Are bone bruises a possible cause of osteochondritis dissecans of the capitellum? a case report and review of the literature

A 17-year old soccer-player sustained a fracture and dislocation of the ulnar epicondyle combined with a bone bruises at the radial head and the capitellum. An open reduction and internal fixation was performed using two K-wires. Initial recovery was uneventful. After the operation he was discharged home and reviewed on a regular basis. When bony union had occurred the two K-wires were removed. However, on follow up he continued to complain of pain on the radial aspect of the joint and did not regain his normal range of movement. A further MRI was performed. Now a grade II osteochondritis dissecans not visible on the previous MRI taken 12 weeks earlier was clearly visualised. Treatment was continued conservatively with physiotherapy but avoiding aggressive mobilisation. On final review 6 months later he was able to move painfree with residual limitation of movement (ROM 0–5–130°). Another MRI taken now was assessed as normal.This study was carried out at the Dept of MRI, Klinik für Radiologische Diagnostik, Klinikum Saarbrücken, Winterberg 1, D- 66119 Saarbrücken.     

Rare double fracture-dislocation of the thumb： a case report and review of the literature

Simultaneous fracture/dislocation of the thumb carpometacarpal (CMC)joint and dislocation of the metacarpophalangeal (MCP)joint is considered as a rare injury pattern.We report an unusual case of dorsa...     

Cystic lesions of the jaws—a review and analysis of 269 cases

Two hundred and sixty-nine patients (160 males and 109 females) with cystic lesions of the jaw were successfully diagnosed and treated. One hundred and twenty-nine (48%) were radicular cysts, 67 (25%) were dentigerous cysts, 19 (7%) were primordial cysts, 16 (6%) were eruption cysts, 14 (5%) were traumatic bone cysts, and 17 (9%) were nonodontogenic cysts. There were 79 in the pediatric age group (1 month to 16 years) and 190 in the adult age group (17 years and older). Male to female ratio was 1 in the pediatric age group and 1.7 in the adult age group. The treatment modalities were marsupialization, enucleation, or enucleation with bone grafting. The findings demonstrate that the distribution and characteristics of jaw cysts in children are different from those in adults. In children, there is a relatively high rate of developmental cysts, whereas in adults, the inflammatory cysts are more common.     

Spontaneous epiphyseal injury as a complication of a simple bone cyst of the femoral neck? Case report and review of the literature

A case of a spontaneous epiphyseal injury of the femoral neck in an 8-year-old boy is reported. The same boy had been seen 8 months before for a pathological fracture caused by a simple bone cyst of the femoral neck on the same side. At the second visit the boy showed spontaneous severe pain of the hip, and radiography was performed under the presumed diagnosis of a slipped capital femoral epiphysis. However, it demonstrated a separation through the growth plate cranially and a fracture through the metaphysis inferiorly, leading to the differential diagnosis of a Salter-Harris type II fracture despite a nontraumatic patient history.A review of the literature failed to reveal a similar report of simultaneous occurrence of a simple bone cyst and epiphyseal injury of the femur. However, slipping of the proximal humeral epiphysis in connection with a simple bone cyst has been described by some authors. We propose a pathophysiological model for the simultaneous occurrence of epiphyseal injury and a simple bone cyst. Physeal involvement by a simple bone cyst and varus deformity of the femoral neck could cause weakening of the growth plate and predispose for epiphyseal injury.Based on these findings, we suggest that a simple bone cyst of the proximal femoral metaphysis can develop into a severe condition. Children presenting with this clinical picture should be treated vigorously and monitored for the development of complications leading to epiphyseal injury.     

Small colorectal cystic metastases to the liver: still a diagnostic dilemma? A report of a case and a review of the literature

Background

Although cystic colorectal metastases are rare (1.8%), they are still a crucial challenge for the surgeon especially in terms of detection and differential diagnosis. Since prognosis after resection is very good (40% 5-year survival), early diagnosis is essential.

Case report

A 55-year-old man was admitted to our hospital with a suspected diagnosis of multiple small liver metastases. He had previously undergone left sided-cholectomy followed by chemotherapy for colonic carcinoma. Computed tomography (CT) revealed multiple small (<15?mm) intrahepatic biliary cysts, suspected for cystic colorectal liver metastases.

Conclusion

The diagnosis of cystic colorectal liver metastases is quite difficult and it is mostly based on the last-generation magnetic resonance (MR). In spite of this, we must often rely on histological results for a definitive diagnosis.     

What makes a competent surgeon?: Experts' and trainees' perceptions of the roles of a surgeon

Background

Assessment of surgical competence is a priority; however little is known about surgeons' perceptions of competence. We investigated components of competence and adequacy of training in achieving them.

Methods

Using questionnaires, Surgical Attendings and trainees rated the importance of 7 CanMEDS roles that define a competent surgeon (Medical Expert; Communicator; Collaborator; Manager; Health Advocate; Scholar; Professional) and whether training enabled them to achieve competency in each role.

Results

Ninety-two of 125 questionnaires (74%) were completed. Junior trainees attributed lower importance to the roles of Manager, Communicator, Collaborator, and Professional than senior trainees or Attendings. No surgeon stated that they had achieved competency in every role.

Conclusion

Trainee surgeons do not appreciate the importance of all the roles required of a competent surgeon and current training does not ensure competence in all roles. These gaps must be addressed to develop surgeons able to provide the highest quality of care.     

Mesodermal (müllerian) adenosarcoma of the ovary: a clinicopathologic analysis of 40 cases and a review of the literature

Forty cases of mesodermal adenosarcoma of the ovary occurred in women 30-84 years of age (mean 54 years). Abdominal discomfort and distension were the usual complaints. All the patients were treated with an oophorectomy, which was accompanied by a hysterectomy in 85%, a contralateral oophorectomy in 65%, and nonsurgical therapy in 28%. Tumor rupture occurred at or before the operation in 67% of the cases. Twenty-six tumors were stage I, 11 stage II, and 3 stage III. The tumors were unilateral in 97.5% of the cases and 5.5-50 cm (mean 14 cm) in greatest dimension; most of the tumors were predominantly solid but contained numerous small cysts. Microscopic examination revealed sarcomatous overgrowth in 12 tumors. Sex cord-like elements were present in six tumors (including four with sarcomatous overgrowth) and heterologous elements in five (including two with sarcomatous overgrowth). The highest mitotic index of the sarcomatous component was 1-25 (mean 6) mitotic figures per 10 high power fields. Only 6 of 26 women (23%) who were followed postoperatively for > or=5 years were free of tumor. In the other 20 patients recurrent tumor appeared at 0.4-6.6 years (mean 2.6 years) after operation as pure sarcoma (low grade or high grade) or adenosarcoma (with or without sarcomatous overgrowth). Eight women had additional recurrences, and four women had blood-borne metastases. One patient was alive at 15.7 years after the excision of pulmonary metastases. The 5-, 10-, and 15-year survival rates were 64%, 46%, and 30%, respectively. Age <53 years, tumor rupture, a high grade, and the presence of high-grade sarcomatous overgrowth appeared to be associated with recurrence or extraovarian spread. Ovarian adenosarcomas have a worse prognosis than uterine adenosarcomas, presumably because of the greater ease of peritoneal spread. Many of the tumors caused problems in differential diagnosis.     

Nora��s lesion of the thumb and a differential diagnosis

In this paper, we report a rare case of a solitary osteochondromatous tumour on the volar tip of the thumb of a 47-year-old woman. An X-ray examination showed a heavily calcific mass close to the bone and an alteration of the bone, next to the lesion. A wide-margin biopsy was performed on this tumour and a histological examination was conducted, which showed the characteristics of a bizarre parosteal osteochondromatous proliferation of the bone (Nora’s lesion). The lesion was 0.8 × 0.9 cm. This neoplasm has a high tendency for local recurrence, although metastatic behaviour has not yet been reported. Due to its possible recurrence, this lesion requires radical surgery and, at times, amputation is necessary. In this case, wound healing was uncomplicated and there was no deficit after surgery. No recurrences were observed after 2 years from the surgery. At the end, we describe six differential diagnoses for the Nora’s lesion. We explain some important characteristics of every one of the six lesions.     

Esthesioneuroblastoma of the pituitary gland: a clinicopathological entity? Case report and review of the literature

Esthesioneuroblastoma (olfactory neuroblastoma) is a rare, malignant neoplasm that typically arises in the nasal vault, invades adjacent tissues, and causes locoregional (cervical lymph nodes) and distant metastases. Only two cases of tumors arising in the sellar region that had the histological characteristics of esthesioneuroblastoma have been reported in the literature to date. The authors present the case of a 35-year-old woman with secondary amenorrhea and a rapidly growing tumor located in the adenohypophysis. After total removal of the lesion through a transseptal-transsphenoidal approach, the histological examination revealed an esthesioneuroblastoma Grade II/III according to Hyams. Considering the particular location of the lesion and the absence of residual tumor on postoperative magnetic resonance imaging, no adjuvant therapy was performed. The patient remained free from tumor recurrence 2 years postoperatively. Because all published cases of this esthestoneuroblastoma have been large neuroblastic tumors of the pituitary gland arising in middle-aged women, pituitary neuroblastoma might represent a rare, specific clinicopathological entity.     

Is lateral ankle sprain of the child and adolescent a myth or a reality? A systematic review of the literature

BackgroundAnkle trauma in children and adolescents is the most common orthopedic injury encountered in pediatric trauma. It has long been recognized that a lateral ankle injury in this population is often a Salter and Harris type I fracture of the distal fibula (SH1). The purpose of this study is to confirm the existence of a lateral ankle sprain and to report the incidence of each pathology of the lateral ankle compartment: SH1 fracture, ATFL injury, and osteochondral avulsions.MethodsA systematic review of the literature is done using the database provided by PubMed and Embase. All articles reporting the incidence of imaging modality-confirmed lateral ankle injury (SH1, ATFL injury, osteochondral avulsion) in children and adolescents were included. Exclusion criteria were the following: case reports or articles with less than ten subjects, unspecified imaging modality and articles unrelated to lateral ankle lesions. Thus, 237 titles and abstracts were selected, 25 were analyzed thoroughly, and 11 articles were included for final analysis.ResultsSH1 fractures were found in 0–57.5% of the cases in all series and 0–3% in the most recent series. A diagnosis of an ATFL injury was found in 3.2–80% and an osteochondral avulsion of the distal fibula in 6–28.1%. The most recent series report 76–80% and 62% for ATFL injury and osteochondral avulsion respectively.ConclusionsThere is a non-negligible incidence of ATFL sprains and fibular tip avulsions in patients with a suspected SH1 fracture of the distal fibula. According to recent evidence and MRI examinations, the most common injuries of the pediatric ankle are ATFL sprain and osteochondral avulsions. This should be taken into consideration in daily practice when ordering radiological examination and deciding on treatment modalities     

Intramuscular haemangioma of the head and neck—a diagnostic dilemma

Intramuscular haemangiomas (IMHs) are acquired lesions and account for 0.8% of all haemangiomas. Fewer than 80 cases of IMHs have been reported, and most of them were located in the trunk or extremities. Head and neck region represents 13.5% of IMHs. They are frequently misdiagnosed as parotid lesions or even temporomandibular joint dysfunction. When a history of an enlarging vascular mass is present, a high index of suspicion for invasive tumour is required.     

Is There a Link between the Late Occurrence of a Brachial Artery Aneurysm and the Ligation of an Arteriovenous Fistula?

Arteriomegaly and aneurysms proximal to long‐standing posttraumatic arteriovenous fistulas (AVF) have been described. Much fewer are the reports of the late occurrence of brachial artery aneurysms following the closure of a hemodialysis AVF. Here, we report the case of a 55‐year‐old male patient. He had received a cadaver donor kidney transplant in 1996; his distal radiocephalic (RC) wrist AVF in the left arm had been ligated in 2001; he developed an aneurysm of the left brachial artery 9 years after the ligation of the AVF (2009). He underwent the surgical intervention of aneurysmectomy at the level of the left brachial artery with construction of a bypass with autologous saphenous vein. In conclusion, the development of a RC wrist AVF is an intrinsically dynamic process characterized by the increase in both blood flow rate and internal diameter of the brachial artery; the latter might be associated with enhanced fracture of the elastic fibers with the consequent risk of the development of an aneurysm. Thus, arteriomegaly and aneurysm of the brachial artery proximal to long‐standing AVFs might be seen as a “continuum” of these morphologic modifications.     

Concurrent rhinoplasty and endoscopic sinus surgery: a review of the pros and cons and a template for success

Historically concurrent FESS/rhinoplasty was avoided due to concerns of increased risk of complication. Recent studies have shown that FESS/rhinoplasty can be performed simultaneously with good outcomes and no significant increase in complications. A thorough and effective approach to the patient with sinonasal obstruction requires attention to aesthetic, functional, and inflammatory issues. Medical treatment is an important adjuvant to surgery in order to optimize outcomes by improving patient symptoms long-term. Surgery for these patients should be performed in a careful, stepwise approach to address the nasal septum, inferior turbinates, paranasal sinuses, and external nasal structures.     

Peritoneal and nodal recurrence 7?years after the excision of a ruptured solid pseudopapillary neoplasm of the pancreas: report of a case

A solid pseudopapillary neoplasm (SPN) of the pancreas is generally regarded as a neoplasm of low malignant potential and there is rarely recurrence of the disease. A 12-year-old female underwent a pylorus preserving pancreaticoduodenectomy for a ruptured pancreatic SPN following a blunt abdominal trauma. The tumor showed no pathological features suggesting malignant potential. Follow-up imaging studies depicted small nodules adjacent to the superior mesenteric vein 7 years after surgery. A laparotomy was performed, and exploration revealed 3 nodules adjacent to the superior mesenteric vein and 4 small nodules in the mesointestine. All of these lesions were extirpated, and were histologically confirmed to be nodal and peritoneal recurrence of SPN. This case indicates that SPN of the pancreas has a latent ability to recur, regardless of its benign pathological features, and peritoneal spread may be promoted by trauma. A close postoperative follow-up is thus mandatory in all patients with SPN even after a radical resection.     

The use of a “rim cutter” device and a flanged cup for improving the mantle of the acetabular component of a cemented Exeter total hip arthroplasty

A retrospective study was performed to evaluate the cement mantle in two groups of patients treated with the acetabular components of cemented Exeter total hip arthroplasties (THAs). Two groups of 20 patients were compared: Group 1 received non-flanged acetabular cemented cups (Contemporary, Stryker) and Group 2 received flanged acetabular cemented cups (X3 Rim Fit, Stryker). Cups in Group 2 were implanted after using a rim cutter device. Group 2 showed better penetration of cement in zone 1 (10.76 mm compared with 2.93 mm; p = 0.008) and a thicker cement mantle in zone 1 (3.57 mm compared with 2.89 mm; p = 0.04). More cups in Group 2 had a cement mantle thickness less than 3 mm (30 % in Group 1 compared with 70 % in Group 2; p = 0.0039). No other radiological differences were observed. These results favor the use of a rim cutter device and flanged cup to improve the cement mantle for the acetabular components of cemented Exeter THAs. However, the improvements were less than expected. In view of the results of previous studies, further research is therefore needed to assess the value of this approach in improving the acetabular cement mantle.