Cases of the Month

The Cases of the Month are published in the SICOT e-Newsletter.

The SICOT Editorial Department invites the SICOT members to participate in its call for cases by submitting their cases to [email protected]. The cases will be reviewed and possibly adapted to fit the "Case of the Month" layout. The reviewers reserve the right to refuse any case. Click on a link below to see the content and layout of previous cases. The "Guidelines for Authors" can be found here.


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  • Issue No. 78 - February 2016 by Alexander S. McLawhorn & Michael B. Cross
    A 67-year-old woman presented 6 years after right primary total knee arthroplasty (TKA) with a complaint of severe knee stiffness, reduced range of motion (ROM), and pain. The TKA had been performed at an outside institution. Immediately after her primary surgery, her wound healed uneventfully, but she never achieved significant improvements in her ROM postoperatively. 

  • Issue No. 77 - December 2015 by Syah Bahari
    A 20-year-old female presented with right knee pain and swelling over one month. The swelling has progressively worsened over that period. Patient denied any history of recent trauma or sport injuries. She also denied any febrile episode. She had no history of surgery to the right knee. She denies any weight loss or night pain.

  • Issue No. 75 - September 2015 by Shalin Maheshwari, Ratna Maheshwari, Jitendra Balakumar & Emily Kong
    A 15-year-old boy was hit on his right shoulder, while playing football. Physical examination showed pain, swelling and deformity of the left SC area and of the medial fourth of the clavicle. Hollow area was felt next to the right sternoclavicular joint. Neurovascular examination was normal and there was no sign of dysphagia or dyspnea. 

  • Issue No. 73 - April 2015 by Mohamed Elhady 
    19-year-old male had fracture of femur which was treated by open IM nailing with aseptic non-union for 2 years where stiff knee arthroscopy and knee manipulation were done.

  • Issue No. 72 - February 2015 by Mohamed Sukeik, Julia Kao & Amar Ranawat
    A 37-year-old athletic male underwent an open reduction and internal fixation (ORIF) of his right hip for a stress fracture sustained whilst running the New York Marathon. However, due to non-union of his fracture he underwent revision of the fixation with bone grafting. He presented with persistent pain in the right hip after 18 months from his second operation.

  • Issue No. 71 - December 2014 by Syah Bahari & John McKenna
    A 22-year-old male presented with one week's history of left ankle injury during a soccer match. According to the patient, he was tackled during the match but was able to continue playing afterwards. However, he noted that the left ankle was quite swollen after the match and was progressively getting worse. He was given anti-inflammatory medication by his team doctor, which eased the pain. 

  • Issue No. 70 - October 2014 by John Mukhopadhaya, A.A. Hai, & Shalin Maheshwari
    38-year-old male patient presents with pain in the left groin and thigh in the past four years. The pain has increased in intensity in the past month and inability to walk in the past four days. On examination, the patient had tenderness over left groin and trochanter. Range of motion at hip was painful and restricted. Patient had normal distal neurovascular status without any other co-morbidities. 

  • Issue No. 69 - August 2014 by Solayar Gandhi, Shannon Fintan
    An 81-year-old lady was admitted after a fall with injury to her right shoulder. She recently had a full course of chemotherapy for transitional cell bladder carcinoma. A plain radiograph of the shoulder was performed.

  • Issue No. 68 - June 2014 by Mohamed Elsagheir & Hatem G. Said
    A 26-year-old male presented recently to our outpatient clinic with progressively increasing left-sided hip pain and limited ROM with no history trauma. On examination he had a palpable immobile hard swelling on the posterior aspect of the proximal femur. Range of movement was affected mainly in abduction and complete limitation of external rotation. His WBC, CRP and ESR were within normal limits. 

  • Issue No. 67 - April 2014 by Ashok Gavaskar, Prasad Sorganvi & Ramakanth Rajagopalan
    20-year-old male presented at the ER with a swollen knee following a MVA. Clinical examination revealed a knee locked in 50 degrees flexion; further extension or flexion not possible; absence of patella in the trochlea. What are your thoughts on the possible diagnosis? Further investigations? 

  • Issue No. 66 - March 2014 by Mahmoud Abdel Kerim
    Thirteen-year-old male patient presented with right groin pain, inability to weight bear on the right side. History revealed that he had left slipped upper femoral epiphysis 16 months earlier, which was managed by single in situ screw fixation. The patient had evidence of endocrinopathy with hypogonadism, so the contralateral (right) hip was simultaneously prophylactically pinned with single screw.

  • Issue No. 65 - February 2014 by A. Najefi, M. Sukeik, K. Hasan, G. Robbins
    A 51-year-old male presented recently to the emergency department with a 4-week history of progressively worsening non-specific left-sided knee pain. He had a total knee replacement done on the same knee 4 years previously and had no postoperative complications. He denied any recent trauma. On examination he had a mild effusion and held his knee in 50 degrees of flexion. 

  • Issue No. 64 - January 2014 by Prasad Ellanti, Syah Bahari & Tom McCarthy
    A 63-year-old female attended the Accident and Emergency Department complaining of lower back and left groin pain for several weeks. She was prescribed pain medication by her GP but unable to relieve the pain. She was able to mobilise full weight-bearing. Examination of the left hip was unremarkable as well as other clinical examination. She was apyrexial. She had a background history of multiple myeloma and chronic anaemia. Her Hb was 9.5, WCC 2.4 and her neutrophil was 2.2.

  • Issue No. 63 - December 2013 by Syah Bahari
    A 60-year-old right-hand dominant female presented to our fracture clinic with painful left wrist over 3 months. The pain became progressively worse. The pain was initially under control with over the counter pain medication, but now she has been taking regular diclofenac sodium to control the pain.

  • Issue No. 62 - November 2013 by Syah Bahari & Tom McCarthy
    A 69-year-old male presented to the Emergency Department complaining of progressive pain in the left hip. He was able to mobilise using the walking frame. He denies any history of fall. He recently had a bipolar hip hemiarthroplasty for intracapsular neck of femur fracture 6 months earlier. He also has a background history of Parkinson’s disease, osteoporosis, hypertension and depression. 

  • Issue No. 61 - October 2013 by Mahmut Nedim Aytekin
    22-year-old male patient presented with pain below his right knee. The characteristic of the pain was dully. The pain increased at night and was relieved by aspirin or non-steroid anti-inflammatory drugs. There was no abnormal finding during his physical examination and in his laboratory blood tests.

  • Issue No. 60 - September 2013 by Shalin Maheshwari, Ratna Maheshwari, John Mukhopadhaya
    A 25-year-old male patient presents with a two-week-old open fracture of right distal femur treated elsewhere with debridement of the wound and k-wire fixation. The patient had fever with foul smelling wound and copious discharge. Patient had normal distal neurovascular status without any other comorbidities. 

  • Issue No. 59 - August 2013 by Bassel El-Osta
    A 77-year-old lady presented to the Orthopaedic clinic with a six-month history of spontaneous gradually worsening pain in the antecubital fossa of the right forearm. This was associated with a discrete lump which grew in size over time. She described the pain as a dull constant ache which could be provoked to sharp pain by elbow and forearm movements, and by heavy lifting. The pain did sometimes radiate to the wrist but there was no tingling, numbness or weakness in the arm. There was no history of any traumatic injury.

  • Issue No. 57 - June 2013 by Bassel El-Osta
    A 52-year-old female was involved in a road traffic accident (RTA), motorbike vs car, at a speed of 40 mph. She arrived to our hospital as trauma call. Patient was assessed by the Advanced Trauma Life Support protocol (ATLS).

  • Issue No. 56 - May 2013 by Maher Halawa
    A lady presented in 2012 with right hip pain after a THA 16 years previously. Currently the pain caused her to use two elbow crutches, with inability to fully weight bear on RT leg. X-rays showed polyethylene wear with wear granuloma in the back of the metal shell of the cup and loose zones around femoral component.

  • Issue No. 55 - April 2013 by Ratna Maheshwari, Shalin Maheshwari & Ashok Johari 
    A two-year-old male child was brought with parental concerns of abnormal gait. On enquiry, patient had a history of premature delivery with high grade fever after birth and neonatal intensive care unit admission. The child had then been treated conservatively with intravenous antibiotics. Parents do not recall any other relevant medical history. They noted an abnormality in the child’s gait in the last 6 months. 

  • Issue No. 54 - March 2013 by Ahmed H. Abdel Azeem, Ahmed Foaud Seifeldin, Mostafa Abusayed & Ahmed Khedr
    A 16-year-old male patient presenting after a fall from height with a swollen right heel and inability to weight bear on it. X-rays and CT scan showed intra-articular fracture of the calcaneus with Sanders' type II, joint depression fracture of the right calcaneus. Further examination and investigations showed no other associated injuries. 

  • Issue No. 53 - February 2013 by Jason Werle & Kamal Bali
    A 45-year-old female police officer underwent Right Birmingham Hip Resurfacing (BHR) in October 2005 and Left BHR in January 2008 secondary to bilateral primary osteoarthritis. Post-operative course was uneventful and patient was able to return to martial arts/judo after the second surgery. The patient returned back in January 2010 with a painful left hip and limitation in activity.

  • Issue No. 52 - January 2013 by Syah Bahari & John McKenna 
    A 53-year-old female referred by her GP to our foot clinic complaining of pain in her left foot and ankle. She twisted her left ankle 2 months prior but never seeked medical attention at the time. 

  • Issue No. 45 - June 2012 by Syah Bahari & Tom McCarthy 
    A 22-year-old male attended the Hip and Knee Clinic complaining of right hip pain during two years. He denies any trauma. He is active in soccer and rugby but finding it difficult to play due to pain. He pointed to the lateral aspect of the hip and groin when describing the site of pain. 

  • Issue No. 44 - May 2012 by Syah Bahari & John McKenna 
    24-year-old female presented to the Emergency Department after sustaining a twisting injury to her left foot. She was unable to weight bear. On examination, it was a closed injury.

  • Issue No. 43 - April 2012 by Camila B. R. De Mattos & John P. Dormans
    Three-year-old girl presents with lumps in the left thigh, right knee and left ankle noted by her mother.

  • Issue No. 42 - March 2012 by Khaled Emara
    Female patient, 24 years old, had limb length discrepancy (LLD) 13 cm due to femoral shortening, the patient had distal femoral physeal arrest after history of motor car accident during childhood with fracture of distal femur. 

  • Issue No. 41 - February 2012 by Werner Knopp
    A 47-year-old male presented to the emergency department with pain in the wrist after trauma in the form of severe fall from his mountain bike. One year earlier he had received a wrist arthroplasty because of posttraumatic osteoarthritis after a distal radius fracture.

  • Issue No. 40 - January 2012 by Ahmed H. Abdel Azeem & Mahmoud Abdel Karim
    15-year-old male patient, overweight (BMI 27), presented to the outpatient clinic complaining of right groin pain and limping for 1 month.

  • Issue No. 37 - October 2011 by Martin Luedemann, Peter Raab & Maximilian Rudert
    A 12-year-old boy is referred to the orthopaedic department accompanied by his parents. They report a fall on his right shoulder during ice skating one week earlier. The boy complains about pain in the right shoulder and limited movement. Physical examination revealed intact peripheral circulation, motor activity and sensibility. 

  • Issue No. 35 - August 2011 by M.A. Masoud & Hatem Said
    A 37-year-old male patient is referred to the orthopaedic department with a 22-month history of pain in the right groin. He reports lower back pain, also over SI-joints. He has a history of lumbar discectomy 2 years before that improved the sciatica. 

  • Issue No. 34 - July 2011 by Martin Luedemann, Gaby Baron & Maximilian Rudert
    A 20-year-old young woman is referred to the orthopaedic department with a three-month history of pain in the right hip joint and buttock. It is aggravated by exercise but exists also at rest. She reports no trauma. Pain medication with Etoricoxib and Tramadol is ineffective. 

  • Issue No. 33 - June 2011 by A. Hobeck, V. Etll, Martin Luedemann & Maximilian Rudert
    A 49-year-old male patient was presented to our out-patient department with persistent pain in his left upper ankle joint after suffering a high-ankle sprain two weeks earlier. In 2006 and 2007 a radiosynovectomy of the ankle joint was performed due to a suspected rheumatic synovitis.

  • Issue No. 32 - May 2011 by Lars Rackwitz, Martin Lüdemann, Ulrich Nöth & Maximilian Rudert 
    A 68-year-old woman, who had received an uncemented total hip arthroplasty in 2003, was referred to the orthopaedic department with a six-month history of pain in the left groin. She reported no trauma, but underwent inguinal hernia surgery in 2008 on the left side.

  • Issue No. 31 - April 2011 by Martin Luedemann, Lothar Seefried & Maximilian Rudert 
    A 33-year-old man is presented to the orthopaedic department with a four-week history of moderate pain in his right knee. He reports no trauma. There is a slight swelling in the area of the distal lateral thigh. Standard laboratory blood tests were within normal limits.

  • Issue No. 30 - March 2011 by Kazuo Ikeda 
    An 83-year-old male suffering from ischemic cardiac disease, was examined using a periodical cardiac catheterization. The left brachial artery was punctured with a 6 Fr. catheter at the antecubital-fossa. No sedation was performed and the procedure was completed without any painful complications. 

  • Issue No. 29 - February 2011 by Martin Luedemann, Peter Raab, & Maximilian Rudert
    A 5-year-old boy is presented to our orthopaedic department with progressive pain in his left leg for 2 weeks, also at night. The mother reports no trauma, but a mild fever. There was a loss of weight of about 2 kg in the last weeks. 

  • Issue No. 28 - January 2011 by Martin Luedemann, Peter Raab, & Maximilian Rudert
    A 44-year-old woman is presented to our orthopaedic department with a one-and-a-half-year history of progressive right shoulder pain. She reports no trauma. This pain appears every once in a while, with a 5x5 cm deformity of the surrounding muscles.

  • Issue No. 27 - December 2010 by Martin Luedemann, Thomas Barthel, & Maximilian Rudert 
    A 20-year-old man is presented to our out-patient clinic. He reports an accident with his bicycle with subsequent pain in his left knee.  

  • Issue No. 26 - November 2010 by Martin Luedemann, Thomas Barthel, & Maximilian Rudert
    A 72-year-old woman is presented to our out-patients clinic with a three-month history of progressive right knee pain. She reports no trauma. This pain is sharp in nature, it is aggravated by exercise and relieved by rest. The physical examination of the right knee shows no swelling or tenderness on palpation. There is no redness or heat. A little Baker's cyst is palbable.

  • Issue No. 25 - October 2010 by Martin Luedemann, Barbara Thumes, Peter Raab & Maximilian Rudert
    A 9-year-old girl is presented to the orthopaedic department with mild pain in her right foot since a couple of weeks. She reports no trauma. The physical examination shows a palpable swelling of the metatarsal I with tenderness on palpation. There is no redness or heat. 

  • Issue No. 21 - June 2010 by Charles Sorbie
    A 53-year-old school teacher presented at an orthopaedic clinic with a complaint of worsening pain in the right knee which had developed over the previous two years. The pain was dull and imprecise in its location.

  • Issue No. 20 - May 2010 by Martin Lüdemann & Thomas Barthel 
    A 15-year-old boy (height: 1.90 metre) is presented to the orthopedic department with a one-week history of progressive pain in his left knee. This pain is aggravated by exercise and relieved by rest. The complaints began after an intensive basketball training, no trauma is reported. 

  • Issue No. 19 - April 2010 by John Dormans & Patrick O'Toole 
    A 19-year-old female with the diagnosis of multiple hereditary exostoses (MHE) is presented to our out-patient clinic with a two-month history of progressive left calf pain. This pain is cramp-like in nature, is aggravated by exercise and relieved by rest. 

  • Issue No. 18 - March 2010 by Osama Farouk and Mohamed Morsy
    A 35-year-old young man was involved in a motorcycle accident 2 weeks ago, where he suffered a massive heamato-pneumothorax. 

  • Issue No. 17 - February 2010 by Martin Luedemann
    A 26-year-old young woman is presented to the orthopaedic department. She reports an operation of the right elbow with transfer of the ulnar nerve 4 years ago, but pain remained moderate to intense, increasing during the night. A medication with nonsteroidal anti-inflammatory drugs (NSAID) is used with good results.

  • Issue No. 16 - January 2010 by Jean Louis Rouvillain
    A sixty-three-year-old man was seen at another institution in July 2009 because of pain in the right part of the groin after swimming.

  • Issue No. 15 - December 2009 by Wissam El-Kazzi 
    A 61-year-old diabetic woman presented to our hand surgery unit with a swollen wrist. 

  • Issue No. 13 - October 2009 by Wilhelm Baur
    In a 50-year-old patient, a cementless total hip replacement with metal bearings was performed on the right hip, with a lengthening of the leg of 2 centimetres.

  • Issue No. 12 - September 2009 by Reinhard Schmidt 
    A 27-year-old woman with fast increasing pain in the area of the left hip with no recollection of trauma.

  • Issue No. 11 - August 2009 by Thomas Barthel
    A 30-year-old man was presented in the orthopaedic department. He complained of lateral knee pain during walking.

  • Issue No. 10 - July 2009 by Peter Wai Pan Yau
    An 82-year-old lady was admitted in the middle of the night because of severe right hip pain and inability to walk after a fall.

  • Issue No. 9 - June 2009 by Hatem Said
    Six-year-old girl presented with bilateral hip swellings. 

  • Issue No. 8 - May 2009 by Volker Ettl
    A 50-year-old woman presented after an ankle sprain with pain and swelling of the left foot.

  • Issue No. 7 - April 2009 by Maximilian Rudert & Martin Lüdemann
    An 18-year-old young man is presented to the orthopaedic department. Permanent pain in the left thigh is reported.

  • Issue No. 6 - March 2009 by Peter Raab 
    A six-year-old girl was presented to the children's orthopaedic department with bone pain in projection to the diaphyseal region of the left tibia.

  • Issue No. 5 - February 2009 by Ahmed Abdel Aal
    A male patient, 38 years old, with pain in his Lt hip and limping for 3 months. 

  • Issue No. 4 - January 2009 by Frank Gohlke
    A 52-year-old male carpenter sustained a fall and presented himself with a painful shoulder.

  • Issue No. 3 - December 2008 by Frank Gohlke
    A 64-year-old man with type 2 diabetes collapsed unconscious due to hypoglycaemia and sustained a fall in his garden. Afterwards, he noticed pain, weakness and loss of active abduction and elevation.

  • Issue No. 2 - November 2008 by Hatem Said
    Male patient, 22 years old, complaining of chronic shoulder pain for 2 years, worse at night.