Reversible vasospasm in association with the use of heparin and dihydroergotamine.

A case of reversible vasospasm is reported in a 54-year-old man with a closed bimalleolar ankle fracture. On admission the patient had normal distal pulses and laboratory studies. He was a heavy smoker who continued to smoke in the hospital. Deep venous thrombosis (DVT) prophylaxis included dihydroergotamine and heparin (DHE-H). In the early postoperative period, marked spasm of all three arteries developed on the operative side. Smoking privileges and DHE-H were discontinued. The vasospasm resolved after intraarterial nitroglycerin. This case suggests an infrequent but potentially limb-threatening complication of DHE-H.

Magnetic resonance imaging of an osteoid osteoma of the proximal femur: a potentially confusing appearance.

Osteoid osteomas are common benign pediatric bone tumors. However, radiographic diagnosis and location of the tumor nidus can be difficult. We recently diagnosed and treated an osteoid osteoma of the right proximal femur in a 9-year-old girl in whom the preoperative magnetic resonance images demonstrated a well-marginated lesion in the medullary canal but no tumor nidus. This was confusing and misleading. Correct diagnosis was made with a computed tomography (CT) scan. Care must be taken in interpretation of magnetic resonance imaging (MRI) in disorders in which secondary bone marrow changes occur to avoid erroneous diagnoses and possible incorrect operative procedures.

Pediatric update #11. Congenital radioulnar synostosis. A new technique for derotational osteotomy.

Hyperpronation deformity due to congenital radioulnar synostosis has previously been managed by derotational osteotomy through the synostosis, while stabilization has been achieved with K-wires and a long arm cast. The technique presented here uses a small external fixation device that allows precise rotational correction and affords adequate stabilization yet avoids cast immobilization.

Bilateral fractures through "giant" patellar tendon ossicles: a late sequela of Osgood-Schlatter disease.

Osgood-Schlatter disease is a common condition which affects many adolescents. It is generally a self-limiting process with a finite clinical course and late sequelae are notably uncommon. In this paper we present a unique case of bilateral fractures through "giant" patellar tendon ossicles in an adult with a history of Osgood-Schlatter disease.

Post-traumatic arthrosis of the index carpometacarpal joint. A rationale for treatment and report of two cases.

Although a relatively rare entity, post-traumatic arthrosis of the carpometacarpal joint of the index finger can be a disabling problem. Its diagnosis must be differentiated from other sources of local pathology. A rationale to the diagnosis and treatment of this entity is presented, demonstrating the usefulness of test injections of xylocaine, an intra-articular injection of a steroid preparation when a relatively congruous joint exists, and arthrodesis of the joint when an incongruous joint is encountered.