Localized hypertrophy of the semimembranosus muscle in a young athlete: a case report

Popliteal fossa and distal thigh swellings have many causes in young active adult. Cysts are the main cause, but they may also evolve from fatty tissue, lymph nodes or the popliteal artery. Semimembranosus muscle hypertrophy, found in athletes and young active adults, is only rarely the main or only cause of swelling, and only four such cases are reported in the literature. The present article reports our experience in the management of a case of semimembranosus hypertrophy as the only cause of a swelling above the popliteal fossa, and its favorable evolution.

[An unusual intratarsal dislocation: cuneonavicular and calcaneocuboid dislocation]

We report a case of tarsal dislocation with cuneonavicular dislocation associated with calcaneocuboidal dislocation. This dislocation is rare and severe because it causes disruption of both the medial and lateral columns of the foot. Early and prompt reduction of this rare injury was successful in this case and appears important.

[Pneumatosis cystoides intestinalis. Diagnostic elements and therapeutic approach]

Pneumatosis cystoides intestinalis is an uncommon condition characterised by multiple gas-filled cysts within the small intestine or colonic wall. Clinical manifestations are unspecific and often found in many other abdominal diseases. To avoid unnecessary laparotomy, radiologic and endoscopic findings are essential to be known. The present case associates symptoms highly suspect of neoplasia like weight loss, rectal mass, bloody stools and tenesmus. Treatment of choice is medical. In the absence of an acute abdomen, surgery is only reserved when it is not responsive to medical treatment.

[A case of isolated avulsion fracture of the posterior cruciate ligament in a child]

PURPOSE OF THE STUDY

The authors report one case of isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament. They recommend the use of 3D CT Scan to appreciate the size, the displacement of the bone fragment or the occurrence of comminuted fracture.

MATERIAL AND METHOD

A 12 years old girl was admitted for knee pain and swelling secondary to horse's hoof blow on the anterior aspect of the proximal tibia. Hemarthrosis, contusion of the anterior surface of the proximal tibia were present. Because of pain and swelling, the knee could not be examined with accuracy. Roentgenographic examination showed isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament. 3D CT Scan confirmed the lesion. Bony fragment was displaced and was not comminuted. Approach through the popliteal fossa was used and bony fragment was screwed back into its bed.

RESULTS

Postoperatively, a long leg plaster of Paris was applied for 6 weeks. The patient was followed for 1.5 year. She returned to her previous occupation. There was no residual laxity. X ray confirmed fracture union.

DISCUSSION

Results of primary repair of interstitial posterior cruciate ligament tears were inconsistent. On the contrary, good functional results were obtained with surgically treated avulsion fracture of the posterior cruciate ligament. Displaced bony fragment will be fixed properly to its bed. 3D CT Scan appreciate the size, the displacement or the occurrence of comminuted fracture. Those informations help to define surgical procedure: screw, wire-suture or staple.

Peroneus quartus muscle: a case report and review of the literature

The peroneus quartus is a supernumerary muscle of the lateral compartment of the lower leg. There are several variations of this accessory muscle, and its terminology is very confusing. The peroneus quartus is found with a frequency varying from 10 to 21.7% of observed individuals. It is rarely involved in pathologic processes of the foot and ankle. Only a few reports exist in the literature involving peroneus quartus in a "retromalleolar conflict" (lateral ankle stenosis), sometimes in association with longitudinal attrition and tears of the peroneus brevis. We present a novel case, together with a review of the clinical, anatomic, and radiologic references about this muscle, and we try to make order in classification and terminology of its different forms.

[Pathologic fracture of the tibia associated with Charcot-Marie-Tooth disease]

The authors report a case of pathologic fracture of the distal tibia associated with Charcot-Marie-Tooth disease. Pathologic fracture was visible four weeks after initial pain. Treatment consisted in a short leg walking cast for six weeks. Charcot-Marie-Tooth disease is a slowly progressive neurogenic muscular atrophy affecting the distal parts of the lower limbs. The muscular atrophy is responsible for radiographic bony changes including narrowing of the shaft with thinning of the cortex, rarefaction at the end of the long bones and relative widening of the medullary cavity. Pathologic fractures in neuromuscular disease are rare; a few cases have been reported following application of very small forces. The authors draw attention to the increased risk of pathologic fractures in patients with neuromuscular disease. Ambulatory treatment of fractures should be used whenever possible; prolonged immobilization could result in further loss of function.

[Peripheral thrombopenic purpura associated with acquired toxoplasmosis]

Acquired Toxoplasma Gondii infection has a benign course in adults and children immunologically competent. Thrombocytopenia is much more common during congenital toxoplasma infection and the rare cases of purpura associated with acquired toxoplasmosis are usually not thrombocytopenic. We report a case of thrombocytopenic purpura in an immunocompetent child, associated with active acquired toxoplasmosis. In rare circumstances, acquired toxoplasmosis in an immunocompetent patient may be associated with severe thrombocytopenia. However, the low incidence of such cases makes a therapeutic consensus difficult.

[Tennis elbow: surgical findings in 17 cases and etiopathogenetic hypothesis]

Lateral epicondylitis is the most common source of elbow pain. Surgical treatment is easy but precise etiology remains uncertain. We reviewed 17 medical files of surgically treated lateral epicondylitis. Chondral lesions of the radial head were systematically looked for. Out of those 17 elbows, 11 showed extension limitation before surgical treatment. From this sub-group, 9 presented chondral lesions. None of the 6 elbows without extension limitation showed chondral lesions. Increased tension of the extensor carpi radialis brevis associated with the eccentric movement of the radial head, seems to be an important factor in the pathogenesis of those lesions. We believe that chondropathy of the radial head is a consequence of lateral epicondylitis.

[Spontaneous dissection of the internal carotid artery: apropos of a case]

Dissections of the extracranial internal carotid artery are probably underestimated in the general population. They are often unrecognized and asymptomatic as shown in this case report and are only the cause of 1 to 4% of cerebral ischaemic accidents. However, they are responsible for 5 to 20% of such accidents in adults younger than 30 years of age. The nontraumatic nature of the carotid artery dissection in our case has been suggested by the medical history although minor trauma could have been missed. A skin biopsy has enabled us to eliminate elastopathies such as Marfan's or Ehlers-Danlos' syndrome. The diagnosis of dissection has been suggested by a Doppler colour echography ; it was confirmed by the arteriography which revealed a long dissection looking like "string sign" at the level of the internal carotid artery just over the carotid bulb. As far as the evolution is concerned, a medical treatment made it quickly favourable.