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Ramadugu R, Suvvari TK, Ramadugu S, Temburu S, Srivastava D. A rare case of osteoarticular tuberculosis and tuberculous osteomyelitis of the left foot without pulmonary involvement. Radiol Case Rep 2024; 19:6609-6613. [PMID: 39380834 PMCID: PMC11459455 DOI: 10.1016/j.radcr.2024.09.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 09/14/2024] [Accepted: 09/17/2024] [Indexed: 10/10/2024] Open
Abstract
Tuberculosis (TB) of the musculoskeletal system is an uncommon manifestation, accounting for only 1-3% of all TB cases and typically affects the spine and large joints. Isolated TB of the foot is even rarer, comprising less than 10% of osteoarticular TB. Tuberculous osteomyelitis, where the infection is limited to the bone without joint involvement, is an even more uncommon presentation. A 55-year-old male with a history of fall presented with chronic left foot pain and swelling. Initial workup led to a misdiagnosis of Charcot foot. Despite treatment with analgesics and intra-articular platelet-rich plasma injections, symptoms still persisted for several months. MRI revealed inflammation in multiple joints with bone damage (erosions & edema) along with reduced joint space in talonavicular joint and Mycobacterium tuberculosis was identified on interferon gamma release assay. The patient was ultimately diagnosed with diffuse osteoarticular tuberculosis and tuberculous osteomyelitis of the left foot and commenced on anti-tubercular therapy. After few months symptoms were resolved and patient was tested negative for TB. Our case highlights the importance of maintaining a high index of suspicion for osteoarticular tuberculosis, even in the absence of pulmonary involvement, especially in immunocompromised patients like diabetics. This case emphasizes the importance of a multidisciplinary approach for accurate diagnosis and effective management of such challenging presentation.
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Affiliation(s)
- Rithika Ramadugu
- Department of medicine, Kamineni Academy of Medical Sciences and Research Centre, LB Nagar, Hyderabad, India
- Department of clinical research, Squad Medicine and Research (SMR), Amadalavalasa, Andhra Pradesh, India
| | - Tarun Kumar Suvvari
- Department of clinical research, Squad Medicine and Research (SMR), Amadalavalasa, Andhra Pradesh, India
- Department of Medicine, Rangaraya Medical College, Kakinada, Andhra Pradesh, India
| | - Sameera Ramadugu
- Department of medicine, Gandhi Medical College, Hyderabad, India
| | - Sravani Temburu
- Department of clinical research, Squad Medicine and Research (SMR), Amadalavalasa, Andhra Pradesh, India
- Department of Medicine, Rangaraya Medical College, Kakinada, Andhra Pradesh, India
| | - Devang Srivastava
- Department of clinical research, Squad Medicine and Research (SMR), Amadalavalasa, Andhra Pradesh, India
- Department of medicine, Kakatiya Medical College, Warangal, India
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Yadav S, Rawal G, Jeyaraman M. Tuberculosis of the Right Fifth Metatarsal and Fourth Web Space Without Pulmonary Involvement: A Rare Case. Cureus 2023; 15:e41160. [PMID: 37525777 PMCID: PMC10387166 DOI: 10.7759/cureus.41160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/02/2023] Open
Abstract
Tuberculosis of the bones and joints is an uncommon entity. The bacterial infection of small bones of the foot, like the metatarsals, is extremely rare. Such cases are often detected late, and as a result, there is delayed management. The present case is that of a 12-year-old Indian boy who came with complaints of pain and swelling below his right foot. In the absence of pulmonary involvement, a definite diagnosis of tuberculosis of the fifth metatarsal with fourth web space was established using histopathology, a cartridge-based nucleic acid amplification test, magnetic resonance imaging, and culture of the pus. He was prescribed first-line anti-tubercular treatment for 12 months.
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Affiliation(s)
- Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
| | - Gautam Rawal
- Respiratory Medical Critical Care, Max Super Speciality Hospital, New Delhi, IND
| | - Madhan Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
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Yadav S, Rawal G, Jeyaraman M. Tuberculous Osteomyelitis of the Left Fifth Metatarsal and Phalanx Without Pulmonary Involvement: A First-of-Its-Type Report. Cureus 2023; 15:e40737. [PMID: 37485150 PMCID: PMC10361337 DOI: 10.7759/cureus.40737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Tuberculosis manifesting at extrapulmonary sites is relatively rare. Isolated cases involving small bones of the foot are the rarest of the rare. We herein present the case of a 30-year-old Indian female who presented with pain and a wound with a discharging sinus over her left foot. In the absence of constitutional symptoms of tuberculosis, this case was diagnosed as isolated tuberculous osteomyelitis of the left fifth metatarsal and phalanx with the help of radiography, a cartridge-based nucleic acid amplification test, a line probe assay, a culture of the biopsy specimen, and magnetic resonance imaging. She was initiated on anti-tubercular treatment per national guidelines.
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Affiliation(s)
- Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, Moti Nagar, New Delhi, IND
| | - Gautam Rawal
- Respiratory Medicine and Critical Care, Max Super Speciality Hospital, New Delhi, IND
| | - Madhan Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, IND
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Harna B, Roy A, Arya S, Sabat D. Midfoot tuberculosis: Clinical suspicion and early investigation is the key. Indian J Tuberc 2022; 69:460-464. [PMID: 36460376 DOI: 10.1016/j.ijtb.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/31/2021] [Accepted: 07/12/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND Tuberculosis affecting midfoot is not common, leading to delay in diagnosis further leading to deformity and difficult management. Tissue diagnosis is always not possible at such sites. MRI is the better imaging modality to diagnose earlier than conventional radiographs. The aim of the study is to have a clinical suspicion of tuberculosis in midfoot pain and a low threshold to perform MRI in these patients. METHODS The data of 7 patients were collected prospectively over 3 years. Inclusion criteria included midfoot pain for more than 4 weeks in a skeletally mature patient with no radiographic findings. MRI and laboratory investigations were done in all the patients. All the patients were given Anti-tubercular therapy and followed up for 12 months. The patients were assessed at 3, 6- and 12-months duration with ESR, CRP, MRI, VAS and AOFAS Midfoot scores. RESULTS There were 3 males and 4 females included in the study with a mean age of 55.5 years. The mean duration of symptoms was 5.2 weeks. The mean ESR and CRP at presentation were 46 and 12 respectively which progressively decreased over 12 months. The mean VAS and AOFAS midfoot score at presentation were 4 and 70 respectively. None of the patients had any complication from ATT drugs. Residual pain was present in 4 patients with no functional limitation of the foot. The follow-up MRI showed healed tuberculosis in all the patients. CONCLUSIONS Tuberculosis can be a cause of vague midfoot pain in tuberculosis endemic countries. The MRI in such patients along with laboratory findings can lead to early diagnosis and the empirical institution of the ATT. The tissue diagnosis is not always possible in the early stages of the disease as there is no radiographic lesion or collection in the midfoot.
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Affiliation(s)
- Bushu Harna
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India.
| | - Abhishek Roy
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
| | - Shivali Arya
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Dhanajaya Sabat
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
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Abbaoui S, Hassan HE, Belahcen M. Tuberculosis of talus: A case report. Int J Surg Case Rep 2022; 95:107208. [PMID: 35609477 PMCID: PMC9130520 DOI: 10.1016/j.ijscr.2022.107208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Osteoarticular tuberculosis represents 1 to 3% of all tuberculosis cases, the tuberculosis of the talus is a very rare form of osteoarticular tuberculosis. Its clinical and radiological features are not specific. In this study, we report a case of ankle tuberculosis involving the talus in a 5-year-old girl. Case report A 5 years old girl, was admitted for pain, swelling, and functional impairment of the left ankle, on the clinical examination, the patient manifested a painful oedematous ankle. The biological examination revealed a slight inflammatory syndrome, The X-ray of the ankle showed a lytic image of the posterior part of the talus with a cortical involvement. The biopsy revealed an epithelioid cell granuloma without any caseous necrosis. The medical management consisted of anti-tuberculosis multi-drug. Discussion The tuberculosis of the talus is a very rare form of osteoarticular tuberculosis. In this study, we report a rare case of this localization of a 5-year-old girl. The non-specificity of symptoms is the main difficulty that causes a delay in diagnosis. Standard radiology, MRI, and biology were non-contributory. Bone biopsy and anatomopathological study led to the diagnosis of tuberculosis of the talus. The main aims of the surgical treatment are to take some sample for histological study, and to curette the diseased part in the bone followed by 6 to 9 months of anti-tuberculosis chemotherapy. Conclusion Tuberculosis of the talus is extremely rare, it deserves special attention especially in endemic areas. Talus localization of tuberculosis is rare and represents less than 1-3 % of skeletal locations. In front of any suspicious bone lesion or atypical clinical picture, the diagnosis of TB must be invoked in order to avoid a diagnostic delay Treatment is medical, but surgery is required for some cases.
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Affiliation(s)
- Siham Abbaoui
- Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco.
| | - Hadi El Hassan
- Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Mohamed Belahcen
- Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
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Jeyaraman N, Jeyaraman M, Muthu S, Packkyarathinam RP. Tubercular Osteomyelitis of Cuboid. J Orthop Case Rep 2021; 11:5-10. [PMID: 35415141 PMCID: PMC8930381 DOI: 10.13107/jocr.2021.v11.i12.2542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/14/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Tuberculosis (TB) affection of foot appears to be a rare clinical entity and accounts for <10% and 0.1-0.3% of osteoarticular and extrapulmonary TB, respectively. In TB foot, tarsal joints and calcaneum are more commonly affected followed by talus, distal end of first metatarsal, navicular, cuneiforms, and cuboid bones. CASE REPORT A 24-year-old female presented with pain and swelling over dorsum of the left foot from the past 8 months. On examination, there was a diffuse round shaped, solitary swelling measuring about 3.5 cm × 2.5 cm (approx.) with its surface smooth, non-pulsatile, non-fluctuant, non-transilluminant, non-compressible, and non-reducible present over dorsum of the left foot. Radiographic investigations revealed osteolytic lesion over the base of 3rd, 4th, and 5th metatarsals, middle and lateral cuneiforms and cuboid bones along with soft tissue swelling and diffuse transient osteopenia. Under spinal anesthesia, trucut biopsy of the mass revealed paucibacillary type of TB in histopathological examination. The patient was provided with ATT drugs in the form of intensive phase drugs (HRZE) daily for 4 months and continuation phase drugs (HRE) daily for 10 months according to the weight of the patient. The patient was followed up with erythrocyte sedimentation rate and C-reactive protein every 2 months once. The patient achieved a normal range of movements in the midtarsal joints except for the painful terminal range of movements. The patient was still under our follow-up. CONCLUSION The cuboid is the second most involved tarsal bone. The diagnosis is not always frankly evident, and a high index of suspicion has to be maintained. Surgical intervention should be limited to biopsy only as multidrug chemotherapy alone is sufficient to achieve complete healing.
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Affiliation(s)
- Naveen Jeyaraman
- Department of Orthopaedics, Atlas Hospitals, Tiruchirappalli, Tamil Nadu, India
| | - Madhan Jeyaraman
- Department of Orthopaedics, Faculty of Medicine - Sri Lalithambigai Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, Tamil Nadu, India
| | - Sathish Muthu
- Department of Orthopaedics, Government Dindigul Medical College and Hospital, Dindigul, Tamil Nadu, India
| | - R P Packkyarathinam
- Department of Orthopaedics, Government Medical College, Omandurar Government Estate, Chennai, Tamil Nadu, India
- Address of Correspondence: Dr. R P Packkyarathinam, Department of Orthopaedics, Government Medical College, Omandurar Government Estate, Chennai, Tamil Nadu, India. E-mail:
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Hanène F, Nacef L, Maatallah K, Triki W, Kaffel D, Hamdi W. Tuberculosis arthritis of the ankle mimicking a talar osteochondritis. Foot (Edinb) 2021; 49:101816. [PMID: 34536816 DOI: 10.1016/j.foot.2021.101816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/18/2021] [Accepted: 04/25/2021] [Indexed: 02/04/2023]
Abstract
Tuberculosis arthritis of the ankle accounts for 10% of all cases of osteoarticular tuberculosis (OT). Because of its rarity and insidious symptoms, diagnosing it may be challenging. Furthermore, its imaging findings mimic those of other diseases. The case of ankle tuberculosis arthritis misdiagnosed as talus necrosis is reported. The difficulties faced by clinicians when confronting such situations are also illustrated.
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Affiliation(s)
- Ferjani Hanène
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology Department, La Mannouba, Tunisia; Research Unit UR17SP04, 2010 Ksar Said, Tunis, Tunisia.
| | - Lilia Nacef
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology Department, La Mannouba, Tunisia; Research Unit UR17SP04, 2010 Ksar Said, Tunis, Tunisia.
| | - Kaouther Maatallah
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology Department, La Mannouba, Tunisia; Research Unit UR17SP04, 2010 Ksar Said, Tunis, Tunisia.
| | - Wafa Triki
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology Department, La Mannouba, Tunisia; Research Unit UR17SP04, 2010 Ksar Said, Tunis, Tunisia.
| | - Dhia Kaffel
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology Department, La Mannouba, Tunisia; Research Unit UR17SP04, 2010 Ksar Said, Tunis, Tunisia.
| | - Wafa Hamdi
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology Department, La Mannouba, Tunisia; Research Unit UR17SP04, 2010 Ksar Said, Tunis, Tunisia.
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Rachakonda KR, Sankineani SR, Gannamaneni VS, Takkallapally HR, Vyas A, Reddy AVG. Osteoblastoma of Cuboid with a Tuberculosis Foot - A Diagnostic Conundrum: A Rare Case Report. J Orthop Case Rep 2021; 11:1-5. [PMID: 35415122 PMCID: PMC8930328 DOI: 10.13107/jocr.2021.v11.i11.2490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/21/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Osteoblastoma is a rare benign bone-forming tumor but causes considerable morbidity if left untreated. Among them, osteoblastoma of cuboid is very rarely seen and hence poses considerable diagnostic and therapeutic challenges especially when it mimics features of tuberculosis of foot. Case Report This case report describes a rare case of cuboid osteoblastoma of the right foot in a 24-year-old female who was initially treated as TB foot elsewhere and presented to our outpatient department with non-resolving pain affecting her daily activities. She was found to have osteoblastoma of cuboid bone along with medial arch collapse and instability of mid foot. She underwent en bloc excision of the cuboid bone with lateral and medial column stabilization procedures. She made an uneventful recovery and reported no recurrence after a follow-up of 2 years. Conclusion Cuboid osteoblastoma can present atypically with mid foot collapse and arthritis leading to an erroneous diagnosis of TB due to the concomitant inflammation. Hence, any atypical lesion of the foot should be subjected to biopsy and a confirmatory result before initiating any therapy.
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Affiliation(s)
- Kamalakar Rao Rachakonda
- Department of Orthopaedics, Sunshine Multispeciality Hospital, Secunderabad, Telangana, India,
Address of Correspondence: Dr. Kamalakar Rao Rachakonda, Department of Orthopaedics, Sunshine Multispeciality Hospital, Secunderabad - 500 003, Telangana, India. E-mail:
| | | | | | | | - Avin Vyas
- Department of Orthopaedics, Sunshine Multispeciality Hospital, Secunderabad, Telangana, India
| | - A. V. Gurava Reddy
- Department of Orthopaedics, Sunshine Multispeciality Hospital, Secunderabad, Telangana, India
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Basnayake O, Mathangasinghe Y, Nihaj A, Pitagampalage R, Jayarajah U, Gunawardena K, Mendis H. Tuberculosis presenting as arthritis of the ankle: A case report. SAGE Open Med Case Rep 2021; 9:2050313X211035574. [PMID: 34377485 PMCID: PMC8320545 DOI: 10.1177/2050313x211035574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis presenting as monoarticular involvement in immunocompetent patients is rare. Here, we report a Sri Lankan patient presenting with ankle swelling due to tuberculosis with no other extrapulmonary or pulmonary involvement. Magnetic resonance imaging showed destruction of articular cartilage of the ankle joint with chronic inflammation of the subtalar joint. The diagnosis was confirmed by synovial tissue culture which was positive for Mycobacterium tuberculosis. The patient recovered uneventfully with anti-tuberculosis treatment. Therefore, a high degree of suspicion is necessary to diagnose extrapulmonary tuberculosis when patients are presenting with atypical monoarthritis.
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Affiliation(s)
| | - Yasith Mathangasinghe
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Ahamed Nihaj
- National Hospital of Sri Lanka, Colombo, Sri Lanka
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Lui TH. Role of arthroscopy and endoscopy in management of tuberculosis of the foot and ankle. Foot (Edinb) 2021; 46:101754. [PMID: 33285493 DOI: 10.1016/j.foot.2020.101754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 02/04/2023]
Abstract
Tuberculosis of the foot and ankle is rare but destructive. It can affect bones, joints and soft tissue and can mimic a wide range of acute and chronic infections or tumorous conditions. The primary treatment objectives for osteoarticular TB include curing the infection, limiting deformity, maintaining mobility, and reducing discomfort. Chemotherapy remains the mainstay of treatment in acute stage. Indications of surgery include biopsy and debridement in early stages to reduce the tuberculosis load and enable better penetration of anti-tuberculous drugs. Other reported indications for surgery in early stage of TB foot and ankle include resection of lesion not responding to chemotherapy and debridement of lesions close to the articular surface, as surgical debridement might halt progression and joint invasion, avoiding worsening of the prognosis. The success of arthroscopic treatment for infectious arthritis with decreased morbidity and postoperative pain makes arthroscopy an excellent alternative to open surgery. The advantages such as minor trauma, short hospitalization time and short post operative rehabilitation period as well as good cosmetic and therapeutic results should lead to a more frequent use of arthroscopy as early as possible as an adjuvant for the tuberculous joint. However, tuberculosis can involve any joints, bone and soft tissue (tendon) of the foot and ankle and surgeons should equip with various arthroscopic and endoscopic techniques in order to deal with the various situations of tuberculosis of the foot and ankle.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT Hong Kong SAR, China.
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Agarwal A, Agarwal S, Singh S, Nandwani S. Spina Ventosa: An often Missed Diagnosis. J Glob Infect Dis 2021; 13:36-37. [PMID: 33911451 PMCID: PMC8054796 DOI: 10.4103/jgid.jgid_198_20] [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: 06/10/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/04/2022] Open
Abstract
Rare and varied presentations of tuberculosis make it difficult for treating clinicians to arrive at the diagnosis. An adolescent female presented to the orthopedic outpatient department with slowly increasing swelling over the dorsum of the hand near the base of the third digit for 5 months. With multiple consultations, she was being treated with antibiotics as a case of abscess. On examination, the swelling was soft bulging with whitish watery discharge. Plain radiography revealed periosteal elevation with bony destruction of the proximal phalanx. Magnetic resonance imaging revealed signal intensity changes with collection suggestive of infection. Blood investigations were within the normal limits, except slightly raised erythrocyte sedimentation rate. A differential diagnosis of chronic osteomyelitis was performed. Since the swelling was growing with the overlying skin likely to give way, it was treated with incision and drainage. Cytology with Gram's and auramine staining helped in confirming the diagnosis of spina ventosa. Biopsy is the gold standard for diagnosis, and antitubercular therapy forms the mainstay of treatment.
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Affiliation(s)
- Ankur Agarwal
- Department of Orthopaedics, Super Specialty Pediatric Hospital and Postgraduate Teaching Institute, Noida, Uttar Pradesh, India
| | - Sheetal Agarwal
- Department of Pediatrics, ABVIMS and RML Hospital, New Delhi, India
| | - Savitri Singh
- Department of Pathology, Super Specialty Pediatric Hospital and Postgraduate Teaching Institute, Noida, Uttar Pradesh, India
| | - Sumi Nandwani
- Department of Microbiology, Super Specialty Pediatric Hospital and Postgraduate Teaching Institute, Noida, Uttar Pradesh, India
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Bikoroti JB, Buteera AM, Manirakiza F, Munezero L, Nzarora J, Nyiraneza S. Tuberculosis of the Left Calcaneum and Collapsed Right Femoral Head: A Case Report. J Orthop Case Rep 2021; 11:55-58. [PMID: 34141643 PMCID: PMC8046462 DOI: 10.13107/jocr.2021.v11.i01.1962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Tuberculosis (TB), one of the oldest diseases known to affect humans, is caused by the bacteria Mycobacterium tuberculosis. The disease usually affects the lungs, although, in up to one-third of cases, other organs are involved. TB of the bone mimics other clinical conditions such as chronic osteomyelitis, Madura mycosis and actinomycosis. Case Report A fifth child and last-born girl, in a family of living four children, aged 9 years, consulted Kigali University Teaching Hospital (CHUK) on December 7, 2017, from Kibuye Referral Hospital (Western of Rwanda) for ulcerated, infected left heel with swollen foot 4 months before our consultation. Physical examination revealed a patient with swollen and tender foot discharging serous bloody fluids accompanied by inability to stand with a painful right hip. Small left inguinal lymph nodes were present. Blood work-up, computed tomography scan of the left foot, and an incisional biopsy at the level of the left calcaneus were performed and revealed extrapulmonary TB. The histopathological features for TB were scanty, but the high index suspicion of possible extrapulmonary TB led to the confirmation of the diagnosis using auramine-rhodamine special stain. Anti-TB therapy for 12 months course was initiated and the monthly follow-up for 11 months was done. Conclusion Although calcaneal TB is very rare, in countries with high incidence of TB, clinicians must have a high suspicion index and skeletal TB must be included in differential diagnosis of bone masses whenever possible bone mass biopsy and special staining technique in addition to most common diagnosis means should be done to rule out the possibility of bone TB.
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Affiliation(s)
| | | | - Felix Manirakiza
- Department of Pathology, Kigali University Teaching Hospital, Rwanda.,Department of Clinical Biology, School of Medicine and Pharmacy, University of Kigali
| | - Louise Munezero
- Department of Clinical Biology, School of Medicine and Pharmacy, University of Kigali
| | - Josué Nzarora
- Department of Anaesthesia, Kigali University Teaching Hospital, Rwanda
| | - Sabine Nyiraneza
- Department of Radiology, Kigali University Teaching Hospital, Rwanda
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Yadav AK, G S PK, K S A, Harsoor A, Mane A, Mishra S. Tuberculosis of Calcaneus - A Case Report and Review of Literature. J Orthop Case Rep 2020; 10:24-26. [PMID: 33312973 PMCID: PMC7706436 DOI: 10.13107/jocr.2020.v10.i05.1822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Osteoarticular tuberculosis (TB) constitutes 1-3 % of cases and about 10% of osteoarticular TB affects the foot and ankle. In foot, TB calcaneus is the most commonly affected bone. Case Report A 21-year-old male presented with pain, swelling in the right heel for 5 months and difficulty in walking for 2 months. Plain X-ray (axial) view of calcaneus showed a lytic lesion in calcaneus. Biopsy was done under local anaesthesia and histologic examination revealed a characteristic granuloma, caseous necrosis, and Langhans giant cells which confirmed our diagnosis. The patient was treated with anti-TB chemotherapy for 12 months. Radiographs at 18 months follow-up showed a healed lesion. At present, the patient is comfortable with no complaints. Discussion and Conclusion TB calcaneus is rare condition and a high index of clinical suspicion along with imaging studies helps in diagnosis. Conservative management with anti-TB chemotherapy for adequate duration helps in complete resolution of the infection with good functional results.
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Affiliation(s)
- Amit Kumar Yadav
- Department of Orthopaedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra. India
| | - Prasanna Kumar G S
- Department of Orthopaedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra. India
| | - Akshay K S
- Department of Orthopaedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra. India
| | - Abhishek Harsoor
- Department of Orthopaedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra. India
| | - Akash Mane
- Department of Orthopaedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra. India
| | - Shaswat Mishra
- Department of Orthopaedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra. India
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He Y, Liu J, Wang Z, Zhou P, Deng X, Yang L, Chen Z, Li Z. Analysis of the early clinical outcomes of arthroscopic debridement in the treatment of shoulder tuberculosis. J Orthop Surg Res 2020; 15:550. [PMID: 33218347 PMCID: PMC7678300 DOI: 10.1186/s13018-020-02086-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background Due to atypical clinical symptoms, it is difficult to diagnose joint tuberculosis infection, which often results in misdiagnosis and missed diagnosis. It is easy to cause joint disability. And there are few reports of using arthroscopy to diagnose and treat shoulder tuberculosis. This case series aims to introduce the clinical outcomes of arthroscopic treatment of shoulder tuberculosis. Methods Twenty-nine patients with shoulder tuberculosis from September 2013 to February 2019 were included (10 males, 19 females; age range from 22 to 69; the average age is 37.6 years). All patients underwent arthroscopic lesion debridement, with preoperative and postoperative regular use of isoniazid, rifampicin, pyrazinamide, and streptomycin quadruple anti-tuberculosis drugs. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded before and at the last follow-up. The shoulder function was evaluated according to the visual analogue scoring method (visual analogue scale, VAS) pain score and Constant score. Results Twenty-nine patients were followed up from 12 months to 2 years, and the average follow-up time was 15.7 months. The pathological diagnosis of all patients after surgery was shoulder tuberculosis. No serious complications were found at the last follow-up, and the incision healed well. VAS pain score, Constant score, ESR, and CRP at the last follow-up were significantly improved compared with those before treatment (P < 0.05). Conclusion On the basis of the standard use of anti-tuberculosis drugs before and after surgery, shoulder arthroscopy is used to treat early and mid-term shoulder tuberculosis, which can be diagnosed by direct observation under the arthroscope and postoperative pathological examination. It has the advantages of thorough lesion removal, minimal invasiveness, rapid recovery, and reliable clinical effect.
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Affiliation(s)
- Yanwei He
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China
| | - Juncai Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China
| | - Zhi Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China
| | - Peng Zhou
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China
| | - Xiangtian Deng
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China.,School of Medicine, Nankai University, Tian Jin, People's Republic of China
| | - Li Yang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China.,Department of Hematology, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China
| | - Zan Chen
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China
| | - Zhong Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China.
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15
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WITHDRAWN: Tuberculosis of calcaneus—A case report and review of literature. Int J Surg Case Rep 2020. [DOI: 10.1016/j.ijscr.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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16
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Qu W, Wei C, Yu L, Deng Y, Fu P, Kang Z, Zhu S. Three-Stage Masquelet Technique and One-Stage Reconstruction to Treat Foot and Ankle Tuberculosis. Foot Ankle Int 2020; 41:331-341. [PMID: 31801382 PMCID: PMC7065448 DOI: 10.1177/1071100719890854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this article was to report the feasibility and effectiveness of 3-stage Masquelet technique and 1-stage operation for different stages of foot and ankle tuberculosis (TB). METHODS Ten consecutive patients with foot and ankle TB were retrospectively analyzed between January 2014 and December 2018. Five patients were treated with the 3-stage Masquelet technique, including thorough debridement with vacuum sealing drainage, implantation of antibiotic cement spacer, and subsequent reconstruction. Five patients were treated with a 1-stage reconstruction. The American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) pain scores were recorded at the last follow-up. The follow-up was 30.3 ± 17.8 months. RESULTS No reactivation of TB was observed in any patients. For the 3-stage operation group, 1 patient developed a distal tibia fracture. The duration of anti-TB therapy was 12.0 ± 0.8 months. The AOFAS score increased from 39.5 ± 9.9 preoperatively to 75.3 ± 7.0 postoperatively (P < .05). The VAS pain score decreased from 6.3 ± 1.9 to 1.5 ± 1.3 (P < .05). For the 1-stage operation, 1 patient had wound necrosis. The duration of anti-TB therapy was 13.8 ± 1.1 months. The AOFAS score increased from 51.8 ± 15.0 to 81.8 ± 6.3 (P < .05). The VAS pain score decreased from 5.4 ± 1.1 to 1.0 ± 0.7 (P < .05). CONCLUSION Three-stage operation was effective for foot and ankle TB with stage IV, sinus tracts or other infections, and 1-stage reconstruction was effective for early-stage TBs. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Wenqiang Qu
- Department of Orthopaedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Chi Wei
- Department of Orthopaedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Li Yu
- Department of Orthopaedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yu Deng
- Department of Orthopaedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Panfeng Fu
- Department of Orthopaedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhe Kang
- Department of Orthopaedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Shaobo Zhu
- Department of Orthopaedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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Kumar P, Dhillon MS, Rajnish RK, Jindal K. Tubercular involvement of the lateral malleolus and adjacent calcaneus: presentation of a rare case and review of the literature. BMJ Case Rep 2019; 12:12/12/e231533. [PMID: 31826905 DOI: 10.1136/bcr-2019-231533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Osteoarticular tuberculosis (TB), despite being on the wane in the developed world, stays a problem of significance in the developing world. The issue is compounded by unusual presentations, inadequate diagnostic skills and limited understanding of its management. For foot infections, despite an increased awareness, many patients may be misdiagnosed, with associated treatment delays. A 19-year-old man presented with pain and swelling on lateral aspect of right ankle for 2 months. The patient had an undermined discharging sinus with surrounding induration and the skin adherent to the underlying bone. Patient was diagnosed as a case of ipsilateral TB lateral malleolus and calcaneus, managed with antitubercular drugs with complete resolution at 3 years of follow up. Foot and ankle TB can have atypical presentations causing delay in diagnosis. Contiguous spread of infection occurs through the synovium or the joint; however, extra-articular spread along the tendon sheaths or other soft tissues is possible, which is highlighted by the present case.
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Affiliation(s)
- Prasoon Kumar
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Singh Dhillon
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Kumar Rajnish
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karan Jindal
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Maignant AF, Salvator H, Montigny JP, Gonin F, Mellot F, Couderc LJ, Catherinot E. Chronic foot pain, an atypical tuberculosis presentation. Med Mal Infect 2019; 49:471-473. [PMID: 31257061 DOI: 10.1016/j.medmal.2019.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/07/2018] [Accepted: 05/17/2019] [Indexed: 11/28/2022]
Affiliation(s)
- A F Maignant
- Service de pneumologie, hôpital Foch, Suresnes, 92150 France
| | - H Salvator
- Service de pneumologie, hôpital Foch, Suresnes, 92150 France; UPRES EA 220, Suresnes, 92150 France; Faculté de médecine Simone-Veil, université Versailles/Saint-Quentin, Versailles, France
| | - J P Montigny
- Service de médecine physique et réadaptation, hôpital Foch, Suresnes, France
| | - F Gonin
- Service de chirurgie thoracique, hôpital Foch, Suresnes, France
| | - F Mellot
- Service d'imagerie médicale, hôpital Foch, Suresnes, France
| | - L J Couderc
- Service de pneumologie, hôpital Foch, Suresnes, 92150 France; UPRES EA 220, Suresnes, 92150 France; Faculté de médecine Simone-Veil, université Versailles/Saint-Quentin, Versailles, France
| | - E Catherinot
- Service de pneumologie, hôpital Foch, Suresnes, 92150 France.
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Gomes VMT, Dos Santos TCS, Cañete LAQ, Figueira C, Albuquerque R. Tuberculosis of the radius in a child. Radiol Bras 2019; 52:61-62. [PMID: 30804619 PMCID: PMC6383540 DOI: 10.1590/0100-3984.2017.0114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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20
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Diagnosis and treatment of tuberculosis of the foot and ankle-A literature review. Foot (Edinb) 2018; 37:105-112. [PMID: 30359882 DOI: 10.1016/j.foot.2018.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/22/2018] [Accepted: 07/24/2018] [Indexed: 02/04/2023]
Abstract
Foot osteoarticular tuberculosis is uncommon. Late diagnosis and sub-optimal management can lead to significant morbidity, deformity and even death. Preservation of life, limb and function can be achieved with prompt diagnosis and treatment. In 1882, Robert Koch published his discovery of mycobacterium tuberculosis as the causative agent of tuberculosis (TB), and showed the disease was infectious rather than inherited. Over two centuries later, TB remains one of the top 10 causes of death worldwide. Whilst in 90% of cases TB infects the respiratory system, in 10% it is extrapulmonary and can infect the skeletal, nervous, lymphatic and genitourinary systems. The spine is the most frequently affected site in the musculoskeletal system and this is known as Pott's disease. The foot and ankle is affected in only 0.13% cases of extrapulmonary TB. A high index of suspicion is thus required. This infrequency in incidence, heterogeneity of its presentation along with the difficulty in early diagnosis often causes significant delays in its treatment and hence results in a considerable disability. The medical treatment is well established but the role of surgery, its usefulness and its correct timing remain controversial. The main diagnostic issues include imaging being non-specific. Plain radiographs remain the first line imaging modality. MRI and CT scans provide greater detail and capture the disease at an earlier stage. Microbiological testing has low sensitivity and specificity becasue TB lesions are paucibacillary. Bone biopsy is of significant diagnostic value as it not only allows histological examination to detect granulomas but enables sensitivity and resistance testing of anti-tuberculous therapy (ATT). Issues relating to treatment include timing, duration, combination of chemotherapy and the challenge of multi drug resistant tuberculosis MDR-TB. The selection and timing of appropriate surgical techniques and optimal duration of follow-up are further points to consider. In this article we aim to review the literature on diagnosis and treatment of foot and ankle TB.
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21
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Shah R, Patel S, Shah S. Unusual Presentation of Tuberculosis of Subtalar Joint. J Orthop Case Rep 2018; 8:80-84. [PMID: 29854701 PMCID: PMC5974685 DOI: 10.13107/jocr.2250-0685.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: A case of seronegative variety of subtalar joint arthritis was treated with subtalar joint fusion surgery. In spite of perfect execution of surgery, fusion did not occur. It was only at a revision surgery that case could be diagnosed as a case of tuberculosis of subtalar joint. Case Report: Elderly female was operated for seronegative subtalar joint arthritis with fusion plus primary bone grafting. Fusion did not progress in spite of every added efforts such as extended immobilization, calcium supplements, and antibiotic therapy. Revision surgery was undertaken considering the reason of failure being a low-grade infection. At a revision surgery, case was diagnosed as a case of tuberculosis of subtalar joint, a very rare presentation. Fusion succeeded just with addition of antituberculous therapy supported with short-term immobilization. Conclusion: Tuberculosis of the foot and ankle joints, though are rare, they can mimic like many other disorders. In developing countries, a high index of suspicion is warranted to early diagnose it.
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Affiliation(s)
- Rajiv Shah
- Department of Orthopaedics, Baroda Hospital, Vadodara, Gujarat, India
| | - Shyam Patel
- Department of Orthopaedics, S. S. G. Hospital & Baroda Medical College, Vadodara, Gujarat, India
| | - Shivam Shah
- Department of Orthopaedics, S. S. G. Hospital & Baroda Medical College, Vadodara, Gujarat, India
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22
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Dey B, Deshpande AH, Ojha P, Gargade CB, Nigam JS, Ray A. A case of painful ankle swelling: Cytomorphological clues and pitfalls. Cytojournal 2017; 14:25. [PMID: 29259651 PMCID: PMC5721663 DOI: 10.4103/cytojournal.cytojournal_49_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 04/18/2017] [Indexed: 11/04/2022] Open
Affiliation(s)
- Biswajit Dey
- Address: Department of Pathology, Andaman and Nicobar Island Institute of Medical Sciences, Port Blair, Andaman and Nicobar Islands, India
| | - Archana Hemant Deshpande
- Address: Department of Pathology, Andaman and Nicobar Island Institute of Medical Sciences, Port Blair, Andaman and Nicobar Islands, India
| | - Pushpanjali Ojha
- Address: Department of Pathology, Andaman and Nicobar Island Institute of Medical Sciences, Port Blair, Andaman and Nicobar Islands, India
| | - Chitrawati Bal Gargade
- Address: Department of Pathology, Andaman and Nicobar Island Institute of Medical Sciences, Port Blair, Andaman and Nicobar Islands, India
| | - Jitendra Singh Nigam
- Address: Department of Pathology, Andaman and Nicobar Island Institute of Medical Sciences, Port Blair, Andaman and Nicobar Islands, India
| | - Amit Ray
- Department of Orthopaedics, Andaman and Nicobar Island Institute of Medical Sciences, Port Blair, Andaman and Nicobar Islands, India
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Uboldi FM, Limonta S, Ferrua P, Manunta A, Pellegrini A. Tuberculosis of the Knee: A Case Report and Literature Review. JOINTS 2017; 5:180-183. [PMID: 29270550 PMCID: PMC5738490 DOI: 10.1055/s-0037-1605591] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Tuberculosis (TB) is currently in resurgence due to immigration from endemic areas. Skeletal TB frequently mimics more common etiologies and can be difficult to diagnose. A case of TB knee arthritis in a young woman with painful and swelling knee is reported here. Arthrotomy was performed and inflamed synovial tissue was found, with multiple rice bodies in the eroded lateral femoral condyle. The patient was treated with an antituberculosis polytherapy and at 1-year follow-up, she reported relief from pain and swelling. We believe that all surgeons assessing patients from TB endemic regions have to adopt an updated approach to TB treatment. Thus, a literature review is also reported here on the current strategies used in different knee TB cases.
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Affiliation(s)
| | - Silvia Limonta
- 3rd Division of Infectious Diseases, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Paolo Ferrua
- Department of Knee Surgery, Gaetano Pini Hospital, Milan, Italy
| | | | - Antonio Pellegrini
- Reparative Orthopedic Surgery and Infectious Complications Unit, San Siro Clinical Institute, Galeazzi Orthopedic Institute, Milan, Italy
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24
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Dhillon MS, Agashe V, Patil SD. Role of Surgery in Management of Osteo-Articular Tuberculosis of the Foot and Ankle. Open Orthop J 2017; 11:633-650. [PMID: 29081861 PMCID: PMC5633720 DOI: 10.2174/1874325001711010633] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 07/21/2016] [Accepted: 07/23/2016] [Indexed: 11/24/2022] Open
Abstract
Background: Tuberculosis of the foot and ankle still remains to be a significant problem, especially in the developing countries, and with an increase in incidence in immunosuppressed patients. Treatment is mainly medical using multidrug chemotherapy; surgical interventions range from biopsy, synovectomy and debridement, to joint preserving procedures like distraction in early cases, and arthrodesis of hindfoot joints and the ankle in advanced disease with joint destruction. Surgical Options: All procedures should be done after initiating appropriate medical management. The ankle is the commonest joint needing intervention, followed by the subtalar and talo-navicular joint. Forefoot TB limited to the bone rarely needs surgical intervention except when the infective focus is threatening to invade a joint. Articular disease can spread rapidly, so early diagnosis and treatment can influence the outcome. Surgical interventions may need to be modified in the presence of sinuses and active disease; fusions need compression, and implants have to be chosen wisely. External fixators are the commonest devices used for compression in active disease, but intramedullary nails better stabilize pantalar arthrodesis. Arthroscopy has become a valuable tool for visualizing the ankle and hindfoot joints, and is an excellent adjunct for arthrodesis by minimally invasive methods. Conclusion: Although Osteoarticular Tb involving the foot and ankle is largely managed with chemotherapy, specific indications for surgical intervention exist. Timely done procedures could limit joint destruction, or prevent spread to adjacent joints. Fusions are the commonest procedure for sequelae of disease or for correcting residual deformity.
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Affiliation(s)
- Mandeep Singh Dhillon
- Deptt of Orthopaedics, Postgraduate Institute Of Medical Education & Research, Chandigarh, India
| | - Vikas Agashe
- Visiting Consultant in Orthopaedics, P.D. Hinduja Hospital & Research centre, Kohinoor Hospital, Mumbai, India
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Pereira J, Anoop S, Pettah GJ. A Case of Chronic Inflammation of the Ankle Joint with Subtle Signs of Inflammation: A Rare Presentation of Tuberculosis Ankle. J Orthop Case Rep 2017. [PMID: 28630849 PMCID: PMC5458707 DOI: 10.13107/jocr.2250-0685.702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Tuberculosis (TB) of the ankle is an uncommon presentation of extrapulmonary infection. The early diagnosis of TB arthritis of the ankle is difficult because of the uncommon site, the ability of TB to mimic other disorders and, all too common, lack of awareness of about this infection in ankle joint. Case Report: A 30-year-old male presented with a 1-year history of right ankle pain and swelling. He denied any history of recent infection but had had recurrent ankle pain that had been treated accordingly. When he visited our outpatient clinic, he was afebrile. The patient, despite a period of conservative treatment, presented with a localized painful fullness of the ankle. Magnetic resonance imaging helps for the diagnosis with variable specificity, but TB arthritis was diagnosed through a diagnostic arthroscopic procedure, and anti-TB therapy eventually eradicated the infection. Conclusion: It is highly recommended that early biopsy and synovial fluid for polymerase chain reaction GeneXpert be performed in suspicious cases to confirm and treat accordingly.
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Affiliation(s)
- Jeevan Pereira
- Department of Orthopaedics, Yenepoya Medical College Hospital, Deralakatte, Mangalore, Karnataka, India
| | - S Anoop
- Department of Orthopaedics, Yenepoya Medical College Hospital, Deralakatte, Mangalore, Karnataka, India
| | - George Joy Pettah
- Department of Orthopaedics, Yenepoya Medical College Hospital, Deralakatte, Mangalore, Karnataka, India
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Abstract
Osteoarticular tuberculosis accounts for only 1–2% of all cases of tuberculosis, and tuberculosis of the olecranon is extremely rare. In the present study, we describe a case of a 54-year-old woman with cystic tuberculosis of the olecranon, which was initially misdiagnosed as a malignant tumor. The patient subsequently underwent regular antituberculosis treatment and autogenous bone graft, which resulted in relief of all symptoms.
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Affiliation(s)
- Conglin Ye
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University. Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Xiaoquan Hu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University. Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Xiaolong Yu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University. Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, 330006, Jiangxi, China
| | - Jin Zeng
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University. Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, 330006, Jiangxi, China.
| | - Min Dai
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University. Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, 330006, Jiangxi, China
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Zou J, Shi Z, Mei G, Xue J, Gu W, Li X. Two-stage operation to treat destructive midfoot tuberculosis: 14 cases experience. Orthop Traumatol Surg Res 2016; 102:1075-1080. [PMID: 27575733 DOI: 10.1016/j.otsr.2016.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/17/2016] [Accepted: 07/18/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Tuberculosis (TB) in midfoot is often secondary to tuberculosis elsewhere in the body. The experience and literatures to treat midfoot tuberculosis are rare. Up until now, no successful method is reported to treat midfoot tuberculosis. HYPOTHESIS Stage surgery is an effective method to treat midfoot bone TB. MATERIAL AND METHODS Between January 2008 to January 2011, 14 patients who were diagnosed midfoot tuberculosis and suffered stage operation were enrolled. All the patients had been diagnosed definitely relying on imaging examination and laboratory tests preoperatively. Two-stage operation was performed to all patients. At the first stage, TB tissue and infective tissue were completely removed and replaced by antibiotic bone cement. Normal foot length and arch would be restored and maintained by K-wires and external fixators. At the second stage, autologous iliac and allogeneic bone graft were used to replace bone cement and by fixed by locking plates. American Orthopaedic Foot and Ankle Society (AOFAS), SF-36 and visual analogue scale (VAS) pain score were recorded at the last follow-up. RESULTS The average bone union time was 3.8 (range 3-6) months. There is no case of local recurrence or skin sinus. Neither implant broken nor screw loosen was present in this study. The AOFAS score was increased from 51.7±6.8 (range 43-61) preoperatively to 82.9±3.9 (range 76-90) postoperatively (P<0.001). The SF-36 score increased from 46.1±6.1 preoperatively to 83.1±5.4 postoperatively (P<0.001). The VAS score decreased from 6.1±1.1 preoperatively to 1.4±0.9 points postoperatively (P<0.001). DISCUSSION Stage operation is an effective treatment to stage III, IV midfoot tuberculosis. LEVELS OF EVIDENCE Level IV, retrospective.
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Affiliation(s)
- J Zou
- Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
| | - Z Shi
- Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China.
| | - G Mei
- Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
| | - J Xue
- Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
| | - W Gu
- Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
| | - X Li
- Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
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Muhamad Effendi F, Ibrahim MI, Rozali KN, Miswan MF. Chronic heel pain: It could be tuberculosis. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2016; 11:20-23. [PMID: 28461854 PMCID: PMC5408872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Heel pain is a common presentation at a primary care setting. The majority of these cases are benign and self limiting in nature. Common differential diagnoses include plantar fasciitis and peroneal muscle sprains. However, certain conditions-if undetected early-may cause significant morbidity to the patient. A high index of suspicion and early referral for further investigations are needed to prevent long-term morbidities. METHODS A clinical review of a patient with chronic left heel pain was performed. Blood parameters and imaging investigations indicated chronic infection of the calcaneum. Histopathological examination was highly suggestive of tuberculosis. RESULT The patient responded well to antituberculous therapy. She was pain free and showed no signs of recurrence at final follow-up. CONCLUSION Here, we report a case of chronic heel pain, which was later diagnosed as tuberculosis of the calcaneum and successfully treated with antituberculous therapy.
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Affiliation(s)
- F Muhamad Effendi
- MS(Orth), Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000 Sungai Buloh, Selangor, Malaysia E-mail:
| | - M I Ibrahim
- MS(Orth), Universiti Teknologi MARA, Selangor, Malaysia
| | - K N Rozali
- MS(Orth), Universiti Teknologi MARA, Selangor, Malaysia
| | - M F Miswan
- MS(Orth), Universiti Teknologi MARA, Selangor, Malaysia
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Vijay V, Gupta N, Vaishya R. Tuberculosis around the tarsal navicular: A rare entity. Foot (Edinb) 2016; 28:20-25. [PMID: 27718385 DOI: 10.1016/j.foot.2016.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/25/2016] [Accepted: 09/18/2016] [Indexed: 02/04/2023]
Abstract
Osteoarticular TB around the tarsal navicular is a chronic, uncommon condition affecting the midfoot, which causes significant morbidity to the patient. Tuberculosis around the tarsal navicular is rarely described in the literature. A series of three cases - two involving the talo-navicular joint and one involving the naviculo-cuneiform joint is described. Biopsy was used in all the cases for achieving diagnosis. All patients had good to fair outcome following medical management with anti-tubercular therapy. Due to the pauci-bacillary nature of the disease, a positive culture of the disease is not always possible. The diagnosis depends on a positive histopathology finding. Once an early diagnosis is achieved, antitubercular therapy is usually the mainstay. Clinical awareness of the rare presentations of this disease can help in early detection, adequate treatment and good to fair outcomes. Due to the destruction of the midfoot joints, some patients report difficulty in walking on uneven surfaces and barefoot, for which triple arthrodesis may be offered.
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Affiliation(s)
- Vipul Vijay
- Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, 110076, India.
| | - Nishint Gupta
- Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, 110076, India.
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, 110076, India.
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Takhar R, Bunkar M, Arya S, Mirdha N. Tubercular osteomyelitis of calcaneum bone: A rare occurrence. ACTA ACUST UNITED AC 2016; 63:203-206. [DOI: 10.1016/j.ijtb.2015.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/01/2015] [Accepted: 07/13/2015] [Indexed: 10/21/2022]
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Kadu VV, Saindane KA, Godghate N, Godghate NN. Tuberculosis of Calcaneum - A Rare presentation. J Orthop Case Rep 2016; 6:61-2. [PMID: 27299130 PMCID: PMC4845416 DOI: 10.13107/jocr.2250-0685.379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Tuberculosis of calcaneum is a rare entity. Osteoarticular tuberculosis of foot is uncommon and that of calcaneum is very rare. In children, diagnosis is often delayed as clinical presentation is non-specific and awareness is low due to its rare presentation. Also pediatric tuberculosis has traditionally received a lower priority than adult TB in National TB programmes. Case presentation: 8 yr old girl presented to OPD with swelling and dull aching pain over left heel. Radiograph of calcaneum showed small lytic puctate lesions in the calcaneum. Further investigations showed presence of multiple tuberculous bacilli. Anti-Kochs treatment was started immediately and patient was treated conservatively. Four drugs (HRZE) were prescribed for a period of 12 months. Radiographs at 2 years follow-up showed a healed lesion. Conclusion: Rare and unusual locations of osteoarticular TB often pose a problem of differential diagnosis. Meticulous history and clinical examination helps in reaching the diagnosis. Start of AKT drugs as soon as reports show presence of tubercular bacilli plays a vital role in treatment as well as functional outcome of the patient.
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Affiliation(s)
- Vikram V Kadu
- Department of Orthopaedic, ACPM Medical College, Dhule - 424001, Maharashtra. India
| | - K A Saindane
- Department of Orthopaedic, ACPM Medical College, Dhule - 424001, Maharashtra. India
| | - Ninad Godghate
- Department of Orthopaedic, ACPM Medical College, Dhule - 424001, Maharashtra. India
| | - Neha N Godghate
- Department of Orthopaedic, ACPM Medical College, Dhule - 424001, Maharashtra. India
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Lemnouer A, Frikh M, Belfquih B, Jaafar A, Bouya A, Jidal M, Boussouga M, Elouennass M. Navicular tuberculosis: A rare localization of bone tuberculosis. IDCases 2016; 2:80-2. [PMID: 26793464 PMCID: PMC4712193 DOI: 10.1016/j.idcr.2015.08.002] [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: 07/24/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 11/26/2022] Open
Abstract
Tuberculosis (TB) is a global public health problem endemic to Morocco. While extrapulmonary TB uncommonly presents in osteoarticular anatomic locations, tarsal or metatarsal osteitis can occur when TB presents in the tarsal bones. Clinical symptoms are often insidious causing a delay in diagnosis that may lead to bone destruction. While diagnosis can be guided by X-ray imaging, bacteriologic and histologic examination of the tissue allows for pathogen isolation, identification of the bacillus and strain sensitivity to antibacillary treatment. We report a rare case of navicular osteitis associated with tarso-metatarsal arthritis caused by tuberculosis in a 68-year-old man. This case illustrates an exceptional location of osteoarticular TB and support diagnostic difficulties encountered: (i) imaging is not specific; (ii) lesions are paucibacillary which reduces conventional microbiological methods sensitivity and (iii) the peripheral location of the Koch bacillus within the lesion dictates surgical biopsy than percutaneous puncture. We recommend testing for tuberculosis in any case of chronic osteolysis and/or arthritis of the foot, especially in TB endemic countries.
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Affiliation(s)
- Abdelhay Lemnouer
- Department of Bacteriology, University Mohammed V, Faculty of Medicine and Pharmacy, Military Hospital of Instruction Mohammed V Rabat, Rabat, Morocco
| | - Mohammed Frikh
- Department of Bacteriology, University Mohammed V, Faculty of Medicine and Pharmacy, Military Hospital of Instruction Mohammed V Rabat, Rabat, Morocco
| | - Bouchra Belfquih
- Department of Bacteriology, University Mohammed V, Faculty of Medicine and Pharmacy, Military Hospital of Instruction Mohammed V Rabat, Rabat, Morocco
| | - Abdelwahab Jaafar
- Department of Orthopedics, Military Hospital of Instruction Mohammed V, Rabat, Morocco
| | - Ayoub Bouya
- Department of Orthopedics, Military Hospital of Instruction Mohammed V, Rabat, Morocco
| | - Mohamed Jidal
- Department of Radiology, Military Hospital of Instruction Mohammed V, Rabat, Morocco
| | - Mustapha Boussouga
- Department of Orthopedics, Military Hospital of Instruction Mohammed V, Rabat, Morocco
| | - Mostafa Elouennass
- Department of Bacteriology, University Mohammed V, Faculty of Medicine and Pharmacy, Military Hospital of Instruction Mohammed V Rabat, Rabat, Morocco
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Saindane KA, Ghodke AB, Patil SS, Godghate NN, Kelkar S. An Isolated Displaced Fracture of the Coracoid Process Treated with Open reduction and internal fixation - A Case Report and Review of Literature. J Orthop Case Rep 2016; 6. [PMID: 27299123 PMCID: PMC5040568 DOI: 10.13107/jocr.2250-0685.422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Isolated coracoid fractures are rare and few scattered cases are reported in literature. Coracoid fractures can be missed and the treatment for coracoid process fractures is still controversial. The case presented here is of an isolated coracoid process fracture which was treated surgically. CASE REPORT A 15-years old male presented after 4 days of injury complaining of persistent pain in the right shoulder following a jerk during bowling. Physical examination revealed tenderness in the left shoulder. There was pain on abduction and external rotation. The neurovascular examination was normal. Osseous avulsion of the distal tip of the coracoid process was confirmed by CT and MRI. The short head of the biceps and coracobrachialis was attached to the avulsed tip, while the pectoralis minor was attached to the coracoid base. The case was managed by open reduction and fixation with a 3.5mm cannulated screw and washer. CONCLUSION Isolated coracoid fracture is a rare entity causing impairment of upper limb movement. It can be diagnosed more accurately by MRI scan and CT scan. In case of young highly demanding individuals like athletes surgical management may be a better option as compared to conservative treatment to achieve early use of the extremity, good radiological union and clinical function.
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Affiliation(s)
- K A Saindane
- Department of Orthopaedics, ACPMMC, Sakhri Road, Dhule, Maharashtra. India
| | - Aashish B Ghodke
- Department of Orthopaedics, ACPMMC, Sakhri Road, Dhule, Maharashtra. India,Address of Correspondence Dr. Aashish B. Ghodke, Junior Resident, Department of Orthopaedics, ACPMMC, Sakhri Road, Dhule, Maharashtra. India. Pin: 424001. E-mail:
| | - Sameer S Patil
- Department of Orthopaedics, ACPMMC, Sakhri Road, Dhule, Maharashtra. India
| | - Neha N Godghate
- Department of Orthopaedics, ACPMMC, Sakhri Road, Dhule, Maharashtra. India
| | - Sagar Kelkar
- Department of Orthopaedics, ACPMMC, Sakhri Road, Dhule, Maharashtra. India
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Saindane KA, Ghodke AB, Patil SS, Godghate NN, Kelkar S. An Isolated Displaced Fracture of the Coracoid Process Treated with Open reduction and internal fixation - A Case Report and Review of Literature. J Orthop Case Rep 2016; 6:37-9. [PMID: 27299123 PMCID: PMC5040568 DOI: 10.13107/jocr.2250-0685.372] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Isolated coracoid fractures are rare and few scattered cases are reported in literature. Coracoid fractures can be missed and the treatment for coracoid process fractures is still controversial. The case presented here is of an isolated coracoid process fracture which was treated surgically. CASE REPORT A 15-years old male presented after 4 days of injury complaining of persistent pain in the right shoulder following a jerk during bowling. Physical examination revealed tenderness in the left shoulder. There was pain on abduction and external rotation. The neurovascular examination was normal. Osseous avulsion of the distal tip of the coracoid process was confirmed by CT and MRI. The short head of the biceps and coracobrachialis was attached to the avulsed tip, while the pectoralis minor was attached to the coracoid base. The case was managed by open reduction and fixation with a 3.5mm cannulated screw and washer. CONCLUSION Isolated coracoid fracture is a rare entity causing impairment of upper limb movement. It can be diagnosed more accurately by MRI scan and CT scan. In case of young highly demanding individuals like athletes surgical management may be a better option as compared to conservative treatment to achieve early use of the extremity, good radiological union and clinical function.
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Affiliation(s)
- K A Saindane
- Department of Orthopaedics, ACPMMC, Sakhri Road, Dhule, Maharashtra. India
| | - Aashish B Ghodke
- Department of Orthopaedics, ACPMMC, Sakhri Road, Dhule, Maharashtra. India
| | - Sameer S Patil
- Department of Orthopaedics, ACPMMC, Sakhri Road, Dhule, Maharashtra. India
| | - Neha N Godghate
- Department of Orthopaedics, ACPMMC, Sakhri Road, Dhule, Maharashtra. India
| | - Sagar Kelkar
- Department of Orthopaedics, ACPMMC, Sakhri Road, Dhule, Maharashtra. India
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Agarwal A, Kant KS, Suri T, Gupta N, Verma I, Shaharyar A. Tuberculosis of the calcaneus in children. J Orthop Surg (Hong Kong) 2015; 23:84-9. [PMID: 25920652 DOI: 10.1177/230949901502300120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To review 10 children with calcaneal tuberculosis in terms of presentation, healing, and functional outcome. METHODS Medical records of 7 boys and 3 girls aged 7 to 12 (mean, 9.8) years who presented with calcaneal tuberculosis were reviewed. The erythrocyte sedimentation rate of all patients was elevated. All patients presented with pain and swelling around the lateral malleolus and a 'heal-up' sign; 7 of them presented with an additional discharging sinus. Three patients had palpable lymph nodes in the right inguinal or left popliteal region. Symptoms had lasted for one month to 1.5 years. Two patients had healed tuberculosis in the lungs; 8 patients had no pulmonary involvement. Seven patients had a single lytic lesion in the calcaneal body (n=1), tuberosity (n=3), and extension to anterior process (n=3). Three patients had multiple lytic lesions in the calcaneum; one of them had bilateral involvement who had lesions in the phalanges, lumbar spine, and ulna. Two patients had subtalar joint involvement. RESULTS The mean follow-up period was 17 (range, 8-60) months. The erythrocyte sedimentation rate returned to normal after 3 months in 7 patients and after >6 months in 3 patients. The subtalar range of movement was normal in all except for 2 patients. One patient developed subtalar ankylosis. Sinuses healed in a mean of 10 (range, 2-16) weeks. No patient had pain on level walking after treatment. At 3 months, remineralisation of bone was evident in all patients. Sclerosis of cavity margins and sequestra resorption was noted from 6 to 9 months. No patient experienced recurrence. CONCLUSION The 'heel up' sign was common in children with calcaneal tuberculosis in this endemic region. The central granuloma-type presentation was the most common. Pathological fractures and involvement of the subtalar joint were not common. Subtalar joint involvement was a poor prognostic factor.
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Affiliation(s)
- Anil Agarwal
- Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
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Mariotti V, Zuppello M, Pedrosi ME, Bettuzzi M, Brancaccio R, Peccenini E, Morigi MP, Belcastro MG. Skeletal evidence of tuberculosis in a modern identified human skeletal collection (Certosa cemetery, Bologna, Italy). AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2015; 157:389-401. [DOI: 10.1002/ajpa.22727] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 01/09/2015] [Accepted: 02/09/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Valentina Mariotti
- Laboratorio Di Bioarcheologia E Osteologia Forense; Dipartimento Di Scienze Biologiche; Geologiche E Ambientali; Alma Mater Studiorum Università Di Bologna; via Selmi 3 Bologna 40126 Italy
- UMR 7268 ADÉS-Anthropologie Bioculturelle; Droit; Ethique Et Santé CNRS/Université d'Aix-Marseille/EFS Faculté De Médecine-Secteur Nord, CS80011; Marseille Cedex 15 Boulevard Pierre Dramard 13344 France
| | - Micol Zuppello
- Laboratorio Di Bioarcheologia E Osteologia Forense; Dipartimento Di Scienze Biologiche; Geologiche E Ambientali; Alma Mater Studiorum Università Di Bologna; via Selmi 3 Bologna 40126 Italy
| | - Maria Elena Pedrosi
- Laboratorio Di Bioarcheologia E Osteologia Forense; Dipartimento Di Scienze Biologiche; Geologiche E Ambientali; Alma Mater Studiorum Università Di Bologna; via Selmi 3 Bologna 40126 Italy
| | - Matteo Bettuzzi
- X-Ray Imaging Group; Dipartimento Di Fisica E Astronomia; Alma Mater Studiorum Università Di Bologna; Viale B. Pichat 6/2 Bologna 40127 Italy
- Centro Fermi, Piazza Del Viminale 1; Roma 00184 Italy
| | - Rosa Brancaccio
- X-Ray Imaging Group; Dipartimento Di Fisica E Astronomia; Alma Mater Studiorum Università Di Bologna; Viale B. Pichat 6/2 Bologna 40127 Italy
- Centro Fermi, Piazza Del Viminale 1; Roma 00184 Italy
| | - Eva Peccenini
- X-Ray Imaging Group; Dipartimento Di Fisica E Astronomia; Alma Mater Studiorum Università Di Bologna; Viale B. Pichat 6/2 Bologna 40127 Italy
- Centro Fermi, Piazza Del Viminale 1; Roma 00184 Italy
| | - Maria Pia Morigi
- X-Ray Imaging Group; Dipartimento Di Fisica E Astronomia; Alma Mater Studiorum Università Di Bologna; Viale B. Pichat 6/2 Bologna 40127 Italy
- Centro Fermi, Piazza Del Viminale 1; Roma 00184 Italy
| | - Maria Giovanna Belcastro
- Laboratorio Di Bioarcheologia E Osteologia Forense; Dipartimento Di Scienze Biologiche; Geologiche E Ambientali; Alma Mater Studiorum Università Di Bologna; via Selmi 3 Bologna 40126 Italy
- Centro Fermi, Piazza Del Viminale 1; Roma 00184 Italy
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Korim M, Patel R, Allen P, Mangwani J. Foot and ankle tuberculosis: case series and literature review. Foot (Edinb) 2014; 24:176-9. [PMID: 25178156 DOI: 10.1016/j.foot.2014.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 05/13/2014] [Accepted: 07/16/2014] [Indexed: 02/04/2023]
Abstract
Foot and ankle tuberculosis (TB) is a rare presentation of skeletal TB. The uncommon site along with low index of clinical suspicion in the western world leads to delays in the diagnosis and treatment. This can make joint sparing procedures less successful, especially in the midfoot where the joints can often be interconnected. Plain radiographs have low sensitivity and specificity and cross sectional imaging in the form of MRI or CT is more reliable. Treatment involves the use of multiple anti-tuberculous drugs in the first instance, followed by surgery to address any symptomatic deformity and/or secondary degenerative changes. We present our experience on the management of this rare problem and review the literature on the clinical presentation, diagnosis, imaging modalities and treatment.
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Affiliation(s)
- Muhammad Korim
- University Hospitals Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom.
| | - Rizwan Patel
- University Hospitals Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom
| | - Patricia Allen
- University Hospitals Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom
| | - Jitendra Mangwani
- University Hospitals Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom
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Hayat Z, Konan S, Olivier A, Briggs TWR. Isolated tuberculosis of the calcaneum in a constitutionally well patient. BMJ Case Rep 2014; 2014:bcr-2014-204016. [PMID: 25312889 DOI: 10.1136/bcr-2014-204016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 66-year-old Caucasian man presented with a 9-month history of a painful left heel with associated soft tissue swelling. Pitting oedema was present to the upper shin. Plain radiograph showed a sclerotic calcaneum with lucent patches and the CT scan revealed bony destruction at the posterosuperior aspect of the calcaneus with a moth-eaten appearance. To obtain a more definitive diagnosis, the patient underwent a CT-guided biopsy, which showed caseating granulomatous inflammation strongly suggestive of Mycobacterium infection. A Ziehl-Neilson stain did not show any microorganisms. Microbiology confirmed the presence of Staphylococcus aureas. A diagnosis of tuberculosis with concomitant Staphylococcus superinfection was made based on the histology and clinical context. The patient was treated with curettage and cementing of the lesion in order to debride the infected tissue and provide structural support to the bone. A 9-month course of quadruple antituberculous therapy was also initiated.
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Affiliation(s)
| | - Sujith Konan
- Bone Tumour Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - André Olivier
- Bone Tumour Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Tim W R Briggs
- Bone Tumour Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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Abstract
Aim and Objective: To know the biological behavior of ankle and foot tuberculosis (AFTB) and to know the reasons for delay in diagnosis and treatment of AFTB in our population. Materials and Methods: Patients with non-healing ulcers/sinuses/swellings in the ankle and foot region are the subjects of present study. Detailed clinical history, physical examination and relevant investigations were done in all cases. Pus/wound discharge for acid fast bacillus (AFB) study and biopsy from wound margin/sinus tract was taken in all the cases. Results: During the period from July 2007-June 2012, 20 cases of AFTB were treated. Out of them five cases were difficult to diagnose and a mean period of 6 month to 5year was elapsed before final diagnosis was established. Out of these five cases – three cases were diabetic with ulcers and sinuses in the heel and ankle region. One case was wrongly diagnosed as angiodysplasia with A-V malformation of foot and diagnosis was delayed for 5 year. In one case of rheumatoid arthritis with abscess in ankle joint, the diagnosis was delayed for 1year. Conclusion: AFTB is very rare condition. AFTB is suspected in cases with long standing pain/swelling/discharging sinus in the foot and thorough investigations is must to differentiate from other foot diseases. Diagnosis is delayed due to lack of clinical suspicion and non-confirmatory biopsy reports. Early diagnosis and ATT for 9-18 months is must in all cases of AFTB to prevent joint involvement and other complications.
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Affiliation(s)
- Biswaranjan Nayak
- Department of General Surgery, S.C.B. Medical College, Cuttack, Orissa, India
| | - Rashmi Rani Dash
- Department of Physiology, S.C.B. Medical College, Cuttack, Orissa, India
| | | | - Geetanjali Panda
- Department of Pulmonary Medicine, S.C.B. Medical College, Cuttack, Orissa, India
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Gursu S, Yildirim T, Ucpinar H, Sofu H, Camurcu Y, Sahin V, Sahin N. Long-term follow-up results of foot and ankle tuberculosis in Turkey. J Foot Ankle Surg 2014; 53:557-61. [PMID: 24846160 DOI: 10.1053/j.jfas.2014.04.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Indexed: 02/03/2023]
Abstract
The incidence of tuberculosis has been increasing, especially in the past 2 decades. Skeletal tuberculosis is very rare compared with the frequency of the pulmonary form. In the present study, we have shared our long-term experience with foot and ankle tuberculosis, providing information about the different aspects of the disease. A total of 70 patients with foot and ankle tuberculosis, treated from 1983 to 2005, were evaluated. The mean patient age was 34.4 (range 7 to 85) years at the diagnosis. The mean interval between the first symptoms and the diagnosis was 26.4 months (range 1 month to 15 years). The mean follow-up period was 21.7 (range 8 to 30) years. The infection affected both the joint and the bones in 29 patients, only the joints in 13, only the bones in 22, and the soft tissues alone in the remaining 6 patients. The most common joint location was the tibiotalar joint. The talus was the most commonly infiltrated bone. All patients underwent biopsy, and 28 patients underwent additional surgical procedures. In 18 patients (25.7%), 1 to 4 recurrences developed during the follow-up period. In the last follow-up visits, either severe destruction of the bones or end-stage arthrosis was evident in 39 patients (55.7%), especially in those with osseous tuberculosis. Foot and ankle tuberculosis is very rare. The diagnosis of the disease will often be late owing to the lack of pathognomonic findings. A histopathologic evaluation should not be omitted in cases with suspicion. The incidence of residual deformity or end-stage arthrosis has been high in the long term; however, the patients will usually be without any symptoms.
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Affiliation(s)
- Sarper Gursu
- Baltalimani Bone and Joint Diseases Hospital, Istanbul, Turkey.
| | - Timur Yildirim
- Baltalimani Bone and Joint Diseases Hospital, Istanbul, Turkey
| | - Hanifi Ucpinar
- Baltalimani Bone and Joint Diseases Hospital, Istanbul, Turkey
| | | | - Yalkin Camurcu
- Baltalimani Bone and Joint Diseases Hospital, Istanbul, Turkey
| | - Vedat Sahin
- Baltalimani Bone and Joint Diseases Hospital, Istanbul, Turkey
| | - Nursu Sahin
- Baltalimani Bone and Joint Diseases Hospital, Istanbul, Turkey
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Elmi A, Tabrizi A, Tolouei FM. Skeletal tuberculosis presenting as a small cystic lesion in the medial femoral condyle. THE ARCHIVES OF BONE AND JOINT SURGERY 2013; 1:112-115. [PMID: 25207301 PMCID: PMC4151416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 12/14/2013] [Indexed: 06/03/2023]
Abstract
Skeletal tuberculosis is an unusual disease involving bone and joints and it may have different manifestations. This report introduces a 25-year-old woman suffering from chronic knee pain without any response to conservative treatments for one year. X-ray was normal but CT-scan and MRI indicated a small lesion in medial condyle of the femur. The patient underwent percutaneous CT-guided biopsy. Following an evaluation of the obtained sample, tuberculous osteomyelitis was detected. After resection of the femoral mass and starting anti TB medical treatment, symptoms dramatically eliminated.
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Affiliation(s)
- Asghar Elmi
- Asghar Elmi MD, Ali Tabrizi MD, Fardin Mirza Tolouei MD, Department of Orthopedic Surgery Shohada Teaching Hospital Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Tabrizi
- Asghar Elmi MD, Ali Tabrizi MD, Fardin Mirza Tolouei MD, Department of Orthopedic Surgery Shohada Teaching Hospital Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fardin Mirza Tolouei
- Asghar Elmi MD, Ali Tabrizi MD, Fardin Mirza Tolouei MD, Department of Orthopedic Surgery Shohada Teaching Hospital Tabriz University of Medical Sciences, Tabriz, Iran
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Upadhaya GK, Jain VK, Sinha S, Naik AK. Isolated calcaneocuboid joint tuberculosis: a rare case report. Foot (Edinb) 2013; 23:169-71. [PMID: 24239029 DOI: 10.1016/j.foot.2013.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 09/29/2013] [Accepted: 10/03/2013] [Indexed: 02/04/2023]
Abstract
Tubercular arthritis affecting the foot is uncommon. Isolated calcaneocuboid joint tuberculosis has never been reported in the literature. Herein we report a case of 43-year-old male who presented with insidious onset pain in hindfoot of 4 months duration. Radiograph revealed destruction of calcaneocuboid joint along with cuboid. Computed Tomography scan further consolidated the findings. Diagnosis was confirmed from aspiration from joint with culture of mycobacterium tuberculosis. Anti-tubercular chemotherapy was started and good clinical response was noted. We reported this case because of its rarity to involve calcaneocuboid joint and the excellent outcome with medical treatment.
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Affiliation(s)
- Gaurav Kumar Upadhaya
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital, New Delhi 110001, India
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Affiliation(s)
- Anil K Jain
- Professor of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi, India,Address for correspondence: Dr. Anil K Jain, Professor of Orthopedics, University College of Medical Sciences and GTB Hospital, Delhi, India. Editor, Indian Journal of Orthopedics. E-mail:
| | - S Rajasekaran
- Chairman, Department of Orthopaedics, Ganga Hospital, Coimbatore, Tamil Nadu, India
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