In order to diagnose these rare presentations, digital radiography and magnetic resonance imaging are essential radiological investigations; magnetic resonance imaging is often considered the preferred choice. Complete excision of the growth remains the gold standard treatment.
Presenting to the outpatient clinic was a 13-year-old boy, who complained of pain in the anterior aspect of his right knee for ten months, along with a history of past trauma. MRI scans of the knee joint displayed a clearly demarcated lesion within the infra-patellar region, precisely the location of Hoffa's fat pad, which exhibited internal septations.
A 25-year-old woman presented to the outpatient clinic complaining of pain in the front of her left knee for the past two years, with no prior history of trauma. Magnetic resonance imaging of the knee joint depicted a poorly defined lesion adjacent to the anterior patellofemoral articulation, attached to the quadriceps tendon, with noticeable internal septations. En bloc excision was carried out in both instances, resulting in a successful restoration of normal function.
Knee joint synovial hemangioma, a rare finding in orthopedic practice conducted outdoors, exhibits a slight female bias often associated with a history of prior trauma. Both cases investigated in this study presented with patellofemoral syndrome, encompassing the anterior and infrapatellar fat pads. Maintaining functional integrity after excision of such lesions was a priority, with en bloc excision, the gold standard for recurrence prevention, being meticulously employed in our study, resulting in favorable outcomes.
Hemangioma of the knee's synovial membrane, an uncommon orthopedic concern, is more prevalent in women and commonly follows a history of injury. Mycophenolic Analysis of two cases in this study revealed patellofemoral syndrome, specifically impacting the anterior and infra-patellar fat pad regions. Our study followed the gold standard en bloc excision procedure for these lesions, effectively preventing recurrence and delivering satisfactory functional results.
A rare after-effect of total hip replacement surgery is the intrapelvic movement of the femoral head.
A Caucasian female, 54 years of age, underwent a revision total hip arthroplasty. Following an anterior dislocation and avulsion of the prosthetic femoral head, open reduction was performed. The surgical procedure revealed the femoral head migrating into the pelvic region, along the psoas aponeurosis. The migrated component was recovered from the iliac wing, via an anterior approach, as part of a subsequent procedure. The patient's post-operative progress was smooth, and two years post-surgery, she demonstrates no related symptoms.
Cases of trial component movement during surgery are frequently described in the existing literature. Mycophenolic Just one documented case highlighted by the authors involved a definitive prosthetic head implanted during the primary THA procedure. Despite the revision surgery, no patients demonstrated post-operative dislocation or definitive femoral head migration. In light of the dearth of long-term studies concerning intra-pelvic implant retention, we recommend the removal of these implants, especially in those who are younger.
Reported cases in the literature primarily concern the intraoperative migration of trial parts. In their study, the authors identified a sole case description of a definitive prosthetic head, all of which occurred during primary total hip arthroplasty. Despite revision surgery, no patients experienced post-operative dislocation or definitive femoral head migration. Because sustained investigation into intra-pelvic implant retention is lacking, we suggest the removal of such implants, particularly in younger patients.
A spinal epidural abscess (SEA) is an accumulation of infection localized to the epidural space, originating from a variety of underlying causes. One of the key etiological factors behind spinal ailments is tuberculosis of the spine. The typical presentation of SEA includes a patient's history of fever, back pain, difficulty in ambulating, and neurological deficits. Magnetic resonance imaging (MRI) is the primary diagnostic tool to identify an infection, subsequently validated by assessing the abscess for microbial growth. Relieving the compression on the spinal cord and draining pus are achieved through the surgical procedure of laminectomy and decompression.
The 16-year-old male student, a student by profession, presented with low back pain that had escalated with difficulty walking for 12 days, further compounded by lower limb weakness for 8 days. The presentation included fever, generalized weakness, and malaise. No significant alterations were observed in computed tomography scans of the brain and entire spine. However, an MRI of the left facet joint at the L3-L4 vertebral level exhibited infective arthritis and an abnormal accumulation of soft tissue in the posterior epidural space. This abnormal collection spanned the region from D11 to L5, causing compression on the thecal sac and nerve roots of the cauda equina, and confirming an infective abscess. Also noted was an infective abscess, evidenced by an abnormal soft-tissue collection in the posterior paraspinal area and the left psoas muscles. For emergency decompression, the patient's abscess was accessed and cleared via a posterior route. From the D11 to L5 vertebrae, a laminectomy was performed, and thick pus was evacuated from multiple pockets. Mycophenolic Soft tissue and pus specimens were sent for investigative purposes. Although the ZN, Gram's stain, and pus culture tests were devoid of microbial growth, GeneXpert testing detected the presence of Mycobacterium tuberculosis. Per the RNTCP program's protocol, the patient's weight determined the commencement of anti-TB drug treatment. Postoperative day twelve marked the removal of sutures, followed by a neurological evaluation to ascertain any improvement. The patient's lower limb strength improved, with the right lower limb achieving a 5/5 strength rating, and the left lower limb a 4/5 rating. The patient's discharge summary includes improvements in other symptoms, with no complaints of back pain or malaise.
In the rare event of a tuberculous thoracolumbar epidural abscess, prompt diagnosis and treatment are crucial to avert the potential for a lifelong vegetative state. Both diagnostic and therapeutic aims are fulfilled by the surgical decompression technique of unilateral laminectomy and collection evacuation.
The infrequent occurrence of tuberculous thoracolumbar epidural abscess underscores the importance of prompt diagnosis and treatment to prevent potentially irreversible vegetative consequences. The surgical decompression procedure, encompassing unilateral laminectomy and collection evacuation, serves both diagnostic and therapeutic goals.
Hematogenous spread frequently initiates the inflammatory process of the vertebrae and discs, a condition clinically recognized as infective spondylodiscitis. The dominant presentation of brucellosis is a febrile illness, despite the possibility of rare cases of spondylodiscitis. In clinical settings, instances of human brucellosis are infrequently diagnosed and treated. A 70-something-year-old man, previously healthy, exhibited symptoms suggestive of spinal tuberculosis, only to be diagnosed with brucellar spondylodiscitis.
A 72-year-old agriculturist, experiencing persistent discomfort in the lumbar region, sought care at our orthopedic clinic. A diagnosis of suspected spinal tuberculosis was formulated at a medical facility near his residence, stemming from magnetic resonance imaging findings characteristic of infective spondylodiscitis. Consequently, the patient was sent to our hospital for enhanced management. Investigations revealed an unusual case of Brucellar spondylodiscitis in the patient, which required tailored management.
Spinal tuberculosis often shares similar clinical characteristics with brucellar spondylodiscitis, making the latter an essential consideration in the differential diagnosis for elderly patients presenting with lower back pain and signs of a persistent infection. The early diagnosis and treatment of spinal brucellosis hinges on the importance of serological screening.
Spinal tuberculosis and brucellar spondylodiscitis can share similar clinical presentations; therefore, brucellar spondylodiscitis should be considered in the differential diagnosis for lower back pain, especially in the elderly, when signs of chronic infection are present. Serological testing is paramount for the prompt recognition and treatment of spinal brucellosis.
Giant cell tumors of bone, a prevalent condition in skeletally mature patients, typically manifest at the ends of long bones. A rare occurrence is the giant cell tumor affecting the bones of the hands and feet, akin to the uncommon giant cell tumor affecting the talus.
A 17-year-old female, with a ten-month history of pain and swelling around her left ankle, has been diagnosed with a giant cell tumor of the talus, as reported. Radiographic examination of the ankle exhibited a whole-talus, lytic, expansive lesion. In light of the unfeasibility of intralesional curettage in this patient, a talectomy was performed and was subsequently followed by a calcaneo-tibial fusion. Following histopathological analysis, the diagnosis of giant cell tumor was validated. The patient's daily activities were largely unaffected by discomfort, as no signs of recurrence were evident during the nine-year follow-up.
In the human body, giant cell tumors are often seen near the knee or the end of the radius furthest from the elbow. Very rarely are foot bones, particularly the talus, found to be involved. In cases of early presentation, the treatment plan often incorporates extended intralesional curettage along with bone grafting; however, in late presentations, talectomy with subsequent tibiocalcaneal fusion is generally recommended.
The knee and distal radius are common sites for the appearance of giant cell tumors. The infrequent involvement of the talus, among foot bones, is notable. Treatment for early stages includes extended intralesional curettage with concomitant bone grafting, whereas advanced stages require talectomy and tibiocalcaneal fusion procedures.