MARCH 2010 VOLUME XXXIX NUMBER 3 pISSN:1078-4519 eISSN:1934-3418

E-PUBLISHING

22	Blastomycosis: Case Report of an Isolated Lesion in the Distal Fibula A. Alex Jahangir, MD, and Robert K. Heck, MD Dr. Jahangir is Assistant Professor, Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee. Blastomycosis (Blastomyces dermatitidis) is a fungal infection that occurs primarily in the lungs, but 15% to 60% of patients with systemic blastomycosis have skeletal involvement. Because the symptoms and radiographic appearance of bony lesions are variable, diagnosis and treatment may be delayed if fungal infections are not included in the differential diagnosis for a patient with a lytic bone lesion. We present the case of a man in his late 30s with no local or systemic signs of infection in whom biopsy-curettage of a painful ankle lesion identified budding yeast consistent with North American blastomycosis. After treatment with itraconazole, the patient was symptom-free and had returned to his previous activities without pain or difficulty. Am J Orthop. 2010;39(3):E22-E24.
25	Posterior Thigh Abscess as a Complication of Continuous Popliteal Nerve Catheter Christopher J. Tucker, MD, Kevin L. Kirk, DO, and James R. Ficke, MD CPT Tucker, MC USA, is Orthopedic Surgeon, Department of Orthopedics and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland. Continuous peripheral nerve catheters (CPNCs) have become increasingly popular for postoperative analgesia in orthopedic surgery involving the lower limbs. The CPNC technique has been found to reduce postoperative pain and facilitate earlier discharge and recovery. Until recently, potential infectious complications associated with CPNCs have remained largely unreported. In this report, we present the case of a posterior thigh abscess that developed after placement of a continuous popliteal nerve catheter and required surgical débridement. Am J Orthop. 2010;39(3):E25-E27.
28	Chronic Sclerosing Osteomyelitis Treated With Wide Resection and Vascularized Fibular Autograft: A Case Report Adam J. Schwartz, MD, Neil F. Jones, MD, Leanne L. Seeger, MD, Scott D. Nelson, MD, and Jeffrey J. Eckardt, MD Dr. Schwartz is Orthopaedic Oncology Fellow, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA and Orthopaedic Hospital, Santa Monica, California. Treatment recommendations for chronic culture-negative sclerosing osteomyelitis in the pediatric population have largely focused on supportive care, given the typical improvement in symptoms that occurs over time. This case report describes a patient with chronic sclerosing osteomyelitis (CSO) of the humerus who failed a prolonged course of nonoperative management. Definitive treatment consisted of resection of the diseased bone and reconstruction using a vascularized fibular osteocutaneous flap. To our knowledge, this is the first reported case of this technique being utilized specifically for CSO refractory to nonoperative management. At the time of most recent follow-up (35 months), the patient was completely pain-free and off all medication. Physical examination revealed full unrestricted passive and active range of motion. Radiographs at the time of most recent follow-up revealed intact hardware, excellent proximal and distal graft incorporation, and cortical hypertrophy. Vascularized fibular osteocutaneous flap reconstruction following resection is a viable alternative to nonoperative, expectant management for patients with refractory chronic sclerosing osteomyelitis. Am J Orthop. 2010;39(3):E28-E32.

117	Haiti—How to Respond? Peter D. McCann, MD Dr. McCann is Editor-in-Chief of this journal and Chair, Department of Orthopaedic Surgery at Beth Israel Medical Center, New York, New York. Abstract not available. Am J Orthop. 2010;39(3):117.
122	In Vivo Micron-Scale Arthroscopic Imaging of Human Knee Osteoarthritis With Optical Coherence Tomography: Comparison With Magnetic Resonance Imaging and Arthroscopy Kathy Zheng, MPH, Scott D. Martin, MD, Christopher H. Rashidifard, BA, Bin Liu, PhD, and Mark E. Brezinski, MD, PhD Ms. Zheng is Research Assistant, Center for Optical Coherence Tomography and Optical Physics, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts. Current treatments for osteoarthritis are pain relief and total joint arthroplasty. There is a clinical need for early osteoarthritis diagnostic methods for potential preventive interventions. The resolution achieved with radiography, magnetic resonance imaging (MRI), and arthroscopy is too limited for the assessment of early disease. The high resolution, small fiber-optic probes, and real-time imaging of optical coherence tomography (OCT) makes this method ideal for assessing articular cartilage. In this article, we describe in vivo human arthroscopic OCT with qualitative baseline comparisons made with MRI and arthroscopy. Two-year MRI follow-ups are under way to quantitatively compare OCT with MRI and to assess the long-term outcomes of changes noted in the OCT images. Am J Orthop. 2010;39(3):122-125.
126	Cementless Femoral Fixation in Total Hip Arthroplasty Kenny T. Mai, MD, Christopher A. Verioti, DO, Kevin Casey, MD, Yury Slesarenko, MD, Louis Romeo, MD, and Clifford W. Colwell Jr., MD Dr. Mai is Attending Orthopaedic Surgeon, Hanford Community Medical Center, Hanford, California. Cementless femoral fixation by means of bone ingrowth has been successful in total hip arthroplasty in patients with sufficient bone quality. Consistent bone ingrowth and resultant long-term success involve many factors, including surgical technique, initial mechanical stability achieved at time of implantation, stem design and material, and implant surface. One potential method for achieving faster, more consistent initial bone ingrowth is use of the osteoconductive ceramic hydroxyapatite. In addition, more stable initial fixation most likely improves long-term outcome. In this article, we review the criteria for successful cementless femoral fixation and the long-term results reported in the literature. Am J Orthop. 2010;39(3):126-130.
131	Incidental “Rotator Cuff Tear of the Hip” at Primary Total Hip Arthroplasty Hal E. Cates, MD, Monica A. Schmidt, PhD, and Rachael M. Person Dr. Cates is in private practice at Tennessee Orthopaedic Clinics, Knoxville, Tennessee, is Co-Director, Joint Replacement Center, Parkwest Medical Center, Knoxville, Tennessee, and is Adjunct Associate Professor, University of Tennessee, Knoxville, Tennessee. Gluteus medius tendon tears are occasionally noted during primary total hip arthroplasty. In this study, we reviewed the cases of 513 total hip arthroplasty patients to determine the incidence of these tears and to report clinical outcomes. We found 8 patients (8 hips) with incidental gluteus medius tendon tears for an incidence of 1.6%. After surgical repair, no patient had a perceptible limp or a Trendelenburg sign postoperatively. Am J Orthop. 2010;39(3):131-133.
134	Acromioclavicular Septic Arthritis: A Case Report of a Novel Pathogen Timothy W. Carey, DO, Keith Jackson, MD, Rafael Roure, MD, and Brian E. Abell, DO CPT Carey, MC USA, Resident, Department of Orthopedics, Eisenhower Army Medical Center, Fort Gordon, Georgia. In immunocompetent patients, septic arthritis of the acromioclavicular (AC) joint is a rare entity. It can be difficult to discern from glenohumeral septic arthritis and AC joint impingement syndrome. The usual symptoms are fever, erythema, swelling, palpable pain over the AC joint, and pain with shoulder motion. The most commonly reported causative organism is a Staphylococcus or Streptococcus species. Haemophilus parainfluenzae is a rare cause of septic arthritis in any joint. Although limited to case reports in the literature, most H parainfluenzae skeletal infections occur after surgical intervention. To our knowledge, this is the first case report of AC septic arthritis with H parainfluenzae. Am J Orthop. 2010;39(3):134-136.
137	Delayed-Onset Slipped Capital Femoral Epiphysis: Case Report of Association With Pituitary Tumor Robert L. Brady, MD, and Andrew Price, MD Dr. Brady is Attending, Department of Orthopaedic Surgery, Norwalk Hospital, Norwalk, Connecticut. Slipped capital femoral epiphysis (SCFE) is an affliction of the hip presenting in adolescent children. There are several theories regarding the pathological cause of SCFE. The hormonal milieu during adolescence, combined with a deficiency in the physeal area of the growth plate, has been postulated as a possible etiology for its specific onset. In atypical circumstances, the early or late onset of SCFE may occur in the setting of unusual hormonal influences. This hormonal imbalance may be secondary to an underlying endocrinopathy—for example, hypothyroidism or hypogonadism. In this case, our patient presented with a clinically and radiographically unstable slip at the age of 22 years. His physical characteristics, along with confirmatory laboratory values and radiographs, indicated that the patient suffered from a disorder of delayed secondary growth. Subsequent thorough work-up revealed a large benign pituitary tumor that was causing severe panhypopituitarism. This article describes the presentation, diagnostic work-up and treatment of our patient with a delayed-onset SCFE in the setting of a pituitary tumor. Am J Orthop. 2010;39(3):137-140.
141	Recurrent Compartment Syndrome: 2 Cases and a Review of the Literature Trevor R. Gaskill, MD, Robert Zura, MD, and J. Mack Aldridge III, MD Dr. Gaskill is PGY-3 Resident, Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina. Compartment syndrome is a potentially devastating entity, and timely recognition is critical for appropriate management. Diagnosis is classically a clinical one and based largely on serial examinations. When clinical examinations are compromised, compartment pressure monitoring may be useful. These diagnostic measures, however, assume recognition of “at-risk” injuries or clinical scenarios. Rarely discussed is whether an open fasciotomy provides any degree of protection from redeveloping compartment syndrome. To this end, we present 2 cases of recurrent compartment syndrome after previous fasciotomy. These reports illustrate a previously unreported at-risk population and demonstrate that compartment syndrome can recur in a previously released compartment. Therefore, prior fasciotomy should not be considered protective against acute compartment syndrome. These patients should be evaluated and managed no differently from patients with primary compartment syndrome. Am J Orthop. 2010;39(3):141-143.
144	Morel-Lavallée Lesion in a Professional American Football Player With Pituitary Tumor Matthew J. Matava, MD, Evan Ellis, MD, Nirav R. Shah, MD, Douglas Pogue, MD, and Tyler Williams, ATC Dr. Matava is Associate Professor of Sports Medicine, Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri. A Morel-Lavallée lesion is a relatively rare condition involving a closed, degloving injury to the pelvis, resulting in a blood-filled cystic cavity created by separation of the subcutaneous tissue from the underlying fascia. This injury typically occurs following high-speed trauma. We describe a case that occurred in a professional American football player who was treated with percutaneous decompression and evacuation of the hematoma. The player returned to playing football at the professional level 22 days after the injury without residual deformity or disability. Am J Orthop. 2010;39(3):144-147.
148	Use Technology to Speed Payment Karen Zupko, BSJ, and Cheryl Toth, MBA Karen Zupko is President, KarenZupko & Associates, Inc. (KZA), a practice management consulting and training firm based in Chicago, Illinois. Abstract not available. Am J Orthop. 2010;39(3):148-149.

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