No abstract

BackgroundAmong the various complications described in literature, the patellar tendon ossification is an uncommon occurrence in anterior cruciate ligament (ACL) reconstruction using bone – patellar tendon – bone graft (BPTB). The heterotopic ossification is linked to knee traumatism, intramedullary nailing of the tibia and after partial patellectomy, but only two cases of this event linked to ACL surgery have been reported in literature.Case presentationWe present a case of a 42-year-old Caucasian man affected by symptomatic extended heterotopic ossification of patellar tendon after 20 months from ACL reconstruction using BPTB. The clinical diagnosis was confirmed by Ultrasound, X-Ray and Computed Tomography studies, blood tests were performed to exclude metabolic diseases then the surgical removal of the lesion was performed. After three years from surgery, the patient did not report femoro-patellar pain, there was not range of motion limitation and the clinical-radiological examinations resulted negative.ConclusionThe surgical removal of the ossifications followed by anti-inflammatory therapy, seems to be useful in order to relieve pain and to prevent relapses. Moreover, a thorough cleaning of the patellar tendon may reveal useful, in order to prevent bone fragments remain inside it and to reduce patellar tendon heterotopic ossification risk.

The surgical treatment in neuromuscular scoliosis is burdened by a large number of complications. An accurate knowledge of possible complications is mandatory to prepare strategies due to prevent adverse events. A difference in definitions could completely change results in good or bad as well as in our same series the adverse events amounted at almost 30% of cases, but complications that due to complete failure would amount at 9.19% of patients.

The assisted self-reduction technique is simple, effective and gentle. Physicians on duty in the Emergency Departments should therefore be encouraged to use it.

Development of osteomyelitis in a closed fracture is rare. Although it has been reported that trivial trauma may be associated with the subsequent development of acute osteomyelitis, no evidence has been found that fractures are involved in the etiology of osteomyelitis. Only 25 cases (11 in adolescents) of osteomyelitis after closed fracture have been reported in literature. The authors report a case of osteomyelitis in an 8-year-old girl after a forearm fracture involving the diaphysis of the radius and ulna. Radiographic examinations were performed 5, 14, and 30 days after trauma. At last examination, the forearm appeared swollen and red. Blood culture and radiographs confirmed the clinical suspicion of osteomyelitis. The cultures grew Pantoea agglomerans, a saprophytic gram-negative bacterium commonly isolated from plants, flowers, seeds, water, and soil and sensitive to all of the most common antibiotics. After the arm was immobilized, high doses of intravenous antibiotics were administered for 4 weeks, and oral antibiotics were prescribed for an additional 4 weeks. The patient responded well to treatment. Twelve months after the initial injury, the patient regained full elbow and wrist flexion-extension range of motion. Based on their experience and a review of the literature, the authors suggest that bone infection be considered for patients with closed fractures complicated by excessive or prolonged pain and swelling with evident signs of inflammation where no other obvious infection is apparent. Moreover, in children, bacterial infection may cause osteomyelitis more frequently than in adults, but no evidence exists that a closed fracture increases the incidence of osteomyelitis in children with a systemic infection.