Progressive hematoma in an older adult: closed internal degloving injury of the knee.

Closed internal degloving injury of soft-tissues has been reported in the pelvic-acetabular area after high-velocity trauma. More recently, this lesion has been reported in the knees of young athletes involved in contact sports. The injury is often brought late to the notice of the clinician, and sometimes the diagnosis is missed. Effective treatment relies heavily on clinical examination, and magnetic resonance imaging is helpful as a diagnostic tool. Treatment may depend on time between injury and presentation, patient age, collection severity, and the effects of previous treatment. Lesions that threaten skin vascularity and show rapid progression require emergency management. Minimally invasive techniques are preferred over extensive procedures. Elderly patients need to be observed for progression of the initial lesion and development of late complications, which may require emergency intervention. Clinicians should tailor the rehabilitation protocol to the patient's age and the severity of the lesion. This case report of a 55-year-old female patient covers the nature, diagnosis, and management of a progressively dissecting hematoma that evolved into a massive closed internal degloving lesion.

Tuberculosis of the entheses.

PURPOSE: Tuberculosis of the osteoarticular system usually manifests as joint arthritis. There is no available English literature on the tubercular involvement of the enthesis (tendon-bone junction). METHODS: We performed a retrospective analysis on 14 patients with tuberculosis of the tendon-bone junction. Patients presenting with a sinus with or without presence of radiological evidence of bone destruction around the enthesis, and pain unresponsive to a trial of analgesics and physical therapy, were evaluated by closed or open biopsy for tuberculosis. A staging system is proposed for biopsy-proven tuberculosis of the enthesis. RESULTS: Between 2006 and 2010, we treated 14 patients with tuberculosis of the tendon-bone junction. Biopsy-proven cases of tuberculosis of the enthesis were administered anti-tubercular drugs for a period of one year. Sequestrectomy was performed in advanced lesions. The tendon-bone junction was rested until the features of its healing were clinically evident. The patients aged between 18 and 52 years were followed up for an average of 1.7 years after cessation of anti-tubercular drug therapy. They responded favourably, and none had recurrence of the disease. CONCLUSIONS: This study describes the tubercular involvement of the entheses, which heretofore has not been described in the literature. The rarity of its occurrence and lack of suspicion of an infectious aetiology in these locations frequently results in late diagnosis and incorrect initial treatment. This study also supports the "microtrauma theory" in the genesis of osteoarticular tuberculosis.

Calcaneal intraosseous lipoma: a case report and review of the literature.

Intraosseous lipomas are rare benign bone tumors. This benign neoplasm has been reported to occur in the calcaneus as well as the proximal femur. In the past, the relative absence of symptoms and radiographic similarity to a bone cyst has accounted for underdiagnosis of intraosseous lipoma. The case presented in this article was diagnosed with the help of computerized tomography and histopathologic analysis, after which the patient was treated by means of curettage and packing with calcium phosphate bone graft substitute. The purpose of this article is to increase awareness among clinicians of the existence of this unusual lesion.

Pseudomonas osteomyelitis of the talus: review of the pathophysiology and report of a rare case.

UNLABELLED: Hematogenous Pseudomonas aeruginosa osteomyelitis of the talus is a rare cause of ankle swelling and limping in children. The case presented herein is that of chronic osteomyelitis of the talus with sequestrum formation. The patient was successfully treated with sequestrectomy and curettage, immobilization, and antibiotic therapy. One year following the operation, the patient displayed mild restriction of ankle dorsiflexion, without evidence of inflammation or arthritis, and radiographs revealed remodeling of the talar neck with increased radiographic density at the site of sequestrectomy. There was no evidence of avascular necrosis or disturbance of the growth of the talus. Although rare, osteomyelitis of the talus should be considered in children and adolescents who present with ankle swelling and an antalgic gait. LEVEL OF CLINICAL EVIDENCE: 4.

Tuberculous pyomyositis of forearm muscles.

Tuberculous pyomyositis is a rare entity reported in literature. The presented case reports the occurrence of such a lesion in forearm muscles, without any bony involvement. The ambiguity in its diagnosis led to inadequate management by the primary care physician. Clinical suspicion, positive tuberculin test, culture of acid-fast bacilli, 'effective drainage', and timely anti-tubercular chemotherapy ultimately resulted in a good clinical recovery. This case has been presented to increase the awareness about the existence of such an entity in clinical practice, thereby influencing its workup and the possible modes of management.