Deep Flexor Tendon Entrapment in a Diaphyseal Fracture of the Proximal Phalanx - A Case Report.

INTRODUCTION: The proximal phalanx fracture is a common fracture of the hand in pediatric ages. Most of these fractures can be treated conservatively with immobilization. There are only few cases reporting tendon entrapment in literature and most of them refer to epiphyseal fractures with only one case reporting tendon entrapment after diaphyseal fracture. CASE REPORT: A 15-year-old boy went to the emergency department after suffering trauma in his right hand caused by a fall. He complained of pain in his second finger of the right hand which was swollen. An imaging study was performed and a fracture of the proximal phalanx diaphysis of the second finger of the right hand was diagnosed. Due to deviation, reduction, syndactyly, and immobilization with Zimmer splint were performed. The control X-ray showed acceptable reduction and the patient was referred for follow-up at an outpatient consultation. During follow-up, the reduction was maintained and the conservative treatment was kept for 25 days, with apparent fracture healing. The patient presented active flexion limitation of the finger that was interpreted as a sequel of the immobilization and he was referred for physical therapy rehabilitation. Six weeks after the initial trauma, the patient was observed at the emergency department for new right-hand trauma. On examination, no active flexion of the third phalanx of the second finger of the right hand was noticed. The patient underwent an ultrasound that revealed deep flexor tendon entrapment at the fracture focus. A surgery was performed consisting in tenolysis and reconstruction of the pulleys using a portion of the long palmar tendon. The patient has good clinical evolution with almost complete recovery of mobility. CONCLUSION: This case illustrates an entrapment of deep flexor tendon after a diaphyseal fracture of the proximal phalanx, with only few cases reported in literature. The authors highlight the importance of having a high index of suspicion to detect this situation once it restrains the success of the conservative treatmentand makes the surgery mandatory to avoid definite sequels and disabilities.

Giant Cell Tumor with Fracture of the Proximal Radius - Reconstructive Surgery with Radius Allograft.

INTRODUCTION: Giant cell tumor (GCT) of bone is a locally aggressive benign neoplasm that accounts for 4-10% of all primary bone tumors. It affects mostly young adults and occurs more frequently at the bones around the knee followed by the distal radius and the sacrum. Surgical treatment with curettage is the optimal treatment for local tumor control, but it can be associated to suboptimal functional outcome when located in periarticular regions. CASE REPORT: We describe a 47-year-old Caucasian female who presented with pain in the proximal third of the left forearm without history of traumatism. The study performed revealed a pathological fracture of the proximal radius associated with lytic lesion. The patient underwent excision and curettage of the lesion with preservation of the periosteum, filling with the left proximal radius (corpse) allograft and osteosynthesis with plate and screws. The anatomopathological examination revealed characteristics compatible with GCT. CONCLUSION: This case presents some unique features: The extremely rare location of the GCT at the proximal end of the radius, its initial presentation as a pathological fracture, and the type of treatment performed (reconstruction with the left proximal radius allograft-corpse), with good results.

Non-union after Fracture of the Anterior Tibial Spine in a 6-Year-old Child: A Case Report.

INTRODUCTION: Fractures of the tibial spines occur in 3/100,000 children per year and are rare in children under 8 years. Non-union after avulsion fracture of the tibial spine is even rarer, especially under 8 years, with only few cases described in the literature. CASE PRESENTATION: A 6-year-old boy with went to the emergency department after suffering trauma in his left knee. In the performed X-ray, no osteoarticular injury was identified. Conservative treatment with immobilization with cast was performed. After removing the immobilization, the initial evolution was positive with no pain on mobilization. A few months later, he went again to the emergency department due to new left knee trauma. On examination, he had pain in the mobilization of the left knee, especially in knee extension which was not entire. Image study led to the diagnostic of avulsion fracture of the anterior tibial spines. The fracture was classified as modified Meyers and Mckeever Type II and conservative treatment with cast immobilization was performed. In the clinical and imaging revaluation done 4 weeks later, an evolution to non-union of the anterior tibial spine was noticed. At arthroscopy, non-union of tibial spines was confirmed, with elephant paw bone fragment with loss of its right to domicile. Open surgery was performed with debridement, cruentation, and fixation of the bone fragment to the tibia with a screw. The patient had favorable post-operative evolution with fracture consolidation, preserved mobility, no instability of the joint, and no limitation in daily and school activities. Four years after the initial surgery, a second procedure was performed for the removal of the screw. During 7 years of follow-up, no limitations or sequels were found. CONCLUSION: This case illustrates a very rare complication of the fracture of the tibial spine, the non-union, which is very rare under 8 years age. Besides, it highlights the importance of having a high index of suspicion to detect non-union after tibial spine fracture as long as timely treatment may be crucial to avoid definite sequels and disabilities.

Popliteal Artery Pseudoaneurysm after Closing Wedge High Tibial Osteotomy.

INTRODUCTION: High tibial osteotomy (HTO) is an adequate procedure for the treatment of medial unicompartmental knee arthritis in the varus knee. It is technically demanding and has a significant complication rate. Although rare, vascular injury is potentially the most serious complication. CASE REPORT: We present the case of a 50-year-old male who developed a popliteal artery pseudoaneurysm needing surgical intervention following closing wedge (CWHTO). The patient presented with worsening pain and progressive neurological symptoms. The osteotomy healed normally but the neurological symptoms showed only minor improvement over the 2-year follow-up period. CONCLUSIONS: Even with proper surgical technique, CWHTO presents a small inherent risk of injury to the popliteal neurovascular structures. Prompt recognition and treatment of this injury are of paramount importance for a good long-term outcome. Further studies are necessary to determine if open wedge HTO would be a safer surgical option.