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1.
Case Rep Orthop ; 2018: 8280415, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30123601

RESUMO

INTRODUCTION: Multiple hereditary exostoses (MHE) is a rare autosomal dominant disorder characterized by the presence of multiple skeletal deformities. They are painless slow-growing lesions. Malignant transformation tends to occur later in adulthood and has only been seen in 1-5% of patients. OBJECTIVE: We describe the clinical, radiological, and pathological characteristics of a child with MHE who developed osteoblastic osteosarcoma beneath an osteochondroma. CASE PRESENTATION: An 11-year-old male Rwandan presented to our hospital with a two-week history of a dull persistent pain in his left distal femur and loss of weight and appetite. There was no relief with pain killers. He was a known case of multiple hereditary exostoses diagnosed at age 3. He began experiencing mild symptoms 6 months prior to admission which worsened in the last two weeks prior to his admission. On examination, he had multiple palpable bony swellings bilaterally on the proximal humeri and distal femurs. X-rays showed multiple exostoses and MRI showed a lesion with heterogeneous signal intensities that suggested malignant transformation. At surgery, a necrotic lesion beneath the exostosis was excised and sent for histopathological analysis which confirmed osteochondroma with an osteoblastic osteosarcoma in the marrow cavity. Chemotherapy and limb-salvaging surgery were done and he has recovered well. CONCLUSION: Osteosarcomas arising at sites of MHE have not been previously reported in Africa. These tumors rarely undergo malignant transformation.

2.
Int J Surg Case Rep ; 44: 42-46, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29475170

RESUMO

INTRODUCTION: Combined anterior cruciate ligament (ACL) and posterolateral corner (PLC) reconstruction are a rare clinical entity in orthopedic literature, whose management requires different types of tendon grafts. Missed PLC injury leads to the failure of ACL repair due to the joint instability. PRESENTATION OF CASE: We are presenting a case of posttraumatic right ACL, PLC and lateral meniscus injury. The patient was taken to theatre for arthroscopic meniscectomy, ACL and PLC reconstruction. We had to harvest bilateral Gracilis and semitendinosus tendon grafts. Intraoperatively, we used a pump and after meniscectomy and ACL reconstruction the knee was quite swollen; we opted to offer a two-staged procedure for PLC reconstruction. Hence we had to preserve the graft in situ for the next procedure. Posterolateral corner reconstruction was done in a week's time and preserved ligament was found to be intact. DISCUSSION: The fact that we did not have a tissue bank or facilities for cryopreservation of the harvested tendons at -80 °C or with liquid nitrogen at -179 °C yet we had to keep the harvested tendons safe. CONCLUSION: In case of absence of graft and bone bank, tendon graft was in situ and found intact and ready to be used after seven days.

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