Osteochondroma of the superomedial scapula managed with a novel muscle sparing approach: case report and review of literature.

Osteochondromas are a common type of benign primary bone tumor rarely occurring in the scapula. When it is symptomatic, surgical removal is recommended. There are multiple approaches for surgical excision that can be used depending on the location and size of the tumor. We present a case of a 14-year-old female who was seen in the orthopedic clinic with right shoulder pain, mechanical symptoms and medial scapular winging due to a superomedial osteochondroma of the scapula. A novel superior approach to the superomedial ventral surface of the scapula was utilized to excise the tumor with good clinical results.

Single staged buttress plating with constrained knee arthroplasty for distal femur fractures in the elderly.

Treatment options for distal femur fractures include open reduction internal fixation (ORIF), arthroplasty, or a hybrid of both. We present a 76 year old female with left knee pain secondary to known osteoarthritis, known lateral condyle insufficiency fracture, and an acute medial condyle fracture. In order to solve the acute and chronic problems in a single procedure, a combined ORIF and constrained condylar knee (CCK) arthroplasty was performed. Arthroplasty alone would have required a highly constrained distal femur replacement, and ORIF alone would have caused prolonged immobilization and continued morbidity from unaddressed chronic problems. We chose a CCK as a less constrained implant would not have protected our ORIF which contained the medial collateral ligament attachment. This technique avoids the complications of ORIF alone, and avoids the known complications of increased constraint in total knee arthroplasty.

Monteggia variant with posterior elbow dislocation and radial shaft fracture: A case report.

INTRODUCTION: The most commonly used Bado classification encompasses the large majority of Monteggia fractures, however, certain patterns cannot be classified with this system. Monteggia injuries and Monteggia-Variants are uncommon but serious injuries that can have dire consequences if not identified and treated appropriately. This paper aims to review relevant literature, discuss current classification systems, and present a case of an atypical fracture pattern. PRESENTATION OF CASE: We present a case of a unique Monteggia variant in an adult that to our knowledge has not been discussed in the literature. The patient presented to the emergency department after a fall while skateboarding. Plain radiographs demonstrated a displaced proximal radial shaft fracture with posterior elbow dislocation and an intact ulna. The patient was closed reduced in the emergency department, and taken to the operating room thirteen days post injury. Open reduction internal fixation with compression plating of the radius was performed, and the patient was discharged home without complications. DISCUSSION: As our knowledge of the forearm and forearm injury patterns has expanded, it has become increasingly clear that our current classification systems and algorithms may not suffice. Monteggia variants are difficult to diagnose, and they also portend to have poorer outcomes. It is to our knowledge that this unique Monteggia Variant has not been previously described. CONCLUSION: The successful identification and classification of forearm fractures is vital to proper treatment. It is our hope that awareness of this Monteggia-variant contributes to the knowledge base of forearm fracture-dislocations and their treatment.

Acute compartment syndrome of the leg caused by cocaine use, creatine supplementation and vigorous exercise.

Delayed diagnosis of acute compartment syndrome (ACS) can be catastrophic. Reporting abnormal presentations to facilitate timely diagnosis and treatment is vital. We present a case of ACS in the deep posterior compartment of the leg with an unusual presentation and cause. The patient presented to the emergency department complaining of numbness on the plantar aspect of his left foot, and described a history of cocaine use, increased exercise and creatine supplementation. The patient was diagnosed with acute deep posterior compartment syndrome of the left leg and underwent a lower extremity fasciotomy. There are case reports demonstrating that strenuous activity, drug use and creatine supplementation cause increased compartment pressures and ACS. Rare in the literature is a case where these activities occur concurrently with the abnormal presentation of symptoms seen in this case. We hope this case brings awareness of atraumatic risk factors and uncommon presentations to the medical community.