Osteoid Osteoma of the Talus Mimicking Pigmented Villonodular Synovitis in a 15-Year-Old Male: A Case Report.

Osteoid osteoma is a benign tumor of the bone which tends to occur in diaphysis or metaphysis of the long bones. The lesion is generally intraosseous with vague clinical symptoms, hence given the name "great mimicker". When located subperiosteally and juxtaarticulary, atypical clinical presentation and radiological may lead to a delayed or missed diagnosis. Performing surgery with a misdiagnosis carries the risk of incomplete resection of the lesion and recurrence. We report the case of a 15-year-old male with a subperiosteal osteoid osteoma of the talus, who was misdiagnosed with pigmented villonodular synovitis and operated through anterior ankle arthrotomy. A nodular lesion 1 cm in diameter with hard rubber consistency was removed from the dorsal aspect of the talar neck. The pathological specimens were consistent with subperiosteal osteoid osteoma. The patient's symptoms resolved rapidly in the early postoperative period. The patient remained asymptomatic at the 20th-month follow-up and the control MRI revealed no signs of recurrence. Atypical radiological and clinical presentation of juxtaarticular subperiosteal osteoid osteomas cause misdiagnosis, delay in diagnosis, incomplete resection and recurrence. It is important to keep in mind "juxtaarticular subperiosteal osteoid osteoma" in the differential diagnosis of cases with suspected Pigmented Villonodular Synovitis.

Guided construction of single cell reference for human and mouse lung.

Accurate cell type identification is a key and rate-limiting step in single-cell data analysis. Single-cell references with comprehensive cell types, reproducible and functionally validated cell identities, and common nomenclatures are much needed by the research community for automated cell type annotation, data integration, and data sharing. Here, we develop a computational pipeline utilizing the LungMAP CellCards as a dictionary to consolidate single-cell transcriptomic datasets of 104 human lungs and 17 mouse lung samples to construct LungMAP single-cell reference (CellRef) for both normal human and mouse lungs. CellRefs define 48 human and 40 mouse lung cell types catalogued from diverse anatomic locations and developmental time points. We demonstrate the accuracy and stability of LungMAP CellRefs and their utility for automated cell type annotation of both normal and diseased lungs using multiple independent methods and testing data. We develop user-friendly web interfaces for easy access and maximal utilization of the LungMAP CellRefs.

Less malunion and shorter bone union time with titanium elastic nail treatment for isolated femoral shaft fractures in three- to six-year-old children.

PURPOSE: Titanium elastic nail (TEN) is a good option for femoral shaft fractures in school-age children, whereas a spica cast is favored for younger patients. We aimed to compare these treatment modalities in a group of children aged three to six years. METHODS: 34 patients aged 3-6 years with an isolated closed femoral shaft fracture treated with TEN or one-leg spica cast immobilization were retrospectively assessed. Age, gender, weight, mechanism of injury, hospital stay time, bone union time, radiographic shortening, malunion, and complications were compared between the treatment groups. RESULTS: 16 (47.1%) patients who were treated with TEN (Group T) and 18 (52.9%) patients with spica casting (Group S) were included with a mean of 51 (24-94) months follow-up. The mean age was 4.98 years and statistically similar between both groups (mean, 5.2 vs. 4.8 years; p = 0.234). The patients in Group T were heavier (mean, 19.3 vs. 17.2 kg; p < 0.001) and were more likely to have a higher-energy mechanism of injury (p = 0.006). The mean late femoral shortening of Group S patient's was 6.5 ± 3.5 mm and significantly higher than Group T, which was 2.0 ± 2.9 (p = 0.050). However, effective late femoral shortening rates were not statistically different between groups (p = 0.347). Malunion was seen in six (33.3%) patients in Group S, whereas none of the patients in Group T had malunion at the last follow-up examination and were statistically different (p = 0.011). CONCLUSION: Our study identified radiographic evidence favoring TEN over spica cast immobilization in treating preschool-age children with an isolated femoral shaft fracture in terms of malunion.

Entrapment of the brachial artery in the cancellous bone in pulseless supracondylar humerus fractures with well-perfused hands: Report of three cases.

Management of pediatric pulseless supracondylar humerus fractures is a point of continuous debate. In this article, we present three cases admitted to the emergency department with pulseless, but well-perfused hands. The fractures were reduced and fixed using the antecubital approach. Prior to reduction, the brachial arteries of all three patients were entrapped in the cancellous bone of the proximal fragment segment. The arteries could only be released after freeing the adventitia by carefully scraping the adjacent bone with the tip of a hemostat. One case required thrombectomy through an arteriotomy using No. 3 Fogarty catheter. In two cases, the pulse returned after a brief period of waiting with no need for vascular intervention. Proceeding with closed reduction, as proposed by the recent guidelines, would result in further damage to the entrapped vasculature, which may go unnoticed due to collateral circulation.

Minimally invasive plate osteosynthesis for short oblique diaphyseal tibia fractures: does fracture site affect the outcomes?

OBJECTIVE: To report the results of patients with short oblique diaphyseal tibia fractures treated with minimally invasive plate osteosynthesis (MIPO). The secondary aim was to understand the effect of fracture location (midshaft or distal 1/3) on outcomes. METHODS: Twenty-eight patients with short oblique (>30°) tibial shaft fractures (AO/OTA 42A2) treated with plate and MIPO technique between 2015 and 2019 were retrospectively assessed. Age, gender, follow-up time, fracture type (open or closed), operation time, postoperative infection rate, union time, ankle joint range of motion, and complications were analyzed. Patients' radiographs at a minimum 1-year follow-up were evaluated for malunion, nonunion, and implant-related complications. RESULTS: Mean age and follow-up time were 47.0 ± 15.7 years and 18.3 ± 12.1 months, respectively. Mean bone union time was 3.66 ± 1.04 months in middle 1/3 diaphysis and 4.23 ± 1.48 months in distal 1/3 tibia fractures. Seven (25%) patients developed superficial infections. Mean union time, malunion rate, coronal and sagittal angulation, operation length, and infection rate were similar between the groups. CONCLUSION: MIPO is an effective method for treatment of short oblique diaphyseal tibia fractures, and results in few complications. Both distal and midshaft fractures have similar union and malunion rates.