The prolapse of the intervertebral disc is most common cause of sciatica; rare causes of sciatica are pelvic fractures, pelvic tumors, piriformis syndrome, a rupture of medial head of gastronemius and sacroiliac joint dysfunction. We report the case of a 30-year-old male with a paralabral cyst of the hip joint with an acetabular labral tear causing sciatica. Our patient had an acetabular labral tear caused by a repetitive micro-trauma and external rotation injury. The diagnosis of the paralabral cyst with acetabular labral tear was based on clinical examination and histopathological examinations, and Magnetic resonance imaging findings. The patient underwent successful surgical excision of paralabral cyst and surgical repair of an acetabular labral tear. The present case reinforces the need for clinicians to be vigilant about rare causes of sciatica.

Purpose:To evaluate the role of immediate and definitive management of Gustilo type Ⅲ A/B tibia fractures with intramedullary nailing and fasciocutaneous flap.Methods:From August 2010 to July 2012,22 patients with Gustilo Grade Ⅲ A/B tibia fractures were managed with a single stage treatment of ipsilateral fasciocutaneous flap & reamed intramedullary nailing and were included in the study.The severity of the injury was calculated with Ganga Hospital injury severity score.Results:The mean age of patients was 41 years and the follow-up time ranged from six months to one year.Among the 22 patients,73％ were type Ⅲ B fractures with upper leg involved in 55％ of them.The time interval from injury to completion of surgery was 8-14 h.The incidence of bone infection requiring secondary procedure was 9％;the major and minor soft tissue complication rate was 9％ and 14％ respectively.The limb salvage rate was 100％.Conclusion:Multidisciplinary management of severe lower limb trauma is important and provides good outcomes,Intramedullary nailing and immediate flap fixation can achieve early bone union and good soft tissue coverage,leading to good outcomes in patient with Grade Ⅲ A & B tibia fractures.

Descending branch of the lateral circumflex femoral artery (LCFA) is commonly used pedicle for ante- rolateral thigh (ALT) flap. Oblique branch of LCFA is an alternative pedicle that can be used in micro- vascular surgery. According to review of literature and to the best of our knowledge we could not find the use of oblique branch of LCFA as a pedicle of the ALT flap in regional soft tissue reconstruction. Here we presented a case of a 55-year-old man sustaining soft tissue injury and wound over the left trochanteric and gluteal region following a road traffic accident, who was treated by the use of extended ALT pedicle flap with oblique branch of LCFA as the pedicle for reconstruction of soft tissue defect in trochanteric and gluteal regions with successful outcome.
Accidents, Traffic ; Buttocks ; Femoral Artery ; surgery ; transplantation ; Femur ; Graft Survival ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Myocutaneous Flap ; blood supply ; transplantation ; Reconstructive Surgical Procedures ; methods ; Risk Assessment ; Soft Tissue Injuries ; diagnosis ; surgery ; Surgical Flaps ; blood supply ; transplantation ; Thigh ; surgery ; Wound Healing ; physiology

Musculoskeletal injuries following seizures have a high morbidity and mortality. These injuries are often missed and the diagnosis is delayed due to a lack of clinical suspicion and appropriate investigations.We report a case of 72 years old male with simultaneous bilateral central acetabular fracture dislocation and bilateral posterior shoulder fracture dislocation secondary to an epileptic seizure. Present study high- lights the significance of clinical suspicion and clinico-radiological evaluation for diagnosis of a rare injury following episode of seizures. Simultaneous fracture dislocation of all four limbs treated with a holistic approach can lead to a good functional recovery. Surgical management with open reduction and internal fixation is preferred and replacement arthroplasty should be reserved for cases with implant failure and elderly patients.
Acetabulum ; injuries ; Aged ; Epilepsy ; complications ; Fracture Dislocation ; diagnostic imaging ; surgery ; Fractures, Bone ; surgery ; Humans ; Male ; Shoulder Fractures ; diagnostic imaging ; surgery

INTRODUCTIONSchwannomas that arise within the muscle plane are called intramuscular schwannomas. The low incidence of these tumours and the lack of specific clinical features make preoperative diagnosis difficult. Herein, we report our experience with intramuscular schwannomas. We present details of the clinical presentation, radiological diagnosis and management of these tumours.

METHODSBetween January 2011 and December 2013, 29 patients were diagnosed and treated for histologically proven schwannoma at the National University Hospital, Singapore. Among these 29 patients, eight (five male, three female) had intramuscular schwannomas.

RESULTSThe mean age of the eight patients was 40 (range 27-57) years. The most common presenting feature was a palpable mass. The mean interval between surgical treatment and the onset of clinical symptoms was 17.1 (range 4-72) months. Six of the eight tumours (75.0%) were located in the lower limb, while 2 (25.0%) were located in the upper limb. None of the patients had any preoperative neurological deficits. Tinel's sign was present in one patient. Magnetic resonance (MR) imaging showed that the findings of split-fat sign, low signal margin and fascicular sign were present in all patients. The entry and exit sign was observed in 4 (50.0%) patients, a hyperintense rim was observed in 7 (87.5%) patients and the target sign was observed in 5 (62.5%) patients. All patients underwent microsurgical excision of the tumour and none developed any postoperative neurological deficits.

CONCLUSIONIntramuscular schwannomas demonstrate the findings of split-fat sign, low signal margin and fascicular sign on MR imaging. These findings are useful for the radiological diagnosis of intramuscular schwannoma.

Adult ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscle Neoplasms ; diagnostic imaging ; Neurilemmoma ; diagnostic imaging ; Postoperative Period ; Retrospective Studies ; Singapore