Glomus tumour.

Glomus tumours are rare tumours accounting for only 1-5% of soft tissue tumours of the hand. They are described classically in the subungual region. We present the case of a 32-year-old woman with a late diagnosis of a glomus tumour that had caused her excruciating pain. Clinical examination was positive for Hildreth's sign and the Love test. Magnetic resonance imaging delineated the tumour, which was excised and confirmed histologically. This case highlights the continued delay in diagnosis of glomus tumours as well as the use of imaging in diagnosis and planning of surgery.

Escobar variant with pursed mouth, creased tongue, ophthalmologic features, and scoliosis in 6 children from Oman.

We report on six Omani children from two consanguineous families, with a multiple congenital anomaly syndrome defined by arthrogryposis multiplex congenita, typical facial appearance, ophthalmologic anomalies, atrophic calf muscles, and interdigital, neck and axillar pterygia. In addition, the patients present unique features as a furrowed tongue and enlarged corneal nerves, undescribed previously in association with other distal arhtrogryposis syndromes (DA). The patients can be classified as multiple pterygium syndrome (Escobar syndrome) but display overlapping features with Freeman-Sheldon syndrome and arthrogryposis with ophthalmologic abnormalities. We excluded two known arthrogryposis loci on chromosome 9p13 (TPM2) and 11p15 (TNNI2, TNNT3). We conclude that our patients display a subtype of multiple pterygium syndrome with overlapping features to other DAs.

Pharyngeal perforation and spontaneous extrusion of the cervical graft with its fixation device: a late complication of C2-C3 fusion via anterior approach.

Stabilisation of the fracture-dislocation of the cervical spine is achieved effectively by anterior or posterior or combined methods with attendant short and long term benefits, risks and complications associated with each procedure. Recently anterior methods have gained wider acceptance. A variety of preoperative and postoperative complications associated with anterior cervical fusion are well recognised. However, the delayed pharyngeal or oesophageal perforation is a rare, serious and life threatening complication of an anterior cervical internal fusion.The authors report a case of delayed pharyngeal perforation and spontaneous extrusion of the C2-C3 graft with its fixation device. After coughing out the entire gamet of the graft with the fixation pin, the patient was relieved of excruciating pain and dysphagia and had no significant morbidity thereafter over a 12-year follow up period. Relevant aspects are discussed with a review of the pertinent literature.

Neonatal cervical osteomyelitis with paraspinal abscess and Erb's palsy. A case report and brief review of the literature.

An unusual case of pyogenic cervical osteomyelitis is reported in a newborn who immediately after birth had no movements in the left shoulder. There was a fullness in the left cervical region. Left Erb's palsy due to an unrecognized birth trauma was diagnosed in a peripheral hospital. Later, the child developed fever and a significant swelling in the left cervical region. On transfer to our institution, the X-rays of the cervical spine, ultrasound and computed tomography (CT) established the diagnosis of C(6) cervical osteomyelitis and paraspinal abscess which extended to the posterior triangle of the neck. The abscess was drained, and the lamina and lateral mass of the C(6) vertebra were debrided. Staphylococcus aureus was grown from the pus. The patient was put on long-term antibiotics to which he responded very well, and he became asymptomatic. In the immediate post-operative period, some movements at the left shoulder were noted, and at 6-month follow-up in the out-patient clinic, the child was virtually normal with near-complete regeneration of the C(6) lamina and lateral mass.

Use of ultrasound in osteomyelitis.

The use of ultrasound in osteomyelitis has been studied in 25 patients clinically suspected of osteomyelitis. A sonographic diagnosis of osteomyelitis was made if fluid was present in direct contact with the bone, without intervening soft tissues. This was thought to represent an inflammatory exudate dissecting in a subperiosteal and/or extraperiosteal location. Ultrasonographically 15 patients were found to have osteomyelitis, proved either by surgical drainage or needle aspiration. Seven patients had soft-tissue abscesses, one had cellulitis and two patients had no abnormality.

Long-term results of silicone rubber implants for Kienböck's disease.

Between 1971 and 1976 eight patients underwent excision of the carpal lunate for pain from Kienböck's disease. The bone was replaced by a silicone rubber implant. An average of 84 months had elapsed when they were reviewed in December 1980. All eight were very satisfied with their operations. Objectively, the clinical results were good, but radiographs showed the presence of degenerative change in the region of the wrist and alteration of the position of the prosthesis on ulnar deviation of the hand. No implant has had to be removed.

Swanson's silastic implants in great toes.

This is a review of 77 partial replacement and interposition arthroplasties in which Silastic implants were used. The operations were carried out between 1971 and 1977 on the metatarsophalangeal joints of the great toes of 62 patients. Twenty-six of the operations were for painful hallux rigidus and 51 for hallux valgus. The patients were reviewed 12 to 92 months after operation, the average follow-up being 60 months. The analysis of results indicated that while the procedure may be suitable for hallux rigidus its use for hallux valgus is not fully satisfactory in the long run.