ABSTRACT
Authors describe two cases of bone lesions ("brown" tumour) secondary to hyperparathyroidism in whom incisional biopsy gave an incorrect diagnosis. The first case was a patient with a lesion of the right femur diagnosed as aneurismal cyst and; the second case was a patient with an isolated lesion of the distal metaphysic of right humerus firstly diagnosed as giant cells tumour. Treatment of the first case was resection and diaphyseal spacer, and the correct diagnosis of brown tumour was performed for the multiple tibial localizations appeared six months later. The second case was diagnosed as affected by a brown tumour secondary to hyperparathyroidism on the basis of clinical history and laboratory analysis. Both diagnoses were firstly incorrect and would have brought to an inadequate treatment with consequences on patients quality life. Differential diagnosis is discussed and the importance to evaluate all the diagnostic data to formulate a correct diagnosis is stressed.
Subject(s)
Bone Cysts, Aneurysmal/diagnosis , Bone Diseases, Metabolic/diagnosis , Diagnostic Errors , Femur/pathology , Giant Cell Tumors/diagnosis , Humerus/pathology , Hyperparathyroidism/complications , Osteolysis/etiology , Biopsy , Bone Diseases, Metabolic/etiology , Bone Diseases, Metabolic/pathology , Bone Diseases, Metabolic/surgery , Diagnosis, Differential , Femoral Fractures/etiology , Femur/surgery , Fibula/injuries , Fibula/surgery , Fractures, Spontaneous/etiology , Giant Cells/pathology , Hemosiderin/analysis , Humans , Hyperparathyroidism/diagnosis , Hyperparathyroidism/surgery , Male , Middle Aged , Osteoclasts/pathology , Osteoporosis/etiology , Parathyroidectomy , Tibial Fractures/etiology , Tibial Fractures/surgeryABSTRACT
AIM: The aim of our study was to analize the results at middle term after M1 "Scarf" osteotomy MATERIALS AND METHODS: We have assessed subjective, clinical and radiologic result of 25 patients operated on for symptomatic hallux valgus by means of diaphyseal SCARF osteotomy, 19 females and 6 men with middle age of 50 y. All the patients were evaluated at 3 months and 1 year from operation and results were compared on clinic and radiologic level and on the base of functional and subjective outcome of patients. Clinical state, at 24 month, was assessed by Hallux Metatarsophalangeal Interphalangeal Scale score system as developed by the American Orthopaedic Foot and Ankle Society (AOFAS Score). RESULTS: It has been observed a remarcable improvement of AOFAS score that varied from 40 to 81 point. In particular, we recorded an improvement of pain from 15 to 29, function from 23 to 40 and alignment from 2 to 12 point. Radiologic angle are also improved: the first metatarsal angle was changed from 16 degrees to 10 degrees degree, the hallux valgus angle from 32 degrees to 17 degrees, the distal articular metatarsal angle from 13 degrees to 10 degrees. M1-M5 angle to 33 degrees to 28 degreees. Méary-Tomeno angle was no significantly changed after surgeon. On subjective level, at follow-up time, 19 patients have declared to be very satisfied, 4 satisfied and only one dissatisfied. Nobody had pain and 1 patient was dissatisfied of a haestetic result. CONCLUSIONS: Based on results, "Scarf" osteotomy permits an adequate deformity correction of first metatarsus varus also with intermetatarsal angle between first and second metatarsal superior to 20 degrees degree.
