1/4. Partial Hawkins sign in fractures of the talus: a report of three cases.OBJECTIVE: We introduce the concept of the partial Hawkins sign in three cases of talar neck fracture that are associated with incomplete avascular necrosis. Our objective is to call attention to the intraosseous blood supply of the talar body, which can be interrupted by fractures to produce patterns of incomplete avascular necrosis. CONCLUSION: We conclude that the Hawkins sign does not always have to be complete. Fractures of the talus occasionally can lead to partial avascular necrosis because of the disruption of end arteries within the body of the talus, even without subluxation or dislocation. Early recognition of the partial Hawkins sign should lead to MRI evaluation that can more readily define the involvement of the talar body and assist the treating physician in recommending when the patient can bear weight.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. Distal phalange necrosis: a severe manifestation of palmar plantar erythrodysesthesia.Palmar plantar erythrodysesthesia is a cutaneous drug reaction induced by chemotherapy. We present a case of a patient with neurosensorial deficit affected by ovarian cancer who experienced a painless necrosis of a distal phalange of the hand during treatment with pegylated liposomal doxorubicin. Palmar plantar erythrodysesthesia may be underestimated by physicians in paucisymptomatic patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. osteoarthritis as a misdiagnosis in elderly patients.Musculoskeletal disorders are very common in the elderly, and x-ray evidence of irreversible damage due to osteoarthritis is found in probably all older people. Thus, when confronted by various pain symptoms in an older patient, the physician must always include osteoarthritis in the differential diagnosis. However, potentially reversible causes for the problem are too often ignored, and a misdiagnosis of osteoarthritis prevents or delays effective treatment of the actual underlying problem, with potentially serious consequences. Six case studies are offered illustrating this problem and pointers in differential diagnosis are suggested.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Spontaneous osteonecrosis of the knee.Spontaneous osteonecrosis is a common cause of knee pain in older patients, but the diagnosis is often overlooked. Sudden knee pain in older women, with marked joint line tenderness and a decreased range of motion, should alert the physician to the diagnosis. Two to three weeks after the onset of symptoms, plain radiographs will usually be normal but bone scan will be markedly positive. Treatment is initially conservative. Surgical intervention (either osteotomy or arthroplasty) is reserved for patients who develop a large radiolucent lesion in the subchondral femoral condyle.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |