Anomalous Extensor Digiti Minimi with Multiple Slips and Bulbous Appearance.

The extensor digiti minimi is a muscle in the posterior compartment of the forearm that extends the fifth digit. Variations of the extensor tendons of the hand are common and mostly asymptomatic, however, some may impinge and occupy the narrow dorsal compartments of the wrist causing dorsal wrist pain and impairment of digital movement. Orthopedic literature illustrates how frequent anomalies of the extensor indicis proprius, extensor digitorum brevis manus, and extensor medii proprius occur; however, minimal literature documents a bulbous, multi slip extensor digiti minimi. Within this case, a 30-year-old, right-handed woman with no prior hand trauma presented with recurrent snapping localized to her right fifth digit, causing intermittent pain and an audible "click". This study aims to provide a thorough anatomical description of a rare extensor digit minimi anomaly and a viable option to treat successfully an inflamed, symptomatic extensor retinaculum affecting the extensor digiti minimi.

Borrelia burgdorferi-A Bacterium Worthy of Consideration in Culture-Negative Prosthetic Joint Infection.

A 68-year-old woman presented to the orthopaedic office with 2 weeks of atraumatic right prosthetic knee pain and swelling. She previously lived pain free and fully functional after a total knee arthroplasty 8 years ago. Initial radiographs showed a small joint effusion, and serum inflammatory markers were elevated. Arthrocentesis yielded 12ccs of culture-negative cloudy serous fluid containing 3,270 white blood cells, 92% polymorphonuclear neutrophils. The patient underwent prosthesis explant, antibiotic spacer placement, and began empiric IV antibiotic therapy as stage one of a planned two-stage revision. Intraoperative tissue cultures were negative, and the postoperative plan was to continue IV vancomycin for a total of 6 weeks. Two weeks post-op, serum Lyme antibody testing returned positive. The patient was switched to doxycycline and ceftriaxone for a total duration of 4 weeks, followed by a successful second-stage revision and remains asymptomatic after 1 year. Five cases of culture-negative prosthetic joint infections caused by the spirochete, Borrelia burgdorferi, have been reported in the orthopaedic literature.1-4 We present a sixth case, occurring in a 68-year-old woman in Northwestern Pennsylvania, 8 years after a primary right total knee arthroplasty.

A Tillaux Fracture and Concurrent Nondisplaced Salter-Harris Type III Fracture of the Distal Fibula: A Case Report.

The Salter-Harris classification system categorizes pediatric fractures in relation to the physis. A Salter-Harris type III fracture occurs from the physis extending to the epiphysis. Tillaux fractures are a type of Salter-Harris type III fracture that occurs due to incomplete fusion of the growth plate and includes the anterolateral tibial epiphysis. This specific fracture is unique to adolescents due to the anterior tibiofibular ligament's strength in relation to the growth plate, causing avulsion of the tibial fragment. The settings for a Tillaux fracture and a Salter-Harris type III fracture are uncommon due to the mechanism of injury, and it is incredibly rare to have two separate fractures of these classifications in the same ankle. In this case study, a 16-year-old male presented to the emergency department after sustaining trauma to the right ankle via a skateboarding accident. Initial radiographs showed no evidence of acute fracture, and CT imaging was performed. CT scan of the right lower leg found a Tillaux fracture of the distal right tibia with a 2 mm displacement and a nondisplaced Salter-Harris type III distal fibula fracture. Closed reduction and percutaneous screw fixation of the distal tibia fracture were performed. The repair of this fracture was complicated due to the presence of two distinct fractures. This case study aims to provide a viable option to successfully repair this complex presentation as well as explain imaging findings that differentiate this fracture from other pathologies that are not managed operatively.

Primary repair of complete Achilles tear augmented with amnion allograft wrap in college basketball player with a history of contralateral Achilles rupture: a case report.

Background: The Achilles tendon is the thickest tendon in the human body and is responsible for plantar flexion with muscle contraction. It is able to withstand tensile loads as large as ten times the body's weight or greater at times of peak stress on the tendon. Due to the repetitive and massive stress inflicted on the Achilles tendon, it is prone to injuries, especially in running and jumping athletes. Ruptures typically present after unsustainable stress placed on the tendon from rapid contraction with classic presentation of a sudden "pop". These injuries tend to occur in middle-aged men after atypical physical exertion with complaints of immense pain in the posterior lower leg. Case Description: This case examines a 20-year-old athlete presenting to the emergency department after sustaining a left calf injury while playing basketball. The patient suffered a full-thickness tear of the Achilles tendon with retraction and subsequent anterior and posterior tibiofibular ligament deficiency. This presentation is unique as he has a past medical history of an Achilles tear in the contralateral limb. Conclusions: This study concluded that the bilateral Achilles tears in such a young patient were caused by anatomical blood supply watershed area to the Achilles tendon and anatomical ankle alignment abnormalities. This study provided a viable option to successfully repair complex Achilles tears via close reduction internal fixation (CRIF) with allograft matrix.