Javed Ahmad

Abstract

We are reporting a rare case of a painful accessory ossification center of the bilateral medial malleoli in a 9 years old girl. Patient was not involved in any sport activity. There was no local foot deformity and limb malalignment. The patient was treated conservatively. There was complete clinical and radiographic healing of the medial malleolus eight months after the first presentation. Osteochondrosis of the accessory ossification center of medial malleolus is generally unilateral and bilateral involvement is very rare. There are various differential diagnosis for this pathological condition with similar clinical features and presentation in this age group. We ruled out the uncommon pathological conditions causing chronic pain in the medial malleolus during this period of skeletal growth. We consider this painful condition to be classified as a bilateral osteochondroses of the accessory ossification center of the medial malleolus. Osteochondrosis of the accessory ossification center of the bilateral medial malleolus is a rare entity. Due to rarity of disease and common presentation similar to other disease this is commonly misdiagnosed or missed in clinical practice. Osteochondrosis is characterized by a disturbance of endochondral ossification in skeletally immature patients and should be investigated in children having a history of persistent foot and ankle pain. An increased clinical attention to this painful condition could lead to improved diagnosis and treatment among the paediatric age group.   Keywords: Osteochondrosis, Medial malleolus, Accessory ossification center

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Abstract

Introduction: Bizarre parosteal osteochondromatous proliferation (BPOP) presents as painless bony swelling and also known as Nora’s lesion. It is a benign surface osteocartilaginous lesion. This condition is seen most commonly in hands followed by feet. Long bone involvement is rare.  Materials and Methods: This is a retrospective study of the patients who had visited the orthopedic OPD of our institute from January 2011 to December 2019. The diagnosis of BPOP was made by radiological evaluation and confirmed by histopathological evaluation. Results: There were 8 cases included in this study. Out of them, 4 cases (50%) were female, and 4 cases (50%) male. The age distribution of patients was 14 years to 36 years. The duration of the history of present illness was 6 months to 3 years. There were 6 cases (75%) of the upper limb and 2 cases (25%) of the lower limb. 4 cases (50%) had a history of trauma. All cases were operated on after pre-operative evaluation and the excisional biopsy specimen was sent for histopathological evaluation for confirmation. On follow up 2 cases (25%) had recurrence for which re-operation was done. Conclusion: BPOP involving long bones is exceedingly rare. The local recurrence rate after surgical resection of the lesion is high. En bloc resection of the lesion along with decortication of the underlying cortical bone was done to reduce the possibility of recurrence. Two patients in our series had a recurrence for which re-operation was done. Keywords: Nora’s lesion, BPOP, Bony swelling, Osteochondramatous proliferation.

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Abstract

Tuberculous tenosynovitis is a chronic and rare infection of flexor tendon sheath of forearm, mainly around the wrist. Patients presents with swelling and pain, and sometime also with neurological symptoms when median nerve get involved. Patient evaluated clinically for the diagnosis, but the MRI is the gold standard tool for the diagnosis. Histopathological evaluation is also needed to confirm the diagnosis. Management is mainly surgical followed by full course of anti tubercular therapy. A delay in the management may leads to complications due to asymptomatic swelling. Keywords: Wrist swelling, Compound palmar ganglion, Tubercular tenosynovitis, Melon seeds, Median nerve.

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