Outcome of Neglected Versus Treated Tuberculous Dactylitis in the Same Patient - A case report.

INTRODUCTION: Skeletal tuberculosis is a rare form of extrapulmonary Mycobacterium tuberculosis infection. When tubular bones are affected, it is called tuberculous dactylitis (TD). This rare entity can be seen in the hand or foot and has been mentioned in a handful of case reports. CASE REPORT: A 56-year-old female patient presented to our clinic for left hand middle finger swelling and pain of 1-year duration. Her medical history was relevant for 15 years history of progressive 4th and 5th fingers malformations that were attributed to "sarcoidosis," and for which she was treated with anti-inflammatory and low dose steroids therapy. At our clinic, physical examination was consistent with a swelling of the base of the middle finger associated with tenderness and decreased range of motion. Radiographs of the hand showed a lytic lesion involving the distal half of the first phalanx, along with blurred limits of the bone surfaces involved. An magnetic resonance imaging was ordered and showed hyper-intense signal of the first phalanx, along with subcutaneous enclosed collections on both sides of the phalanx. Surgical debridement with open biopsy and culture was done. Pathology results showed caseating granulomas, and cultures confirmed the diagnosis of TD. A computed tomography scan of the chest was done postoperatively; where few calcified nodules were noted. She also received a 9-months course of anti-tuberculous drugs and had complete cure by 9 months postoperatively. CONCLUSION: TD of the hand is a very rare entity of the spectrum of extrapulmonary M. tuberculosis infection. Clinicians should have a high index of suspicion concerning this pathology not to delay the diagnosis, which could lead to permanent deformity. Early diagnosis and treatment can significantly improve outcomes.

Reconstruction of Tibial Plateau Fracture Malunion in the Setting of a Large Cartilage Defect in an Adolescent: A Case Report.

CASE: An 18-year-old adolescent boy presented with knee pain and stiffness secondary to tibial plateau valgus malunion and osteochondral defect, 8 months after initial injury/fixation. We opted for a novel technique that reconstructs the convex lateral tibial plateau by using osteotomy and an osteochondral autograft harvested from the lateral aspect of the ipsilateral femoral condyle. CONCLUSION: The reported novel reconstruction technique is inexpensive, achievable with routine techniques, and demonstrated a favorable short-term outcome. At 3 years of follow-up, the patient had excellent, asymptomatic, left knee mobility and function with radiographic evidence of mild posttraumatic arthritis despite normal knee alignment.

Squamous Cell Carcinoma of the Heel Invading the Calcaneus Treated by Radical Excision and Reverse Sural Flap.

Cutaneous squamous cell carcinoma (cSCC) is relatively rare in the heel and foot. It is characterized by great loco-regional aggressiveness but low metastatic potential. If left untreated, cSCC can grow to a large diameter. The rarity and unfamiliarity of this condition pose therapeutic difficulties to many surgeons. We hereby submit the case of a 32-year-old male patient presenting with a large 14 x 8 cm scaly, ulcerated, and bloody skin lesion covering the entire left heel and invading the calcaneus. The patient was treated with radical excision of the mass and a reverse sural fasciocutaneous flap to cover the remaining heel defect, with a very positive outcome and no complications. This case is presented due to the rarity of the squamous cell carcinoma of the heel, and its large size (14 x 8 cm) in a relatively young patient, especially when it is invading the calcaneus.

Complete Extrusion of Talar Body Associated With Ipsilateral Floating Knee.

Talar injuries represent serious medico-surgical conditions because of the involvement of the talus in multiple articulations, such as the subtalar, the transverse talar, and the ankle joint complex. Its complete detachment from the surrounding ligaments and bone is known as talar extrusion, a very rare injury with a complicated treatment course. We report a case of a 43-year-old female patient presenting with a non-retrieved complete left talar body extrusion associated with a floating knee, manifested by left tibial shaft fracture and left supracondylar femoral fracture. The patient was treated with open reduction and internal fixation for the floating knee and a manually shaped talar cement spacer with staged tibiocalcaneal arthrodesis for the ankle. The patient was monitored over a six-year period. This case is reported for the extreme rarity of lost open talar body extrusion, and its problematic treatment in the absence of clear guidelines, especially with the presence of multiple concomitant ipsilateral fractures of the limb, such as floating knee, as in this case.

Tuberculous Extensor Tenosynovitis Presenting as Huge Mass on the Dorsum of the Hand.

Infectious tuberculous tenosynovitis (TS) of the extensor tendons of the wrist is an exceptional location of musculoskeletal tuberculosis. We present a case of tuberculous extensor TS in a 52-year-old diabetic male patient presenting as a huge mass on the dorsum of the hand, in the absence of other pulmonary or extrapulmonary manifestation of tuberculosis. This report increases physicians' vigilance when dealing with patients with risk factors of tuberculosis, allowing early diagnosis and optimal treatment.

A case of ureteral duplication in adult presenting with symptoms of bladder outlet obstruction.

BACKGROUND: Ureteral duplication is a rare congenital anomaly usually found in childhood. It manifests in various anatomic forms. AIM: To report a case of a ureteral duplication in adult man and a review of the literature in attempt to categorize this rare entity. CASE: This report describes a case of a Y-type ureteral duplication presenting in a 30-y-old man with symptoms of bladder outlet obstruction. CONCLUSION: Ureteral duplication is quite rare but a very distinct entity. It occurs exclusively in children and male adolescents. Its occurrence in adulthood imposes serious diagnostic and therapeutic difficulties.