Osseous Rim Research Articles

Two cases of femoroacetabular impingement due to bone apposition on the osseous rim

Two cases of femoroacetabular impingement due to bone apposition on the osseous rim

Acetabular Labral Limbus as a Cause of Hip Pain

The treatment of hip disease in the young adult is a rapidly evolving and growing area of orthopaedic surgery1, driven by improved imaging techniques2,3, safe and reproducible open hip surgery4, and less invasive techniques such as hip arthroscopy5. Currently, the most common indication for hip arthroscopy is the treatment of labral abnormalities6, usually from one of four causes7: trauma, a degenerative condition, dysplasia, and impingement. Labral abnormalities are often associated with acetabular chondral damage8,9, varying in severity from a softening and/or fibrillation to complete cartilage detachment from its osseous bed. Because the treatment of the labral abnormality varies, depending on the underlying etiology and associated pathological condition, it is critical that variant anatomy of the labrum and the labral chondral junction be recognized and treated accordingly7,10. Descriptions of variations of the labral anatomy have focused mainly on the manner in which arthroscopic findings correlate with magnetic resonance imaging (MRI) findings. The primary variation has been termed sublabral sulcus, defined as a cleft between the labrum and adjacent articular cartilage. The reported location of this sublabral sulcus is variable, as is the prevalence, although it is most commonly noted anteriorly. Byrd was the first, as far as we know, to describe as “normal anomalous variations” these partial separations of the labrum from the lateral aspect of the osseous rim of the acetabulum11. However, previous studies have some limitations since the magnetic resonance arthrography (MRA) was reviewed retrospectively to determine the prevalence and location of these sulci, making the exact location difficult to interpret. We report on a clinical series of five female patients seen with mechanical hip pain secondary to an acetabular labral limbus. The clinical presentation, …

Eyelid tumour and juvenile hyaline fibromatosis

We report the case of a 2-year-old boy suffering from juvenile hyaline fibromatosis. Our patient had all the main clinical features of the disease, i.e. multiple cutaneous facial nodules, gingival fibromatosis and osteolytic lesions in the proximal metaphysis of the tibia and humerus symmetrically. However, he also presented an eyelid tumour scalloping the superior orbital osseous rim, causing blepharoptosis. The histopathology confirmed this very rare condition. After 6 months, our patient has improved functionally and cosmetically following surgical resection of the eyelid tumours without recurrence.

GIANT-CELL TUMOR OF THE TENDON SHEATH INVOLVING THE CERVICAL SPINE

Giant-cell tumor of the tendon sheath is a common lesion of the synovial membrane, and it frequently occurs in the hand. It is related to pigmented villonodular synovitis, has variable areas of involvement, and rarely causes osseous destruction 1. We describe a rare case of a giant-cell tumor of the tendon sheath in the cervical spine. An otherwise healthy twenty-seven-year-old woman presented to us with a three-month history of neck pain and intermittent numbness in the fingers of both hands. The patient also described severe migraine-type headaches over the previous two years. The neck pain was worse on the left side, and there was no inciting trauma or history of similar pain. The patient had no arm pain, and her medical and surgical histories were unremarkable. The physical examination revealed mild tenderness to palpation of the mid-cervical spine, which was worse on the left side. No masses were palpated. Motion of the cervical spine, especially extension, was limited. Neurological testing failed to detect any functional deficits in the upper or lower extremities. Radiographs revealed an osteolytic lesion involving the left fourth and fifth cervical facet joints ( Fig. 1 ) with a minimal amount of subluxation of the vertebral body visible on the lateral radiographs. Computerized tomography demonstrated an expansile lesion in the left facet joint between the fourth and fifth cervical vertebrae that was encased in an osseous rim measuring 2 by 2 cm ( Fig. 2 ). Magnetic resonance imaging showed a mass with soft-tissue density that had increased signal intensity relative to muscle on T2-weighted images. The tumor was noted to abut the vertebral foramen and obliterate the lateral recess, but it did not impinge on the spinal cord ( Fig. 3 ). Fig. 1: Anteroposterior radiograph demonstrating a …

Cheilectomy for hallux rigidus.

Cheilectomy is the excision of an irregular osseous rim that interferes with joint motion. Twenty cases of hallux rigidus/limitus treated by cheilectomy have been reviewed 18 months after surgery. A satisfactory outcome was achieved in all but 2 cases, which were failures. Range of joint motion, in particular dorsi flexion, improved in all but 6 cases. Cheilectomy is a simple and effective alternative to arthrodesis in the treatment of hallux rigidus.

Hallux rigidus

Cheilectomy, the excision of an irregular osseous rim that interferes with motion of a joint, was performed on the distal part of the first metatarsal of twenty-five patients who had hallux rigidus. Relief of pain was achieved in all but three patients, whose cases were considered as failures. Joint motion improved by an average of 20 degrees, and it was in an acceptable range in twenty-three patients. There were no complications other than persistence of swelling in six patients. No patient required additional operative intervention during an average follow-up of fifty-six months. We concluded that cheilectomy is a better method of treatment for hallux rigidus than arthrodesis, resection arthroplasty, or arthroplasty with the use of a flexible implant.

Computed tomography in the differential diagnosis of pelvic and extrapelvic disease

Displacement of various landmarks within the pelvis by enlarging mass lesions can be used advantageously to determine the nature and origin of a particular mass. The noncompliant pelvic osseous ring accentuates the effect of displacement by forcing the vector inwards. This usually results in cephalad extension of a pelvic process into the abdomen. Lesions originating in the sidewall force the neurovascular bundle medially while central lesions will displace these structures against the noncompliant osseous pelvis. The differentiation of supralevator from infralevator lesions by CT aids in planning the appropriate approach to a lesion preoperatively. The various peritoneal spaces can become enlarged by intraperitoneal abscesses, fluid collections or tumor. These processes will also displace sidewall structures laterally against the osseous rim. It is extremely rare for an intraperitoneal process to extend below the level of the mid-femoral head. Extraperitoneal disease arising out of the pelvis may involve areas caudad to the femoral heads as there is no peritoneum to limit the distal spread. The differentiation of intraperitoneal and large extraperitoneal masses arising out of the pelvis can be difficult. A mass which incorporates bowel loops suggests intraperitoneal disease, whereas one which abuts them smoothly suggests an extraperitoneal lesion.