It is uncommon in clinical practice to discover cancer as either a metastasis within soft tissue or containing heterotopic bone formation. These rarities are documented primarily through case reports in the literature. This report describes a patient with colon cancer whose painful wrist lesion was proven to exhibit both of these unusual features. It is important to...
(Vol 14 p 16-20, General Surgery; Orthopaedics; Pathology; Radiology: 3 September 2014)
This report describes a pathologic fracture of the patella secondary to destruction by a giant cell tumour. Diagnosis was made after non-union of a patella fracture, with osteolysis and soft tissue invasion. Delayed union of any fracture should raise the possibility of an underlying pathologic process.
(Vol 14 p 6-10, Orthopaedics: 4 August 2014)
Multiple pathologic fractures in a patient with sickle cell disease is rare; bone involvement is well documented in this disease, however multiple pathologic fractures as a complication are uncommon. We present a case involving a 19-month-old boy known to have sickle cell disease who developed multiple pathologic fractures as a complication of his disease. The patient was...
(Vol 13 p 63-68, Haematology; Orthopaedics; Paediatrics; Pathology; Radiology: 22 July 2013)
We present the case of a healthy seasoned marathon runner who sustained bilateral quadriceps tendon rupture following a low-energy fall. Radiographs demonstrated bilateral patellar spurs. Our case report serves to highlight the importance of maintaining a high index of clinical suspicion in patients of all ages. This is the first report of bilateral quadriceps rupture in...
(Vol 11 p 77-80, Orthopaedics; Radiology: 4 November 2011)
Knee pain, stiffness and swelling are common complaints. Trauma and osteoarthritis are the most common diagnoses. However, benign and malignant tumours may also present around the knee. These tumours require characterization prior to definitive treatment. Here we describe a rare cause of knee stiffness with a popliteal mass.
(Vol 11 p 44-47, Orthopaedic Surgery; Rheumatology: 14 June 2011)
Plantar fibromatosis is a complex problem encountered by many surgeons in different specialties. Understanding the complexity of this debilitating disease and awareness of the concept of the reconstructive toolbox is crucial in achieving best surgical outcome. We present a case where an instep defect following an excision of recurrent plantar fibromatosis was...
(Vol 11 p 28-33, Orthopaedics; Plastic Surgery: 6 April 2011)
Static winging of the scapula is a rare diagnosis. It may be caused by pathology of the scapula or the chest wall. Solitary osteochondroma of the scapula is one of the rare causes and may present an initial diagnostic difficulty. We present a case of an 18-year-old man who presented with non-specific pain in his right shoulder following a fall. Initial examinations and...
(Vol 10 p 86-88, Emergency Medicine; Trauma; Orthopaedics: 22 October 2010)
Femoral neck fractures are common in the elderly and are broadly grouped into either intracapsular or extracapsular fractures. We report an unusual femoral neck fracture that had features of both and discuss the management of such a case.
(Vol 10 p 74-77, Orthopaedic surgery; Trauma surgery: 22 October 2010)
Arterial injury is a rare complication of knee replacement. We present a delayed presentation which was proven with arteriography and successfully treated with embolisation rather than open surgery. In atypical clinical pictures of swelling and equivocal inflammatory markers, clinicians should consider the differential diagnosis of persistent arterial bleeding.
(Vol 10 p 51-54, Orthopaedic surgery; Vascular surgery: 22 July 2010)
A woman with known adenocarcinoma of the right parotid gland presented with bony metastasis in her left proximal femur. This was histologically confirmed and the patient underwent prophylactic intramedullary nail and hip screw fixation of her left proximal femur. This represents the first report of adenocarcinoma of parotid origin metastasising to a long bone in an adult.
(Vol 9 p 59-62, Oncology, Orthopaedic surgery: 22 July 2010)
Rhabdomyolysis is considered a relative contra-indication to free tissue transfer because of the formation of free radicals that cause endothelial damage to the microcirculation. We describe the case of a young man who required free tissue transfer coverage of a large open fracture of his right tibia and fibula. This was performed successfully in the presence of...
(Vol 10 p 34-37, Orthopaedic surgery; Plastic surgery: 27 June 2010)
Radiation-induced sarcomas are a well-recognized late complication of radiation therapy. We present a rare case of a periosteal osteosarcoma of the femur developing 10 years after radiation treatment for a soft tissue sarcoma to highlight the clinical and radiological features of this rare complication of therapy and to describe its management.
(Vol 10 p 13-18, Orthopaedics; Radiology: 16 February 2010)
A rare case of local recurrence of a high-grade osteosarcoma of the pelvis is described, 19 years after initial presentation, highlighting the need for continued long-term follow-up of patients with osteosarcoma. We review the literature concerning osteosarcoma of the pelvis, local recurrence and treatment with custom-made hemipelvic replacements.
(Vol 10 p 8-12, Oncology; Orthopaedics: 16 February 2010)
Intramuscular supraspinatous cysts are rare and usually related to partial supraspinatous tendon tears. Conventional magnetic resonance imaging (MRI) and MRI arthrography are the most commonly used modalities for imaging such rotator cuff pathology. Treatment and follow-up of such cysts is not well documented in the literature. We report the successful conservative...
(Vol 9 p 29-32, Orthopaedic surgery, Radiology: 17 November 2009)
Spontaneous spinal epidural haematoma is a rare condition that may lead to spinal cord or cauda equina compression resulting in severe neurologic impairment. Predisposing factors include anticoagulation, vascular malformation, disc herniation. Both surgical and more recently conservative modes of treatment have been described in the literature. This is the first reported...
(Vol 9 p 24-28, Neurosurgery, Orthopaedic surgery: 17 November 2009)
Compartment syndrome is a potentially limb- and life-threatening clinical entity resulting from elevated intra-compartmental pressures. A high clinical suspicion is paramount in diagnosis since full recovery is time-sensitive. We present a unique case of chronic myelomonocytic leukemia-induced (CMML) compartment syndrome which illustrates the importance of quick diagnosis...
(Vol 8 p 31-34, Accident and Emergency Medicine and Surgery (including Trauma); Orthopaedic Surgery; Vascular Surgery: 1 October 2008)
We report on an 81-year-old male with bilateral septic arthritis of the knee joints, who was treated with multiple joint washouts and intravenous antibiotics. As far as we know, there has been no case report in the English literature, on bilateral septic arthritis of the knee secondary to group G β-haemolytic streptococcal endocarditis.
(Vol 8 p 28-30, Cardiology; Microbiology; Orthopaedic Surgery; Infection and Immunity: 29 September 2008)
We report the case of a healthy 44-year-old gentleman who sustained bilateral patellar tendon rupture while jumping on a trampoline. Although this kind of injury has been reported in the literature previously, it is extremely rare in healthy individuals. We believe it is the first documented case associated with the use of a trampoline.
(Vol 7 p 70-74, Accident and emergency medicine and surgery (including trauma); Orthopaedic surgery: 20 November 2007)
Primary glenoid dysplasia, although a relatively rare diagnosis, has been well described clinically and published in the orthopaedic literature. However, very few cases of familial occurrence of the disease have been reported. We present two cases of the condition in a father and son. Both presented in childhood with recurrent shoulder pain and radiologically display...
(Vol 7 p 13-15, Orthopaedic surgery, Paediatrics: 20 February 2007)
Musculoskeletal injuries following low voltage electrocution are extremely rare. We present the case of a 54-year-old gentleman who had an accident while working with 240-volt live wires. The absence of any associated trauma should not rule out the presence of scapular fractures in such cases.
(Vol 4 p 10-12, Orthopaedics, Emergency medicine: May 2004)
The internal fixation of fractures is associated with a risk of infection. Open fractures in particular are susceptible to such infection. Treatment is difficult and patients can develop a chronic osteomyelitis. We present the case of a patient who developed chronic osteomyelitis with a persistent discharging sinus following internal fixation of an open fracture of tibia...
(Vol 4 p 4-6, Orthopaedics and Oncology: March 2004)
Total dislocation of the talus with dislocation of the talonavicular, subtalar and ankle joint is an extremely rare injury. Coltart in 1952 included no fracture total talar dislocation in his classification system [1]. Leitner considered subtalar dislocation to be the preliminary stage to total talar dislocation [2]. He stated that severe supination or inversion forces...
(Vol 2 p 29-31, Orthopaedics: May 2002)
A 19-year-old boy presented with a 3-month duration of intermittent low back pain. SPECT imaging and CT scan confirmed the diagnosis of osteoid osteoma in the left pars inter-articularis of the L4 vertebra. Surgical enucleation of the tumour, curettage and bone grafting was performed through a posterior approach. The pars inter-articularis of L4 is an unusual location of...
(Vol 2 p 21-23, Orthopaedics: May 2002)
A 78-year-old lady, with no history of trauma, was admitted with gradually increasing pain in the right groin and thigh; she had been unable to weight-bear for 24 h. The patient also complained of intermittent left shin pain. She had been treated for carcinoma of the breast 22 years earlier by total mastectomy with axillary clearance followed by local radiotherapy; she...
(Vol 2 p 13-16, Orthopaedics: March 2002)


Frank Cross
Consultant Vascular and General Surgeon
The London Clinic, UK


Neil Barnes
Consultant Physician
Barts Health NHS Trust, London, UK
Ali Jawad
Professor of Rheumatology
Barts Health NHS Trust, London, UK

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