Images in Clinical Rheumatology
Diagnosis of osteochondromatosis as an incidental finding in revision surgery after failed intramedullary nailing of the hip
Diagnóstico de osteocondromatosis como hallazgo casual en cirugía de fallo de enclavado entromedular de cadera
Servicio de Cirugía Ortopédica y Traumatología, SSIBE - Hospital de Palamós, Palamós, Girona, Spain
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Radiografía simple de cadera izquierda, proyección anteroposterior, que muestra fractura pertrocantérea. B. Fluoroscopia intraoperatoria, proyección anteroposterior, que muestra enclavado endomedular de fémur proximal. C. Radiografía simple de cadera izquierda, proyección anteroposterior, que muestra fallo de enclavado endomedular con luxación de cabeza femoral. D. 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It can be observed that the changes are more aggressive in the 2nd and 3rd metacarpophalangeal joints bilaterally with reduced joint space, subchondral sclerosis, and hook-like osteophytes in the radial area (*).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miriam García García" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Miriam" "apellidos" => "García García" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X18300329" "doi" => "10.1016/j.reuma.2018.01.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X18300329?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319300632?idApp=UINPBA00004M" "url" => "/21735743/00000016000002P1/v1_202005010847/S2173574319300632/v1_202005010847/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Diagnosis of osteochondromatosis as an incidental finding in revision surgery after failed intramedullary nailing of the hip" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "125" "paginaFinal" => "126" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Antonio García-Jiménez, Anna Álvarez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Antonio" "apellidos" => "García-Jiménez" "email" => array:1 [ 0 => "agarciaj@ssibe.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Anna" "apellidos" => "Álvarez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía Ortopédica y Traumatología, SSIBE - Hospital de Palamós, Palamós, Girona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diagnóstico de osteocondromatosis como hallazgo casual en cirugía de fallo de enclavado entromedular de cadera" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2011 "Ancho" => 1500 "Tamanyo" => 287508 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A. Simple X-ray of the left hip, anteroposterior projection, showing perthrocantheric fracture. B. Intraoperative fluoroscopy, anteroposterior projection, showing intramedullary nailing of the proximal femur. C. Simple X-ray of the left hip, anteroposterior projection, showing failure of the intramedullary nailing with luxation of the femoral head. D. Macroscopic appearance of the osteochondromatosis nodules sent to pathological anatomy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 72 year-old woman with sequelae of multiple traumatisms in the left lower limb, in the form of loss of strength in all of the muscle groups. She visited the Emergency Department after low energy trauma, with the diagnosis of intertrochanteric femur fracture (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, and she was received surgery with the emplacement of a short intermedullary nail (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). She was discharged from hospital after 7 days with no complications.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">6 weeks after surgery she visited the outpatient department with dysmetria of the limbs and a gradual increase in pain over recent days, without fever. The wound showed slight erythema with a slight increase in the local temperature. X-ray imaging showed failure of the nailing, with luxation of the femoral head (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a><span class="elsevierStyleSmallCaps">C</span>), so that surgery was repeated.</p><p id="par0015" class="elsevierStylePara elsevierViewall">During surgery capsular destruction was observed together with the presence of multiple tissue fragments with a hard elastic consistency and whitish-yellowish in colour (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). Suspecting infection, samples were taken for microbiology and anatomical pathology, and resection arthroplasty (Girdlestone) was performed. The sample cultures were negative, and anatomopathological study identified the samples as synovial osteochondromatosis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Six months after the second operation the patient walked with great difficulty, using a raised insole to partially correct the dysmetria.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Synovial osteochondromatosis is a multifocal chondral metaplasia of the synovial tissue.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The cartilaginous nodules which characterise it may detach from the synovial tissue, calcify and appear as free radio-opaque bodies in a simple X-ray.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It may occur in any location, although it is more common in the large joints, and it rarely affects the hip.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Dissemination outside the joint from a primary focus is exceptional,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and it has been described as a possible cause of pathological fracture of the proximal femur.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In patients diagnosed with the primary form and painful symptoms, the treatment is the surgical resection of the synovial tissue of the joint in question, using open or arthroscopic surgery.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-11-29" "fechaAceptado" => "2018-01-08" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Jiménez A, Álvarez A. Diagnóstico de osteocondromatosis como hallazgo casual en cirugía de fallo de enclavado entromedular de cadera. Reumatol Clin. 2020;16:125–126.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2011 "Ancho" => 1500 "Tamanyo" => 287508 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A. Simple X-ray of the left hip, anteroposterior projection, showing perthrocantheric fracture. B. Intraoperative fluoroscopy, anteroposterior projection, showing intramedullary nailing of the proximal femur. C. Simple X-ray of the left hip, anteroposterior projection, showing failure of the intramedullary nailing with luxation of the femoral head. D. Macroscopic appearance of the osteochondromatosis nodules sent to pathological anatomy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary sinovial osteochondromatosis of the hip: report of two cases with long-term follow-up after synovectomy and a review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.R. Gilbert" 1 => "P.F. Lachiewicz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Orthop (Belle Mead NJ)." 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"fecha" => "2006" "volumen" => "88" "paginaInicial" => "2456" "paginaFinal" => "2464" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17079404" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/00000016000002P1/v1_202005010847/S2173574320300113/v1_202005010847/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/00000016000002P1/v1_202005010847/S2173574320300113/v1_202005010847/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574320300113?idApp=UINPBA00004M" ]
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| 2022 July | 28 | 28 | 56 |
| 2022 June | 30 | 25 | 55 |
| 2022 May | 28 | 33 | 61 |
| 2022 April | 29 | 35 | 64 |
| 2022 March | 32 | 35 | 67 |
| 2022 February | 24 | 29 | 53 |
| 2022 January | 51 | 35 | 86 |
| 2021 December | 29 | 42 | 71 |
| 2021 November | 28 | 38 | 66 |
| 2021 October | 29 | 40 | 69 |
| 2021 September | 27 | 33 | 60 |
| 2021 August | 14 | 28 | 42 |
| 2021 July | 57 | 21 | 78 |
| 2021 June | 17 | 26 | 43 |
| 2021 May | 16 | 31 | 47 |
| 2021 April | 35 | 66 | 101 |
| 2021 March | 36 | 29 | 65 |
| 2021 February | 28 | 15 | 43 |
| 2021 January | 20 | 17 | 37 |
| 2020 December | 16 | 14 | 30 |
| 2020 November | 21 | 14 | 35 |
| 2020 October | 11 | 10 | 21 |
| 2020 September | 30 | 15 | 45 |
| 2020 August | 4 | 1 | 5 |
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