Lipomas are common, benign, soft tissue masses in adults. Sarcomatous change within a giant lipoma is a very rare event. We present a case of a woman presenting with a forearm lipoma that subsequently developed a central, well-differentiated, spindle-cell sarcoma within the lipoma. This case underlines the importance of identifying red flags for referral of soft tissue tumours.
Altered wrist biomechanics consequent to a scapholunate dissociation or a scaphoid nonunion accelerates the degeneration of the surrounding articular surfaces and often induces arthritic progression referred to as a scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC). 1,2Watson and Ballet described four stages of the arthritic progression of the affected articulations. 2 Stage III progression is determined by radiological evidence of degenerative changes to both the radioscaphoid and the lunate-capitate joint surfaces, and is generally associated with progressive pain and reduced wrist Keywords ► scaphoid nonunion advanced collapse ► arthritis ► advanced collapse ► biomechanics ► wrist AbstractBackground Scapholunate advanced collapse and scaphoid nonunion advanced collapse result in high morbidity and pose significant challenges for active patients. Multiple treatment options have been proposed to yield satisfactory results; however, restoration of physiological wrist motion remains an issue. Questions/Purposes The objective of this study was to compare wrist mobility after four different treatment methods for grade III wrist collapse: (1) no treatment, (2) scaphoidectomy and lunate-capitate arthrodesis, (3) scaphoidectomy, lunate-capitate arthrodesis, and triquetrum-hamate arthrodesis, and (4) scaphoidectomy, lunatecapitate arthrodesis, and triquetrum excision. Methods Four paired (n ¼ 8) fresh-frozen human cadaveric upper limbs were used in this controlled laboratory study. Computed tomography scans were collected at all testing states and measurements were made to evaluate midcarpal joint mobility and alignment. Results A significant decrease in wrist extension was observed for all treatments. Middle column and two-column arthrodesis demonstrated no significant differences for carpal alignment and mobility. No significant differences were observed for triquetrumhamate mobility or wrist extension between the partial and two-column arthrodesis. Triquetrum excision significantly improved ulnar deviation. Conclusion The most important finding of this study was that the one-column arthrodesis has comparable carpal alignment and range of motion to that of bi-column arthrodesis. Clinical Relevance The results of this study suggest that a stage III advanced wrist collapse can be treated by isolated lunate-capitate arthrodesis with scaphoidectomy. Fusion between the remaining carpal bones may not be necessary because the carpal alignment and range of motion of the remaining joints were not significantly different in the present study.
<p>Las prótesis abisagradas de rodilla tienen índices de complicaciones que pueden llegar al 44% en 15 años. La luxación protésica secundaria a una rotura del mecanismo abisagrado resulta ser la complicación alejada más frecuente luego del aflojamiento mecánico.</p><p>Presentamos un caso de luxación protésica posterior, en un implante abisagrado rotatorio de tercera generación (Rotax, FII SA®, Saint Just Malmont, Francia), implantada originalmente en una paciente de 69 años, con artritis reumatoidea y tratamiento prolongado con Metilprednisona y Metotrexato a altas dosis. El tratamiento fue realizado en ambas rodillas en dos tiempos para corregir una deformidad en ráfaga altamente invalidante.</p><p>Nuestra hipótesis postula que la luxación se debió a la rotura del buje de polietileno del implante, siendo este el eslabón más débil del mecanismo abisagrado.</p><p>Existen escasos reportes bibliográficos sobre esta particular complicación. Sin embargo, encontramos homogeneidad en las conclusiones de los mismos, considerando el ensamble entre el componente tibial y femoral, como el punto más frágil del sistema.</p>Recomendamos en estos complejos escenarios realizar la revisión protésica solo ante la presencia de episodios clínicos evidenciables, como luxaciones o Inestabilidad persistente
El tumor mesenquimático fosfatúrico es una entidad clinicopatológica sumamente infrecuente. Además de provocar dolor óseo insidioso y polimialgias, se acompaña de alteraciones del metabolismo fosfocálcico de difícil manejo clínico. El abordaje multidisciplinario resulta la clave del éxito en esta enfermedad. Presentamos una paciente de 52 años de edad con antecedente de tumor mesenquimático fosfatúrico en la hemipelvis derecha con extensión a la cadera homolateral de 10 años de evolución. Clínicamente presentaba osteomalacia oncogénica (hipofosfatemia e hiperfosfaturia) que no se corregía, pese a un agente de últimageneración, el burosumab, un inhibidor del factor de crecimiento fibroblástico 23, que aumenta la tubular renal de fosfatos. En un comité multidisciplinario, se decidió la resección con márgenes oncológicos y se logró una mejoría clínica franca. Comunicamos este caso, debido a que es un cuadro infrecuente
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