Talar injuries that are associated with pilon fractures include talar body fractures, osteochondral defects, and posterior process talar fractures. Pilon fractures, in combination with talar dome fractures, have not yet been reported in the scientific literature. We report the case of a 15-year-old boy who sustained a pilon fracture with a lateral talar dome fracture. The pilon fracture was initially fixed using a temporary external fixator for soft-tissue care. After the swelling subsided, definitive internal fixation was performed. First, the lateral talar dome fracture was directly reduced and fixed using a small anterolateral approach of the ankle. Then, the intra-articular portion of the pilon fracture was directly reduced using the same anterolateral approach and an additional small anteromedial approach, and the extra-articular metaphyseal portion of the pilon fracture was indirectly reduced. The pilon fracture was finally fixed with an anterolateral distal tibia plate, using a submuscular plating technique through the anterolateral approach and a separate proximal skin incision. A medial distal tibia plate was later added using a subcutaneous plating technique through the anteromedial approach and another proximal skin incision. Both the pilon fracture and the lateral talar dome fracture were addressed simultaneously through a combination of the small anterolateral and anteromedial approaches.
Tillaux fracture is known to occur in adolescents once it happens during the transition period when the medial and central physis has finished closure, but the lateral physis is still opened. The trauma mechanism is typically external rotation ankle injury resulting in an avulsion fracture of the anterolateral tibial plafond. This fracture has rarely been reported in adults, especially associated with other injuries. We report a case of Tillaux fracture in an adult, associated with a Volkmann fracture and a Maisonneuve fracture, that were surgically treated with open reduction and internal fixation and had an excellent outcome. Recognizing and appropriately treating these injuries is key in the prevention of further degenerative arthritis and instability.
We present a case of tibial pilon fracture where only the lateral part of the distal tibia was affected. The transfibular approach to the ankle was used for the surgical treatment of the fracture. After an initial nonweightbearing period of 3 weeks, full weightbearing was allowed 8 weeks after surgery. The second-year follow-up showed no evidence of degenerative signs, with full ankle range of motion.
Verrucous skin lesions on the feet of diabetic patients in conjunction with a neuropathic foot ulcer is an uncommon incident. Currently, there are approximately 20 reported cases in the literature. Herein we report two cases of verrucous lesions superimposing a chronic diabetic ulcer. Patients failed several conservative treatments, and several biopsies were performed with inconclusive results, suggesting possible underlying verrucous carcinoma. Given the possibility of underlying malignancy, both patients were treated with wide excision, and both were negative for malignancy, thus confirming verrucous skin lesions on the feet in diabetic neuropathy. We also summarize the current literature on verrucous skin lesions on the feet in diabetic neuropathy.
Nora's lesion, or bizarre parosteal osteochondromatous proliferation (BPOP), is a rare benign lesion that is made up of varying degrees of cartilage, bone, and spindle cells. Most notably, calcification of the cartilage or “blue bone,” is a feature of the disorder. The condition principally affects long tubular bones of the hands and feet, and is generally seen in patients in their second and third decades of life. We present a case of BPOP occurring in the second interspace with symptoms that would be consistent with a more common diagnosis of predislocation syndrome, or a second interspace neuroma. This case study may help the clinician in considering a more subtle cause of a splay deformity in the second interspace, and walk through the diagnostic and treatment course for BPOP.
Psoriatic arthritis is an uncommon, chronic inflammatory disease. Laboratory testing for psoriatic arthritis, although necessary for a complete work-up, is generally nondiagnostic for most patients. We present a case of a 26-year-old woman with unilateral plantar forefoot pain and swelling that was diagnosed as psoriatic arthritis. The diagnosis was made without the benefit of skin manifestations or definitive laboratory results, other than those from laboratory tests performed for an initial evaluation of acute-phase reactants. Radiographs showed nonspecific subchondral bone changes at a few metatarsophalangeal joints of the involved foot that suggested an inflammatory arthropathy. This case illustrates that the absence of specific serum markers for psoriatic arthritis can make its diagnosis challenging, especially in the absence of dermatologic changes of psoriasis.
Over a time frame of less than 1 year, a 23-year-old competitive horseback rider experienced a midsubstance tear of both the tibialis anterior and extensor hallucis longus tendons without inciting injury. It was after the second spontaneous tear that the patient's recent diagnosis of Lyme disease became the likely culprit. Often, patients with chronic Lyme disease present with an elaborate clinical picture that can mimic many more common diagnoses such as septic arthritis, transient synovitis, ligamentous sprain, and various other traumatic injuries. With the pathognomonic erythema migrans rash reported to be present less than 50% of the time in late-stage infections, the diagnosis of Lyme disease can often be difficult, with a high rate of underdiagnosis. It is important that Lyme disease be included in the differential diagnosis of spontaneous tendon pathology, especially for physicians practicing in highly endemic areas. The treatment is relatively simple and successful—especially for an acute infection—and it is important to initiate treatment promptly to prevent disability.
Angioleiomyomas are benign soft-tissue tumors that present painfully and are more commonly found in the extremities. Although benign soft-tissue tumors do not require excision, the clinician may not always know the type of tumor, and patient symptomatology may require removal of the offending body. In this article, we present our case findings of a 45-year-old man presenting with a subcutaneous angioleiomyoma subcalcis.
A 36-month follow-up of the management of bilateral adolescent unicameral bone cysts in a high school gymnast treated with a calcium sulfate/calcium phosphate (CSCP) bone void filler (BVF) is presented. The more developed left calcaneal cyst was managed with a traditional, open approach consisting of allogenic bone graft, CSCP BVF mixed with platelet-rich plasma. The less developed right calcaneal cyst was managed with a less used approach, a percutaneous bone cortex incision with only the CSCP BVF. The rationale for the selection between the open and percutaneous approaches, long-term BVF incorporation, and positive patient outcome allowing a quick return to athletics are presented.
Enchondroma is the most common benign cartilage bone tumor of the toes. In contrast, the foot is a rare region for chondrosarcoma, and the involvement of phalanges is extremely rare. In this article, we report an unusual case of intermediate chondrosarcoma involving the proximal phalanx of the great toe of a 52-year-old woman who was previously treated with curettage and bone grafting because of misinterpretation of enchondroma at a local hospital. She presented complaining of pain and swelling that she had experienced for a period of 1 year after the first operation. Radiography revealed a lytic lesion with a subtle punctuate calcification and endosteal scalloping in the proximal phalanx of the great toe. Gadolinium-enhanced magnetic resonance imaging confirmed soft-tissue involvement and cortical destruction. Staging evaluation with computed tomographic scan of the chest, abdomen, and pelvis was performed to ensure that there was no metastatic disease. Subsequently, a bone biopsy was performed, and the diagnosis was grade 2 chondrosarcoma. The patient was informed about the recurrence of the lesion and the clinical context on the basis of tumor biology of chondrosarcoma and was offered the option of either amputation or wide resection. She preferred the latter. The patient was treated with wide resection and underwent reconstruction with cement and Kirschner wire. She remains free of disease after 1 year of follow-up.