Scaphotrapezial dislocation: a case report

Traumatic dislocation of either trapezium or trapezoid is rare. We found less than 20 cases of each reported in the literature. We describe a case of traumatic dislocation of the scaphotrapezial joint associated with subluxation of the scaphotrapezoidal joint, which to our knowledge has not been reported.     

Hyperthyroidism after pregnancy in a patient with rheumatoid arthritis. A case report

A 42-year-old Indian woman with long-standing rheumatoid arthritis became pregnant. Exacerbation of her arthritis during pregnancy and in the puerperium is described and mechanisms for the deterioration in her condition are postulated. Two months after delivery, thyrotoxicosis was suspected because of marked weight loss. Initially the interpretation of her thyroid function was difficult because of certain unusual biochemical findings, the reasons for which are discussed.     

Total bilateral carpal coalition with carpometacarpal fusion: one case

Carpal coalition may involve more than two carpal bones which is more common when coalition occurs as part of a syndrome of congenital malformations. We describe an unusual case of congenital complete entire carpal coalition with massive carpometacarpal coalition except the first carpometacarpal joint and abnormal distal radioulnar joint bilaterally. In addition, radiocarpal joint surfaces were slightly irregular but compatible. There were abnormal distal radioulnar joints and ulnar styloids articulated with the ulnar side of the lunate of the both wrists.     

Multiple epidermal inclusion cysts in a patient with rheumatoid arthritis: a case report

A construction worker with rheumatoid arthritis presented with multiple soft tissue masses on the volar surface of the palm and digits. A misdiagnosis of rheumatoid nodules was made secondary to the patient's history of rheumatoid arthritis. Subsequent excision confirmed multiple epidermal inclusion cysts, which was not entertained in the preoperative differential diagnosis. Follow-up evaluation 3 years later revealed no evidence of local recurrence. Based on our literature review, multiple epidermal inclusion cysts is a rare entity and has not been reported in a patient with rheumatoid arthritis.     

Septic gonococcal arthritis in a pediatric patient: Rare case report

IntroductionSeptic arthritis is an orthopedic emergency that requires rapid diagnosis and treatment due to the rapid destruction to cartilage. The responsible organism and etiology differs depending on patient age, especially in children. Gonococcal Arthritis in toddlers is a rare occurrence with few documented cases in the literature. An orthopedic surgeon is likely not to come across this either in training or through their careers. Consequently, its presentation and subsequent treatment algorithms leave several gray areas.Presentation of caseIn this case report, we present a rare and not so straightforward presentation of a toddler with septic gonococcal arthritis along with a summary of treatment considerations described in the current literature and the course of treatment for this patient.Our patient is a toddler who originally presented to the emergency department with shoulder and knee pain for several days after an unwitnessed fall. He was subsequently discharged and presented again the next day with a knee effusion and elevated inflammatory markers. An MRI showed a large joint effusion without any underlying abscess or osteomyelitis to explain his elevated inflammatory markers. A knee aspiration was subsequently preformed which eventually grew out Neisseria Gonorrhea on hospital day 3 after the patient had been on antibiotics. He was taken back for an arthroscopic irrigation and debridement for definitive treatment.Clinical discussion/conclusionDisseminated gonococcal infection in toddlers is a rare occurrence without much information in the literature and should not be dismissed as a differential. We recommend a high index of suspicion with thorough work up. We also recommend surgical management of a septic joint due to DGI diagnosed via arthrocentesis (gross purulence, symptoms not improving on medical therapy, positive aspiration cultures, elevated synovial cell counts, and medically unstable patients) given the sequelae of medical management alone. The importance of interdisciplinary team collaboration that include pediatrician, infectious disease specialist, social worker, and government child safety associations is pivotal.     

Bilateral arthroscopic tendon interposition arthroplasty of the thumb carpometacarpal joint in a patient with Ehlers-Danlos syndrome: a case report

A common finding in progressive osteoarthritis of the carpometacarpal joint of the thumb is ligamentous laxity. In patients with Ehlers-Danlos syndrome, which is a disorder characterized by generalized ligamentous laxity, splinting and arthrodesis have been recommended because of the random results achieved by other reconstructive procedures. We report a patient with thumb carpometacarpal joint osteoarthritis secondary to Ehlers-Danlos syndrome who was treated with bilateral arthroscopic tendon interposition arthroplasty.     

Spinal epidural hematoma in a scoliotic patient with long fusion: a case report.

BACKGROUND CONTEXT: This is the only reported case on a spinal epidural hematoma occurring in a fused scoliotic segment. PURPOSE: To report the first case of a spinal epidural hematoma developed within the fused segment of a scoliotic curve and to raise clinicians' awareness of the pathology of a spinal epidural hematoma. STUDY DESIGN/SETTING: A case report. PATIENT SAMPLE: A 53-year-old woman with long spinal fusion for severe kyphoscoliosis diagnosed as a teenager. OUTCOME MEASURES: Neurological improvement and clinical follow-up for any occult spinal fracture. METHODS: A patient was surgically treated for a spinal epidural hematoma causing paraparesis. Clinical and radiological features were reported. RESULTS: The etiology of this case could not be defined, although the patient had a minor fall injury. Radiography and computed tomography scans could not detect any obvious fracture. Magnetic resonance imaging showed typical features of an epidural hematoma. After the hematoma evacuation, the patient's neurology gradually improved. CONCLUSIONS: Long fusion, differential stiffness along the fusion block, implant removal, and significant residual deformity may increase the risk of an epidural hematoma formation after trivial trauma without an obvious fracture on imaging. Clinicians should be mindful of this possibility and look out for any hematoma in the fused segment(s).     

Difficult intubation in a patient with rheumatoid arthritis. A case report

A 12-year-old White girl underwent bilateral extracapsular lens extraction. She was known to be suffering from rheumatoid arthritis. The peri-operative handling and anaesthetic implications are discussed.     

Isolated carpometacarpal dislocation of the thumb: a case report

The traumatic fracture-dislocation of the first carpometacarpal joint is not frequent, isolated dislocation being even more uncommon. A twenty-five-year-old male patient was diagnosed as having carpometacarpal dislocation of the thumb by means of radiologic and physical examination findings. After immediate reduction, the thumb was immobilized in a short thumb spica cast for six weeks, after which he was enrolled into a rehabilitation program. No pain or instability were found at the end of six months.     

Divergent dislocation of the carpometacarpal joints: a case report

A motorcyclist presented for treatment with divergent dislocation of the bases of the four medial metacarpals, avulsion of the hook of the hamate, dislocation of the trapezium from the scaphoid, and palmar fracture-dislocation of the wrist. This constellation of injuries has never been described. The carpometacarpal joints were reduced at surgery and pinned. The patient is doing well 8 years later despite nonunion of the hook of the hamate.     

Fracture-dislocations of all five carpometacarpal joints: a case report

Injuries to all five carpometacarpal joints are rare. Only four cases have been reported in the English literature. A case of fracture-dislocations of all five carpometacarpal joints is presented. An excellent result has been obtained 2 years after open reduction and internal fixation. This case is the only one in the English literature so treated and with prolonged follow-up.     

Posterior thoracolumbar fusion in a patient with Kleefstra Syndrome related scoliosis: The first case reported

Spine deformities could be considered a possible manifestation of the childhood hypotonia, typical feature of Kleefstra Syndrome (KS). There is a paucity of literature describing posterior spinal fusion in the Kleefstra syndrome patient. For patients who develop severe scoliotic curve, bracing is often ineffective and surgery is recommended. We report the first corrective surgery for scoliosis in one patient with KS.We describe a case of 13-year-old female with severe developmental scoliosis in KS. Preoperative examination showed a thoracolumbar scoliosis with left convex thoracic curve (T3-T9, 97°) and right convex thoracolumbar curve (T9-L3, 88°). Posterior correction, pedicle screw fixation and bone graft fusion T3-L5 was performed. Postoperatively, the thoracic curve was corrected to 33° while the thoracolumbar one to 26° and better standing posture was obtained. Six month follow-up images showed no loosening of the hardware. The patient is still in our follow-up program.Scoliosis seems to be a rare evenience of the severe hypotonia of patients with KS. We report the first case of scoliosis in KS treated successfully with surgery. Corrective surgery for spinal deformity, such as scoliosis, could help in posture and improve the quality of life especially in complicated patients such as syndromic ones.     

Acute kidney injury in a patient with gout and polyarticular septic arthritis: a case report

International Urology and Nephrology -     

Hemifacial spasm associated with Marfan's syndrome: A case report

The authors describe a case of hemifacial spasm associated with Marfan's syndrome. A 24-year-old-woman suffered from left hemifacial spasm for 6 years. She had undergone surgical treatments for bilateral ectopia lentis and kyphoscoliosis in the second decade of life. She also had unusually long and slim limbs with arachnodactyly. Three-dimensional CT angiography revealed bilateral tortuous and elongated vertebral arteries. Microvascular decompression was performed following a left lateral suboccipital craniotomy. The root exit zone of the left seventh nerve was directly compressed by the proximal segment of the anterior inferior cerebellar artery (AICA) and the left vertebral artery. These arteries were decompressed with pieces of Teflon cotton. The patient's symptoms completely resolved following surgery. We review cerebrovascular disorders in Marfan's syndrome and discuss the pathogenesis and possible mechanisms of vascular compression in these patients.     

Simultaneous dislocations of the carpometacarpal joints: a case report.

A case of simultaneous dislocations of the carpometacarpal joints is reported. Closed reduction and splinting produced a good result.