Left Distal Femur Research Articles

Unusual “Mini-Rugby Ball” Pattern Solitary Lung Metastasis in Relapsed Ewing's Sarcoma

AbstractEwing's sarcoma (ES) is a mesenchymal origin malignant neoplasm that affects children and adolescents. It is the second most common type of bone sarcoma and accounts for approximately 1.5% of all childhood cancers with an annual incidence of 1 to 3 cases per million children under 16 years of age. In this article, we present the case of a 16-year-old adolescent girl. Lung metastasis at the initial diagnosis of ES is relatively uncommon but carries significant prognostic implications. Lung metastases in ES can vary significantly in size, ranging from small nodules (just a few millimeters in size) to the largest reported case being 15 cm. The size of the metastases impacts the choice of therapeutic strategies and the prognosis. Approximately 30% of patients with ES experience a relapse, with the lungs being a common site for metastatic disease. Relapsed lung metastasis on follow-up is a critical concern in the long-term management of ES. We describe a relapsed case of ES in a 16-year-old adolescent girl who presented with a solitary large metastatic right lung mass, with the longest dimension of 16 cm on craniocaudal measurement. The primary site of the tumor was the left distal femur, for which the patient received six cycles of neoadjuvant chemotherapy, followed by en bloc tumor excision and rotationplasty of the left distal femur, after which the patient received seven cycles of adjuvant chemotherapy. Subsequent 5 years of regular follow-up was asymptomatic. Later, the patient presented with back pain and cough, and was diagnosed with a solitary large right lung mass. Computed tomography (CT) guided biopsy of the right lung mass revealed a metastatic ES, for which she underwent chemoradiotherapy. This case highlights the large size of solitary lung metastases in relapsed ES.

Ginsenoside Rc alleviates osteoporosis by the TGF-β/Smad signaling pathway.

Osteoporosis is a common chronic bone disorder in postmenopausal women. Ginsenosides are primary active components in ginseng and the effects of various ginsenoside variants in osteoporosis treatment have been widely revealed. We planned to explore the impact of ginsenoside Rc on bone resorption in an osteoporosis rat model. We used ovariectomized rats to assess the potential impact of ginsenoside Rc on osteoporosis. μ-CT was implemented for analyzing the microstructure of the distal left femur in rats. H&E staining together with Masson staining were applied for bone histomorphometry evaluation. ELISA kits were implemented to detect serum concentrations of TRACP-5b, OCN, CTX, as well as PINP. Ginsenoside Rc treatment lessened the serum levels of TRACP-5b as well as CTX, while increasing serum levels of OCN, and PINP of OVX rats. Moreover, we found that ginsenoside Rc contributed to the synthesis of type I collagen via increasing Col1a1 and Col1a2 levels in femur tissues of ovariectomized rats. Our findings also revealed that ginsenoside Rc activated the TGF-β/Smad pathway by increasing TGF-β as well as phosphorylated Smad2/3 protein levels. Ginsenoside Rc alleviates osteoporosis in rats through promoting the TGF-β/Smad pathway.

Electroacupuncture attenuates nociceptive behaviors in a mouse model of cancer pain.

Pain is a major symptom in cancer patients, and cancer-induced bone pain (CIBP) is the most common type of moderate and severe cancer-related pain. The current available analgesic treatments for CIBP have adverse effects as well as limited therapeutic effects. Acupuncture is proved effective in pain management as a safe alternative therapy. We evaluated the analgesic effect of acupuncture in treatment of cancer pain and try to explore the underlying analgesic mechanisms. Nude mice were inoculated with cancer cells into the left distal femur to establish cancer pain model. Electroacupuncture (EA) treatment was applied for the xenograft animals. Pain behaviors of mice were evaluated, followed by the detections of neuropeptide-related and inflammation-related indicators in peripheral and central levels. EA treatment alleviated cancer-induced pain behaviors covering mechanical allodynia, thermal hyperalgesia and spontaneous pain, and also down-regulated immunofluorescence expressions of neuropeptide CGRP and p75 in the skin of affected plantar area in xenograft mice, and inhibited expressions of overexpressed neuropeptide-related and inflammation-related protein in the lumbar spinal cord of xenograft mice. Overall, our findings suggest that EA treatment ameliorated cancer-induced pain behaviors in the mouse xenograft model of cancer pain, possibly through inhibiting the expressions of neuropeptide-related and inflammation-related protein in central level following tumor cell xenografts.

SOLITARY DIAPHYSEAL OSTEOCHONDROMA OF DISTAL FEMUR - A CASE REPORT

Osteochondromas are among the most common benign bone tumours with a male predilection which are usually incidentally detected. They are usually found in the metaphyseal region of long bones.This case is reported in view of the unique origin of the tumour in the diaphyseal region in a female. A woman came to the outpatient department with complaints of a painless, non mobile swelling over left distal femur for past 4 years.The swelling initially small gradually increased in size over 4 years but was not associated with pain or restriction of movements. Clinical examination revealed bony hard swelling in the anteromedial aspect of left distal femur not involving the knee joint. X ray showed a cauliflower shaped, pedunculated bony mass arising from the diaphyseal region of distal femur. MRI done was suggestive of osteochondroma. In order to confirm the diagnosis and to rule out malignant transformation,surgical excision and biopsy of the bony mass was performed. Histopathological reports confirmed the diagnosis of osteochondroma.

Abstract 17742: Anterior Papillary Muscle Rupture After a Motor Vehicle Collision: A Rare Case of Torrential Tricuspid Regurgitation After Blunt Cardiac Injury

Introduction: Blunt cardiac injury is difficult to diagnose in the setting of polytrauma. Here we present a rare case of a torrential tricuspid regurgitation from a ruptured anterior papillary muscle after a motor vehicle collision (MVC). Case: A 55-year-old male presented to the ED after an MVC. He was hemodynamically unstable and hypoxic en route complaining of severe chest and left leg pain. Imaging demonstrated multiple rib fractures, a left acetabular fracture, and left open distal femur fracture. EKG identified atrial fibrillation with RVR and nonspecific ST changes. Labs were significant for leukocytosis and a troponin elevation to 11.98 concerning for blunt cardiac injury. A TTE demonstrated a mobile density in the RA and RV consistent with papillary muscle rupture and severe tricuspid regurgitation. An underfilled left ventricle compressed by the right heart and dilated RV were noted with septal flattening consistent with RV pressure and volume overload. Cardiothoracic surgery was consulted and recommended delayed tricuspid valve repair after other acute injuries were addressed considering the need for full anticoagulation. While in the ICU, his orthopedic injuries were addressed though his hemodynamics were complicated by frequent orthopedic interventions requiring blood transfusions. He later underwent TV replacement and it was found that the anterior papillary muscle was ruptured at its base without leaflet perforation. One week post-operatively the patient suffered a hypoxic PEA arrest. The shock team was consulted and he underwent bedside ECMO cannulation with impella placement for LV failure. After ten days on ECMO he was decannulated. Ultimately, the patient recovered well and was discharged to acute rehab. Discussion: MVCs are a leading cause of traumatic tricuspid insufficiency. However, this life-threatening condition may go undetected due polytrauma and the presence of coexisting distracting injuries. Guidelines are needed for the specific management of traumatic tricuspid regurgitation and associated right heart dysfunction. Additionally, the need for multiple surgical interventions can preclude anticoagulation which is a unique barrier to urgent valve replacement in these patients.

Femoral Magnetic Lengthening After Distal Femur Endoprosthetic Reconstruction in a Pediatric Patient: A Case Report.

A 10-year-old boy with osteosarcoma of the left distal femur underwent resection with compressive osseointegration endoprosthetic reconstruction, gradually resulting in a 4.5-cm leg-length difference with significant predicted progression. Two years after resection, he underwent right distal femur and proximal tibia epiphysiodesis and placement of a left femoral magnetic lengthening nail. At 2 years after lengthening and skeletal maturity, the patient has symmetric limb lengths, no pain, and returned to sports. A magnetic lengthening nail with contralateral epiphysiodesis is a viable option for correcting limb-length discrepancy after distal femur endoprosthetic reconstruction in a pediatric patient.

THE ROLE OF DENTIN MATRIX PROTEIN 1 (DMP1) IN LIPUS-ACCELERATED OSTEOPOROTIC FRACTURE HEALING

Osteoporotic fracture has become a major problem in ageing population and often requires prolonged healing time. Low Intensity Pulsed Ultrasound (LIPUS) can significantly enhance fracture healing through alteration of osteocyte lacuno-canalicular network (LCN). DMP1 in osteocytes is responsible for maintaining LCN and mineralisation. This study aims to investigate osteocyte-specific DMP1's role in enhanced osteoporotic fracture healing in response to mechanical stimulation.Bilateral ovariectomy was performed in 6-month-old female SD rats to induce osteoporosis. Metaphyseal fracture was created at left distal femur using oscillating micro-saw. Rats were randomised to groups: (1) DMP1 KD, (2) DMP1 KD + LIPUS, (3) Control, or (4) Control + LIPUS, where KD stands for knockdown by injection of shRNA into marrow cavity 2 weeks before surgery. Assessments included weekly radiography, microCT and immunohistochemistry on DMP1, E11, FGF23 and sclerostin.DMP1 KD significantly impaired LIPUS-accelerated fracture healing when comparing KD + LIPUS group to Control + LIPUS group. The X-ray relative opacity showed less tissue growth at all timepoints (Week 1, 3 & 6; p=0.000, 0.001 and 0.003 respectively) and the bone volume fraction was decreased after DMP1 KD at Week 3 (p=0.006). DMP1 KD also significantly altered the expression levels of osteocyte-specific DMP1, E11, FGF23 and sclerostin during healing process.The lower relative opacity and bone volume fraction in DMP1 KD groups indicated that knockdown of DMP1 was associated with poorer fracture healing process compared to non-knockdown groups. The similar results between knockdown group with and without LIPUS showed that blockage of DMP1 would negate LIPUS-induced enhancement on fracture healing.Acknowledgment: General Research Fund (Ref: 14113018)

Periprosthetic Femur Fracture on Alkaptonuric Patient: A Rare Case Report in Indonesia

A 74-year-old male with alkaptonuria (AKU) was admitted to the emergency department with left distal femur pain and Rorabeck type 2 periprosthetic femur fracture following total knee arthroplasty (TKA). AKU is an autosomal recessive disorder characterized by homogentisic acid buildup in connective tissues and joints, leading to ochronosis and arthritis. Multiple joint replacements are common in AKU patients, and periprosthetic fractures may occur due to osteopenia. Rorabeck type 2 fracture is treated with intramedullary nailing or locked plating. The patient underwent internal fixation with locking plate and bone grafts using minimally invasive plate osteosynthesis (MIPO) procedure, resulting in good fracture healing. The case highlights the importance of considering AKU as a differential diagnosis in arthritis patients and managing periprosthetic fractures with care in AKU patients.

Aid in need - Manageable but not ideal a tale of knee replacement in distal femur fracture for early mobilisation

We present a case of 70 year female who is a prior patient for knee arthritis at our clinic and who fell down and sustained a fracture in left distal femur over medial condyle. Patient demand was early mobilization. We discussed various options of management and advantages, disadvantages and complications. As per patient request planned for bilateral knee replacement with fracture stabilization. Postop recovery is monitored and patient recovered and is able to walk and satisfactory range of movement of both knee was achieved this case adds to the evidence that elderly distal femur fractures that can be replacement and made to walk as early as possible. Especially in scenarios of arthritis and fracture together.: Informed consent was obtained from the patient and family for the publication of the case report and all the figures included.

Disseminating MSSA Infection in a Preterm Infant With Rare Finding of Spinal Epidural Abscess: A Case Report.

Methicillin-susceptible Staphylococcus aureus (MSSA) occurs more frequently in the neonatal intensive care unit (NICU) than methicillin-resistant S. aureus (MRSA) and can result in comparable morbidity and mortality in the neonatal population. MSSA infection may present as pustulosis or cellulitis and evolve into bacteremia, pneumonia, endocarditis, brain abscesses, and osteomyelitis. There is a paucity of literature regarding the treatment and long-term outcomes in the premature infant. A 32-week twin developed MSSA sepsis with presentation of pain, decreased movement of upper extremities, and global hypotonia. Blood cultures remained positive despite antibiotic coverage. The infant was admitted to the level IV NICU with the diagnosis of MSSA bacteremia, with concern for dissemination and osteomyelitis. Diagnostic studies included laboratory testing for sepsis evaluation, radiologic studies to evaluate for dissemination, immunologic testing to rule out complement deficiency, and hematology testing to rule out hypercoagulable conditions. Diagnostic testing showed extensive cellulitis, osteomyelitis, multiple liver abscesses, and epidural abscesses suggestive of spinal epidural abscess (SEA). Abscess debridement and irrigation on the left distal femur, left elbow, and right tibia were performed. The infant completed 8 weeks of IV antibiotic therapy. Immunologic and hematology testing was within normal limits. Prompt recognition and follow-up for clinical signs of sepsis are vital when caring for premature infants. Inclusion of pediatric subspecialist recommendations to assure all diagnostic studies and treatments are completed can significantly impact the patient's outcome. Long-term follow-up is needed for premature infants with the diagnosis of SEA.

Incidental osteonecrosis in the distal left femur in a case of beta-thalassemia with COVID-19: Role of [99mTc]Tc-MDP whole-body bone scan.

Secondary anemia in hemoglobinopathies like thalassemia can cause expansion of the bone marrow cavities because of compensatory marrow hyperplasia. This case demonstrates spontaneous osteonecrosis of the distal left femur in a patient with β-thalassemia that may be secondary to ischemic infarction secondary to occlusion of the microvasculature within the expanded cancellous bone. This subject was referred to Hazrat Rasool Akram Hospital because of fever, cough, and bone pain. In the CT scan she had scattered peripheral CGO in both lungs due to COVID-19 with two paravertebral masses due to extramedullary hematopoiesis. The patient had also generalized bone pain so the physician asked for a whole-body bone scan and incidentally, we found a cold lesion with a rim of increased uptake in the distal left femur that with bone biopsy it was consistent with osteonecrosis. This case illustrates the importance of performing a whole-body bone scan in β-thalassemia for the management of patients and diagnosis of occult osteonecrosis.

Corrective Osteotomy in a Dog to Address Increased Distal Femoral Procurvatum Ascribed to a Distal Femoral Salter-Harris Type V Injury

AbstractIncreased distal femoral procurvatum has been reported sporadically in dogs following malunion of Salter-Harris type I, II, and III fractures of distal femur. The resultant increased procurvatum can be poorly tolerated because of subsequent loss of stifle extension. This case report represents a dog with the increased procurvatum of the distal femur ascribed to a previous Salter-Harris type V injury. Surgical planning and successful outcome following the corrective procedures have been documented. A 6.5-month-old fox-terrier presented with a persistent weight bearing left pelvic limb lameness, 2 months after being hit by a car. The predominant orthopaedic finding was a 20-degree decrease in left stifle extension. Radiographic and computerized tomography evaluation revealed premature eccentric closure of the left distal femoral physis ascribed to a previous Salter-Harris type V injury. The left femoral procurvatum was 30 degrees. The left tibial plateau angle was increased by 11.5 degrees compared with the right. The femoral deformity was characterized, and a corrective procedure was planned using Paley's centre of rotation of angulation methodology. A cranial closing wedge ostectomy of the left distal femur was performed and stabilized using a locking plate. Proximal tibial epiphysiodesis was also performed to reduce the tibial plateau slope. Union of the osteotomy site and reduction in tibial plateau angle by 5.4 degrees were documented 50 days after surgery with a good functional outcome.

P152 African Woman With a Knee Knocked by a Rare Dematiaceous Fungi

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectives/IntroductionIncidence of fungal peri-prosthetic joint infection (PJI) is rare (1%-3%) and the majority are caused by Candida and Aspergillus. We report a peri-prosthetic knee joint infection caused by a rare dematiaceous fungi—pleurostomophora richardsiae, probably the first case in the world.Methods/Case DetailsA 78-year-old East African female from Malawi, housewife, with no known medical comorbidities presented with a chronic history of left knee pain and pus discharge. She had left knee pain since 2008 and was given several intra-articular injections between 2008 and 2010 for pain relief suspecting osteoarthritis. She denied a history of splinter injuries, trauma, systemic, or constitutional symptoms.In 2010 she underwent left total knee replacement (TKR) in the USA, but the pain persisted post-operatively associated with intermittent swelling of both knees. She was evaluated again in 2015 and revision left TKR done with single stage exchange.She was asymptomatic for a few years but symptoms worsened again and drainage of pus from her left knee started in December 2019. She was treated in Malawi with multiple courses of parenteral and oral antibiotics but did not improve.She presented to our hospital in January 2022 with swelling in left knee and restriction of movements. On examination, a discharging sinus was noted over the medial aspect of left knee. She was anemic with a normal leucocyte count, HIV negative, ESR of 85 mm/h, and CRP of 23 mg/L. Her renal and liver function tests were normal. CT left leg with sinogram showed features of chronic osteomyelitis of left distal femur and proximal tibia with active sinus tract in left tibia.Sinus tract excision with removal of prosthesis, debridement, and antibiotic cement spacer insertion was done. Bone and peri-prosthetic tissue were sent for histopathology and microbiological analysis including fungal and mycobacterial cultures. Xpert MTb was negative.Histopathology showed granulomatous synovitis with fungal hyphae and spores. Cultures grew a slender septate dark pigmented fungus, Pleurostomophora richardsiae which was confirmed by fungal PCR sequencing of internal transcribed spacer (ITS) region.Results/TreatmentShe was treated with Liposomal amphotericin B 5 mg/kg IV OD for 2 weeks followed by oral Itraconazole. She had persistent raised inflammatory markers at 4 weeks which settled after changing to posaconazole for 2 weeks. Conservative management will continue for 3-6 months with second stage revision arthroplasty/arthrodesis later.ConclusionDematiaceous fungi usually cause skin and soft tissue infections and they are extremely rare in causing prosthetic joint infection. Case reports of P. richardsiae causing osteomyelitis of foot and endocarditis are available but we couldn't find a published case of prosthetic joint infection caused by it. Identifying the causative organism in PJI is the most important step because the management depends mainly on it.Two-stage exchange in combination with antifungal administration between stages and post-revision should be the procedure of choice for fungal PJI. Incorporation of antifungal agents into cement spacers appears to be effective in eradicating local infections and reducing the duration of antifungal treatment and should be strongly considered.

Determine the vertical ground reaction forces and knee mechanics with different gait inclinations in the sheep model.

Our current understanding of knee mechanics and anterior cruciate ligament (ACL) function is predominately based on data recorded during simulations of clinical examinations or the application of nonphysiologic loads and motions. These methodologies provide little information on knee and ACL mechanics during activities of daily living (ADLs). Additionally, researchers have not directly measured knee kinetics, knee contact pressures, and ACL forces, and it is unknown how these parameters change with different activities. This study quantified the effects of activity level on vertical ground reaction forces, knee kinematics, and joint and ligament forces during in vivo motions. Five female Suffolk sheep were walked twice weekly on a treadmill during level (0°), inclined (+6°), and declined (-6°) gait for 12 weeks. Electromagnetic (EM) trackers were surgically implanted onto the left distal femur and the left proximal tibia, and in vivo motions were recorded for all activities. Following sacrifice, the in vivo motions were applied to their respective knees using a serial robot with a multi-axis load cell. In vitro simulations were repeated to measure (a) total knee forces, (b) contact pressure maps, and (c) ACL-only forces. Declining the gait surface led to increased posterior translation during the swing phase and decreased flexion at hoof-strike, decreased medial contact pressure at push-off, decreased ACL force at hoof-strike and increased ACL force at push-off. This study established a system that can be used to examine knee mechanics and ACL forces during ADLs for different knee states to define design requirements for ACL reconstruction techniques.

Abstract 3071: A reconstruction of evolutionary trajectories in primary tissue and PDTOs in a patient with metastatic osteosarcoma

Abstract Metastatic osteosarcoma is a rare and highly lethal cancer that affects children and young adults. The rarity of osteosarcoma and its highly heterogeneous genetic composition have resulted in a lack of curative treatments for recurrent and metastatic disease. In this study, we present the functional and molecular characterization of a case of a pediatric patient with left distal femur osteosarcoma and pulmonary metastases at presentation. Through longitudinal sampling over the course of the patient’s illness, we have procured tissue from the initial treatment-naïve diagnostic biopsy, primary tumor resection and multiple subsequent lung metastasectomies, and have developed patient-derived tumor organoids (PDTOs) from the viable samples. PDTOs are useful pre-clinical models that are representative of the source tissue and allow further interrogations of the biology of tumors. These models can also help with the identification of effective personalized therapies (Al Shihabi et al, 2021). We applied our mini-ring organoid screening technology (Phan et al, 2019; Nguyen et al, 2020) to perform high-throughput drug screening with different pharmacologic agents. We also performed deep whole-genome sequencing on all collected samples and corresponding organoids to reconstruct their evolutionary history, identify driver mutations and quantify heterogeneity in mutational processes across time and space. Our preliminary data show that the subclonal content of the tumor and derivative organoids as well as the PDTO drug responses vary with the patient’s treatment history. We identify the genomic makeup of the subclones and posit changes that may be responsible for chemoresistance. Furthermore, our data shows correlations between the subclonal genomic composition of the PDTOs and source tissue, thereby reinforcing that PDTOs are capable of accurately recapitulating the subclonal heterogeneity of the parental tumor. Citation Format: Ardy Davarifar, Jane Yanagawa, Ahmad Al Shihabi, Huyen T. Nguyen, Lydia Y. Liu, Adriana Salcedo, Alfredo Gonzalez, Takafumi N. Yamaguchi, Nicholas Bernthal, Scott D. Nelson, Noah Federman, Paul C. Boutros, Alice Soragni. A reconstruction of evolutionary trajectories in primary tissue and PDTOs in a patient with metastatic osteosarcoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3071.

Distal Femoral Replacement as a Salvage Treatment After Desmoplastic Fibroma Resection

Desmoplastic fibroma is an extremely rare primary bone tumor that can mimic the presentation of other bone lesions. We describe the case of a middle-aged male with a mass on the left distal femur initially diagnosed as fibrous dysplasia that underwent a wide margin excision followed by a distal femoral replacement to restore anatomy and functionality. Histologic examination of the complete surgical specimen was consistent with a desmoplastic fibroma. This case is the first report of a successful application of endoprosthetic reconstruction after desmoplastic fibroma resection.

Primary total knee arthroplasty assisted by computed tomography-free navigation for secondary knee osteoarthritis following massive calcium phosphate cement packing for distal femoral giant-cell bone tumor treatment: a case report

BackgroundGiant cell tumor of bone (GCTB) is an intermediate tumor commonly arising from the epiphysis of the distal femur and proximal tibia. Standard GCTB treatment is joint-preserving surgery performed using thorough curettage and the filling of the cavity with allo-, auto-, polymethyl methacrylate (PMMA), or synthetic bone graft. Calcium phosphate cement (CPC) is an artificial bone substitute, which has the benefit of being able to adjust defects, consequently inducing immediate mechanical strength, and promoting biological healing. Secondary osteoarthritis may occur following GCTB treatment and may need additional surgery if severe. However, details regarding surgery for secondary osteoarthritis have not been fully elucidated. There are no reports on the use of total knee arthroplasty (TKA) for the treatment of secondary osteoarthritis following CPC packing. The insertion of an alignment rod is a standard procedure in TKA; however, it was difficult to perform in this case due to CPC. Therefore, we used a computed tomography (CT)-free navigation system to assist the distal femur cut. This study presents a knee joint secondary osteoarthritis case following CPC packing for GCTB curettage that was treated with standard TKA.Case presentationA 67-year-old Japanese woman, who was previously diagnosed with left distal femur GCTB and was treated by curettage and CPC packing 7 years ago, complained of severe knee pain. Left knee joint plain radiography revealed Kellgren and Lawrence (K-L) grade 4 osteoarthritis without evidence of tumor recurrence. Therefore, she was scheduled for TKA. There are no reports on the cutting of a femoral condyle surface with massive CPC with accurate alignment. Because it is difficult to insert the alignment rod intramedullary and cut the femoral condyle with CPC, we planned CT-free navigation-guided surgery for accurate bone cutting using an oscillating tip saw system to prevent CPC cracks. We performed standard TKA without complications, as planned. Postoperative X-ray showed normal alignment. Knee Society Knee Score (KSKS) and Knee Society Function Score (KSFS) ameliorated from 27 and 29 to 64 and 68, respectively The patient can walk without a cane postoperatively.ConclusionThere was no report about the surface TKA guided by CT-free navigation after primary GCT surgery with CPC. We believe that this case report will help in planning salvage surgery for secondary osteoarthritis after CPC packing.

Distal femoral arthropometry in Nigerians and its correlation to total knee replacement implants.

Total Knee replacement (TKR) is performed to relieve pain and restore both the mechanical axis and joint line whenever indicated. Most of prostheses being used for TKR were manufactured using dimensions from Caucasians' measurements. This study documented the dimensions of distal femora of Nigerians and correlated the dimensions with different TKR prostheses. Fifty-six matured femora were measured. Dimensions of distal femora from other regions were retrieved from published articles. The dimensions of TKR prosthesis were extracted from product monographs. Analyses were done with Microsoft excel 2010 (Microsoft Corporation, Redmond, Washington, United States) and STATA version 13 (StataCorp, Texas. USA). Statistical significance was set at p ≤ 0.05. The average Mediolateral dimension was 79.3 ± 4.4 mm. The anterioposterior dimensions of the medial and lateral condyles were 63.7 ± 3.6 mm and 64.9 ± 3.3 mm respectively. There were no significant differences between the left and right distal femur. The average aspect ratio calculated was1.23 ± 0.05. There was a mismatch of aspect ratio of the distal femora and those of the prostheses. Equations that can be useful both clinically and in forensic medicine were generated. This study has provided measurements that can be considered when the designing of a suitable femoral component of total knee prosthesis for Nigerians. This study also provided equations that can be used to estimate the dimensions of the medial and the lateral condyles and femoral length from parts of distal femur in forensic medicine. Self-funded.

Progressive Arterial Insufficiency in a Displaced Salter-Harris Type 1 Distal Femoral Fracture: A Case Report.

A 17-year-old male patient presented with Salter-Harris type I hyperextension injury of left distal femur with delayed development of acute limb ischemia secondary to popliteal artery injury. Popliteal artery injury associated with distal femoral physeal fracture may not be clinically obvious at the time of initial presentation. When initial pulse examination and segmental Doppler measurements are normal, it is important to perform serial examination by experienced examiners because arterial insufficiency may develop over the subsequent 48 hours. If unidentified, this can lead to significant disability and/or limb loss. This emphasizes the importance of serial monitoring along with judicious use of ankle brachial pressure index, pulse oximetry, and imaging.

BCG Vaccine Induced Tuberculous Osteomyelitis of Left Distal Femur in a Young Child: Case Report and Literature Review

Tuberculosis (TB) is an essential problem for healthcare systems especially in developing countries. TB continues to pose a significant global health burden [1]. Bacillus Calmette-Guérin (BCG) is an important vaccine used to prevent Tuberculosis (TB), especially meningeal TB and disseminated TB disease in children [2]. BCG is prepared from live bovine tuberculosis bacillus, and is given to protect against TB. Although vaccination against TB by means of BCG is widespread all over the world and is generally considered to be safe, but serious adverse reactions can occur. These may be minor such as abscess formation or skin ulceration at the site of vaccination to major adverse reaction such as fatal disseminated infection especially in patients with immune deficiency [3]. These adverse reactions after BCG vaccination depend on the BCG dose, vaccine strain, vaccine administration method, injection technique, and recipient’s underlying immune status [4]. The aim of this case report is to point out that clinical suspicion of BCG-induced osteomyelitis is warranted in pediatric patients with chronic symptoms of pain, limping, swelling and a limited ROM in the extremity. We also aimed to remind that imaging and culture studies may guide the clinician although tissue biopsies and genetic tests can confirm the histopathology and to review related articles.