Radiological case of the month. Severe chronic hemophilic synovitis resulting in epiphyseal overgrowth.
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Biomedical subjects
Publications and source records attributed to H Horoszowski.
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Percutaneous lateral discectomy (PLD) in a 32-year-old man was followed by postoperative disc space infection and adjacent vertebral osteomyelitis caused by Staphylococcus aureus. The simplicity and decreased morbidity associated with PLD may be offset by severe infections. The small incision made in the annulus during PLD may not allow adequate drainage in the case of infection and may subsequently direct the infective process to the adjacent vertebral endplates. Meticulous aseptic technique, and possibly the use of prophylactic antibiotic therapy, is important in PLD.
Pillars of calcification are rarely found in the skin. An interesting case is described where rows of new bone developed in the skin which had been grafted 31 years previously to cover partial skin thickness burns of the shin. The problems of heterotropic ossification are discussed.
The vast majority of bleeding episodes in hemophilia occur in the musculoskeletal system. When bleeding occurs, within a closed compartment, the possibility of neurovascular compromise must be suspected. We present an interesting case where this danger was overlooked in a young hemophiliac boy and resulted in bone growth retardation and permanent deformity.
A patient with Salmonella group D (Salmonella enteritidis) acute osteomyelitis of an operated femur is described. The patient failed to respond to chloramphenicol therapy and aztreonam therapy. The local infection that complicated the presence of a foreign body was eradicated only with the removal of the foreign body, an internal fixation plate.
An adult patient with isolated septic arthritis of the sternoclavicular joint (SCJ) caused by Staphylococcus aureus is described. The patient had no underlying diseases other than paronychia, which might have served as the portal of entry. Antibiotic therapy resulted in clinical cure but x-ray revealed progression of the destructive process.
An asthenic 30-year-old dentist presented at the orthopaedic clinic complaining of pain in both hip joints. There was no history of systemic disease, and all of the results of serologic and hematologic investigations were within normal limits. Clinical examination revealed a limitation of hip movement, and roentgenograms showed early osteoarthritis of both joints. In addition, there were bony protuberances between the pelvis and the proximal femur. Whether these bony struts caused the development of the osteoarthritis or whether they developed as a result of the osteoarthritis will be discussed.
A case is presented of a 32-year-old man who sustained a closed posterior dislocation of the left elbow. The dislocation was reduced immediately under intravenous sedation. When, after reduction, the pulse remained weak, angiography revealed a complete tear of the brachial artery. The artery was repaired with end-to-end anastomosis, resulting in a good radial pulse at the end of the procedure. Though dislocation of the elbow is a relatively common traumatic injury, associated brachial artery injury is rare. The authors note that the diagnosis of arterial trauma in such cases should rely heavily on angiography.
A 14-year-old boy with severe hemophilia had a swollen immobile left shoulder joint. A roentgenogram showed a severely deformed humeral head that had interlocked onto the glenoid ring. After manipulation, the motion promptly returned. Incongruency of the shoulder in adolescence poses a serious therapeutic problem.
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A patient with isolated pyogenous arthritis of the acromioclavicular joint (A-C joint) caused by Streptococcus viridans is described. The patient had no underlying disease. Minor trauma preceded shortly the development of the septic process. The patient was treated successfully with surgical drainage and antibiotics. To our knowledge this is the first case report of septic arthritis of the A-C joint caused by Streptococcus viridans. The A-C joint is rarely involved in septic processes. Even conditions such as intravenous drug abuse [3, 6] and renal dialysis [4, 7] which tend to infect unusual joints [5] have only rarely been described in association with A-C septic arthritis.
An analysis is presented of 1763 consecutive injuries that occurred in the Ybrig region in Switzerland, a ski resort, during the 1976-1982 ski seasons. The study included all persons injured while skiing and treated at the emergency care facility at the base of the Ybrig region. Fractures were the most frequent injury. Over the years, a decrease in the total number of injuries was noticed. The severity of the injuries was increased. More attention should be paid to the individual preparation of the skier.
Anterior dislocation of the hip joint is rare, accompanied usually by a fracture of adjacent bony structures. A case of isolated anterior inguinal dislocation of the hip joint is hereby presented with 22 months of followup. The mechanism of this rare injury is usually forcible abduction and extension of the hip joint. Early diagnosis and reduction, with immediate post-reduction roentgenograms to discover any fragments in the joint space, should be done. In this patient, X-rays 11 and 22 months after reduction appeared normal.
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Injuries to the iliopsoas muscle are rarely mentioned in the literature dealing with soccer-related trauma. This report describes our experience in the successful diagnosis and treatment of iliopsoas injury in 40 professional soccer players. These injuries were not associated with direct external trauma to the muscle. Anatomical and functional characteristics of the iliopsoas are reviewed as they relate to the diagnosis and to the treatment by direct local injection with corticosteroids. A safe anatomical approach to the iliopsoas below the inguinal ligament is described.
A hemophiliac child with flexion contracture of the knee and symptoms of leg length difference was treated with a shoe lift on the affected side, which failed to aid the problem. Further investigation revealed that the affected limb was actually longer than the contralateral side. The chronic synovitis of the knee that had resulted in the contracture also caused supplementary bone growth around the distal femoral epiphysis, resulting in the lengthening of that leg.
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A 16-year-old male high jumper sustained a stress fracture of the tibial tuberosity. Continued activity resulted in a type III fracture of the tibial tuberosity necessitating treatment via open reduction and internal fixation.