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Roca disease: An osteochondrosis of the inferior pole of the scapula with review of the literature. Radiol Case Rep 2020; 15:1523-1527. [PMID: 32670453 PMCID: PMC7339011 DOI: 10.1016/j.radcr.2020.06.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/17/2020] [Accepted: 06/21/2020] [Indexed: 11/29/2022] Open
Abstract
Osteochondrosis is a developmental condition affecting the endochondral ossification. It is commonly idiopathic however can be due to vascular anomalies, dietary conditions, hormonal irregularity, or overuse trauma. Osteochondrosis occurring in the inferior pole of the scapula is an extremely rare condition and is referred to as roca disease. A higher degree of suspicion is required especially in a young patient with atraumatic shoulder pain and additional unconventional MRI sequences focusing on the inferior pole of scapula can be taken to rule out such conditions. We report a case of Roca disease in a 16-year male who presented with right shoulder pain. This is the third case report of roca disease in the English literature according to our knowledge and the first case report to demonstrate extensive MRI imaging features with a normal radiograph. Imaging, particularly MRI, plays a pivotal role in the diagnosis of this extremely rare entity. Also, the inferior pole of the scapula is usually not included in routine shoulder MRI imaging thus close scrutiny with additional MRI sequences should be done to diagnose such a rare entity.
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Turati M, Leone G, Zanchi N, Omeljaniuk RJ, Brahim L, Zatti G, Courvoisier A, Bigoni M. Clinical presentation and surgical treatment of distal fibular non-union with talus chondral lesions in a pediatric patient: a case report. BMC Surg 2020; 20:125. [PMID: 32517685 PMCID: PMC7285572 DOI: 10.1186/s12893-020-00782-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 05/24/2020] [Indexed: 11/30/2022] Open
Abstract
Background In children, fracture non-union is uncommon yet, curiously, non-union of distal fibula fractures are rarely reported. Historically, the most common treatment of a lateral malleolus fracture after an ankle sprain is conservative, which usually leads to fracture union. However, even in clinically stable ankles, subsequent pain arising from fracture site could suggest non-union, thereby necessitating reexamination and possible secondary treatment. Case presentation We report the case of an 8-year-old girl with an epiphyseal distal fibula fracture complicated with a symptomatic non-union associated with the chondral flap of the talar dome after conservative treatment. Surgical excision of the fragment and chondroplasty was performed and resulted in an excellent clinical outcome. Conclusion This case report illustrates the necessity of particularly meticulous evaluation of pediatric post-traumatic ankle pain. Surgical treatment as well as talar chondral evaluation should be taken into consideration in the treatment of pediatric distal fibular nonunion.
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Affiliation(s)
- Marco Turati
- Department of Paediatric Orthopedic Surgery, University Hospital Grenoble-Alpes, University Grenoble-Alpes, Grenoble, France. .,Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, Italy. .,Department of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy.
| | - Giulio Leone
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Nicolò Zanchi
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | | | - Lilia Brahim
- Department of Paediatric Orthopedic Surgery, University Hospital Grenoble-Alpes, University Grenoble-Alpes, Grenoble, France
| | - Giovanni Zatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Aurélien Courvoisier
- Department of Paediatric Orthopedic Surgery, University Hospital Grenoble-Alpes, University Grenoble-Alpes, Grenoble, France
| | - Marco Bigoni
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
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Abstract
Osteochondroma is one of the most common benign bone tumors; however, as it rarely affects any bones in feet, it may easily escape detection without rigorous examination. We present an exceptionally rare case of tarsal navicular dorsal osteochondroma diagnosed in an 11-year-old female child affected by chronic foot pain. Radiographs, MRI, and computed tomography scan revealed bony excrescences extending outward from the navicular bone. After conservative treatment failed, the navicular dorsal exostosis was excised in open surgery with complete resolution of symptoms. Navicular-cuneiform impingement was diagnosed by instrumental and intraoperative techniques. Histological analysis confirmed the diagnosis of navicular dorsal osteochondroma. This case report illustrates the necessity of particularly rigorous evaluation of the substrates of pediatric chronic foot pain.
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Percutaneous injection of calcium phosphate composite in pediatric unicameral bone cysts: a minimum 5-year follow-up study. SPORT SCIENCES FOR HEALTH 2019. [DOI: 10.1007/s11332-018-0513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Intra-Articular Cytokine Levels in Adolescent Patients after Anterior Cruciate Ligament Tear. Mediators Inflamm 2018; 2018:4210593. [PMID: 30245587 PMCID: PMC6136581 DOI: 10.1155/2018/4210593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 06/22/2018] [Accepted: 07/18/2018] [Indexed: 02/01/2023] Open
Abstract
The treatment of anterior cruciate ligament (ACL) injuries in children and adolescents is challenging. Preclinical and clinical studies investigated ACL repairing techniques in skeletally immature subjects. However, intra-articular bioenvironment following ACL tear has not yet been defined in skeletally immature patients. The aim of this study was to measure cytokine concentrations in the synovial fluid in adolescent population. Synovial levels of IL-1β, IL-1ra, IL-6, IL-8, IL-10, and TNF-α were measured in 17 adolescent patients (15 boys) with ACL tears who underwent ACL reconstruction including acute (5), subacute (7), and chronic (5) phases. Femoral growth plates were classified as “open” in three patients, “closing” in eight, and “closed” in six. Eleven patients presented an ACL tear associated with a meniscal tear. The mean Tegner and Lysholm scores (mean ± SD) of all patients were 8 ± 1 and 50.76 ± 26, respectively. IL-8, TNF-α, and IL-1β levels were significantly greater in patients with “open” physes. IL-1ra and IL-1β levels were significantly higher in patients with ACL tear associated with a meniscal tear. Poor Lysholm scores were associated with elevated IL-6 and IL-10 levels. IL-10 levels positively correlated with IL-6 and IL-8 levels, whereas TNF-α concentration negatively correlated with IL-6 levels. Skeletally immature patients with meniscal tears and open growth plates have a characteristic cytokine profile with particularly elevated levels of proinflammatory cytokines including IL-8, TNF-α, and IL-1β. This picture suggests that the ACL tear could promote an intra-articular catabolic response in adolescent patients greater than that generally reported for adult subjects. The study lacks the comparison with synovial samples from healthy skeletally immature knees due to ethical reasons. Overall, these data contribute to a better knowledge of adolescent intra-articular bioenvironment following ACL injuries.
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Turati M, Glard Y, Griffet J, Afonso D, Courvoisier A, Bigoni M. Osteochondrosis of the medial malleolar epiphysis: A case report and review of the literature. Int J Surg Case Rep 2017; 39:176-180. [PMID: 28846950 PMCID: PMC5573787 DOI: 10.1016/j.ijscr.2017.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/05/2017] [Accepted: 08/08/2017] [Indexed: 11/26/2022] Open
Abstract
Presentation and management of medial malleolar osteochondrosis based on our experience and a complete literature review. All ossification centres are predisposed to develop osteochondrosis: we report a rare case of this painful condition. The first review of all described cases of medial malleolar osteochondrosis. In a pediatric ankle pain medial malleolar osteochondrosis should be considered in the differential diagnosis. A complete clinical and radiological description of a rare case of medial malleolar osteochondrosis.
Introduction Osteochondrosis is characterized by a disturbance of enchondral ossification in skeletally immature patients and should be investigated in children having a history of persistent foot and ankle pain. Involvement of the medial malleolar epiphysis is rarely reported. Presentation of case We describe the case of a sporty 12-year-old male with osteochondrosis of the left medial malleolar epiphysis treated with a conservative management. Discussion Calcanear, navicular and metatarsal apophysis are the most common locations for osteochondrosis in ankle and foot. Anyway other osteochondrosis should be excluded. Medial malleolar osteochondrosis is occasionally described. We performed a review of the relevant literature and we summarized clinical aspects, radiological characteristics and reported management of this painful and probably underestimated condition. Conclusion Medial malleolar osteochondrosis is a rare but well recognized condition. Only seven cases are described in literature.
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Affiliation(s)
- Marco Turati
- Department of Paediatric Orthopedic Surgery, University Hospital Grenoble-Alpes, University Grenoble-Alpes, France; Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
| | - Yann Glard
- Department of Paediatric Orthopaedics, Saint Joseph Hospital, Marseille, France
| | - Jacques Griffet
- Department of Paediatric Orthopedic Surgery, University Hospital Grenoble-Alpes, University Grenoble-Alpes, France
| | - David Afonso
- Department of Paediatric Orthopaedics, Saint Joseph Hospital, Marseille, France
| | - Aurélien Courvoisier
- Department of Paediatric Orthopedic Surgery, University Hospital Grenoble-Alpes, University Grenoble-Alpes, France
| | - Marco Bigoni
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
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Bigoni M, Gaddi D, Gorla M, Munegato D, Pungitore M, Piatti M, Turati M. Arthroscopic anterior cruciate ligament repair for proximal anterior cruciate ligament tears in skeletally immature patients: Surgical technique and preliminary results. Knee 2017; 24:40-48. [PMID: 27815015 DOI: 10.1016/j.knee.2016.09.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 09/14/2016] [Accepted: 09/16/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears in children are increasingly common and present difficult treatment decisions due to the risk of growth disturbance. Although open primary ACL repair was abandoned in the historical literature, recent studies have suggested that there is a role for arthroscopic primary repair in patients with proximal tears. METHODS This is a retrospective review of five consecutive patients aged 9.2years (range 8 to 10) who underwent suture anchor ACL reinsertion. Patients were included if they were Tanner stages 1-2 and proximal ACL tears with adequate tissue quality confirmed arthroscopically. The time frame was 81days. Arthroscopic ACL reinsertion was performed with bioabsorbable suture anchor. Clinical evaluation, KT-1000™, and MRI were re-evaluated. Clinical outcomes were measured using International Knee Documentation Committee (IKDC), Lysholm and Tegner activity score. RESULTS At a mean follow-up of 43.4months (range 25 to 56), no re-injury and leg length discrepancies were observed. Four patients had negative Lachman tests. The remainder had a grade 1 Lachman test. The mean side-to-side difference was 3 (2-4mm). In MRI obtained at the last follow-up, no articular lesions or growth arrest were observed and the reinserted ACL was recognized in every exam. All patients returned to previous level of activity and presented normal and nearly normal IKDC score. The mean Lysholm score was 93.6. CONCLUSION Arthroscopic ACL repair can achieve good short-term results with joint stability and recovery of sport activity in skeletally immature patients, with proximal ACL avulsion tear.
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Affiliation(s)
- Marco Bigoni
- Orthopedic Department, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy
| | - Diego Gaddi
- Orthopedic Department, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy
| | - Massimo Gorla
- Orthopedic Department, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy
| | - Daniele Munegato
- Orthopedic Department, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy
| | - Marco Pungitore
- Orthopedic Department, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy
| | - Massimiliano Piatti
- Orthopedic Department, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy
| | - Marco Turati
- Orthopedic Department, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy.
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