Open Access Case Report

Neurosyphilis Charcot’s Joint

Aung Kyi Winn, Kyi Swe Tint, Thin Nandi Swe Win, Viriya Low Hui Jian

Asian Journal of Orthopaedic Research, Page 1-5

Charcot’s joints or neuropathic joints is a progressive arthropathy associated with loss of pain sensation and proprioception of the involved joint. The painless destructive joint is associated with tertiary syphilis (tabes dorsalis). Other causes are Diabetic neuropathy, Leprosy (mainly lower limb joints), Syringomyelia (upper and lower limbs), Multiple Sclerosis, Myelomeningocele, alcoholism, and spinal cord compression [1].

We would like to report a case of Charcot’s joint in a neurosyphilis patient. A 55 years male, known syphilis for 30 years, presented with a history of progressively painless swelling both knees following instability and unable to walk for six years. Last 6 years ago, he noticed that both knee joints were swollen and deformed. There was a history of instability while walking and weight-bearing. Hence, he is ADL (Advance daily life support) dependent and uses a wheelchair. He has no history of alcohol consumption and drugs.

This case is selected for reporting due to its relatively rare incidence and unusual presentation.

Open Access Case Report

Giant Cell Tumour of Extensor Tendon Sheath in the Hand–A Case Report and Strategies to Prevent Recurrence

Ling Lee Siang, Seo Soon Teck, Sivapathasundaram A/L C. Nadarajah

Asian Journal of Orthopaedic Research, Page 1-5

Aims: Giant cell tumour of tendon sheath (GCTTS) was first described by Chassaignac back in 1852 as a rare benign tumour of uncertain aetiology. GCTTS is a painless slow growing benign tumour that develops over period of months to years. They present a surgical dilemma due to their high incidence of recurrence.

Presentation of Case: A 50 years old Malay lady presented to us with left middle finger pain and swelling for 4 months which was slowly increasing in size. She was diagnosed with giant cell tumour of left middle finger proximal phalanx and underwent excision biopsy and on regular follow up to monitor for any recurrence. So far after one year of follow up there is no recurrence of the disease.

Discussion:  Giant cell tumour of tendon sheath (GCTTS) is a locally aggressive, proliferative disorder of the synovium involving a joint, bursa or tendon sheath. Surgery remains the primary treatment of choice for GCTTS. However, surgery alone in GCTTS has high recurrence rate of as high as 30%. We will discuss on strategies to prevent recurrence of this condition.

Conclusion: Every effort should be made to have complete excision of tumour without leaving behind satellite lesions and bony erosions should be thoroughly curetted to reduce the risk of recurrence. Patient may also be offered the benefit of radiotherapy if the excised specimen shows evidence of mitosis or if the excision is less than complete. Patients with these risk factors should be offered regular follow up for up to five years to make sure that any recurrences are identified early.

Open Access Case Report

Challenges in Subtrochanteric Femur Fracture Management: A Case Report of Inappropriate Implant Choice Leading to Fixation Failure and Update on Management Options

Ling Lee Siang, Seo Soon Teck, Sivapathasundaram A/L C. Nadarajah

Asian Journal of Orthopaedic Research, Page 1-7

Subtrochanteric fractures of the femur remains one of the most challenging fractures encountered by orthopaedic surgeons. They account for 10 to 15% of all hip fractures. Subtrochanteric region of the femur is defined as the proximal femoral shaft located within 5 cm of the lesser trochanter. It is common in older patients after low energy trauma along with osteoporosis and in younger patients with high energy trauma. The management of subtrochanteric fractures is challenging because of the inherent instability of the fracture pattern. Fractures to this area can result in significant complications and poor clinical outcomes such as failure of fixation, shortening, malrotation and non-union if not managed properly and inappropriate choice of implant was used. We are presenting a case report of an elderly lady with history of alleged fall in bathroom at home and sustained closed left subtrochanteric femur fracture. She was initially planned for dynamic hip screw fixation however choice of implant was changed to interlocking femoral nail during preoperative census meeting. Patient underwent interlocking nail of left femur. Intraoperative reduction was satisfactory. However, on day 1 postoperative was noted that distal femur was externally rotated and proximal femoral fragment displaced in valgus direction. There was a failure of fixation and patient was counselled for operation in which patient’s family declined and opted for conservative management. The purpose of this presentation is to highlight the challenges, examine the various treatment modalities and implant options in treatment of subtrochanteric femur fracture for optimal postoperative outcome.

Open Access Case Report

Bertolotti’s Syndrome: An Underdiagnosed Cause of Lower Back Pain; A Case Report of Two Cases and Current Management Options

Ling Lee Siang, Seo Soon Teck, Sivapathasundaram A/L C. Nadarajah

Asian Journal of Orthopaedic Research, Page 1-7

Bertolotti’s syndrome is a disorder of the spine characterized by chronic lower back pain associated with lumbosacral transitional vertebra (LSTV) in which there is an abnormal enlargement of the transverse process of the fifth lumbar vertebra. It may be a source of chronic pain in 10% of lower back pain patients younger than 30 years.  In Bertolotti’s syndrome, the fifth lumbar vertebra transverse process may be enlarged either unilaterally or bilaterally and may articulate or fuse with the sacrum or ilium. It is an anatomical variant of sacralization of fifth lumbar vertebra. This causes alterations in the biomechanical characteristics of the lumbar spine resulting from asymmetrical motion between the sacrum and LSTV. It is often a factor that is not taken into consideration in the workup and management of lower back pain. The syndrome affects 4% to 8% of the population. It can cause pain due to involvement of various structures: lumbosacral neo-articulation, contralateral facet arthrosis, sciatica, discogenic, or sacroiliac pain. Physical examination usually shows normal findings. Bertolotti’s syndrome is oftentimes underdiagnosed and should be suspected as a differential diagnosis for lower back pain. Therefore, this case report highlights two cases with Bertolotti’s syndrome and explains its epidemiology, pathophysiology and management which is an important topic of general knowledge to all doctors.

Open Access Case Study

Operative Management (Bosworth Procedure) of Osgood – Schlatter Disease in an Adolescent Indian National Hockey Player: A Case Report

Nitin Patil, Sapan Vora, Chitresh Mehta

Asian Journal of Orthopaedic Research, Page 1-5

Osgood-Schlatter’s disease remains the most frequent cause of chronic knee pain in adolescent children although it is an uncommon disorder whose incidence is generally unknown. We report a 16-year-old boy who was national hockey player came to the clinic with his father complaining of recurrent both sided knee pain for one year without fever and limitation of ambulation. There was no history of trauma or previous injury to knees. Initially he was only aware of pain when playing hockey and relieved with rest but over time he began to experience pain at rest. Plain radiograph showed features of bilateral tibial osteochondrosis with right tubercle fragmentation suggesting Osgood-Schlatter’s disease. We managed left knee conservatively and right knee surgically, both with good results.