Intraosseous tophus deposits in the os trigonum.
نویسندگان
چکیده
High levels of uric acid cause accumulation of monosodium urate crystals. This formation of masses is called tophus. Intraosseous tophus deposits are rare, even for patients with gout. We report an unusual case of intraosseous tophus deposits in the os trigonum. The patient presented with ankle pain with no previous history of gout. On examination, tenderness on the posterior aspect of his ankle and limitation of plantarflexion was noted. Laboratory values were normal, except for an elevated serum uric acid value. Radiographs of the right ankle showed the presence of a large os trigonum with osteosclerotic changes, whereas magnetic resonance imaging showed intraosseous tophus deposits in the os trigonum. Conservative therapy failed, and the patient was admitted for an endoscopic resection of the os trigonum.Intraosseous chalky crystals were detected during endoscopic resection of the os trigonum. The histological diagnosis was tophaceous gout. The underlying pathological mechanism of intraosseous tophi is uncertain. Penetration of urate crystals from the joint due to hyperuricemia may be the mechanism of deposition in this patient.When a patient with hyperuricemia presents with posterior ankle impingement symptoms, intraosseous tophus deposits should be included in the differential diagnosis. Posterior endoscopic excision may be an option for treating intraosseous lesions of the os trigonum because of good visualization, satisfactory excision, and rapid recovery time.
منابع مشابه
Fracture of the os trigonum: a case report.
The os trigonum is an inconsistently present accessory bone of the foot situated at the posterolateral aspect of the talus. It may be radiographically confused with fractures of the posterior process of the talus. Fracture of the os trigonum per se is extremely rare. Hyperplantarflexion of the ankle is the mechanism of injury in which the os trigonum is compressed between the posterior malleolu...
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Soft-tissue tophaceous deposits have been reported in the finger, carpal tunnel, spine (cervical and lumbar), hip, knee, and Achilles tendon.1,3,6,8,10,13,16 Intraosseous and intradermal sites have also been described, and there is also a report of a tophus being the cause of fracture nonunion.4,5,17 Glenohumeral joint involvement in gouty arthropathy, however, is unusual.7 Tophaceous gout corr...
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ورودعنوان ژورنال:
- Orthopedics
دوره 35 1 شماره
صفحات -
تاریخ انتشار 2012