Minimally invasive TKA has benefit in quadriceps recovery at earlier rehabilitation period although catch-up recovery in conventional TKA was accelerated from the postoperative 6 weeks to 3 months. It may support the concept of early return to full activity after minimally invasive TKA, and patients might get back early to normal life.
An eight year old girl presented with a progressively increasing deformity of the left proximal tibia since last 2 years. She had no history of trauma, fever and swelling of left knee. There were no obvious signs of rickets/muscular dystrophy. She had 25 degrees of tibia vara clinically with lateral thrust and a prominent fibular head. The radiograph of left knee revealed tibia vara with medial beaking and a significant depression of the medial tibial epiphysis and metaphysis. A computed tomography (CT) scan revealed significant depression of the medial tibial epiphysis but no bony bar in the physis or fusion of the medical tibial epiphysis. There was a posterior slope in addition to the medial one. She was treated with elevation of the medial tibial hemiplateau with subtuberosity valgus derotation dome osteotomy. She also underwent a lateral proximal tibial hemiphysiodesis (temporary stapling). A prophylactic subcutaneons anterolateral compartment fasciotomy was also performed. All osteotomies united in 2 months. All deformities were corrected and she regained a knee range of 0 to 130 degrees. At final followup (4 years), there was no recurrence of varus deformity, knee was stable, with 1cm of leg length discrepancy. In Langenskiold stage IV tibia vara, elevation of medial tibial plateau, a subtuberosity valgus derotation osteotomy and a concomitant lateral hemiephiphysiodesis has given good results.
a b s t r a c tNonbacterial osteitis (NBO) is an underdiagnosed and poorly understood condition caused by sterile inflammation. It can mimic the presentation of many other orthopaedic conditions, for example, osteomyelitis, septic arthritis, or malignancy, in particular for those patients who have unifocal presentation. Because NBO is a diagnosis by exclusion, it poses much difficulty and confusion to many orthopaedic surgeons in treating such disease. Clavicular involvement is common but it is typically present at the medial aspect of the clavicle. We report a case of NBO with atypical clavicular involvement who presented to our orthopaedic clinic with painful swelling in the left shoulder. Appropriate investigations and management are discussed together with literature review.
Septic arthritis is a surgical emergency requiring prompt drainage of the accumulation of pus in the joint. We report an eight-year-old boy who was referred to the Armed Forces Hospital, Salalah, Oman, in 2016 with limping and pain in his right hip along with an abduction deformity. He was initially diagnosed with synovitis and underwent conservative management. However, two weeks later, he presented to another centre due to persistent pain. Magnetic resonance imaging was suggestive of septic arthritis or osteomyelitis. Eight weeks later, the patient presented again to the Armed Forces Hospital. An arthrotomy was performed, during which an amount of what appeared to be frank pus was drained; however, cultures of the intraoperative samples returned no growth. A histopathological analysis revealed an osteosarcoma. The patient was subsequently referred elsewhere and underwent neoadjuvant chemotherapy and limb salvage surgery. Several months later, he relapsed and developed extensive pulmonary metastasis and died as a result of progressive deterioration.Keywords: Osteosarcoma; Hip Joint; Septic Arthritis; Osteomyelitis; Differential Diagnosis; Case Report; Oman.
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