Periacetabular Brucella Osteomyelitis

Introduction: Although Brucellosis has a limited geographic distribution;it remains a challenge in certain parts of the world such as in Mediterranean, western Asian, Latin American and African regions. We present a unique case of periacetabular Brucella osteomyelitis and increase awareness of possible widespread distrubition of Brucella osteomyelitis and its ability to affect any region of the musculoskeletal system. Case Presentation: A 44-year-old male farmer presented with symptoms of pain radiating from his left hip to his thigh of five years duration. There was a history of night sweats and fever for the past two months. A lytic area with smooth borders in left periacetabular region was detected on pelvic roentgenography of the patient. Magnetic resonance imaging revealed a cavitatory lesion in relation to hip joint. Open biopsy was undertaken with the differential diagnosis of an infectious (Brucella or Tuberculous) or tumoral lesion. Intraoperative frozen sections showed granulomatous inflammatory tissue. Post debridement, the cavity was filled with autograft taken from the patient’s right iliac wing. Postoperative immunohistochemistry confirmed diagnosis of Brucella osteomyelitis. Oral Doxycyline, Rifampicine and Ciprofloxacin were administered for 3 months. At one-year postoperatively, the patient had a painless, unrestricted range of motion and function in relation to the affected hip. Conclusion: In endemic regions, Brucella osteomyelitis should be considered in differential diagnosis in patients with arthralgia and/or spondylodiscitis in the presence of radiologically suspected osseous lesions.

Intramedullary Nailing of Femoral Shaft Fractures with Compressive Nailing Using Only Distal Dynamic Hole and Proximal Static Hole

Objectives: In this study we aimed to present our treatment results of intramedullary nailing of femoral shaft fractures with compressive nailing using proximal static hole and only distal dynamic hole with one screw. Methods: Forty-three patients who had a fracture of the femoral shaft were managed between 2005 and 2008 with intramedullary nailing and the use of only one screw for distal interlocking. Prospectively we evaluated the union time, possible reoperation, fixation and fracture alignment, range of knee motion and complications. Results: Union occurred within a mean duration of 18.7 weeks. No failures of the fixation and fracture alignment and no more than 1 cm shortness were detected. The knee range of motion was all more than 90 degree. Only one deep venous thrombosis was detected as complication. Conclusions: Compressive nailing using proximal hole and only distal dynamic hole with one screw is a convenient technique for femur fractures.

Benign Giant Cell Tumor of the Foot Originating from Talonavicular Joint

Benign Giant Cell Tumor is a relatively common benign lesion which usually appears as an enlarging painless mass and has a synovial origin. Although benign giant cell tumors generally involve tendon sheaths, they are infrequently documented in the foot. A 45 years old female presented with a complaint of a lump on the top of her left foot. Under general anesthesia with a pneumatic tourtniquet the mass excised with great care not to leave any residual tumor tissue that can cause recurrence. Benign giant cell tumor of the foot can be associated with talonavicular joint capsule which can be detected with MRI imaging and total excision of the lesion is mandatory to prevent recurrence.