Multiple Intraosseous Cysts of the Carpal Bones Presenting as Unilateral Carpal Tunnel Syndrome.

Intraosseous ganglion cysts (IGC) of the carpal bones are frequently reported in the literature, involving at most two carpal bones of the same wrist. Only one case recently described the presence of multiple intraosseous ganglion lesions in the capitate, lunate, and triquetrum, resulting in chronic wrist pain. The following study reports the first case of multiple IGCs causing a unilateral carpal tunnel syndrome (CTS), in a 56-year-old woman, with no previous history of trauma. Failure of conservative management prompted carpal tunnel release and the surgical excision of the ICGs, followed by autologous bone grafting to fill in the defects. Consequently, IGCs must be considered in the differential diagnosis of unilateral CTS due to the expansile nature of the bone lesions.

Locked Central Fracture Dislocation of the Hip in a Child after Low-Energy Trauma.

We present the case of a 13-year-old boy who sustained a locked central fracture dislocation of the right acetabulum following a bicycle fall. Immediate external reduction maneuvers under general anesthesia were unsuccessful due to intrapelvic entrapment of the femoral head. Open reduction internal fixation was achieved 48 hours later. After an initial satisfactory postoperative course, the patient ended up developing severe hip osteoarthritis 16 months after the procedure. The rarity of this injury in children is discussed, with its possible implications on joint congruity and potential growth injury.

Surgical Hip Dislocation for Management of Acetabular Osteochondroma in an Adult.

The purpose of this study is to report a rare case of acetabular osteochondroma with a unique clinical presentation occurring in an adult with normally developed hips. The distinctive size and location of the lesion required an open approach with surgical dislocation of the hip for complete resection.

Arthroscopic Resection of a Bilateral Calcaneonavicular Coalition in a Child.

Calcaneonavicular coalition is a congenital anomaly characterized by a connection between the calcaneus and the navicular. It can manifest as lateral foot pain, peroneal spastic flatfoot, and repeated ankle sprains. Surgery is required in the case of chronic pain and after failure of conservative treatment. The aim of surgical intervention is pain relief and preventing recurrence. Arthroscopic resection is a minimally invasive alternative that has the advantages of quicker recovery and better aesthetic results. This technique has shown significant symptomatic improvement and no recurrence at early follow-up points in a small number of reported cases. The present report presents the case of a child with bilateral calcaneonavicular coalition. This is the first report to our knowledge that describes the outcome of simultaneous bilateral arthroscopic resection of calcaneonavicular coalition in a child with a 2-year follow-up period.

Arthroscopic excision of intra-articular hip osteoid osteoma: a report of 2 cases.

Intra-articular osteoid osteoma is uncommon accounting for approximately 12% of all osteoid osteomas. It presents diagnostic and therapeutic challenges since several traumatic or degenerative pathologies of the joint can be simulated with delay in the diagnosis. We report the clinical, radiographic, and histopathological findings in 2 cases of intra-articular osteoid osteoma of the femoral neck and of the acetabulum. Technical aspects of arthroscopic excision and results of surgery are discussed. Arthroscopy allowed complete excision of the osteoid osteomas, with a short postoperative rehabilitation and excellent functional results.

Long-term follow-up on microsurgical free-tissue transfer in foot and ankle reconstruction.

BACKGROUND: We have previously reported on the efficacy of free-tissue transfer in ankle and foot reconstruction with a mean follow-up period of 3.7 years (9 months-7.5 years) postoperatively. This study will evaluate the long-term results of free-tissue transfer performed for soft tissue defect coverage, diabetic foot salvage and the treatment of chronic osteomyelitis in 38 patients. METHODS: The long-term efficacy of free-tissue transfer for foot and ankle reconstruction was evaluated in a retrospective study among patients operated during a period of 5 years (January 1992-December 1996); 38 were available for follow-up. Indications for reconstruction included acute wounds with soft tissue defects, diabetic foot ulcers, and chronic osteomyelitis. RESULTS: At a mean follow-up of 12 years, there were no major complications in the soft tissue defect group. Among the diabetic patients, two patients had recurrent ulcerations of the forefoot which were detected early and treated conservatively. In the osteomyelitis group, however, there were no recurrences of the foot infection. CONCLUSIONS: The free-tissue transfer provided an excellent method of soft tissue reconstruction with a very minimal long-term complication rate, and a very high rate of success in the treatment of diabetic foot ulcers and chronic osteomyelitis.

Meralgia paresthetica: a result of tight new trendy low cut trousers ('taille basse').

Meralgia paresthetica is an entrapment neuropathy involving the lateral femoral cutaneous nerve of the thigh. Patients complain of a persistent burning sensation, tingling and aching pain, and hypersensitivity or hyposensitivity in the anterolateral aspect of the thigh. Numerous direct and indirect causes for the disease have been suggested in the literature. We present 12 cases that were diagnosed to have meralgia paresthetica due to tight new fashion low cut trousers ('taille basse'). The diagnosis was confirmed by injecting a small amount of a short acting local anesthetic around the lateral femoral cutaneous nerve which alleviated the symptoms for several hours. Electrophysiologic studies were sensitive in 83.3% of the cases. All cases were treated successfully using conservative methods, namely avoiding tight trousers, local steroid infiltration and weight reduction.

Arthroscopically assisted reconstruction and percutaneous screw fixation of a pilon tibial malunion.

We report a case of distal tibial fracture (AO 43-C3) originally treated with close reduction and ligamentotaxis, which was seen at our institution at 6 weeks with malunion of the medial malleolus. It was successfully treated with arthroscopy-assisted mobilization of the malunion with subsequent percutaneous reduction and fixation. Four months after surgery, with an American Orthopedic Foot and Ankle Society score of 100, the patient felt no pain when walking. Techniques and postoperative treatment are described.

Phalangeal osteosonogrammetry age-related changes and assessment of a Lebanese reference population.

This study was aimed to assess age changes in quantitative ultrasonometry (QUS) of the phalanx in a sample of Lebanese women to determine a reference data for the Lebanese population. Velocity of ultrasound (amplitude-dependent speed of sound; AD-SOS) and the interpretation of the ultra sound signal (ultrasound bone profile index; UBPI) were measured in 211 women with a mean age of 50 years (range 20-79 years) using a DBM sonic Bone profiler device. Women were randomly selected and asked to participate in a nation-wide screening program. Age is an important factor affecting the two parameters: the AD-SOS declines from 2200 m/s at 20 years to 1700 at 80 years. The climacteric condition is another important factor, with significant decrease of the two parameters after the menopause (P<0.0001). This effect is highly influenced by the duration of the postmenopausal period. No influence of weight or height was observed in UBPI variability. The AD-SOS values are similar to those of European population before the age of 50 years. After this age, a significant difference is noted between the two populations. Phalangeal QUS curve of AD-SOS and UBPI are age-dependent. The Lebanese reference curve for AD-SOS is significantly lower from the European curve after the menopause; a 2% decrease in AD-SOS after the age of 50 years can be observed. This decrease in AD-SOS reference values is relevant in the classification of osteoporotic subjects; in fact, if we had used the European reference data set, we had generated 10.9% more Lebanese patients being osteoporotic. Therefore, the use of our standardized reference data reduces the risk of overestimating osteoporosis in the Lebanese population.

The varying distribution of intra- and inter-vertebral height ratios determines the prevalence of vertebral fractures.

Credible inferences regarding the burden of vertebral fractures (VFs) cannot be made without a globally accepted quantitative definition of 'fracture'. Currently, differences in anterior, middle, or posterior vertebral heights (VHs) within a vertebra, or between adjacent vertebrae, are used to define 'fracture'. However, VH differences are essential for the construction of thoracolumbar curves, evolutionary adaptations that provide stability in bipedal stance and gait. As there is no reference standard to distinguish anatomical variation from fracture, approaches to defining a VF use a reference range of VH ratios derived in premenopausal women or derived by trimming, a method that iteratively removes the tails of a distribution of VH ratios to produce a normal distribution. From this, reference ranges of VH ratio means and standard deviations (SDs) are obtained and a nominal deviation of 15% or more, or 3 SD or more is regarded as a 'fracture'. We measured VHs by quantitative vertebral morphometry (QVM) and bone mineral density (BMD) by dual energy X-ray absorptiometry in 697 Lebanese women (age 20-89 years) to compare the prevalence of VF ascertained by published methods and a new method that uses the premenopausal range (without trimming) and requires two VH abnormalities. VF prevalence using published methods reached 60% to 70% in pre- and post-menopausal women, and in women with normal or high BMD because VH ratios were not normally distributed and cut-offs used to define VF fracture fell within the observed distribution of the data. The new method resulted in a VF prevalence of 3.3% in younger and 14% in older women, 7% (high), 10% (middle), and 20% (low) BMD tertiles consistent with the notion that the method detected VF due to bone fragility. We suggest that using a fixed trimming method to define reference range and cut-offs or applying fixed cut-offs to identify VFs in populations, where these ratios are not normally distributed, may result in the capture of anatomical variation, not structural failure. Thus, group differences in the VF prevalence may reflect differences in methodology, not bone fragility. Improved criteria to define VF are needed before credible inferences can be made regarding the burden of VFs in women and men, and between sexes, races, countries, decades, and placebo arms of clinical trials.

Surgical treatment of traumatic lesions of the axillary nerve. A retrospective study of 33 cases.

The purpose of this study was to evaluate the recovery of muscular strength after surgical intervention in axillary nerve injuries. Surgery was elected when no signs of recovery were noted after three months of conservative treatment. Between 1980 and 1996, 46 traumatic lesions of the axillary nerve were surgically treated. Thirteen patients were excluded from the study for various reasons. Among the remaining 33, 20 with interruption of the nerve trunk were treated with nerve grafts and 13 lesions with the nerve in continuity underwent neurolysis. After a mean follow-up of more than two years, deltoid muscle strength was good or fair in 18 patients and poor in 15 cases. The outcome seemed to be better in isolated lesions than in complex nerve lesions with a favourable outcome in 6/10 patients vs 8/14, in patients younger than 25 years compared to older patients (8/14 vs 8/19), in patients treated with neurolysis (9/13) compared to grafting (9/20), and when graft length was limited (4/4 patients with a graft 6cm or less, 5/8 with a graft over 6cm in length). The outcome was less favourable when associated osteoarticular lesions were present (8/23 versus 8/10) and most convincingly, when surgery was delayed beyond six months (10/22 versus 8/11).