A case of symptomatic non-union of the clavicle occurred in a 12-year-old boy. Differential diagnosis roentgenographic and histologic observations, including the results of resection of the non-union site and stablization of the proximal clavicle using the coraco-acromial ligament demonstrated that this rare condition can be restored to full asymptomatic function without any internal metallic fixation devices.

Child↗

PubMedDate not supplied

Chondrosarcoma of the hand arising from a pre-existent benign solitary enchondroma.

Chondrosarcomas of the hand are relatively rare. Chondrosarcomas may arise by malignant transformation of a pre-existing enchondroma, but this causal relationship has been difficult to establish in solitary enchondroma. This is a case report of a chondrosarcoma of the proximal phalanx of the right index finger in a 66-year-old woman demonstrating histologic evidence of malignant transformation of a pre-existent benign solitaary enchondroma. Careful analysis of the preoperative X-ray for punctate endosteal calcification or cortical expansion and ample histologic sampling of the endosteal component of chondrosarcomas arising from within bone may demonstrate a greater incidence of preexistent enchondroma.

Aged↗

PubMedDate not supplied

Femoral neck stress fractures and metabolic bone disease.

OBJECTIVE: To determine whether metabolic bone disease plays a role in the cause of femoral neck stress fractures. STUDY DESIGN: Twenty-three patients with femoral neck stress fractures were enrolled prospectively in the study. Examination included computed tomography bone densitometry, trace mineral analysis, and histomorphometric analysis of the iliac crest in thirteen patients who underwent surgical treatment of their stress fractures. A control group of fifteen patients undergoing iliac crest bone grafting for scaphoid nonunions underwent similar examinations. SETTING: Tertiary military medical center. RESULTS: Patients with femoral neck stress fractures had lower bone mineral density than did control patients (p = 0.010), but no trace mineral deficiencies or consistent histomorphometric differences were noted. CONCLUSIONS: Bone mineral density is decreased in patients with femoral neck stress fractures. Despite observations of decreased bone mineral density in the stress fracture group, osteoporosis, as determined by histomorphometry, is not a consistent finding.

Absorptiometry, Photon↗

PubMedDate not supplied

Enchondroma versus chondrosarcoma in the appendicular skeleton: differentiating features.

Distinction of enchondroma versus intramedullary chondrosarcoma affecting the appendicular skeleton (proximal to the metacarpals and metatarsals) is a frequent diagnostic dilemma. The authors studied a large series of patients with these lesions (92 with enchondromas, 95 with chondrosarcomas) using statistical assessment of both clinical parameters and numerous radiologic manifestations on images from multiple modalities to identify differentiating features. Multiple clinical and imaging parameters demonstrated statistically significant differences between enchondroma and chondrosarcoma, particularly pain related to the lesion, deep endosteal scalloping (greater than two-thirds of cortical thickness), cortical destruction and soft-tissue mass (at computed tomography or magnetic resonance imaging), periosteal reaction (at radiography), and marked uptake of radionuclide (greater than the anterior iliac crest) at bone scintigraphy. All of these features strongly suggested the diagnosis of chondrosarcoma. These criteria allow distinction of appendicular enchondroma and chondrosarcoma in at least 90% of cases.

Adult↗

PubMedDate not supplied

Rectus femoris muscle tear appearing as a pseudotumor.

Quadriceps muscle strains are common sporting injuries, but occasionally a tear of the rectus femoris muscle can appear as a soft tissue mass of the anterior thigh with or without a significant history of trauma. Between 1992 and 1996, seven patients were referred to the Orthopaedic Oncology Unit at Walter Reed Army Medical Center with an unexplained soft tissue mass of the thigh. Three were active duty soldiers, three were military dependents, and one was a retired serviceman. All patients were men, and the mean age was 32 years (range, 15 to 73). A palpable, mildly tender mass was confirmed on clinical examination. Laboratory studies and plain radiographs were normal. Magnetic resonance imaging showed an obvious, but often ill-defined, lesion at the musculotendinous junction of the rectus femoris muscle. Four patients subsequently underwent a tissue biopsy to rule out a soft tissue sarcoma. Histologic studies showed fibrosis, degeneration of muscle fibers, and chronic inflammatory cells with no evidence of malignancy. A chronic rectus femoris muscle tear can mimic a soft tissue tumor or sarcoma and needs to be excluded in the differential diagnosis. These tears may occur acutely or may represent an overuse injury caused by repeated microtrauma. Careful history taking, physical examination, and selective radiographic studies, specifically magnetic resonance imaging, can confirm the diagnosis of muscle tear and full functional recovery can be anticipated.

Adolescent↗

PubMedDate not supplied

Cortisone induced bone changes and its response to lipid clearing agents.

Thirty-two rabbits were used experimentally to study the effect of cortisone in bone, lungs, kidneys, and liver. Cortisone does induce abnormal increases in the serum cholesterol, fatty metamorphosis of the liver and the fatty emboli of the subchondral vessels of the femoral heads. Clofibrate therapy appeared to modify the cortisone induced changes as evidenced by a lower serum cholesterol level, prevention or lessening of the increase in the marrow fat cell size. This might significantly improve microcirculation of the femoral head.

Animals↗