RESUMO
Leclercia adecarboxylata and Pseudomonas oryzihabitans are two bacteria rarely seen in human infections. We present an unusual case of a patient who developed a localized infection with these bacteria after repair of a ruptured Achilles tendon. We also present a review of the literature regarding infection with these bacteria within the lower extremity.
Assuntos
Tendão do Calcâneo , Infecções por Enterobacteriaceae , Humanos , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/microbiologia , Antibacterianos/uso terapêutico , Tendão do Calcâneo/cirurgiaRESUMO
Metatarsalgia is a common problem that refers to the tenderness and pain beneath the forefoot. Many metatarsal shortening osteotomies have been described to alleviate metatarsal overload; however, these osteotomies have been associated with a high complication rate of floating toe deformity. We present a case study that describes an innovative technique for the treatment of lesser metatarsalgia that allows for the repositioning of the metatarsal head, using a stable screw fixation designed to minimize the common complication of the floating toe.
Assuntos
Deformidades do Pé , Ossos do Metatarso , Metatarsalgia , Parafusos Ósseos , Humanos , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Metatarsalgia/diagnóstico por imagem , Metatarsalgia/etiologia , Metatarsalgia/cirurgia , OsteotomiaRESUMO
Juvenile xanthogranuloma is a benign histiocytic cell proliferative disorder that occurs in early childhood. The most common presentation occurs within the first 2 years of life with papular or nodular changes to the skin on the head, neck or upper trunk. This case study documents the findings and treatment of a single solitary soft tissue mass in the forefoot of a 17-year-old patient. Unique to this case, the initial diagnosis of tuberous xanthoma was made and, with referral to an outside hospital, changed to a juvenile xanthogranuloma. In addition, unlike most juvenile xanthogranulomas in the literature, there was no superficial dermatological abnormality seen clinically. This change was not a dramatically different diagnosis, but further immunohistochemical staining was necessary for ultimate diagnosis. The soft tissue mass was self-contained to the deeper tissue layers and not the epidermis. The patient was followed for 12 months for possible recurrence and medical workup, without postoperative complications. The purpose of this study was to report on a unique finding and presentation of a xanthogranulomatous soft tissue mass in the forefoot of a pediatric patient.
Assuntos
Xantogranuloma Juvenil , Adolescente , Criança , Pré-Escolar , Diagnóstico Diferencial , Pé , Humanos , Recidiva Local de Neoplasia , Pele , Xantogranuloma Juvenil/diagnóstico por imagem , Xantogranuloma Juvenil/cirurgiaRESUMO
Tumoral calcinosis is a benign, progressive disorder characterized by massive periarticular deposition of calcium salts into subcutaneous and deeper tissue layers. While a majority of cases present secondary to underlying metabolic disorders, it can rarely present as a primary, idiopathic phenomenon. We present an atypical case of a pediatric patient with a large, ulcerated pedal soft tissue mass found to be consistent with primary tumoral calcinosis. This was confirmed by histopathologic analysis and comprehensive metabolic workup. The patient underwent surgical excision of the mass, with complete resolution of symptoms and no recurrence after a 1-year follow-up period.
Assuntos
Calcinose , Calcinose/diagnóstico por imagem , Calcinose/cirurgia , Criança , Humanos , Recidiva , Tela SubcutâneaRESUMO
The treatment options for osteochondral lesions of the ankle are scarce, and newer modalities are becoming available. We describe a minimally invasive arthroscopic approach with implantation of juvenile particulated allograft to facilitate the growth of true hyaline cartilage in patients with osteochondral lesions of the talus. The purpose of this study was to subjectively review clinical outcomes using the validated Foot and Ankle Outcomes Score in patients who underwent this technique. Our technique was performed on 82 consecutive patients with average follow-up of 24 (range 9 to 86) months. We found that 28 (88%) of 32 patients who responded to the questionnaire had good or excellent results for activities of daily living; 26 (82%) of 32 patients had at least a good result for both pain and symptoms; and 25 (78%) of 32 had at least a fair result for functional sports and quality of life.
Assuntos
Artroscopia/métodos , Cartilagem Articular/transplante , Osteocondrose/cirurgia , Qualidade de Vida , Tálus/cirurgia , Atividades Cotidianas , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteocondrose/diagnóstico , Estudos Retrospectivos , Tálus/diagnóstico por imagem , Transplante Homólogo , Adulto JovemRESUMO
Advances have been made in the treatment for osteochondral defects of the talus, but these injuries continue to be a challenge for foot and ankle surgeons. We present an arthroscopically assisted technique that uses an allogenic cartilage graft in treating an osteochondral lesion of the medial dome of the talus. A brief discussion on current surgical options for osteochondral defects of the talus is also provided.
Assuntos
Traumatismos do Tornozelo/cirurgia , Artroscopia , Cartilagem Articular/transplante , Tálus/lesões , Tálus/cirurgia , Adulto , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/etiologia , Feminino , HumanosRESUMO
Leiomyomas within the foot are rare occurrences that are difficult to diagnose clinically and radiographically. They are benign and tend to be slow growing, often with minimal or no pain. We present an unusual case of a worker's compensation patient who presented with a new-onset mass within his foot that was thought to be a fibroma, but was later discovered to be a fast-growing leiomyoma after surgical excision. We also present a review of the literature regarding leiomyomas within the foot and ankle.
Assuntos
Pé/cirurgia , Leiomioma/patologia , Leiomioma/cirurgia , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia , Adulto , Pé/diagnóstico por imagem , Humanos , Leiomioma/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Neoplasias de Tecidos Moles/diagnóstico por imagemRESUMO
Stenotrophomonas maltophilia is a gram-negative rod rarely associated with osteomyelitis. To date, only 3 cases of osteomyelitis due to this pathogen have been previously referenced. We describe the case of a 77-year-old male who developed osteomyelitis secondary to S. maltophilia infection after an open distal tibial fracture sustained by falling off a ladder. The purpose of the present case report was to highlight this highly resistant microbe as an infectious etiology.
Assuntos
Fraturas Expostas/complicações , Infecções por Bactérias Gram-Negativas/diagnóstico , Osteomielite/diagnóstico , Osteomielite/etiologia , Stenotrophomonas maltophilia , Fraturas da Tíbia/complicações , Idoso , Infecções por Bactérias Gram-Negativas/etiologia , Humanos , MasculinoRESUMO
Plantar fasciitis is one of the most common chief complaints seen in the foot and ankle clinic. With a relatively benign course, most cases are self-limiting or amendable to conservative therapy; ~90% of all plantar fasciitis cases will respond to these methods. When conservative treatment and time fail, surgical intervention can be necessary to improve outcomes. We present a novel method using Subchondroplasty® (SCP®; Zimmer Holdings, Inc.; Warsaw, IN) and revision fasciotomy in a case in which initial fasciotomy had failed. After the patient had failed to improve, a worsening underlying bone marrow lesion was identified at the origin of the plantar fascia; thus, SCP® was used with repeat fasciotomy. SCP® involves injecting calcium phosphate into bone marrow lesions to stimulate long-term bone repair. At 10 months after SCP®, the patient remained pain free and had returned to running at the final follow-up examination. This surgical treatment should be considered as an adjunctive procedure for those patients with plantar fasciitis, identifiable bone marrow lesions on magnetic resonance imaging, and continued pain when other treatment modalities have failed.
Assuntos
Doenças da Medula Óssea/cirurgia , Fosfatos de Cálcio/uso terapêutico , Fasciíte Plantar/cirurgia , Fasciotomia , Doenças da Medula Óssea/complicações , Doenças da Medula Óssea/diagnóstico por imagem , Fasciíte Plantar/complicações , Fasciíte Plantar/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Fracture-dislocations of the talus are one of the most complex injuries involving the foot and ankle. These injuries are often accompanied by additional traumatic orthopedic injuries, avascular necrosis, and infection. When approaching limb reconstruction and salvage, the overall prognosis and functionality of the limb are key factors to consider. In the present report, we draw attention to the importance of a multidisciplinary team approach for formulating a treatment plan that incorporates the talar injury and associated injuries or pathologic features. We also reviewed the published data related to avascular necrosis of the talus, open talar fracture management, and treatment outcomes.