sustained fatal injuries at the scene. The LPT was openly reduced and fixed with successful outcome at 3 months. This case is unusual in the method of injury, in particular in relation to the isolated relatively minor injury sustained.
Subject(s)
Accidents, Traffic , Fractures, Bone , Talus/injuries , Fractures, Bone/diagnostic imaging , Fractures, Bone/surgery , Humans , Male , Radiography , Talus/diagnostic imaging , Talus/surgery , Young AdultABSTRACT
We compared five classification systems for clavicle fractures. The aim of this study was to evaluate the prognostic value of each system. Over a two-year period we reviewed all new radiographs of the shoulder region and identified 487 clavicle fractures. Each radiograph was classified using five classification systems. We reviewed all subsequent X-rays and clinical records until the patient was discharged. We assessed each classification system's prognostic value in predicting delayed/non-union. Our data show that 79.3% of clavicle fractures occur in the middle third, 19.3% in the lateral third and 1.4% in the medial third. The overall prevalence of delayed/non-union was 7.3%, with 3.2% requiring operative management and 4.1% developing asymptomatic non-union. The incidence of non-union in the lateral third was 9.6%, but only 0.4% required operative management. Craig's classification had the greatest prognostic value for lateral third fractures, and Robinson's classification had the greatest prognostic value for middle third fractures. Fractures of the clavicle are common injuries but non-union is an uncommon occurrence. Non-union is more common in the lateral third, but we found these to be mostly asymptomatic. Middle third fractures are more likely to require operative fixation. Middle third fractures should be classified according to Robinson's classification system and lateral third fractures according to Craig's classification. We did not assess sufficient medial third fractures for the data to be significant.