Acta Orthop Belg
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Aneurysmal bone cyst (ABC) is an uncommon, benign but locally destructive bone lesion of unknown origin. Differential diagnosis can be challenging as it shares common radiological and pathological features with other benign and malignant bone lesions. The degree of diagnostic difficulty grows even more when an unusual location has to be taken into account. We report a rare and challenging case of a large primary ABC located at the scapula of a young male, who was surgically treated with subtotal removal of the scapula.
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Comparative Study
Intra-operative cerebral microembolisation during primary hybrid total hip arthroplasty compared with primary hip resurfacing.
Fat embolism during total joint arthroplasty or intramedullary procedures is well documented and is infrequently fatal. Considerable morbidity is associated with fat embolism syndrome, and post operative cognitive dysfunction is frequently seen, yet the exact pathophysiology remains unclear. Intraoperative cerebral microemboli can be detected using transcranial Doppler ultrasound and moreover the presence of a patent foramen ovale (PFO) may be examined for using a validated technique employing this modality. ⋯ The incidence of cerebral microembolisation during hip resurfacing appears to be very low. Although our study demonstrated cerebral microemboli in a significant proportion of patients undergoing primary hybrid THR, the numbers of microemboli were low and the presence of a patent foramen ovale did not influence microemboli incidence or load. Finally, patients who demonstrated cerebral microemboli did not have a worse outcome than patients who did not.
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A prospective study was conducted to evaluate the efficacy of percutaneous Kirschner-wire fixation for the management of high-risk distal forearm fractures in children. Thirty two children (22 boys & 10 girls) with displaced fractures of the distal third of the radius with or without ulnar fractures were managed by closed reduction and percutaneous Kirschner-wire fixation. Their average age was 10.1 years (4-16 years). ⋯ Satisfactory results were obtained in 87.5% of all cases. The residual radioulnar and dorsovolar angulations were significantly related to the decrease in forearm rotation and the unsatisfactory results. High-risk distal forearm fractures in children should be treated by primary percutaneous Kirschner-wire fixation supplemented by cast immobilisation.
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Review Case Reports
Posterior epidural mass: can a posteriorly migrated lumbar disc fragment mimic tumour, haematoma or abscess?
A 60-year-old woman complained of low back pain radiating to both buttocks and to the anterior aspect of the left thigh. MRI showed a left posterolateral epidural mass at the L1-L2 level. An epidural abscess was suspected, but the biochemistry was normal. ⋯ Eleven of the 27 lumbar cases (40%) were complicated with Cauda Equina Syndrome (CES). MRI is the method of choice to make the diagnosis. The differential diagnosis includes tumour, haematoma and abscess.
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Patellar tendon ruptures are rare but very invalidating lesions. We describe a case of re-rupture of a sutured patellar tendon. ⋯ Additionally, the strength of the graft allows early rehabilitation, and no further surgery for hardware removal is necessary. For these reasons we recommend this procedure for acute patellar tendon ruptures with a poor tissue quality or for revision surgery of the patellar tendon.