Sequelae of old nail distal femur wound

Case contributed by Dr Andrei Tsoriev

Presentation

Trauma of the knee with sharp nail 45 years ago, non specific symptoms, attributable to anterior knee osteoarthritis.

Patient Data

Age: 51
Gender: Male

X-rays of the knee joint unremarkable.

Annotated image

Arrows point at the wound channel in the distal femur, left after old direct nail puncture. There is a deep cartilage defect at the level of puncture. Short patellar tendon, relation of tendon length to patellar height is 0,61 (normal mean range is 1; ratio >1.2 is diagnostic of patella alta and <0.8 is diagnostic of patella baja).

Linear intensity changes in anterior portion of distal femur, direction is from medio-anterior to latero-posterior, length is 24 mm. PD+fatsat - hypersignal, T1 - hyposignal, which is consistent with edema along wound channel in the cancellous bone.

Short patellar tendon, relation of tendon length to patellar height is 0.61 (normal mean range is 1; ratio >1.2 is diagnostic of patella alta and <0.8 is diagnostic of patella baja).

Case Discussion

This case is interesting because edema along the wound channel, left after old direct puncture of the nail is sustained for more than 40 years. Possibly there is a chronic inflammation around traumatic channel because of irritating effect of small foreign particles. Also there is a defect in the femoral cartilage, at the first impression was attributed to patellofemoral osteoarthritis due to patella baja (or patella infera), which is known to be a predisposition to patellofemoral joint overload with osteoarthritis development.

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Case information

rID: 33891
Case created: 28th Jan 2015
Last edited: 23rd Sep 2015
Inclusion in quiz mode: Included

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