Subscapularis pyomyositis, a rare cause of shoulder pain, in a patient without apparent risk factors: A case report.

INTRODUCTION: Pyomyositis, previously tropical, now seen more in temperate zones, particularly in those with HIV, cancer, or diabetes. Even healthy individuals, like athletes, can get it post-exercise or minor injuries. Our patient, in a desert-like area, adds an interesting aspect. Diagnosing is challenging due to deep tissue occurrence and subtle symptoms, leading to delayed detection and higher risks of morbidity. PRESENTATION OF CASE: A 45-year-old female patient presented with acute left shoulder pain and functional impairment, exacerbated by movement. Clinical examination revealed tenderness upon deep palpation in the left upper posterior thoracic region and restricted range of motion of the affected shoulder. DISCUSSION: Initial assessments at medical facilities suggested musculoskeletal strain and lower cervical disc prolapse despite normal X-ray results. MRI scans confirmed a developing abscess in the left subscapularis muscle, with intraoperative findings revealing extensive purulent fluid and necrotic tissue. Four surgeries drained the abscess and treated fat necrosis, with tailored antibiotics administered. Subsequent arthroscopy showed fibrous tissue, swelling, and inflammation. At the 3-month check-up, she had fully recovered, experiencing no pain or complications, and had almost regained full range of motion. CONCLUSION: Shoulder pyomyositis presents diagnostic challenges, causing delayed treatment. This case highlights the importance of considering pyomyositis in severe shoulder pain cases, even without typical risk factors or inconclusive X-rays. Timely recognition, surgical drainage, tailored antibiotics, and physical therapy are crucial. An interdisciplinary approach with orthopaedic surgery, infectious disease specialists, radiology, and physical therapy is vital for comprehensive management, improving outcomes, and reducing complications.

Long-term follow-up of patients with rotationplasty.

INTRODUCTION AND IMPORTANCE: Rotationplasty considered a limb-salvage procedure and has a lot of advantages when comparing it with endoprostheses or above-knee amputation. CASE PRESENTATION: We report two cases of young patients with osteosarcoma with rotationplasty being performed for both of them. CLINICAL DISCUSSION: Patients with rotationplasty have less restrictions in daily life activities due to pain comparing with patients with endoprostheses. CONCLUSION: Our aim here is to confirm that rotationplasty is an applicable, successful and alternative procedure to endoprostheses or above-knee amputation, when doing it based on an accurate indication and patients regain their previous daily life activities and satisfaction.

A case report of an arthroscopic-assisted fixation of a small Hoffa fracture in a young patient.

INTRODUCTION: Hoffa fracture is a type of rare tangential supracondylar distal femoral fracture. The most common mechanism of this fracture injury is high energy trauma. In some cases, its poor visibility on X-rays makes its diagnosis difficult and needs more than routine X-rays. Treatment methods include conventional ORIF, or arthroscopy-assisted fixation as a more challenging method. CASE REPORT: We present a case of a young female patient who sustained a low energy injury trauma to her left knee, which caused in a small minimally displaced lateral unicondylar Hoffa fracture. DISCUSSION: Although it needs more experience and special tools, arthroscopy-assisted fixation of Hoffa fracture provides a good method of treatment, and it has many advantages over open method. CONCLUSION: Our aim here is to confirm that Hoffa fracture may occur even with low energy knee trauma, and that arthroscopy-assisted fixation is a successful, applicable and alternative method to ORIF for small and thin osteochondral fragments, and could provide good stability and union even when using only one screw for fixation.