Surgical management of tibia refracture with a bent intramedullary nail: A case report and review of the literature.

Intramedullary nailing is the gold standard for long bone fractures in the lower limbs. Fractures of the tibia with bending of the intramedullary nail is a very uncommon complication. Removing a bent nail is an unpredictable and challenging procedure for any trauma surgeon. We report the case of a 34-year-old man presenting a refractured tibia with a bent intramedullary nail following a motor vehicle accident. We describe the management of this patient as well as a substantial review of the literature to depict the peculiarities of this entity compared to its more commonly reported femoral counterpart. When approaching a deformed tibia nail, standard extraction techniques should be attempted and are more likely to be successful than in deformed femoral nails.

Extraspinal osteoarticular tuberculosis: A diagnostic and therapeutic challenge.

Tuberculosis (TB) is a major cause of morbidity and mortality, representing a challenge for health-care providers worldwide. Extraspinal osteoarticular tuberculosis (ESOTB) represents a rare location of TB. We aim to describe ESOTB focusing on clinical, diagnostic, and therapeutic characteristics of this entity. We report a retrospective case series of patients diagnosed with ESOTB, treated, and followed up between 2015 and 2022. The diagnosis was based either on bacteriological results (culture and polymerase chain reaction [PCR]) or histological analysis. Five patients with confirmed ESOTB, three women and two men, with a mean age of 46.4 (16-72), were enrolled in study. The affected sites were the elbow (one case), the shoulder (one case), the greater trochanter (one case), the second metatarsal (one case), and the distal interphalangeal joint (one case). The mean delay to diagnosis was 5.8 months (3-10)]. The most common symptoms on presentation were pain (all cases), swelling (all cases), and limited joint range of motion (all cases). One case presented with a draining sinus (20%). Radiological findings were soft tissue swelling (two cases) and periarticular bone destruction (all cases). Four patients presented with pathognomonic histology. PCR was performed in two patients and was positive in both of them. All cases were cured after 9-12 months of oral TB treatment without relapse for the 12-18 months of follow-up. Only one patient underwent surgery for abscess drainage to gain local infection control. ESOTB is a mysterious condition that must not be overlooked and should be suspected in cases of long-standing bone and joint pain and swelling.

Sternoclavicular septic arthritis in a healthy adult: A case report and a review of the literature.

Sternoclavicular joint septic arthritis is rare and commonly associated with specific risk factors. We report the case of a 58-year-old female with no previous medical or surgical history who presented complaining of a warm, indurated mass overlying the right sternoclavicular joint. Computed tomography of the chest showed erosion of the sternal end of the clavicle and the manubrium sternum associated with thickening of the synovium and a sternoclavicular joint space narrowing, suggestive of an infective process. Intraoperative finds a purulent collection extending both over the clavicle and the sternum. Limited destruction of small parts of the sternoclavicular joint was noted. The abscess was drained. Simple debridement and limited curettage were preferred to en bloc resection given the limited size of necrotic tissues. Sternoclavicular joint septic arthritis is a condition with significant morbidity and potential mortality. All medical practitioners must maintain a high degree of suspicion, even in healthy patients, as it can lead to serious complications.