Massive subacromial-subdeltoid bursitis with rice bodies secondary to an orthopedic implant.
Both early and late complications following open reduction and internal fixation of proximal humerus fractures have been reported extensively in the literature. Although orthopedic implants are known to cause irritation and inflammation, to our knowledge, this is the first case report to describe a patient with rice bodies secondary to an orthopedic implant. Although the etiology of rice bodies is unclear, histological studies reveal that they are composed of an inner amorphous core surrounded by collagen and fibrin. The differential diagnosis in this case included synovial chondromatosis, infection, and the formation of a malignant tumor. Additional imaging studies, such as magnetic resonance imaging, and more specific tests were necessary to differentiate the rice bodies due to bursitis versus neoplasm, prior to excision. The patient presented 5 years following open reduction and internal fixation of a displaced proximal humerus fracture, with swelling in the area of the previous surgical site. Examination revealed a large, painless tumor-like mass on the anterior aspect of the shoulder. The patient's chief concern was the unpleasant aesthetic of the mass; no pain was reported. Upon excision of the mass, the patient's full, painless range of motion returned.
Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, USA.
Adriana M
AM
Urruela
Timothy B
TB
Rapp
Kenneth A
KA
Egol
D000368:Aged; D002062:Bursitis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D019736:Prostheses and Implants / Q000009:adverse effects*; D012784:Shoulder Fractures / Q000601:surgery*; D012785:Shoulder Joint / Q000473:pathology*