Septic arthritis caused by Mycobacterium marinum.

The incidence of infection by Mycobacterium marinum is rising, mainly due to the increasing popularity of home aquariums. The infection typically manifests as skin lesions, with septic arthritis being a rare presentation form. The disease is difficult to diagnose even when there is a high clinical suspicion, as culture in specific media may not yield positive findings. Thus, establishment of appropriate treatment is often delayed. Synovectomy, capsular thinning, and joint drainage together with prolonged, combined antibiotic therapy may be needed to cure the infection.

Fracture of the anteromedial tibial plateau associated with posterolateral complex injury: case study and literature review.

We report an unusual case of anteromedial tibial plateau compression fracture following hyperextension and forced varus of the knee, resulting in an anterior bone fragment large enough to require osteosynthesis. This uncommon lesion was associated with posterolateral complex injury, diagnosed with magnetic resonance imaging (MRI), while both cruciate ligaments were preserved. After proceeding with tibial plateau osteosynthesis, a peroneal tendon allograft was used for supplementation repair of the lateral collateral ligament and biceps tendon in a single surgical intervention. Tibial plateau fractures are often associated with soft-tissue involvement, mainly of the anterior cruciate ligament and external meniscus. Posterolateral complex injuries also occur with a mechanism of forced varus and hyperextension. These lesions require an accurate diagnosis to avoid future knee instability; moreover, adequate treatment in the acute phase provides a better functional outcome. Physicians should suspect associated posterolateral complex injury when an anteromedial tibial plateau fracture is diagnosed. MRI allows adequate diagnosis and permits surgical treatment in one procedure.

Simultaneous development of Dieterich disease and Freiberg disease.

Dieterich disease is an uncommon arthropathy of the hand, with few studies published. This lesion shares a similar etiopathogenesis with Freiberg disease, although the association of both conditions has only been described once. We report a 65-year-old man consulting for inflammatory pain in his right hand of 1 month's duration and also in his right foot of 4 months' duration. The rheumatology department was consulted to rule out systemic disease because the synovitis had occurred simultaneously in 2 different locations. The plain radiography and magnetic resonance imaging findings supported the diagnosis of Dieterich disease and Freiberg disease, although only increased uptake was found on scintigraphy in the affected zones. Few studies have been published about Dieterich disease, most in case report form. To our knowledge, only 1 study has described the association of Dieterich disease and Freiberg disease. Surgical treatment has been described when conservative management is unsuccessful, with multiple techniques used. The present case is the first in which Dieterich disease and Freiberg disease manifested simultaneously in the initial painful inflammatory phase.

Recurrent adjacent segment disease and cauda equina syndrome.

PURPOSE: A case of cauda equina lesion as a result of recurrent adjacent segment degeneration (ASD) after multiple lumbar fusions is reported. ASD might be a consequence of biomechanical overload or simply a normal degenerative process. The reported clinical relevance of ASD is rather low. We describe an unusual case of cauda equina compression at L1-L2 in a patient who had undergone L2-L4 fusion 8 years previously and 2 decompression-fusion surgeries 16 years before. MATERIALS AND METHODS: A 72-year-old man, who had two previous lumbar fusion-decompression procedures, underwent a third lumbar surgery in December 2000 to treat symptomatic spinal canal stenosis associated with L3-L4 pseudoarthrosis. After a symptom-free period of 8 years, the patient experienced low back pain radiating to both legs while standing, associated with saddle sensory disturbances and incontinence. Physical examination ruled out significant motor deficits. Plain radiographs showed solid fusion from L2 to L4, good spinal alignment, and low-grade L1-L2 retrolisthesis. Stainless steel pedicular instrumentation distorted magnetic resonance imaging, preventing adequate spinal canal evaluation. Electromyography demonstrated signs of cauda equina compression (bilateral L3-S2). CT myelography showed a stop at L1-L2, due to a severe spinal canal stenosis. L1-L2 decompression and fusion were performed. RESULTS: After an uneventful surgery with no complications, the symptoms abated and incontinence recovered. CONCLUSIONS: Even if the reported clinical relevance of ASD is very low, fused patients with a constitutional narrow spinal canal are at risk of developing severe neural compression at the level adjacent to the fusion.

Lateral subtalar dislocation associated with bimalleolar fracture: case report and literature review.

Subtalar dislocation is an uncommon injury that affects the talocalcaneal and talonavicular joints, with the tibiotalar and calcaneocuboid joints remaining intact. The 4 types of subtalar dislocation are medial, lateral, anterior, and posterior, although the latter 2 are rare. These injuries-especially lateral dislocation-occur as a result of high-energy trauma. Medial dislocation is the most common type, and lateral dislocation is associated with osteochondral fractures of the talus and calcaneus, as well as with open injuries; hence, its worse prognosis. We report the case of a 62-year-old woman diagnosed with lateral subtalar dislocation accompanied by an ipsilateral bimalleolar fracture after a fall downstairs. She underwent emergency reduction of the dislocation under sedation. Surgical treatment of the bimalleolar fracture was delayed 9 days to avoid cutaneous complications. This is the first report of a subtalar dislocation accompanied by a bimalleolar fracture.

Multicentric liposarcoma.

Liposarcoma is one of the most common malignant soft tissue tumours. It usually presents as a single mass, and the prognosis varies according to the degree of histological differentiation. Multicentric liposarcoma is an unusual presentation of this tumour in which several independent lesions develop and generally display an aggressive pattern. It may be difficult to establish a precise diagnosis because of the problems differentiating between recurrence or metastasis of a single liposarcoma and multicentric primary lesions. A systematic review was undertaken, assessing articles on multicentric liposarcoma, with emphasis on the diagnostic criteria and treatment for this condition. Illustrative cases of multicentric liposarcoma from our Institution are presented.

Avascular necrosis of the metacarpal head: Dieterich's disease.

A 68-year-old woman presented with an osteolytic image on the metacarpal head of the ring finger, first attributed to inflammatory or septic arthritis. She had experienced increasing pain three months before presentation, requiring orthopaedic treatment. At the time of clinical assessment, there was some limitation in the range of movement, accompanied by local pain and chronic swelling. Inflammatory arthritis was not confirmed on laboratory testing or scintigraphy. A diagnosis of Dieterich's disease was established based on the evolution of the condition, with chronic limitation of movement and no associated findings. Surgical treatment by arthroplasty was suggested, but was not accepted by the patient, given her satisfactory functional status.

Reduction in neural injury with earlier delivery in a mouse model of congenital myelomeningocele: laboratory investigation.

OBJECT: The authors undertook this study to assess the effect of preterm delivery with respect to neural protection in a congenital myelomeningocele (MMC) mouse model. METHODS: After confirmation of pregnancy in 15 female mice, a congenital MMC model was produced by administration of retinoic acid on the 7th day of gestation. The pregnant mice underwent cesarean sections on Days 15 (n = 5, Group E15), 17 (n = 5, Group E17), and 19 (n = 5, Group E19). Histological analyses were conducted on the lumbar defect and on the craniocervical junction in all fetuses with MMC. RESULTS: Fetuses in Group E19 showed the most significant injury to neural tissue of the spinal cord at the MMC area followed by those in Group E17, with Group E15 being the least affected. All groups exhibited a degree of Chiari malformation; Group E19 was the most affected, followed by Group E17, and Group E15 was the least affected. CONCLUSIONS: Development of both Chiari malformation and exposed spinal cord injury are progressive during gestation. Preterm delivery in this mouse model of congenital MMC may minimize the degree of injury to the spinal cord neural tissue and the degree of Chiari malformation.

Massive psoas haematoma causing lumbar plexus palsy: a case report.

An 84-year-old man who was receiving oral anticoagulation therapy presented with complete lumbar plexus palsy caused by a massive psoas haematoma. Conservative treatment rather than drainage of the haematoma was undertaken, because of the risk of bleeding complications and mortality. At the one-year follow-up, the patient had no clinical signs of neurological recovery. The patient died 2 months later due to his concurrent medical problems. A high degree of suspicion is needed for the diagnosis because of the insidiously developing neurological deficit.

Proximal tibiofibular dislocation associated with fracture of the tibia: a case report.

INTRODUCTION: We report a case of proximal tibiofibular dislocation associated with an ipsilateral tibial fracture, a rare association of injuries that can remain undiagnosed. CASE PRESENTATION: A white 23-year-old man experienced a road accident and was diagnosed with proximal tibiofibular dislocation associated with an open fracture of the tibia and injury to the external popliteus sciatic nerve. He was treated immediately with an intramedullary tibial nail and a cancellous screw at the level of the proximal tibiofibular articulation. CONCLUSION: In addition to this case and the surgical treatment, a review of the clinical cases described in the literature is provided, assessing the type of injury and the therapeutic options used, which depend mainly on the stage in which the condition is diagnosed.