Traumatic iliac muscle hematoma: A rare etiology of quadriceps palsy (case report).

INTRODUCTION AND IMPORTANCE: Quadriceps palsy is a sign of femoral nerve injury. Classically it is a compression of the nerve by a haematoma of the iliopsoas muscle in haemophiliacs and patients on anticoagulants. Could this haematoma form after a trauma in a healthy athlete? CASE PRESENTATION: We report a case of 16-year-old kickboxer with no previous history who had been complaining of the left groin for 3 weeks after being struck in the left iliac fossa. The examination revealed a complete palsy of the left quadriceps with anesthesia of the anterior aspect of the thigh. Femoral nerve involvement was suspected. MRI of the pelvis revealed a large hematoma of the left iliac muscle compressing the femoral nerve. Blood tests did not show any abnormalities. Surgical evacuation of the hematoma with neurolysis of the femoral nerve was performed. Six months postoperatively, the patient had fully recovered from their neurological deficit and was able to return to all his normal activities. CLINICAL DISCUSSION: The post-traumatic etiology of iliopsoas muscle hematoma compressing the femoral nerve in the absence of any hematological cause is rare. Few cases have been published (39 in 75 years). According to the literature, treatment is conservative if the paralysis is partial, but it must be surgical in case of complete paralysis. CONCLUSION: This rare pathology of the adolescent must be known to avoid any prejudicial diagnostic error for the often athletic patient. Whatever the diagnostic delay, a surgical procedure is necessary in case of complete paralysis of the femoral nerve.

Chronic recurrent multifocal osteomyelitis of clavicle: a rare isolated location (a case report).

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare disease. It is a non-microbial inflammatory bone affection that occurs more often in children with insidious onset and non specific presentation making diagnosis challenging. This study reports a case of CRMO with an unusual location. A 9-year-old child had a painful swelling over the medial side of clavicle with fixed mass. Radiographs showed osteolytic lesion on the medial part of clavicle extending to the acromioclavicular joint with soft tissue edema in magnetic resonance imaging (MRI). No inflammatory markers in biological exam. Needle biopsy, initially performed, suspected bone infection but children didn´t recover after 2 weeks of antibiotics. Surgical biopsy, histology sections were compatible with CRMO diagnosis. Children received a non steroid inflammatory drug with positive response, pain relief and decreasing of the clavicle swelling. CRMO should be suspected and biopsy is some time helpful in such unusual location.

A knee stiffness unusual etiology.

Progressive unilateral knee stiffness is an uncommon complaint in older adult. Tumor and specific infection should be considered in addition to osteoarthritis. We report a case of intracapsular and paraarticular chondroma in the infrapatellar Hoffa's fat pad that presented as a painless limited knee in 64-year old man. A physical examination revealed a firm, movable mass in the infrapatellar area. Radiographs and Magnetic resonance images showed an ovoid, well-defined, soft tissue mass with focal calcification in the infrapatellar fat pad. The mass was completely resected surgically through a medial parapatellar approach. The final pathology revealed an intracapsular and paraarticular chondroma. At follow-up, 3 years after the operation, patient was pain-free, with complete recovery of the range of motion of the knee and without any clinical or radiographic evidence of recurrence. Intracapsular and paraarticular chondroma is a rare benign lesion of the large joints (mostly the knee). The Pathogenesis of these tumours is controversial. The diagnosis is made with correlation of clinical, radiological and histological features. The treatment of choice is surgical excision.