Chee Ching Chan

Comparison of Outcomes of Operatively Treated Bicondylar Tibial Plateau Fractures by External Fixation and Internal Fixation

ABSTRACT The outcome of bicondylar tibial plateau fractures treated with either external fixation (35 patients) or internal fixation (24 patients) was reviewed. Outcome measures included the Rasmussen score, clinical complications, development of osteoarthritis and the requirement for total knee replacement (TKR). Twenty-two (92%) anatomical reductions were achieved in the internal fixation group compared to 27 (77%) in the external fixation group. Infective complications were more common in the external fixation group (9 patients, 26%) due to pin tract infection. There were no deep infections in the internal fixation group. The mean Rasmussen score was not significantly different (mean score 32 in external fixation and 29 in internal fixation) between the two groups and the incidence of osteoarthritis was the same in both groups. Four patients in the external fixation group underwent a TKR compared to 5 patients in the internal fixation group. Bicondylar tibial plateau fractures have similar outcomes following external or internal fixation. KEY WORDS bicondylar, tibial, plateau, external, internal, fixation, outcome.

A rare case of spontaneous thyroid cyst haemorrhage

BACKGROUND We report a case of hypopharyngeal swelling secondary to a spontaneous thyroid cyst haemorrhage. Haemorrhage is a known complication of thyroid cysts, and usually presents as external swelling and localised pain. CASE REPORT A 93-year-old woman developed hypopharyngeal swelling, dysphagia and odynophagia. A computed tomography scan was consistent with thyroid cyst haemorrhage. The patient was treated with needle aspiration and intravenous steroid injections, with full recovery at thyroid clinic review. CONCLUSION To our best knowledge, there has been no previous report of a hypopharyngeal swelling occurring secondary to spontaneous thyroid cyst haemorrhage. Our case is unusual because of the risk of airway compromise at the level of the hypopharynx, secondary to thyroid cyst haemorrhage.

A rare case of Dirofilaria repens infection.

OBJECTIVE This paper reports a case of Dirofilaria repens infection in a patient who presented with an anterolateral neck swelling. Dirofilaria repens infection of the neck region is rare even in countries where dirofilarial infestation is endemic. The diagnosis is made by identifying the worm in surgical or pathological specimens. CASE REPORT A 47-year-old man presented with an 8-week history of non-tender, right-sided, lower anterolateral neck swelling and weight loss. An ultrasound scan showed a cystic lesion containing a living worm. The cyst was excised and the patient showed full recovery at follow up. CONCLUSION To our knowledge, there has been no previous report of an anterolateral neck swelling secondary to Dirofilaria repens infection in Europe. Our case is unusual because of the rarity of Dirofilaria repens presenting as a neck swelling.

Recurrent Anterior Instability Manifesting as Luxatio Erecta Humeri: A Case Report

Luxatio erecta humeri is a rare type of glenohumeral dislocation. The mechanisms of this injury involve either direct axial loading on a fully abducted extremity or leverage of the humeral head across the acromion by a hyperabduction force. The clinical diagnosis can be made by recognizing the classic position of an upward-pointing upper limb, resembling the position of the Statue of Liberty’s right arm. Because inferior glenohumeral dislocations usually result from high-energy trauma, they are commonly associated with other injuries. These include greater tuberosity fractures, rotator cuff tears, and injuries to the brachial plexus or axillary vessels. Fery and Sommelet published a series of ten cases of inferior dislocations, noting that these injuries were always seen with either a greater tuberosity fracture or a rotator cuff tear1. Orthopaedic referral is required and surgery is almost always warranted with inferior glenohumeral dislocations. Luxatio erecta humeri is associated with inferior glenohumeral ligament tears and adhesive capsulitis. Cases of recurrent luxatio erecta have rarely been reported in the current literature2. We searched the Medical Subject Headings in PubMed with the keywords “luxatio,” “erecta,” “repeated,” and “recurrent,” and found only one documented case report of recurrent luxatio erecta through January 2013. Although this case report does not describe a true recurrent luxatio erecta, it is unique because it is a case of recurrent anterior instability that had manifested as acute luxatio erecta without any of the usual associated injuries. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A twenty-seven-year-old right-handed man presented to the emergency department after waking with an acutely painful, fixed hyperabducted left shoulder. He had been sleeping with the left hand behind his head. He had experienced five similar presentations of acute dislocation previously but had never …

A rare case of primary malignant melanoma in an ileostomy

The vast majority of malignant melanomas occur in the skin. These are associated with sunlight exposure and thought to be due to ultraviolet radiation. Melanomas in rare instances (1.3-1.4 percent) may originate from extracutaneous tissues such as the leptomeninges.(1) They have also been reported arising from gastrointestinal, respiratory and genitourinary mucosa. Sunlight is not an aetiologic factor with mucosal melanomas. Herein, we report an extremely rare example of malignant melanoma arising from the mucocutaneous junction of an ileostomy. Only one such case has been reported in the literature.(2).

Posterior communicating artery aneurysm presenting with writing apraxia

Objectives: We report the first case of writing apraxia as the main presenting feature of a posterior communicating artery aneurysm. Cerebral aneurysm usually presents with visual impairment, nausea and vomiting, severe headache and loss of consciousness. Case report: A 58year-old man presented to the neurological department because of writing difficulty, which affected his work as an executive. Detailed clinical examination and supplementary radiological investigations confirmed a posterior communicating artery aneurysm. The patient was treated surgically with clipping of the aneurysm and he had full recovery at clinic review. Conclusion: To the best of our knowledge, there has been no previous report of a posterior communicating artery aneurysm presenting with writing apraxia. Our case is unusual because the patient’s main presenting feature was writing apraxia secondary to a posterior communicating artery aneurysm.

Episodic cauda equina compression from an intradural lumbar herniated disc: a case of 'floppy disc'

Intradural disc herniation (IDDH) is a rare complication of intervertebral disc disease and comprises 0.26-0.30% of all herniated discs, with 92% of them located in the lumbar region (1). We present a case of IDDH that presented with intermittent symptoms and signs of cauda equina compression. We were unable to find in the literature, any previously described cases of intermittent cauda equina compression from a herniated intradural disc fragment leading to a “floppy disc syndrome”.