ABSTRACT
The use of magnetic resonance imaging (MRI) in pigmented villonodular synovitis (PVS) has been well described in the literature. MRI has been used predominantly with diffuse PVS lesions. We recently had a patient with an unusual case of localized PVS of the ankle with bone and cartilage destruction. Preoperative MRI was useful in the diagnosis of localized PVS and in the planning for surgery. MRI in a patient with this lesion had not been documented previously, but should be considered whenever PVS, either diffuse or localized PVS, is suspected.
Subject(s)
Ankle Joint/pathology , Magnetic Resonance Imaging , Synovitis, Pigmented Villonodular/diagnosis , Ankle Joint/surgery , Humans , Male , Middle Aged , Preoperative Care , Synovitis, Pigmented Villonodular/surgeryABSTRACT
We present a case of symmetrical EG of the lower extremities in a 36-year-old man. Several entities are considered in the differential diagnosis. However, many of the features bear a striking resemblance to ECD, which probably coexists in this case. A link between the two entities, EG and ECD, has been suggested by others. Future experience may confirm this hypothesis.
Subject(s)
Eosinophilic Granuloma/diagnosis , Adult , Bone and Bones/diagnostic imaging , Bone and Bones/pathology , Diagnosis, Differential , Eosinophilic Granuloma/diagnostic imaging , Humans , Leg/diagnostic imaging , Leg/pathology , Male , Radiography , Radionuclide ImagingABSTRACT
Over the period 1973-1983, we treated by external fixation 110 severe grade three open or complicated fractures caused in war (minimum follow-up, 7 years). We present our data analyzed according to method, location, and type of fracture. The methods we have evolved over the years are described in detail: primary wound stabilization by fixateur externe; primary radical wound excision, repeated every 48 hours as required, including excision of dead bone; delayed primary vascular soft tissue cover; delayed primary or secondary skeletal and soft tissue reconstruction as dictated by local wound conditions; prophylactic antibiotics and intensive physiotherapy to the joints and muscles of the injured limb and as rapid an ambulation of the patient as possible. The advantages and limitations of external fixation are enumerated. It is possible to avoid the complications of pin tract infection and ring necroses, but care is required to avoid refracture after removal of the apparatus, since the quality of bone healing is not always good with the use of external fixation. External fixation has greatly facilitated the various methods for achieving delayed primary vascular soft tissue cover over severe open fractures, bringing about an improved prognosis; micro-vascular techniques hold great promise for wound cover and skeletal reconstruction. Similarly, the Ilizarov method of bone osteotaxis has opened up new vistas in the treatment of bone mass loss. The latter requires a sophisticated set-up which will not be available in most war zones. In spite of the advances in treatment and in the improved results achieved by modern techniques of wound stabilization, wound soft tissue cover, and bone and soft tissue reconstructions, the temptation to try to salvage useless limbs must be resisted. Amputation, judiciously adjudged and correctly timed, remains one of the most successful forms of treatment in these severe injuries, saving the casualty from a physical and spiritual via dolorosa. Enthusiasm for surgical endeavor must be well tempered with mature judgment and realistic clinical acumen.
Subject(s)
Arm Injuries/surgery , External Fixators , Fractures, Open/surgery , Leg Injuries/surgery , Warfare , Amputation, Surgical , Arm Injuries/therapy , Fractures, Open/therapy , Humans , Leg Injuries/therapy , Male , Time Factors , Wound Infection/therapyABSTRACT
We have reviewed 11 patients with idiopathic transient osteoporosis of the hip; the six who were women all developed the condition during pregnancy. Both simultaneous and sequential bilateral involvement were seen, but biochemical studies were consistently normal and one synovial biopsy showed only non-specific inflammation. Radioisotope bone scans and CT scans were useful to aid diagnosis. Treatment by limiting weight-bearing relieved symptoms, and spontaneous resolution was paralleled by radiographic remineralisation, usually within a few months. One patient developed a stress fracture of the hip and other areas of transient osteoporosis. A hip involved by the condition should be protected from overloading until bone density has recovered.
Subject(s)
Hip Joint , Osteoporosis/diagnosis , Adult , Crutches , Female , Hip Joint/diagnostic imaging , Humans , Male , Middle Aged , Osteoporosis/therapy , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/therapy , Radiography , Radionuclide Imaging , Technetium Tc 99m Medronate , Walkers , WheelchairsABSTRACT
A 55-year-old woman had a dislocation of a total hip arthroplasty that could not be reduced by closed manipulation because of an obstructing cement fragment. The use of percutaneous arthroscopic instrumentation allowed reduction by successful manipulation of the fragment out of the joint.
