The Cunéo and Picot fracture-dislocation of the ankle: A case report and review of the literature.

The Cunéo and Picot fracture-dislocation is an atypical trimalleolar fracture-dislocation of the ankle with unique anatomopathologic and radiographic features, which has not been reported in English literature. We report a case of a 42-year-old woman that was diagnosed with a trimalleolar fracture-dislocation and treated surgically with an open reduction and osteosynthesis of the lateral and medial malleolus. At one-month follow-up, X-rays showed secondary displacement of the medial malleolus requiring revision surgery. The patient complained of persisting pain, with X-rays showing no signs of apparent fracture displacement. A CT scan performed after hardware removal 10 months after trauma showed severe ankle arthritis and fracture malunion at the level of the syndesmosis. The patient was retrospectively diagnosed with a Cunéo and Picot fracture-dislocation. The treatment of trimalleolar fractures is discussed, especially regarding the correct indication of synthesis of the posterior malleolus. Cunéo and Picot fractures are usually inherently unstable even if the posterior malleolar fragment may be small and can easily be recognized from standard X-rays. Whenever this type of fracture is not correctly recognized and managed by osteosynthesis of only the medial and lateral malleolus, clinical outcomes and radiographic follow-ups tend to be unsatisfactory. Fixation of the posterior malleolus is indicated in the management of Cunéo and Picot fractures. Level of clinical evidence: 4.

Angioleiomyoma in the posterior knee: A case report and literature review.

The authors present a case of angioleiomyoma situated in the posterior knee. A 47-year-old Caucasian woman presented in 2011 with recurrent stabbing pain on the lateral aspect of her right knee. She reported having pain for the last 6years. She had no history of trauma. In 2008 she was treated with a diagnostic arthroscopy and transposition of the tibial tuberosity, with no benefit to her symptoms. Electromyography of the lower limbs showed asymmetry of the amplitude of sensitive action potential of the superficial fibular nerve. Based on the clinical suspicion of entrapment of the common fibular nerve at its bifurcation, a surgical exploration was performed, but pain persisted. In 2014, ultrasonography localized at the trigger point showed a solid ovular formation of 1cm in diameter situated on the posterior aspect of the external femoral condyle in proximity to the joint capsule, which was confirmed by magnetic resonance imaging (MRI). Surgical excision of the 1-cm diameter tumor mass relieved the symptoms immediately and permanently. Histology evidenced the presence of a solid-type angioleiomyoma. The presence of an angioleiomyoma at the knee joint is very rare and few cases are reported in the literature. To the authors' knowledge this is the first time an angioleiomyoma in the posterior knee has been described. In case of unexplained and persistent pain in and around the knee, clinicians should be aware of the atypical locations of this tumor, considering that its surgical excision alone may relieve symptoms permanently.