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PubMed1984

Operative reduction and fixation of a difficult supracondylar extension fracture of the humerus.

We evaluated the results of the operative treatment of a difficult supracondylar fracture of the elbow. A series of 45 consecutive children, the majority presenting initially with a complete dislocation of the humerus, was reexamined. Thirty-two of the patients had undergone an early operation applying the anterior cubital approach and 13 patients had been treated by traction. The lengths of the follow-up periods were 3.1 +/- 1.5 and 8.8 +/- 2.6 years, respectively. Normal range of extension-flexion and rotation movements was preserved almost invariably by either modality of therapy, whereas the carrying angle of the elbow was reduced significantly more often in the group treated by traction. None of the patients presented with permanent nerve dysfunction, keloid formation, or myositis ossificans. The two preventable early complications, slipping of the osteosynthesis and entrapment of the ulnar nerve, were related to the fixation of the fracture. There were no early or late infectious complications. When the anterior approach was used, operative reduction and fixation of a difficult supracondylar fracture of the humerus proved to be both safe and timesaving. Anatomical results of operation were superior to those attained by traction therapy in our series.

Child↗

PubMed2005

Iliopsoas haemorrhage in patients with haemophilia: results from one centre.

Iliopsoas haematoma is a well-recognized complication of haemophilia, and is considered as potentially life threatening and significantly associated with morbidity. There are only rare reports on the incidence or outcomes of iliopsoas bleeding since the widespread usage of modern therapies for haemophilia. In this study, we present the experience of Ege University Haemophilia Centre with iliopsoas bleeding and its early and late complications. We reviewed 146 haemophiliacs (106 haemophilia A, 40 haemophilia B). Fourteen iliopsoas bleeding episodes were identified in eight haemophiliacs. Three patients (37%) had one episode, four (50%) had two episodes and one (13%) had three episodes. Two patients had a high titre inhibitor against factor VIII and accounted for three bleeding episodes (21%). We did not observe any episodes in six patients receiving prophylaxis. Iliopsoas haematomas were confirmed by ultrasonography in all patients. In physical examination, the most common symptoms were thigh, hip and groin pain, hip flexion contracture, abdominal tenderness and paraesthesia in the distribution of the femoral nerve. The mean duration of therapy with clotting factor concentrate was 7.8 +/- 1.6 days. The mean duration of hospitalization was 4.8 +/- 2.0 days. All patients started to receive a physical therapy program 6.0 +/- 2.4 days after the initiation of haemostatic therapy which lasted 20.0 +/- 6.0 days. Ultrasonographic findings related to iliopsoas haematoma disappeared in all patients within 3 months from the initial episodes. Only in one patient with mild haemophilia A, heterotopic bone formation (myositis ossificans) developed as a long-term complication. In conclusion, pain around the hip joint, femoral neuropathy and hip flexion contracture in a patient with haemophilia should alert the physician to the possibility of an iliopsoas haematoma. Early and effective factor replacement therapy is essential in the prevention of the complications.

Adolescent↗

PubMed1994

Perce the permissive pathologist: a cautionary tale of one who misdiagnosed a pseudosarcoma, killed the patient and was found out.

Perce, a promising young trainee pathologist, correctly recognizes a biopsy of a benign pseudosarcoma but his diagnosis is overruled by the less well read Head of Pathology. Acting under instructions from his Chief, Perce knowingly and without protest 'signs out' this benign condition as a sarcoma. The surgeon accepts the diagnosis without question and performs radical surgery, which is complicated by postoperative haemorrhage from which the patient dies. The Coroner orders a review of the slides and the misdiagnosis is discovered. Perce's defense that he did as he was told is rejected; he is forced to quit pathology and becomes an administrator. This unfortunate tale, which is related in verse, is intended to stress the importance of such benign but uncommon pseudosarcomas as nodular fasciitis, proliferative myositis, myositis ossificans, postoperative spindle cell nodule, pseudosarcoma of the bladder and juxta-articular myxoma. The poem also implies that surgeons should not carry out radical surgery based on an uncommon pathological diagnosis without checking on the adequacy of consultation and informed review of the sections.

Diagnostic Errors↗

PubMed1983

Diphosphonates and painful feet.

Localised foot pain occurred in four patients with Paget's disease of bone or myositis ossificans who were treated with disodium etidronate (EHDP) in a dose of 10 to 20 mg/kg body weight/day for four to six months. There was localised tenderness and sometimes slight swelling at the painful areas. Bone x-rays were normal, but bone scans showed increased uptake of the isotope at these areas. The pain persisted for several weeks, causing considerable difficulty in walking. The symptoms were most likely due to diphosphonate-induced stress fractures. These cases emphasise the importance of administering EHDP in low dosage for short periods only.

Diphosphonates↗

PubMedDate not supplied

Lameness associated with coxofemoral soft tissue masses in six dogs.

Six cases of mechanical lameness involving the coxofemoral joint are presented. All dogs had a history of chronic rear leg pain and lameness, and decreased range of motion of the hip. On physical examination, ventral subluxation of the coxofemoral joint during extension was present in three dogs. A radiographic diagnosis of subluxation was made in five dogs. In each dog, surgical exploration of the area caudal to the coxofemoral joint revealed a fibrous mass between the lesser or third trochanters and the ischium, diagnosed as a nonneoplastic fibrous reaction by microscopic examination. The clinical, radiographic, and histopathologic signs were similar to previously described cases of myositis ossificans. Five dogs returned to normal function after excision of the soft tissue mass, and one dog was normal when lost to follow-up 4 weeks postoperatively.

Animals↗

PubMed1975

Ectopic calcification around joints of paralysed limbs in hemiplegia, diffuse brain damage, and other neurological diseases.

Mechanical deformity associated, with neurological disease is commonly encountered in the form of contractures, or pre-existing arthritis. Less common is the occurrence of ectopic calcification around the joints of a paralysed limb. Two forms of this are presented in a series of twenty patients. Para-articular calcification with the appearance of myositis ossificans around large joints of the affected limbs occurred most often. The interior of the joints was not affected, nor was there evidence of bony injury. In some cases, however, the excessive outgrowth of bone around the joint eventually resulted in a functional ankylosis by a uniting bar of bone outside the joint. The second form of calcification was periosteal, which unlike the first type was resorbed and left an area of cortical bony thickening.

Aged↗

PubMed1995

The painless soft tissue mass in childhood--tumour or not?

Soft tissue malignancies are uncommon in adults and even rarer in children. Twelve children presented to the radiology department over a three-year period with a clinical diagnosis of a malignant lower limb mass. This diagnosis was usually based on the presence of a firm, painless mass. However, imaging revealed a heterogeneous group of benign pathologies: haemangioma (two cases), haematoma (two cases), aneurysm (two cases), and one case each of infection, myositis ossificans, Baker's cyst, lipoma, muscle rupture, and venous malformation. During the same period there was only one malignant soft tissue neoplasm. A variety of imaging techniques were used but ultrasound combined with colour flow Doppler was the single most helpful modality. The radiological diagnosis were confirmed by biopsy, surgery or clinical follow-up.

Adolescent↗

PubMed1977

Intervertebral disk calcification associated with spine fusion.

Intervertebral disk calcification and spine fusion were observed in patients with Klippel-Feil syndrome, myositis ossificans progressive, juvenile rheumatoid arthritis, ankylosing spondylitis, and surgical spine fusion. The fusion appears to come first, leading to calcification. This suggests that fusion prevents the normal mechanical stresses within the disk, leading to premature degenerative changes and calcification of the nucleus pulposus.

Ankylosis↗

PubMed1993

Extraosseous Tc-99m MDP uptake: a pathophysiologic approach.

Scintigraphy with technetium-99m methylene diphosphonate (MDP) delineates a wide spectrum of nonosseous disorders. Neoplastic, hormonal, inflammatory, ischemic, traumatic, excretory, and artifactual entities demonstrate abnormal soft-tissue uptake of Tc-99m MDP. Mechanisms leading to increased extraosseous Tc-99m MDP uptake include extracellular fluid expansion, enhanced regional vascularity and permeability, and elevated tissue calcium concentration. The composition of the calcium deposition and the presence of other metallic ions (eg, iron and magnesium) are important. Soft-tissue Tc-99m MDP uptake is seen in benign (tumoral calcinosis, myositis ossificans) and malignant (sarcomas, adenocarcinomas, metastases) neoplastic entities. Hormonal disturbances in calcium metabolism, especially in hyperparathyroidism, can lead to metastatic calcification, visualized with Tc-99m MDP scintigraphy. Tissue damage from inflammation, infection, or physical trauma results in localized hyperemia, edema, or calcium (and hemosiderin) deposition based on their pathophysiologic characteristics. Urinary tract obstruction, anomalies, or dysfunction are demonstrated by Tc-99m MDP imaging. Common artifacts are related to faulty radiopharmaceutical preparation, Tc-99m MDP administration, and imaging technique. Recognition of these modes of extraskeletal Tc-99m MDP uptake can enhance the diagnostic value of bone scintigraphy.

Adult↗

PubMedDate not supplied

Tumoral calcinosis: pearls, polemics, and alternative possibilities.

Massive periarticular calcinosis of the soft tissues is a unique but not rare radiographic finding. On the contrary, tumoral calcinosis is a rare familial disease. Unfortunately, the term tumoral calcinosis has been liberally and imprecisely used to describe any massive collection of periarticular calcification, although this term actually refers to a hereditary condition associated with massive periarticular calcification. The inconsistent use of this term has created confusion throughout the literature. More important, if the radiologist is unfamiliar with tumoral calcinosis or disease processes that mimic this condition, then diagnosis could be impeded, treatment could be delayed, and undue alarm could be raised, possibly leading to unwarranted surgical procedures. The soft-tissue lesions of tumoral calcinosis are typically lobulated, well-demarcated calcifications that are most often distributed along the extensor surfaces of large joints. There are many conditions with similar appearances, including the calcinosis of chronic renal failure, calcinosis universalis, calcinosis circumscripta, calcific tendonitis, synovial osteochondromatosis, synovial sarcoma, osteosarcoma, myositis ossificans, tophaceous gout, and calcific myonecrosis. The radiologist plays a critical role in avoiding unnecessary invasive procedures and in guiding the selection of appropriate tests that can result in a conclusive diagnosis of tumoral calcinosis.

Calcinosis↗

PubMedDate not supplied

Acute medial elbow ruptures.

Disruption of the ulnar collateral ligament, flexor muscles, and anterior elbow capsule may result from valgus vector forces and subsequently cause difficulty in throwing, pulling, pushing and catching. Complete medial elbow tears were diagnosed acutely in four elbows by abduction stress tests at 15 degrees of flexion. Three elbows had associated ulnar nerve compression. We repaired torn medial structures by direct suture without ligamentous reconstruction. We also decompressed ulnar nerves and performed one anterior transposition. Full range of motion, strength, and return to previous functional level was attained without infection, neurovascular compression, or myositis ossificans.

Adult↗

PubMed2006

Extraskeletal osteochondroma in the nape of the neck: a case report.

Extraskeletal osteochondroma in the nape of the neck is rare and its pathological diagnosis is based on radiological and histopathological examination. It is vital that such a diagnosis be considered when a discrete, ossified mass is localised in soft tissues, even at atypical sites. Differential diagnoses include myositis ossificans, a lipomatous lesion, a pseudomalignant osseous tumour, an ossifying fibromyxoid tumour, an extraskeletal chondroma with endochondral ossification, synovial (osteo) chondromatosis, tumoural calcinosis, a synovial sarcoma, and an extraskeletal osteosarcoma. Clinical awareness of this benign entity is important as no malignant transformation or metastasis has been reported. Marginal excision with histopathological identification is the treatment of choice.

Adult↗

PubMed1987

The effect of head injury on fracture healing. A quantitative assessment.

Using a simple method of quantifying fracture healing, 53 patients who had limb fractures and also severe head injuries were studied; they were compared with 30 patients who had limb fractures but no head injury. Those with head injuries had a greater healing response and united more rapidly. Radiological and histological analysis revealed that the terms "myositis ossificans" and "heterotopic bone" may be more appropriate than "fracture callus" to describe the healing response in these patients.

Adolescent↗

PubMed1984

Untreated posterior dislocation of the elbow in children.

Fifteen children with an untreated posterior dislocation of the elbow were seen between 1965 and 1980. Three had a useful range of painless flexion and were not treated by operation. Twelve had a stiff elbow and had an open reduction between three weeks and three years after injury. The triceps was lengthened when it prevented reduction and Kirschner wires were used when necessary to stabilize the elbow. Complications included a transient paralysis of the hand in one patient and myositis ossificans with a rigid elbow in another. The length of follow-up ranged from one to six years. In eleven patients the average range of flexion was increased fourfold, and in all children the elbow had a useful range through 90 degrees of flexion. Eleven children said that the function of the arm was improved. However, four of them had been operated on within six weeks of the accident and might have regained a functional range of movement with a short trial of conservative therapy. We now recommend an interval of conservative treatment for children who are seen three weeks to two months after injury.

Adolescent↗

PubMed1998

The use of padding in rugby union. An overview.

In any contact sport where impact and collision are an accepted feature, the use of various forms of external padding has become more common. Rugby union players experience a combination of characteristic extrinsic forces through the acts of tackling and scrummaging. The laws which are part of the international regulation of rugby union only permit the wearing of certain, clearly delineated forms of padding. Only then is such padding permitted on medical recommendation, provided that this padding is attached to the body or sewn into the jersey. This article discusses the padding of the shoulders, shins and thighs of rugby union players and highlights the need to address these issues with respect to the increasing number of women who are now playing this sport, particularly in the Southern hemisphere. There is little evidence to show that shoulder pads decrease the incidence of severe shoulder injuries. However, well-fitting shoulder pads constructed of materials that effectively disperse the force of impact appear to reduce the effect of direct contact and reduce the potential for soft tissue damage. Shin guards that are made of light, soft, compliant materials are effective in reducing impact to the shin and thereby reduce the risk of bruising injuries which are common to the pretibial region. Similarly, thigh pads are considered to be able to modify the effects of direct contact forces to the anterior thigh where deep contusional injuries with the potential for myositis ossificans are well reported. Informed advice for women rugby players regarding the use of specific padding is unavailable at present. Current information is anecdotal and not confirmed by statistical studies or well-conducted research. In these circumstances, women rugby players should observe the same recommendations that apply to their male counterparts.

Female↗

PubMed1987

Osteomyelitis complicating fracture: pitfalls of 111In leukocyte scintigraphy.

111In-labeled leukocyte imaging has shown greater accuracy and specificity than alternative noninvasive methods in the detection of uncomplicated osteomyelitis. Forty patients with suspected osteomyelitis complicating fractures (with and without surgical intervention) were evaluated with 111In-labeled leukocytes. All five patients with intense focal uptake, but only one of 13 with no uptake, had active osteomyelitis. However, mild to moderate 111In leukocyte uptake, observed in 22 cases, indicated the presence of osteomyelitis in only four of these; the other false-positive results were observed in noninfected callus formation, heterotopic bone formation, myositis ossificans, and sickle-cell disease. These results suggest that 111In-labeled leukocyte imaging is useful for the evaluation of suspected osteomyelitis complicating fracture but must be used in conjunction with clinical and radiographic correlation to avoid false-positive results.

Adult↗

PubMed1996

Heterotopic ossification of midline abdominal incisions: CT and MR imaging findings.

OBJECTIVE: Heterotopic ossification of a midline surgical incision in a form of myositis ossificans traumatica in which osseous, cartilaginous, and, occasionally, myelogenous elements develop within an abdominal wound. When large amounts of internal ossification are present, the scar may demonstrate a complex radiologic appearance and potentially may be misinterpreted as a retained foreign body or incisional neoplastic recurrence. This report describes the CT and MR imaging findings of this entity. SUBJECTS AND METHODS: The authors retrospectively reviewed the cross-sectional imaging findings of 11 patients with ossified midline abdominal wounds. All but one of the patients were men, and the median age at diagnosis was 40 years old (range, 20-76 years old). Initial imaging was performed 7 days to 36 months after surgery (mean, 6.7 months). CT and MR imaging scans were reviewed, and lesion size, location, distance from the xiphoid, shape, and stability were assessed. Pathologic proof was obtained in one patient. RESULTS: CT and MR imaging examination in all patients showed ossified surgical scars, with the attenuation or signal intensity of the ossified components equivalent to that of the spine. Intralesional, fat-density components suggestive of marrow were present in two patients. All scars were located in the upper abdomen between the anterior abdominal fascia and the peritoneal surface, at the level of or inferior to the xiphoid process. Scars ranged in length from 0.7 to 13.4 cm (mean, 6.9 cm). Distances from the inferior tip of the xiphoid to the superior aspect of the ossified scar ranged from 0 to 4.9 cm (mean, 2.2 cm). Time from surgery to the initial postoperative demonstration of scar ossification ranged from 11 days to 36 months (mean, 6.8 months). None of the five patients who underwent preoperative CT examinations had abnormalities in the location of subsequent scar ossification. Of the nine patients with multiple postoperative examinations, scar size and appearance remained stable in six. In the remaining three patients, scar size was stable but showed progressive internal ossification. CONCLUSION: Heterotopic ossification within midline abdominal scars can be diagnosed by both CT and MR imaging examination. Recognition of the imaging appearances of such ossification should help prevent diagnostic confusion when attending postoperative patients.

Abdominal Muscles↗

PubMed1999

MR imaging of myotendinous strain.

Myotendinous strain predominantly exhibits pathognomonic MR features. Whenever a patient's musculoskeletal symptoms lack temporal correlation with exercise, MR imaging may be valuable in distinguishing strain injury from other disorders of the myotendinous unit. Compared with myotendinous strain, myositis ossificans has variable and nonspecific MR appearances that may simulate neoplasm and require biopsy for diagnosis.

Adolescent↗