Recurrent focal myositis is a rare entity and can be difficult to diagnose and treat. A long-term follow-up and diagnostic evaluation was carried out in a patient who presented with ankle stiffness secondary to a painful mass within the calf. This process was diagnosed as focal myositis of the peroneal muscles, which recurred over a period of 7 yr. A review of the literature regarding focal myositis, treatment options and a successful conservative therapy regimen, as an alternative to a surgical protocol, are presented. After making the diagnosis with the help of a muscle biopsy, long-term therapy should be considered. Conservative treatment of focal myositis with anti-inflammatory drugs and physical therapy can be successful but recurrence may occur if the medical treatment is interrupted.
We report the case of a 30-year-old female patient, who had suffered a grade III open femur fracture in a motor vehicle accident 14 weeks prior to being transferred to the trauma department of the University Hospital in Bonn. Upon admission to our unit, posttraumatic osteitis, an unstable fracture following compression plating, and a soft tissue defect of the anterolateral distal thigh were discovered. Following removal of the hardware and stabilization of the fracture with external fixation, the infection was brought under control. Because the patient refused the time-consuming segmental transport utilizing the callus distraction technique, local muscle transfer and shortening of the femur were carried out. The most lateral of the hamstring muscles, the biceps femoris, was used as a distally based muscle flap utilizing a delay technique. With the help of a reversed biceps femoris flap, the soft tissue defect was closed, the infection subsided and the fracture healed. The surgical technique is outlined.
The fracture through the apophysis underlining the tibial tuberosity remains an infrequent traumatic lesion. The simultaneous bilateral occurrence of this injury is rare. A 16-year old athlete suffered an Ogden type 1B fracture on the left and a type 1B injury combined with a Salter II lesion on the right side during the acceleration phase of a high jump. Open reduction and internal fixation were carried out bilaterally on the day of the injury. Hardware removal was performed after 12 weeks. Full range of motion and return to athletic activity was obtained 20 weeks after the injury. A modification of the Ogden classification is suggested.
Two cases of sports-related two-plane fractures of the distal tibia, their operative treatment and the result of therapy after hardware removal are reported. The incidence and mechanism of this type of fracture in adolescents are shown as well as the indication for surgical reconstruction depending on the gap in the joint surface of the distal tibia.
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