Cavernous hemangioma of the forearm muscles: Three case reports and literature review.

Introduction: Hemangiomas are common benign vascular tumors. Intramuscular hemangioma is a very rare type of hemangioma occurring in the skeletal muscle. The lower limb muscles are more likely to be affected. The location within the muscles of the forearm is extremely rare. Case Report: We present three cases of intramuscular hemangioma of the upper limb. Magnetic resonance imaging (MRI) revealed a vascular tumor within the pronator teres muscle in two cases and the extensor pollicis brevis muscle in the other. The tumors were surgically excised, and histopathologic examination confirmed the diagnosis of intramuscular cavernous hemangioma. The limb function was good and there was no recurrence at 12-month follow-up in the three cases. Conclusion: Intramuscular hemangiomas of the forearm are a condition that should be evoked by orthopedic surgeons in front of pain and swelling of this region. MRI is the most effective imaging method to suspect the diagnosis.

Solitary plasmocytoma of the thoracic spine: A case report.

INTRODUCTION AND IMPORTANCE: Solitary spinal plasmacytoma (SSP) is an uncommon neoplasm originating from bone marrow plasma cells. Although infrequent in the thoracic region, it has the potential to induce substantial damage. In this study, we present the case of a patient with thoracic spine SSP treated through surgical intervention. CASE PRESENTATION: We report the case of a 38-year-old female who presented with progressive mid-back pain, numbness, weakness in both lower limbs and gait disturbance. Imaging showed an osteolytic lesion with vertebral collapse of T11. MRI was strongly suggestive of solitary plasmocytoma. Hematologic tests were normal. Surgery was carried out. At the first stage, a posterior approach with laminectomy and fixation were performed. Biopsy of tumor cells confirmed the diagnosis of SSP. At the second stage, a trans-thoracic approach was performed, the tumor was resected in a single block and anterior interbody fusion was done. After the surgery the patient fully recovered from the paraparesis and at two years follow up no recurrence of tumor cells was detected. CLINICAL DISCUSSION: Spinal malignant bone tumors are rare, with solitary plasmacytoma being the most common. Diagnosis of SSP is based on bone biopsy findings. MRI and CT scans assess tumor extent and spinal stability. Prognosis relates to the likelihood of progressing into multiple myeloma. Though radiotherapy is common, surgery offers local control, especially for instability and neurological issues. CONCLUSION: SSP in the thoracic spine is a rare condition that requires a multidisciplinary approach and a prompt treatment.

Tunnel enlargement after anterior cruciate ligament reconstruction surgery.

INTRODUCTION: Tunnel enlargement following anterior cruciate ligament (ACL) reconstruction has been frequently reported since the nineties, yet its etiologies remain unclear. AIM: To elucidate the factors favoring this phenomenon and to investigate its clinical and anatomical consequences. METHODS: This was a descriptive retrospective study conducted on 37 patients who underwent ACL reconstruction surgery using single-bundle hamstring tendons with fixation using absorbable interference screws at the Traumatology Department of the Kassab National Institute of Orthopedics. The patients were collected between January 2014 and September 2016. Tunnel enlargement, footprint, and tunnel orientation were assessed using standard knee radiographs. At follow-up, patients were evaluated using functional scores (Lysholm, Tegner, and IKDC), clinical examination, and Telos radiographs. RESULTS: The average global Tunnel enlargement was 51.7% in the femur and 48.88% in the tibia. Femoral tunnel enlargement values were higher than tibial tunnel enlargement at all measurement levels, and it appeared to be a time-evolving phenomenon. Factors favoring tunnel enlargement seemed to include advanced age, male gender, delayed surgery, accelerated rehabilitation protocols, non-compliant placement of transplant footprints, and tunnel horizontalization. Tunnel enlargement did not influence functional scores (Lysholm, Tegner, and IKDC). However, based on the differential study of Telos radiographs, femoral and tibial tunnel enlargement in the lax knees group (38% of cases) was higher than in the stable knees group (62%). Nonetheless, our results were statistically non-significant with respective p-values of 0.584 and 0.53. CONCLUSION: Several modifiable factors such as delayed surgery, accelerated rehabilitation protocols, incorrect footprint placement, and tunnel orientation appeared to influence the tunnel enlargement phenomenon. However, prospective studies with a larger sample would be necessary to confirm these findings.

About a rare cause of calf pain in an athlete: the popliteal artery entrapment syndrome (a case report).

Claudication of the young patient is a very rare symptom for orthopaedic surgeons and it is often overlooked. We report a rare case of popliteal artery entrapment syndrome (PAES), discovered during a vascular claudication following post-traumatic anterior instability of the knee. The diagnosis was confirmed by CT angiography which showed a PAES, with a pathway in the inter-condylar notch. The patient had a releasing of the trapped vessel by myomectomy, with disappearance of vascular symptoms six months later. Through this case, we wanted to draw the attention of orthopaedic surgeons to the fact that the PAES can be asymptomatic. Its symptomatology can be triggered by a traumatic instability of the knee. Its presence represents a risk of lesion of the popliteal artery during arthroscopic ACL reconstruction. Therefore, it is important to think about this disease if a calf pain occurring after a ligament injury of the knee.

An unusual cause of shoulder pain: osteochondroma of ventral scapula (a case report).

Osteochondromas mainly affect the metaphysis of long bones such as femur, humerus, and tibia. It is unusual in flat bones such as scapula. Osteochondroma of ventral surface of scapula is one of the rare cause of shoulder pain and difficult to diagnose in first place. We report the case of an 18-year old girl, presenting progressive right shoulder pain for two years. Physical examination showed an imbalance of the shoulders, a winging of the right scapula, and a snapping of the shoulder on mobilization. Radiographic evaluation showed a pedunculated bony structure extruding from the scapula. Computed tomography (CT) scanner and magnetic resonance imaging (MRI) revealed a bony exostosis along the medial border on the ventral surface of the right scapula. The patient had an excision of the exostosis. Histologic examination confirmed that the specimen was an osteochondroma with no signs of malignant transformation. The shoulder was immobilized for two weeks. The patient has regained full function of her shoulder, six weeks postoperatively.