Osteosarcoma of rib in a seven-year-old child: a case report.

Primary tumours of ribs are relatively uncommon in adults and are even rarer in children. (William in Am Surg June: 338-342, 1972; Eskenasy in Rev Roum Morph Embryol Physio 1:35-50, 1985) Osteosarcoma is the most common primary bone malignancy in children and young adults. (Whelan in Eur J Can 33(10):1611-1619, 1997) Very few cases of osteosacoma of the rib have been described in literature. We report a 7-year-old girl with primary osteosarcoma of the rib which was managed by wide excision followed by adjuvant chemotherapy. She is disease free after 12 months of follow-up. We believe our case to be the youngest with primary osteosarcoma of the rib. Primary osteosarcoma of the rib should be considered in the differential diagnosis in a child with rib swelling. Early diagnosis and treatment improves the outcome.

Tennis elbow--outcome following the Garden procedure: a retrospective study.

PURPOSE: From 1993 to 1999, 17 patients (18 elbows) underwent the Garden procedure for clinically diagnosed tennis elbow. Non-operative treatment was ineffective for these patients. METHODS: The study group consisted of 10 men and 7 women, with a mean age of 49.6 years. Follow-up duration ranged from 18 months to 6 years, with a mean of 37 months. Patients' pain, activity level, and hand grip strength were evaluated postoperatively. RESULTS: 14 (77.8%) elbows had an excellent or good result, 2 elbows had a fair result, and another 2 elbows had a poor result and required revision surgery. Most patients had immediate relief of elbow pain, returned to work early, and did not notice any weakness of hand grip strength or radial wrist extension. There were no significant complications. CONCLUSION: The Garden procedure produced good results for tennis elbow with minimal morbidity in an unselected group of patients. This retrospective study supports the view that the underlying lesion in tennis elbow is in the origin of extensor carpi radialis brevis.

Correlation between rotator cuff tears and repeated subacromial steroid injections: a case-controlled study.

INTRODUCTION: Concern exists regarding potential damage to the rotator cuff from repeated corticosteroid injections into the subacromial space. PATIENTS AND METHODS: In this retrospective, case-controlled study, 230 consecutive patients presenting to three orthopaedic units with subacromial impingement and investigated as an end-point with magnetic resonance imaging (MRI) of the shoulder were divided into groups having received less than three or three or more subacromial injections of corticosteroids. RESULTS: With no significant difference in age and sex distribution, analysis by MRI showed no significant difference between the two groups in the incidence of rotator cuff tear (P < 1.0). CONCLUSIONS: This suggests that corticosteroid use in patients with subacromial impingement should not be considered a causative factor in rotator cuff tears.

Septic hip after a fractured neck of femur in a rheumatoid patient: A case report.

A 63-year-old rheumatoid patient presented with severe pain in her left hip without a preceding history of trauma. An initial clinical and radiological examination revealed no "obvious" abnormality and the patient was symptomatically treated. The patient presented again five weeks later as weightbearing became increasingly difficult due to worsening pain. Inflammatory markers were found to be elevated and a repeat radiological examination revealed a displaced ununited fracture of the neck of femur. Isotope imaging suggested increased activity around the hip. A formal arthrotomy revealed pus in the joint. She continued to deteriorate and subsequently died due to sepsis. Spontaneous fractures without any history of trauma have been described in patients with rheumatoid arthritis. The fracture haematoma serves as a good culture medium for micro-organisms in immuno-compromised rheumatoid patients. Any hip pain arising in a rheumatoid patient should be thoroughly investigated and a high index of suspicion is necessary for both sepsis and fracture. (Hip International 2005; 15: 59-61).

Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur--13 year results of a prospective randomised study.

In this prospective randomised trial we compare the mortality, morbidity and functional results of patients following each of the three principal methods of treatment for displaced subcapital fractures of the femur. Two hundred and ninety patients over the age of 65 years were included and randomly allocated to undergo closed reduction and internal fixation with a sliding compression screw plate or uncemented Austin Moore hemiarthroplasty or cemented Howse II total hip arthroplasty (THA). Nineteen patients were subsequently excluded. The 13 year results show that there was no statistical difference in the mortality between the three groups (81, 85 and 91% respectively). Internal fixation and hemiarthroplasty groups fared poorly with a revision rate of 33 and 24%, respectively, compared with 6.75% in the THA group. The dislocation rate was 13% following hemiarthroplasty and 20% following THA. Average Harris hip scores were 62, 55 and 80, respectively, for the internal fixation, hemiarthroplasty and THA groups. In the long term, both internal fixation and hemiarthroplasty resulted in a poor outcome with respect to pain and mobility. Despite high early complications, THA resulted in least pain and most mobility both in the short and long-term and was encouraging with a revision rate of only 6.25%. THA should be seriously considered in physiologically active patients with a displaced subcapital fracture of the femur.