Orthopedics
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Simultaneous avulsions of the tibial tubercle and patellar ligament have been reported, but are rare. We present an 11-year-old boy who was initially diagnosed with a Type IIIA tibial tubercle avulsion fracture after falling off of his bicycle. Intraoperatively, following exposure and fixation of the tibial tubercle fragment, knee range of motion under live fluoroscopy revealed a stationary patella with no tension in the patellar ligament. ⋯ In retrospect, a clue to this diagnosis in our patient was the preoperative radiographic finding of multiple calcified fragments below the patella. The calcified fragments likely represent the avulsed tibial tubercle periosteum attached to the distal patellar ligament. In addition, the large tibial tubercle fragment is separated and rotated superiorly, a finding that was also noted in two other similar case reports.
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Case Reports
Delayed posttraumatic pseudoaneurysm of the anterior tibial artery mimicking a malignant tumor.
The anterior tibial artery arises at the lower border of the popliteus muscle, and passes anteriorly to lie on the interosseous membrane medial to the fibular neck. Injury to the artery results in extravasation of blood, and the tamponade effect of the surrounding tissue may contain acute hemorrhage. The blood clot gradually liquefies resulting in the formation of a fibrous capsule. ⋯ Three previous such presentations have been found in the literature and illustrates the importance of suspecting a delayed vascular injury following lower leg trauma. Duplex ultrasound examination should be performed initially to avoid an inadvertent incision and catastrophic bleeding as might occur with an inappropriate biopsy. Preoperative and intraoperative angiograms are essential to confirm the diagnosis, delineate the site and type of injury, and help to plan the treatment.
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We present a case of upper arm compartment syndrome following a biceps tendon rupture in a 77-year old man on warfarin sodium. Compartment syndrome is common in the forearm and leg, but rare in the upper arm with only a handful of cases reported in the literature. Our patient's anticoagulated state predisposed him to the development of compartment syndrome. ⋯ Once the diagnosis was formed, the patient was treated with emergent fasciotomy and evacuation of hematoma. After a prolonged hospital stay, the patient was released with minor neurological deficits. At final follow-up, the patient was neurovascularly intact with no complaints of numbness or tingling, and he had regained full motor function throughout.