Localized pigmented villonodular synovitis presenting as a locked lateral meniscal bucket handle tear: a case report and review of the literature.

Pigmented villonodular synovitis involves proliferation of the synovium of joints, bursa, or tendon sheaths. It is a rare disorder that can occur in two forms. The diffuse form involves the entire synovium and occurs in the majority of cases. The localized form involves a discrete section of the synovium. The disorder almost always involves a single joint, and the knee is most commonly affected. The treatment of choice for the diffuse form is total synovectomy. Recurrence is common. The treatment of choice for the localized form is partial synovectomy. Recurrence is uncommon. We present a case report of a localized pigmented villonodular synovitis presenting as a locked lateral meniscal bucket handle tear in an otherwise healthy 27-year-old man.

A longitudinal tibial stress fracture.

Tibial stress fractures are common in an athletic population. The patient is usually an athlete who is involved in highly repetitive impact activities that have increased in intensity, and who develops pain over the anterior tibia that is felt with exercise and relieved by rest. Physical examination usually reveals focal bony tenderness. Plain roentgenograms initially tend to be normal, and bone scan is the gold standard for diagnosis. Most tibial stress fractures are transverse or oblique. The authors present the first reported case of an activity-related longitudinal stress fracture of the distal tibia in a previously healthy, premenopausal woman. A discussion of this unusual presentation, its radiographic appearance, and its response to treatment is presented.

Outpatient percutaneous screw fixation of the acute Jones fracture.

Nine patients (8 men and 1 woman, ranging in age from 17 to 22 years) who sustained a Jones fracture were treated with percutaneous intramedullary screw fixation as outpatients. All of the patients were varsity athletes. Seven were Division I scholarship athletes. Beginning at 7 to 10 days after surgery, all patients were allowed weightbearing as tolerated with a CAM walker. Stationary bicycling, swimming, and Stairmaster were allowed at 2 to 3 weeks. The average return to running was 5.5 weeks (range, 3 to 10). The average return to full competition was 8.5 weeks (range, 7 to 12). No perioperative or postoperative complications occurred. Average followup was 2.5 years. All fractures attained clinical and radiographic union. We believe that outpatient percutaneous intramedullary screw fixation of the acute Jones fracture is a reasonable alternative for those active patients who would have difficulty with a non-weightbearing cast and crutches or who desire an expeditious return to activities. Time restraints are particularly critical for in-season or preseason athletes. With the outpatient screw fixation method, our patient population had predictable healing, and they returned to full sports participation within 12 weeks.