A 40-Year-Old Male Presenting with Hereditary Multiple Exostosis: Management and Considerations

A Masquerading Hematoma Resulting in the Delayed Diagnosis of a Soft Tissue Sarcoma: A Case Report

A 27-year-old male with insidious right arm swelling was diagnosed with a hematoma secondary to a partial biceps tear, later identified as a rhabdomyosarcoma. Soft tissue sarcomas (STS) may present with misleading patient histories and nonspecific symptoms, resulting in misdiagnosis and delayed treatment. One of the classic masqueraders of soft tissue sarcomas is hematomas secondary to trauma. Obtaining a prudent history with careful scrutiny of appropriate imaging often helps establish the correct diagnosis. Ultimately, tissue biopsy can resolve any ambiguous cases and prevent delays in diagnosis and treatment.

Premalignant Conditions of Bone

Development of malignancy is a multifactorial process, and there are multitude of conditions of bone that may predispose patients to malignancy. Etiologies of malignancy include benign osseous conditions, genetic predisposition, and extrinsic conditions. New-onset pain or growth in a previously stable lesion is that should concern for malignant change and should prompt a diagnostic workup for malignancy.

Accelerometer-Based, Computer-Navigated Total Knee Arthroplasty to Correct a Complex Deformity in a Patient With Multiple Hereditary Exostoses

Background

Accelerometer-based computer-assisted navigation systems (ABCANSs) have been shown to improve alignment accuracy in total knee arthroplasty (TKA) and are effective in treating complex extra-articular deformity. We present an ABCANS-assisted TKA performed in a 68-year-old male with end-stage arthritis of the right knee, in the setting of a severe valgus deformity secondary to multiple hereditary exostoses.

Methods

The KneeAlign 2 system (OrthAlign, Inc.; Aliso Viejo, CA) was used to perform the TKA in this clinical scenario, given its functionality, which allows angular correction to be tailored to a given deformity, and its reported accuracy in performance of bony resection in TKA. The patient was prospectively followed up for one year postoperatively. Radiographs, PROMs, and patient satisfaction were reported.

Results

After the ABCANS-assisted TKA, the patient's alignment was improved from 25° to 4° of valgus. His final range of motion was 0-135° without an instability. In addition, the patient reported excellent scores on multiple joint-specific outcome measures, including the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, the Forgotten Joint Score, and the Oxford Knee Score.

Conclusion

This case report illustrates the rationale, technique, and the excellent clinical outcomes achieved in a complex patient with extra-articular deformity using an ABCANS-assisted TKA.