Abstract: Aneurysmal bone cysts rarely affect the carpus. We present a case of aneurysmal bone cyst affecting the lunate. Curettage and bone grafting of the lesion was successful, with no recurrence after 2 years of follow-up.
Abstract: Stress fractures may be easily misdiagnosed as another entity, especially tumors, which may prompt very severe surgical treatment and sometimes amputation. The appropriate use of modern radiography may make the difference in proper diagnosis of stress fractures.
Abstract: Secondary chondrosarcoma is a distinctive type of tumor that originates from a preexisting cartilaginous lesion. Most commonly, it is associated with solitary or multiple osteochondromas. A fraction of cases arises from other conditions, such as Maffucci syndrome and Ollier disease. A sudden increase in the size of the cartilaginous cap of an osteochondroma is a sign of malignant transformation to secondary chondrosarcoma. However, there is no strict cutoff in terms of thickness of the cartilaginous cap that can be regarded as being pathognomonic of malignancy. Most cases of secondary chondrosarcoma are low to intermediate grade. Distant metastasis is uncommon, and the prognosis is good for most patients. Overall survival at 5 years is approximately 90%. Surgical resection with wide margins is the best treatment option, but local recurrence remains a significant problem in approximately 10% to 20% of patients. Patients with secondary chondrosarcoma of the pelvis are especially at risk for local recurrence.
Abstract: We present a case of delayed presentation of a subdural haematoma causing cauda equina syndrome which occurred 96 hours after a spinal anaesthetic had been administered for an elective total hip replacement in an 86-year-old man. The patient had received low-molecular-weight heparin anticoagulation which had been delayed until 12 hours postoperatively. No other cause of the haemorrhage could be identified.
Abstract: Malignant eccrine porocarcinoma is a rare tumor of sweat glands with a high local recurrence rate and a tendency to metastatic spread. We present a case of a 77-year-old male patient that presented with a recurrent, periungual porocarcinoma mimicking onychomycosis and ingrown toe nail that was successfully treated by surgical excision. To our knowledge no such case has been described in this location in the English literature.
Abstract: Septic arthritis of the adult hip is an uncommon condition, usually presenting in the setting of direct or local contamination next to a nearby abscess, or following acute septicemia. Local risk factors include preexisting inflammatory or non-inflammatory arthritis and aseptic necrosis. Septic arthritis in a hip that has been previously irradiated is very rare and to our knowledge has been reported only three times in the English literature. We present an 83 year old man with septic arthritis of the hip joint that appeared two months following irradiation of the same hip. This patient was treated successfully by surgical drainage and antibiotherapy. Radiation therapy seems to be a risk factor for septic arthritis and positive history of irradiation should raise its possibility.
Abstract: Anticoagulation and epidural catheters have always been a problematic issue. While being a very common application in orthopedic surgery, puncture of epidural vessels during catheter placement occurs during 3–12% of attempts1. Spinal hematoma causing neurological damage is rare but has devastating complications leading to irreversible paraplegia if immediate actions are not taken. In this concise review of literature, we try to provide you some information, that stands to be very useful in the practice of orthopedic surgery and to avoid the complication of spinal hematoma with the use of epidural catheters.
Abstract: To The Editor:
It is with great interest that I read the case report by Ryzewicz(1) et al. concerning post-operative arterial bleeding due to injury of a muscular branch of profonda femoris artery after fixation of an intertrochanteric hip fracture. Some addtional information would be helpful in assessing the factors that might have been associated with this complication.
The authors did not mention if this elderly patient was given any form of anticoagulation prior to or soon after the operation that might have contributed to the bleeding.
In our practice, we apply pre and intra-operative traction gently and with great care, especially in elderly patients with atherosclerosis.
The pre-operative history and physical examination should elicit whether there is claudication of the lower limbs or absence of distal pulses. The finding of arterial calcifications on pre-operative radiographs of the hip is very important and indicates poor elasticity of the vessels, rendering them more susceptible to injury(2) when traction is applied.
Notes: Letter to the editor to :
Vascular Injury During Fixation of an Intertrochanteric Hip Fracture in a Patient with Severe Atherosclerosis. A Case Report
J Bone Joint Surg Am 2006; 88: 2483-2486
Abstract: To The Editor:
I read with interest the case report by Sasaki et al.(1)concerning a patient with a diagnosis of anterior slip of the capital femoral epiphysis and I congratulate them for achieving an excellent surgical outcome.
However, I do not totally agree with the initial diagnosis. On the plain X-ray of the pelvis, the femoral neck-shaft angle on the affected side is less when compared to the controlateral hip. The computed tomography scan shows a sclerotic metaphysis in the region of the femoral neck, and a slight widening of the physis that does not seem of sufficient magnitude to be associated with a slip.
I would suggest an alternative diagnosis of primary or secondary femoral neck deformity ie. coxa vara, especially since the Hilgenreiner-epiphyseal angle is more than 25 degrees. A change of the loading characteristics from shear to compressive forces of the femoral neck could explain the slight widening of the physis.
Notes: Mikito Sasaki, Satoshi Nagoya, Mitsunori Kaya, and Toshihiko Yamashita
Anterior Slip of the Capital Femoral Epiphysis. A Case Report
J Bone Joint Surg Am 2007; 89: 855-858
Abstract: Background: Fulvestrant is shown to be an effective hormonal agent in menopausal hormone-receptor positive metastatic breast cancer (MBC) patients. This study aimed at showing if Ld of fulvestrant will improve its efficacy over the FDA approved Std schedule. Methods: We retrospectively reviewed our pharmacy electronic database over a period of two years to identify MBC patients who were treated with fulvestrant. Patients received either Std of 250 mg IM on day (d) 1 and repeated Q28d or Ld of 500 mg IM d1 and 15 and Std on d28 which was repeated every 28 days until evidence of progression. All medical records were reviewed and responses were recorded as improved disease (ID), stable disease (SD), or progressive (PD) as documented by the treating oncologist. Time to response (TTR) (the interval from first injection until response) as well the duration of response (DR), was determined. Results: Medical records of 157 consecutive, evaluable patients who received F for their MBC were identified and reviewed. Group 1 (Gp1) received std (N = 122) and Group 2 (Gp2) received loading dose (N = 35). There were no significant differences between the two groups in relation to age, pathology, grade, Her-2, ER and PR status or number of prior chemotherapy regimens (p > 0.05). Gp2 had statistically significant more prior hormone therapies (p = 0.0159). Median number of doses for Gp2 was 5 (R: 1-18) compared to 3 (R: 1-25) for Gp1 (p = 0.0169). Responses (ID) 14% for Gp1 and 18% for Gp2; clinical benefits (ID + SD) were 37.7% and 38%, respectively, NSS (p = 0.9550). TTR was 10 (R: 6-32) wks for Gp1 and 8 (R: 4-20) wks for Gp2; the DR was 15.5 (R: 4- 84) weeks for Gp1, and 12 (R: 2- 96) for Gp2. No statistical significance was detected between the 2 groups. Conclusions: This study showed there is no significant difference between the 2 dose schedules, either in the response rate or its duration. Prospective studies are needed to prove the equivalence of the Std and Ld of F.
