Poster Print Size: Open Treatment of Joint Synovial Chondromatosis: A Report of 2 Cases Change Color Theme: This poster template is 24” high by 48” Brian Schenavar, DPM Garret Strand, DPM Thomas Paulick, DPM, FACFAS This template is designed to use the wide . It can be used to print any poster built-in color themes in the newer Ascension Wisconsin – Milwaukee and Racine, WI with a 1:2 aspect ratio including 30x60, versions of PowerPoint. 36x72, 42x84, and 48x96. To change the color theme, select the Statement of Purpose Analysis and Discussion Design tab, then select the Colors Placeholders: 1.A 1.B 1.C 2.A 2.B 2.C Synovial chondromatosis is an extremely rare disorder occurring in the foot and ankle. Synovial chondromatosis is a rare, benign condition affecting synovial linings. drop-down list. The various elements included in this One that leads to loose bodies affecting joints and surrounding synovium. Although Typically, synovial chondromatosis affects larger joints but has been described in the 1 poster are ones we often see in there is no gold standard of treatment, typical treatment options include direct removal ankle and in even rarer cases, the smaller joints of the foot. There are 3 stages 5 with synovectomy. The purpose of this study is to evaluate the open treatment method associated with this condition as well as a primary vs a secondary form. Literature medical, research, and scientific and outcomes of two case reports of synovial chondromatosis. has described a 5% risk of malignancy and recurrence ranges from 3-23%.4 Prior posters. Feel free to edit, move, add, research agrees that the most definitive treatment option includes synovectomy and and delete items, or change the layout Literature Review removal of the loose bodies, rather that be by arthroscopy or open arthrotomy.1-5 We describe two separate cases of synovial chondromatosis presenting within the to suit your needs. Always check with Synovial chondromatosis is a benign and rare condition in which synovial linings ankle joint. Both cases presented with pain and decreased range of motion in which your conference organizer for specific undergo metaplasia resulting in the formation of cartilaginous loose bodies.1 Synovial A A advanced imaging confirmed the formation of loose bodies within the joint. These chondromatosis is of unknown etiology and was first described by Leannac in 1813. Figure 2.A: Transverse T2 weighted MRI image with extensive peri ankle joint involvement. (Case #2) patients did very well after being treated with open arthrotomies and removal of loose Figure 2.B: Sagittal T2 weighted MRI image consistent with posterior SC and anterior effusion (Case #2) requirements. These loose bodies have been found in all areas of the body including the , , bodies. Figure 1.A: Clinical photograph of Case #2 showing large lateral soft tissue swelling Figure 2.C: Coronal T2 weighted MRI image of posterior ankle. (Case #2) 2,3 , shoulder, and temporomandibular joints. Synovial chrondromatosis also located at the ankle joint Our reports align well with previous studies treated in a similar way. Our first doesn’t just affect joints as any anatomic region with a synovial lining can develop Figure 1.B: Lateral ankle preoperative radiograph (Case #2) patient benefitted from a staged procedure in order to correct her flat foot deformity. Image Quality: Figure 1.C: Mortise ankle preoperative radiograph (Case #2) An ankle arthrotomy with removal of loose bodies, and Brostrom-Gould was these loose bodies. Some studies have described these lesions presenting performed. A lateral utilitarian incision was placed over the lateral ankle to allow access Our second patient had a history of ankle trauma requiring ancillary procedures to 1 You can place digital photos or logo art extra-articularly. When presenting within a joint, patients often complain of pain, Stage one was to remove the large osteophyte to the posterior ankle and decompress to the posterior ankle joint as well as the anterior lateral portion. Greater than 15 loose correct for ankle instability. Both patients were followed post operatively for over 12 crepitus, swelling, and diminished range of motion.3, 4 months reporting excellent results in foot function and decrease in pain. Due to the in your poster file by selecting the the soft tissue structures involved including the tarsal tunnel and flexor tendons. bodies were identified and sent as pathological specimens. Synovial chondromatosis The exact prevalence is unknown but synovial chondromatosis is twice as likely to Intraoperatively a large lobulated, multifragmented osseous body communicating with was the diagnosis with the largest measuring 0.4cm x 2.9 cm. reported recurrence rates and risk for malignancy, these patients will be followed on an The default color theme for this 2,4 Insert, Picture command, or by using present in males over females predominantly in their 3rd to 5th decades of life. the posterior ankle joint was identified and removed along with 5-6 additional smaller The patient was placed into posterior splint and kept NWB. The patient was then annual basis for re-evaluation. template is “Office”, so you can always standard copy & paste. For best results, Stages include an early stage without the formation of loose bodies, a transitional loose bodies. A biopsy was taken and sent to pathology that revealed synovial tissue transitioned into ta CAM boot and kept NWB for a total of 4 weeks postoperatively. She In conclusion, synovial chondromatosis in the foot and ankle is of rare occurrence. stage with presence of intrasynovial nodules, and a late stage with multiple loose with chondroid metaplasia and ossification confirming synovial chondromatosis. Post continued to progress well throughout the postoperative period transitioning out of the But a condition in which surgeons should be aware. The diagnosis is made with return to that after trying some of the all graphic elements should be at least bodies. Further descriptions include primary without an identifiable pathology vs clinical suspicion and confirmed with advanced imaging. The best treatment option to operatively, the patient was placed in a posterior splint. She progressed throughout the CAM boot and into physical therapy at 6 weeks. She was seen again at 3 months, 6 alternatives. 5 150-200 pixels per inch in their final secondary which is associated with pre-existing joint pathology. postoperative period well and the second stage was carried out 12 weeks later. months and 12 months postoperatively. Upon discharge we did reiterate the potential decrease recurrence is surgical excision of the loose bodies with complete Just as the etiology remains unclear, the treatment options are also not well synovectomy. And due to reported recurrence, long term follow up is suggested. printed size. For instance, a 1600 x 1200 After the patient recovered her pes planus and degenerative rearfoot was corrected need for a TAR vs. Ankle fusion in the future due to her history of trauma and described. Typically, surgical excision and removal of the loose bodies, either open or with a gastrocnemius recession and a STJ and TN fusion. Post operatively the patient degenerative changes to the ankle joint. She continued to progress as expected with Printing Your Poster: pixel photo will usually look fine up to arthroscopically, have been documented in the past as effective techniques for relief was placed in a NWB splint and transition to a cast for 8 weeks. She did quite well excellent results. and pain with low recurrence.2-4 Kunzler et. al. described a case of a 54 year old male References 8“-10” wide on your printed poster. going on to heal both of her fusion sites and reported significant pain relief to her left Once your poster file is ready, visit with ankle joint synovial chondromatosis treated with arthroscopic excision and lower extremity. synovectomy in which they removed 76 loose bodies.5 Scholl et. al. alternatively 1. Galat D, Ackerman D, Spoon D, Turner N, Shives T. Synovial Chondromatosis of the Foot and Ankle. www.genigraphics.com to order a To preview the print quality of images, Foot Ankle Int. 2008;29(3):312-317. doi:10.3113/fai.2008.0312 presented a 58 year old female treated with open synovectomy and removal of 38 high-quality, affordable poster print. select a magnification of 100% when Case #2: 50-year-old female presented to clinic with a chief complaint of right ankle 3.A 3.B 2.. Scholl D, Taddie K. Asymptomatic Synovial Chondromatosis of the Ankle: An Incidental Finding. The loose bodies within the ankle joint. Both patients did very well after the operation pain. History of ankle sprain and trauma noted including distal fibula fracture. The Journal of Foot and Ankle Surgery. 2010;49(6):565.e13-565.e17. doi:10.1053/j.jfas.2010.08.002 Every order receives a free design 2,5 previewing your poster. This will give throughout the entirety of their follow up. patient reports that over the years her ankle has continued to increase in size. Pain 3. Saxena A, St. Louis M. Synovial Chondromatosis of the Ankle: Report of Two Cases With 23 and 126 Loose Bodies. The Journal of Foot and Ankle Surgery. 2017;56(1):182-186. review and we can deliver as fast as noted to be 5/10 to medial and lateral malleoli. Radiographs note multiple loose bodies doi:10.1053/j.jfas.2016.02.009 you a good idea of what it will look like Case Study present laterally, anteriorly and posteriorly measuring up to 8mm. MRI scan has been 4. Sedeek S, Choudry Q, Garg S. Synovial Chondromatosis of the Ankle Joint: Clinical, Radiological, and next business day within the US and in print. If you are laying out a large Intraoperative Findings. Case Rep Orthop. 2015;2015:1-3. doi:10.1155/2015/359024 previously completed and revealed numerous synovial osteochondral bodies with 5. Kunzler D, Shazadeh Safavi P, Warren B, Janney C, Panchbhavi V. Arthroscopic Treatment of Synovial Canada. Case #1: 61 year old female presented to the office with a chief complaint of persistent marked hypertrophy and degenerative arthropathy of the ankle joint. There was a poster and using half-scale dimensions, Chondromatosis in the Ankle Joint. Cureus. 2017. doi:10.7759/cureus.1983 left rearfoot pain. Radiographs demonstrated a pes planus deformity with degenerative be sure to preview your graphics at chronic ATFL tear noted as well. This deformity has been progressively getting worse Genigraphics® has been producing changes. CT scan was obtained and confirmed degenerative changes to the TN and and her ankle and continued to increase in size. All conservative measures have been 200% to see them at their final printed STJ along with large irregular osteophyte in the posterior aspect of the STJ and ankle exhausted and surgical intervention was recommended. Conflicts of Interest output from PowerPoint® longer than joints. Conservative care with bracing, injections, Nsaids and rest were all attempted Figure 3.A: Intraoperative photograph showing loose bodies within the size. anyone in the industry; dating back to and failed to relieve symptoms. Surgery was scheduled as a staged procedure. posterior ankle joint (Case #2) None Figure 3B: Multiple, heterogeneously shaped and sized SC loose bodies when we helped Microsoft® design the Please note that graphics from websites PowerPoint® software. (such as the logo on your hospital's or university's home page) will only be

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