Cases reported "Hypertrophy"

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1/11. Distraction of hypertrophic nonunion of tibia with deformity using Ilizarov/Taylor Spatial Frame. Report of two cases.

    Two cases of hypertrophic nonunion of the tibia with deformity for which distraction treatment using an Ilizarov/Taylor Spatial Frame (Smith & Nephew, Memphis, TN) are presented. This frame utilizes a computer program to help plan correction of the deformity.
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2/11. Treatment of rigid hypertrophic posttraumatic pseudarthrosis of the tibia in children using distraction osteogenesis.

    Posttraumatic tibial pseudarthrosis is a relatively uncommon complication of tibia fractures in children. Although reported as a successful method of treating tibial nonunions in adults, distraction osteogenesis through a nonunion site via ring external fixation has not been described in children. The authors report three consecutive cases of distraction through an angulated, shortened, hypertrophic, posttraumatic nonunion to achieve successful union and concurrent correction of deformity. Distraction was carried out using a ring fixator with computer-guided correction. Union was achieved in each of the three patients with complete correction of deformity and length. Lengthening of 8 to 31 mm was achieved. The length of time in the external fixator ranged from 7 to 27 weeks. Pin tract infections developed in all patients; they were treated successfully using oral antibiotics. No deep infections or other significant complications developed. Each patient was followed up for at least 1 year.
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keywords = tibia
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3/11. Calf pseudohypertrophy in a patient with double neurogenic pathology.

    A pseudohypertrophy of the calf can be rarely associated with neurogenic pathologies as S-1 radiculopathy, poliomyelitis, spinal muscular atrophy, traumatic lesions of peripheral nerves, intraspinal neurinoma. The causes of this particular phenomenon are unknown. The authors present the case of a 52-year-old man with an enlargement of the left calf suffering from a mild form of spinal paralytic poliomyelitis in the early childhood and episodes of severe left sciatica in the last four years. electromyography demonstrated a pattern of denervation in both legs and an h-reflex absent when the left tibial nerve was stimulated. An open muscle biopsy of the left calf was performed. light microscopic and ultrastructural examination of the muscle confirmed the presence of a pattern of "neurogenic type" pseudohypertrophy. Our results could be interesting for the understanding of the mechanism of neurogenic pseudohypertrophy. This case suggests that timing of stimulus or "dose" of denervation may be important factors in such a phenomenon.
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keywords = tibia
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4/11. Persistent unilateral tibialis anterior muscle hypertrophy with complex repetitive discharges and myalgia: report of two unique cases and response to botulinum toxin.

    Unilateral enlargement of the tibialis anterior muscle associated with complex repetitive discharges occurred over several months in two patients and was preceded by pain and numbness in the lower leg. Neuroradiologic investigations excluded a compressive radiculopathy, but pharmacologic and neurophysiologic studies suggested a neurogenic basis for the muscle hypertrophy. Botulinum toxin A injection into the hypertrophied muscles led to a decreased muscle volume and cessation of muscle pain.
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keywords = tibia
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5/11. Long-term follow-up of vascularized bone grafts for the reconstruction of tibial nonunion: evaluation with computed tomographic scanning.

    Ten cases of reconstruction of the tibia with vascularized bone grafts were evaluated by computed tomographic (CT) scanning. In all cases the grafts were placed because of pseudarthrosis. The patients ranged in age from 20 to 64 years. The duration of follow-up was 1-9 years. In six cases fibular grafts were used to bridge the defect and in four cases iliac crest grafts were used. No additional bone grafts were placed after the initial operation. The pseudarthroses were classified into three types: type N--no bony defect (4 cases); type P--partial bony defect (3 cases); and type C--complete segmental bone loss (3 cases). Our evaluation showed that the grafts used to treat the type N and type P pseudarthroses were the same shape and size as at the time of placement. The grafts used to treat the type C pseudarthroses were hypertrophied, although the medullary canal of the graft remained the same size as at the time of placement. hypertrophy was a result of an extraperiosteal reaction. The fibular grafts were square rather than triangular in cross section. It was concluded that mechanical loading is important in promoting hypertrophy of the graft.
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6/11. intermittent claudication caused by compression of tibial vessels as a result of calf muscle hypertrophy: case report.

    We present a case with findings suggestive of popliteal artery entrapment in a patient with intermittent claudication and localized muscle hypertrophy in the calf muscles after removal of a herniated disk. angiography failed to demonstrate popliteal artery entrapment but instead revealed compression of the tibial vessels caused by calf muscle hypertrophy. The concept of muscle hypertrophy caused by denervation is also discussed.
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keywords = tibia
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7/11. A case report of EMO syndrome showing localized hyperhidrosis in pretibial myxedema.

    We describe here a case of EMO syndrome, which is defined as a combination of exophthalmos, pretibial or localized myxedema, and hypertrophic osteoarthropathy. A 34-year-old Japanese man with Graves' disease developed the characteristic eye changes. He showed 22 mm protrusion of both eyes and hypertrophy of the right lateral rectus muscle as well as both superior rectus muscles by computerized tomography. He subsequently developed lightly erythematous, indurated, nonpitting, peau d'orange plaques and nodules on his lower legs. Finally, he developed Graves' acropathy with hypertrophic osteoarthropathy in the metacarpal bones. Histological examination of myxedematous skin showed typical deposition of mucin accompanied by changes in the amount and distribution of elastic fibers. In addition, the lesional skin showed localized hyperhidrosis, a rarely reported complication of pretibial myxedema. We speculate that this hyperhidrosis of the lesional skin was brought about by stimulation of peripheral sympathetic nerves by surrounding mucin deposition, in the setting of poorly controlled hyperthyroidism.
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keywords = tibia
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8/11. Transient idiopathic periosteal reaction associated with dysproteinemia.

    Periosteal reaction with new bone formation in a child is a radiographic finding with an extensive differential diagnosis. The present case is that of a child who presented with a clinical syndrome of fever, bone pain in the forearm and leg, bony tenderness in these areas, radiographic evidence of a periosteal reaction in both tibiae and ulnae, and an abnormality of serum proteins. It was a self-limited disease process requiring no specific treatment, with eventual return to normal of both the radiographic and serum protein abnormalities. Its relationship to Caffey's disease remains to be defined.
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keywords = tibia
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9/11. Spontaneous rupture of the posterior tibial tendon secondary to chronic nonspecific tenosynovitis.

    Presented is a case history of complete rupture of the posterior tibial tendon and its subsequent surgical repair. Treatment included tendon repair followed by physical therapy and orthotic devices. Nine months after repair the patient was experiencing considerably reduced symptomatology but demonstrated significant posterior tibial muscle weakness and moderate subtalar joint pronation with forefoot abduction, with the deformity appearing to progress. This may indicate the need for additional surgical procedures to halt progression and lessen the chance of persistent pronation deformity.
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ranking = 1.2
keywords = tibia
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10/11. A case of massive osteolysis after knee prosthesis polyethylene failure.

    A case of massive osteolysis of the distal femur in response to particulate polyethylene from a broken uncemented tibial component is described. The osteolysis was so extensive that it made the revision arthroplasty extremely difficult. Early detection and early revision is recommended.
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keywords = tibia
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