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Proper knee kinematics depends upon the integrity of ACL at its femoral and medial tibial spine attachments. Tibial spine fractures disrupt this complex and if untreated can lead to pain, instability and functional limitation. So proper diagnosis and early treatment of tibial spine avulsion fracture is important. Tibial spine fractures are often associated with intra-articular injuries which are more common in adults. Diagnosis and treatment of these associated injuries along with proper fixation of tibial spine fractures are essential. Surgical options for tibial spine fractures include reduction and fixation through arthrotomy or arthroscopic technique. Arthroscopic technique is now more popular as it allows accurate diagnosis and treatment of associated injuries, reduction and fixation of all types of tibial spine fractures and reduced morbidity compared with open techniques.

Unlabelled: Dematiaceous fungi are the etiological agents of phaeohyphomycosis. Diverse presentations of infectious syndromes are seen, ranging from local infections after trauma to widely disseminated infection in immunocompromised patients. Fonsecaea pedrosoi species have been reported to cause an increasing number of infections, particularly in severely immunocompromised patients. Colonization of normal skin has been reported. We present a case of F. pedrosoi osteomyelitis in an immunocompetent patient. A high level of suspicion and routine fungal cultures are required to identify these cases. Tissue culture and pathologic examination are necessary for definitive diagnosis and for distinguishing infection from colonization. Therapy includes antifungal drugs (itraconazole) and aggressive surgical debridement, and, even when these modalities are readily implemented, the outcome may not be optimal because of the angioinvasive character of the organism., Level of Clinical Evidence: 4.

Unlabelled: Isolated midtarsal (Chopart's) joint dislocations are rare, although cases involving medial, lateral, plantar, and dorsal displacement have been reported. These dislocations are often associated with osteochondral fractures. To the best of our knowledge, isolated dorsal midtarsal dislocation owing to plantarflexion of the forefoot on the hindfoot with the ankle in a neutral or dorsiflexed position is rare. In this article, we describe a case of isolated Chopart's dorsal dislocation and discuss the mechanism of injury, management, and outcome. The patient was treated with open reduction and repair of ligamentous structures, and Kirschner wire transfixation. At approximately 96 weeks following treatment, the patient was walking without aid, despite the development of posttraumatic degenerative changes at the calcaneocuboid joint. In retrospect, primary arthrodesis of the calcaneocuboid joint may have been more beneficial for the patient. We also describe the unusual mechanism whereby a plantarflexory force applied to the forefoot, without ankle plantarflexion, results in dorsal dislocation of the midtarsal joint., Level of Clinical Evidence: 4.

Introduction: Angio-osteohypotrophic syndrome is also known as Servelle-Martorell angiodysplasia. It is characterized by venous or, rarely, arterial malformations, which may result in limb hypertrophy and bony hypoplasia. Extensive involvement of the upper limb is a rare feature of Servelle-Martorell syndrome. Cases with minimal upper limb involvement have been described in the literature., Case Presentation: A young man presented with multiple separate swollen areas over the right upper limb and functional difficulty since birth. The arm muscles and muscles of the limb girdle were atrophic. The forearm and hand bones were hypoplastic and tender., Conclusion: We report a case of Servelle-Martorell syndrome with extensive involvement of the entire upper limb and periscapular region. Servelle-Martorell syndrome is highlighted as one of the causes of angiodysplastic limb hypertrophy.

Background Context: Epithelioid angiosarcoma (EA) is a high-grade sarcoma of vascular origin. EA is a rare variant of angiosarcoma. It is characterized by large cells with an epethelioid morphology. EA has been reported in sites like skin thyroid, adrenal gland, soft tissue, and rarely in bone., Purpose: The current article describes a case of multicentric EA of the spine that presented simultaneously at T4 spine and the posterior one third of the left fourth rib. STUDY DESIGN/SETTINGS: This study included a patient with a rare spinal tumor, which presented insidiously. Radiologically, the lesions were osteolytic with erosion of cortices. The tumor was composed of nests and cords of malignant cells with epithelioid morphology with areas of vascular differentiation, necrosis, and hemorrhage. Anastomosing vascular spaces lined by epithelioid endothelial cells suggested focal endotheliod differentiation., Methods: Histopathological evaluation of the tumor obtained from en bloc resection of the fourth rib and specimen from decompression of the fourth thoracic vertebra was done. Immunohistochemistry showed positivity for endothelioid cell markers like CD31 and factor VIII related antigen. The authors point out the need for immunohistochemical evaluation after careful histological analysis for vascular differentiation for an accurate diagnosis of vascular bone tumors with epithelioid features so that an erroneous diagnosis of metastatic carcinoma can be avoided. EA occurs rarely in bone. EA is marked by the presence of large polygonal epithelioid malignant cells with marked cellular atypia and pleomorphism. The arrangement of the cells may mimic epithelial neoplasm. These types of lesions are a definite diagnostic challenge in bone biopsy. The tumor was treated with en bloc resection of the rib and decompression of the body of T4 spine, followed by megavoltage radiotherapy. Follow-up X-rays showed regression of the tumor at 2 years. CD31 is the most sensitive marker for EA. Even in the absence of obvious vascular differentiation, abundant intratumoral hemorrhage and intratumoral neutrophils are definite morphologic changes that should suggest a vascular origin., Results: The patient was followed up for 2 years. A conservative surgical approach with a radical course of megavoltage radiotherapy could yield a good result in EA of bone. At the time of writing this report, there is no evidence of tumor recurrence., Conclusion: It is important to differentiate EA from other tumors because the clinical course and treatment are specific for these conditions. Careful histologic and immunohistochemical analysis will clinch the diagnosis. Even though rare, we stress the importance to be aware of the existence of this tumor, which is essential for correct diagnosis.