Primary intra-osseous myoepithelioma of phalanx mimicking an enchondroma.

Myoepitheliomas (MEs) are uncommon tumours of the soft tissue with an intermediate biological behaviour and uncertain differentiation. Primary intra-osseous MEs are rare and occur predominantly in the axial and proximal appendicular skeleton in middle-aged patients. The morphological variation of the tumour cells and stromal metaplasia may cause considerable diagnostic confusion, especially when it occurs in an unusual location. A wide panel of immunohistochemical markers is required to exclude other histological mimics. A 37-year-old male presented with a recurrent swelling in the right middle finger for 1-month duration. Radiographic images showed an expansile, lytic, intra-osseous lesion with high signal intensity on T2W fat-suppressed MR images in the proximal phalanx of the right middle finger without cortical breach, highly suggestive of an enchondroma. Histopathology revealed a lobulated tumour comprising of polygonal to spindle cells in groups and cords in a chondromyxoid stroma. No cellular atypia was noted. The tumour cells were immunopositive for epithelial membrane antigen (EMA), p63, S100 and smooth muscle actin (SMA), compatible with the diagnosis of an intraosseous ME. The proximal phalanx of the right middle finger was excised, revealing a similar tumour, and the patient has been on regular follow-up for the last 18 months without any recurrence. Primary intra-osseous MEs are extremely rare, and this is the second reported occurrence in small bones. A differential diagnosis of ME should be kept for enchondroma-like lesions of the bone for proper histopathological assessment and accurate diagnosis. Documentation of such cases and follow-up will enhance our understanding of their clinical course and prognosis.

Arthroscopic anatomic double bundle anterior cruciate ligament reconstruction: Our experience with follow-up of 4 years.

BACKGROUND: Double bundle (DB) anterior cruciate ligament (ACL) reconstruction has been proposed to recreate the natural anatomy of ACL. Reconstruction of the anatomy of both the bundles of ACL has been thought to be able to restore the rotational stability of the knee joint. Nevertheless, it remains unclear whether DB reconstruction has better functional outcome than single bundle (SB) ACL reconstruction. PURPOSE: To evaluate the clinical outcomes, patient satisfaction and manual laxity tests of knee in patients treated with DB ACL reconstruction in Indian population. METHODS: We prospectively followed 25 patients with an isolated ACL injury operated for DB ACL reconstruction after applying the inclusion and exclusion criteria. Patients were evaluated pre-operatively and in the post-operative period at regular intervals with the minimum follow up of 4 years. Clinical stability was assessed by anterior drawer test, Lachman test and pivot shift test. Functional outcome was assessed by IKDC, Lysholm and Modified Cincinnati scores. RESULTS: At the end of 4 years, functional outcome in terms of all subjective scores was satisfactory. Graded stability results of the Lachman, Anterior drawer and pivot shift tests were almost near to that in normal knee. No complication occurred post-operatively. CONCLUSION: Anatomical DB ACL reconstruction seems to offer satisfactory results in terms of subjective scores and stability tests to patients with ACL tear. It has been found to be associated with no obvious complications and no failures. However a larger patient pool is desired for conclusive results.

Web-based information on minimally invasive total knee arthroplasty.

PURPOSE: To evaluate information available on the internet regarding minimally invasive total knee arthroplasty (TKA). METHODS: The 3 most popular search engines (Google, Yahoo, and MSN) were used to search the keyword 'minimally invasive knee replacement'. The top 50 websites from each search engine were evaluated for authorship and contents; duplicate websites were not double-counted. RESULTS: Of the 150 websites, 51% were authored by a hospital/university, 26% by private medical groups, 14% were news stories, and 9% were from orthopaedic industry sources. 73% offered the opportunity to make an appointment. 18% described the surgical technique, whereas only 9% explained patient eligibility. 25% described the risks, whereas only 3% made reference to peer-reviewed publications. >82% made specific claims regarding the advantages of minimally invasive surgery. CONCLUSION: Most websites providing minimally invasive TKA information were insufficient in terms of explaining surgical technique, patient eligibility, and assoicated risks.

Multifocal osteoid osteoma of tibia.

Multifocal osteoid osteoma of the bone is extremely rare. We report a 25-year-old man who presented with pain in the left leg since 11 months which was partially relieved by over-the-counter analgesics. Radiograph demonstrated two lytic lesions with surrounding sclerosis along the anterior cortex of the left tibia. Three-phase Tc 99m bone and CT scans confirmed the diagnosis of multifocal osteoid osteoma. The patient underwent surgical excision followed by protected weight bearing. The patient was asymptomatic at 6 months postoperatively. Multifocal osteoid osteoma needs to be considered in the differential diagnosis of multiple lytic lesions in the bone.

Posttraumatic cortical defect of femur.

Posttraumatic cortical defect of bone is a rare entity which occurs in a maturing skeleton following green stick or torus fracture. Most of the cases are asymptomatic and they are detected incidentally on radiograph. These lesions usually require no treatment. However, the appearance of these lesions can mimic various pathological conditions affecting bone. Knowledge about this entity is important as it avoids unnecessary investigations. We present this case as the occurrence of this entity in femur is very rare and the child was symptomatic.