Acta Orthopaedica et Traumatologica Hellenica

Acta Orthopaedica Hellenica is the official Journal of the Hellenic Association of Orthopaedic Surgery and Traumatology.  Το Viagra, είναι το καλύτερο, καλύτερο από το Cialis; Ναι, είναι
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It is published in four quarterly issues written in Greek language and the same original article in English language. The original articles of the English issues are appeared in electronic form in this present site.

The Editorial Board invite the submissions of original articles for publications as well as other correspondence should be adressed to: the Editor, Acta Orthopaedica Hellenica Hellenic Association of Orthopaedic Surgery and Traumatology. Το Viagra, ε?ναι το καλ?τερο, καλ?τερο απ? το Cialis; Ναι, ε?ναι
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A rare presentation of bone metastasis: a case report

 

T. VANNIASINGHAM, O. SHABLAHIDIS, M. KOIZIS, S. PARIDA, N. REISSIS
Department of Orthopaedic Surgery, Watford General Hospital,
West Herts NHS Trust, Watford, UK

 

ABSTRACT
Bone metastasis in endometrial carcinoma is relatively uncommon and the kind involving the tibia is extremely uncommon. Endometrial carcinoma metastasising to the tibia with coexsistent osteomyelitis due to Methicillin Resistant Staphylococcus Aureus (MRSA) is a rare presentation. We present a case report about this subject and review the literature.
Key words: bone metastasis, endometrial carcinoma, osteomyelitis, Methicillin Resistant Staphylococcus Aureus (MRSA).

CASE HISTORY
ML, a 62 year-old patient, presented to the gynaecologist in July 2000 with postmenopausal bleeding. Endometrial biopsy was performed, histology of which revealed endometrial neoplasia.
She was treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy. Perioperatively it was found that the tumour was limited to the fundus with no extension into the endocervical canal. There was no tumour extension in the pelvic cavity and the liver was free of tumour. Histology revealed an invasive grade 2 endometrial adenocarcinoma extending through more than half of the endometrial wall thickness and present 2 mm from the serosa on the posterior fundal aspect. Lymphatic invasion was present. Her disease was classified as stage 1C according to FIGO staging. CT scan of the abdomen and pelvis revealed no evidence of liver metastasis or evidence of retrocrural, retroperitoneal, mesenteric or pelvic floor lymphadenopathy. The surgical treatment was followed up in November 2000 with postoperative radiotherapy. She received standard external beam schedule radiotherapy with 40 Gy in 20 daily fractions followed by 2 intravaginal brachytherapy treatments delivering 11 Gy in 2 fractions.
In July 2001, 12 months following initial presentation, she complained of right calf and shin discomfort. Doppler ultrasound revealed no evidence of deep vein thrombosis. This was followed by the development of bilateral groin varicosities with generalized bilateral leg swelling. Repeat CT scan of the abdomen and pelvis in November 2001 revealed no evidence of metastasis and it was decided that the likely cause of the bilateral leg swelling and groin varicosities was lymphoedema secondary to pelvic radiotherapy.
Her shin gradually became more painful requiring stronger analgesia. The shin pain was described as a burning pain. In February 2002 she was commenced on morphine for her shin pain. In September 2002, as the shin pain became more intolerable and she was beginning to have difficulty in weight bearing, an X-ray of the shin was requested.


Epidemiology of ankle fractures

Κ. Papageorgiou, Τ. Liakos, K. Evmiridis
Orthopaedics Clinic, General Hospital of Drama, Greece

Abstract
In our article, we present an epidemiological study on 154 fractures, during the years 1999-2002. The overall incidence rate was 91 fractures per 105 person-years. The patients’ age was up to 50 years of age, with an average of 28.9 years; the third decade [47 (30%)], male patients [95 (61%)], and placement on the right side [89 (57%)] were the predominant groups. The commonest causes of the fractures were: falling, in 63 (40%), sporting activity, in 51 (34%), and traffic accidents, in 40 (26%). 1/3 of the patients were treated surgically and half of the patients were hospitalized for a few days. The most frequent fracture was that of the lateral malleolus, in 82 patients (53.25%). Studying the epidemiogical parameters, the following were extracted: 1) fractures of the ankle are common everyday injuries caused by insignificant violence, 2) any kind of sporting activities, by amateur athletes of the week-end, come second in frequency, after falls, 3) among population groups, those who work in the open (farmers) are the most exposed, 4) considering that, roughly, 1/3 of the patients are treated surgically and that the average time of rehabilitation is 6-8 weeks, the morbility of the fractures of the ankle means a considerable loss in working hours, as well as heavy charge on social security.

Key words: Malleolar, epidemiology, prevention.

Ιndroduction
Ankle fractures are the second most frequent injuries, after fractures of the lower part of the radius (Solgard & Petersen, 1985). They are everyday fractures and, yet, bibliography referring to their epidemiology is poor. In 1969, Νilsson, from Malmo, studied their overall incidence rate in terms of age and gender. In 1986, Begner & Johnell study the incidence rate in a 30 year study, where it is pointed out that fractures, especially those of the lateral malleolus, are age dependent for men over 60 years of age and women over 50. Another study from Minessota presents conclusions from other indications and regards athletics as the commonest cause of injuries (Daly et al, 1987). 10 years later, Jensen et al (1998), from Denmark, study these fractures in a survey among 212 patients, where it is stressed that a fracture is caused by insignificant violence during physical exercise. The aim of this study is, through focusing on the epidemiological character of the fracture, to point out the possibility to reduce the frequency and morbility, within the framework of prevention.


Table 1: Prefecture of Drama - Composition of people according to sex and origin.
Census of Greece, March 1991.