Spinal epidural involvement in adult Langerhans cell histiocytosis (LCH): A case report.

RATIONALE: Spinal involvement in adult Langerhans cell histiocytosis (LCH) is rare, and epidural involvement is unusual. LCH is mostly indistinguishable from other spinal lesions such as infection, lymphoma, and metastasis. So, it could be easily misdiagnosed without suspicion. PATIENT CONCERNS: We report a case of a 33-year-old man who complained of gait disturbance with weakness in both legs and severe back pain. DIAGNOSES: A continuous enhancing epidural lesion with cord compression from the T7 to L1 level was detected in magnetic resonance imaging. Laboratory analysis indicated the possibility of spinal infectious disease. We assumed that the lesion could be tuberculous spondylitis. INTERVENTIONS AND OUTCOMES: The patient underwent posterior laminectomy with marginal excision of the epidural mass to relieve cord compression. Pathological examination confirmed the diagnosis of LCH. The 12-month follow-up evaluation revealed that the patient was neurologically intact and had no gait disturbance. LESSONS: This case report presents a patient with epidural LCH of the thoracic spinal cord, which can mimic spinal infections such as tuberculous spondylitis with abscess formation. Therefore, LCH could be considered as a possible diagnosis when a patient presents with features of infectious spondylitis with vertebral involvement.

Significant proportion of severe lateral osteoarthritis in korean patients have non-valgus knee alignment with milder clinical manifestation.

BACKGROUND: Knee malalignment is strongly associated with risk of knee osteoarthritis (OA). Although several studies have described the relationship between valgus knee alignment and incidence of severe lateral OA, little research is available on the association with non-valgus (neutral or varus) knee alignment. Therefore, we performed a retrospective study to determine: 1) whether a substantial proportion of severe lateral OA patients have non-valgus knee alignment and 2) whether there are any difference in clinical manifestations between patients with valgus and non-valgus alignment. HYPOTHESIS: A large proportion of severe lateral OA patients in Korea have non-valgus knee alignment. PATIENTS AND METHODS: The medical records of 647 patients (825 knees) who visited our outpatient clinic from 2008 to 2018 and were diagnosed with lateral OA were retrospectively reviewed. Knee OA severity was evaluated according to the Kellgren-Lawrence (K-L) grading system and those with K-L grade 3 or 4 were enrolled in this study. Alignment was measured by the hip-knee-ankle angle on full-limb radiographs and classified as varus (<180°), neutral (180°), or valgus (>180°). Patients with K-L grade 4 lateral OA (bone-on-bone arthritis) were divided into two groups according to knee alignment (non-valgus or valgus) and compared for recommended treatment (surgery or conservative treatment) as an indicator of clinical manifestations. RESULTS: Of the 825 knees, 67.1% (553/825) were K-L grade 3 or 4. Of these 553 K-L grade 3/4 knees, 20.4% (113/553) had neutral, 23.3% (129/553) varus, and 56.2% (331/553) valgus knee alignment. Notably, 43.8% (242/553) of the K-L grade 3 or 4 knees had non-valgus alignment (95% CI: 40%-48%, exact binomial test). Of the K-L grade 4 patients (263 knees), the proportion recommended conservative treatment was significantly higher in the non-valgus group (80.2% (69/86)) than the valgus group (62.1% (110/177)) (χ2 test, p=0.003)). CONCLUSION: In contrast to the widespread belief that most lateral OA patients have valgus knee alignment, a substantial proportion of Korean patients with severe lateral OA in this study had non-valgus alignment. In addition, these non-valgus alignment patients presented with significantly milder clinical manifestations in bone-on-bone lateral OA than valgus patients. While orthopaedic surgeons tend to initially consider surgery for bone-on-bone lateral OA, full-limb radiographs should be acquired to assess knee alignment, because patients with non-valgus alignment may be treated conservatively. LEVEL OF EVIDENCE: III, Case control study.

Surgical Intervention for Pectoralis Major Muscle Rupture: Report of Acute and Chronic Cases.

Pectoralis major muscle rupture is becoming more frequent due to the current trends toward high-contact sports. We reported 2 cases with acute and chronic injury settings along with the strategy to treat each of it.