JOS Case Reports最新文献

Tibial-hindfoot turn-up plasty following proximal femur and periacetabular resection for unplanned sarcoma resection: A case report 股骨近端和髋臼周围切除术后胫骨-后足隆起成形术治疗计划外肉瘤切除术：1例报告

JOS Case Reports

Pub Date : 2025-05-30 DOI: 10.1016/j.joscr.2025.05.001

Daniela Kristina Carolino, Hirohisa Katagiri, Junji Wasa, Hideki Murata, Kan Ito, Shunichi Toki, Mitsuru Takahashi, Ryo Satake

Introduction

Various reconstruction options are available following femoral resection for malignancies or complex cases with femoral involvement. Tibia-hindfoot osteomusculocutaneous rotationplasty, a rare reconstruction alternative introduced by Peterson in 1997, is a modification of the original technique of total tibial turn up proposed by Sauerbruch in 1922. However, data on the outcomes of this procedure are lacking.

Case report

A 50-year-old male patient with a 15-year history of right hip pain underwent unplanned resection, followed by total hip arthroplasty for clear cell chondrosarcoma of the femoral head and neck, with tibial-hindfoot turn-up plasty subsequently performed as a salvage procedure. Thirty-two months postoperatively, he was ambulatory with a prosthetic leg and a single crutch.

Conclusion

Benefits of tibial-hindfoot turn-up plasty include a longer stump for better prosthesis fitting, and better functional outcomes than hemipelvectomy. Furthermore, unlike a tumor prosthesis, revision is unlikely, and compared with rotationoplasty, this results in better cosmesis and fewer vascular complications.

在恶性肿瘤或累及股骨的复杂病例行股骨切除术后，可选择多种重建方法。胫骨-后足骨骼肌-皮肤旋转成形术是Peterson于1997年引入的一种罕见的重建方法，是对Sauerbruch于1922年提出的胫骨全翻起的原始技术的改进。然而，缺乏关于该手术结果的数据。病例报告：一名50岁男性患者，右髋关节疼痛15年，接受了计划外切除手术，随后因股骨头和颈部透明细胞软骨肉瘤接受了全髋关节置换术，随后进行了胫骨-后足翻出成形术作为挽救手术。术后32个月，患者仅靠一条义肢和一根拐杖行走。结论胫后足翻成形术的优点是残端较长，假体安装效果较好，功能预后较半骨盆切除术好。此外，与肿瘤假体不同，不需要翻修，与旋转成形术相比，修复效果更好，血管并发症更少。

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引用次数: 0

Achilles tendon rupture in previously treated clubfoot: Is there a correlation? A pediatric case report and a literature review 先前治疗过的内翻足的跟腱断裂：是否有相关性？一份儿科病例报告和文献综述

JOS Case Reports

Pub Date : 2025-05-07 DOI: 10.1016/j.joscr.2025.04.003

Giulia Masci , Valeria Calogero , Luca Basiglini , Marco Giordano , Martina Marsiolo , Angelo Gabriele Aulisa , Francesco Falciglia

Backgrounds

Achilles tendon rupture in children is very rare. The cause could be traumatic or non-traumatic such as clubfoot deformity, auto-immune, infectious or genetic diseases with collagen alterations. Regarding clubfoot, only a few case reports of Achilles tendon injury in previously treated feet diagnosed with this deformity are available in the literature. The most accepted treatment for clubfoot is represented by the Ponseti method which includes manipulations, corrective casts and Achilles tendon tenotomy. After surgery, the tendon fibres appear to heal properly.

Case report

We present the case of a 14-year-old girl who was referred to the emergency department for intense right ankle pain aroused while running, which resulted in a ruptured Achilles tendon. She had a history of bilateral clubfoot previously treated in her neonatal age with the Ponseti method including Achilles tendon tenotomy. The actual tendon lesion was treated surgically with an open terminus-terminal tenorrhaphy and immobilisation with a cast. Full recovery occurred after 2 months.

Discussion and conclusions

This study presents a rare case of Achilles tendon injury in previously treated clubfoot. Treatment of clubfoot is necessary to avoid invalidating sequelae. Achilles tenotomy is a widely accepted and effective procedure and studies have shown that tendon quality and muscle strength at week 12 are comparable to those of a normal tendon and the remodelling process continues up to three years later. Further studies are needed to investigate the possible link between clubfoot treatment and the later rupture of the Achilles tendon.

背景：儿童跟腱断裂非常罕见。原因可能是创伤性或非创伤性的，如足内翻畸形、自身免疫性疾病、传染性疾病或胶原蛋白改变的遗传性疾病。关于内翻足，文献中只有少数病例报告先前治疗过的脚部跟腱损伤诊断为这种畸形。最被接受的治疗内翻足的方法是Ponseti方法，包括手法、矫正石膏和跟腱切开术。手术后，肌腱纤维似乎愈合正常。病例报告我们报告了一个14岁的女孩，她在跑步时引起强烈的右脚踝疼痛，导致跟腱断裂，被转介到急诊科。她有双侧内翻足病史，在新生儿时期曾用Ponseti方法治疗，包括跟腱切断术。实际的肌腱病变通过手术治疗，采用开放的端-端腱束缝合和用石膏固定。2个月后完全恢复。讨论与结论本研究报告了一例罕见的跟腱损伤病例。治疗内翻足是必要的，以避免无效的后遗症。跟腱切断术是一种被广泛接受和有效的手术，研究表明，12周时的肌腱质量和肌肉力量与正常肌腱相当，重建过程可持续至3年后。需要进一步的研究来调查畸形足治疗与后来的跟腱断裂之间的可能联系。

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引用次数: 0

Urethral injury secondary to advanced fragility fracture of the pelvis: A case report 晚期骨盆脆性骨折继发尿道损伤1例

JOS Case Reports

Pub Date : 2025-05-03 DOI: 10.1016/j.joscr.2025.04.001

Takumi Kaku , Yoto Oh , Toshitaka Yoshii

Background

Fragility fracture of the pelvic ring (FFP) is rarely associated with urinary tract complications. We experienced a case of advanced FFP with urethral injury as late complications.

Case presentation

The patient was an 83-year-old woman with no trauma episode who was admitted to our hospital due to acute groin pain. After several examinations, we diagnosed urethral rupture, urine leakage with bacterial contamination, urinary retention, and advanced FFP. We immediately performed cystostomy, puncture drainage for urine leakage, and antibiotic administration. Three weeks later, as the leakage and infection were controlled, internal fixation was performed for the FFP. Although she could walk alone with a cane at 1 year after the surgery, complete bone union was not achieved.

Conclusion

This case was the advanced FFP complicated with urethral rupture, and the sequential treatments for each urinary retention, infection, and pelvic ring instability resulted in an acceptable outcome. Surgeons should recognize that chronic instability and repetitive friction in FFPs may be factors of urinary tract complications.

背景：骨盆环脆性骨折（FFP）很少与尿路并发症相关。我们报告了一例晚期FFP伴尿道损伤的晚期并发症。病例介绍：患者为83岁女性，无外伤，因急性腹股沟疼痛入院。经过多次检查，我们诊断为尿道破裂，尿漏伴细菌污染，尿潴留和晚期FFP。我们立即进行了膀胱造口术，穿刺引流尿漏，并给药抗生素。三周后，随着渗漏和感染得到控制，对FFP进行内固定。虽然术后1年她可以用拐杖独立行走，但骨未完全愈合。结论本病例为晚期FFP合并尿道破裂，经尿潴留、感染、盆腔环不稳序治疗，预后良好。外科医生应该认识到FFPs的慢性不稳定和反复摩擦可能是尿路并发症的因素。

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引用次数: 0

Sequential multimodal management of methicillin-resistant Staphylococcus aureus-infected tibial pseudoarthrosis: A case report on the application of an antibiotic-loaded cement spacer and the continuous local antibiotic perfusion technique across three stages 耐甲氧西林金黄色葡萄球菌感染胫骨假关节的序贯多模式治疗：应用抗生素负载水泥间隔器和连续局部抗生素灌注技术的病例报告

JOS Case Reports

Pub Date : 2025-04-28 DOI: 10.1016/j.joscr.2025.04.002

Yosuke Kaneko , Yunhan Ji , Sho Nojiri , Kazue Hayakawa , Nobuyuki Fujita

Background

Infected pseudoarthrosis requires effective infection control and successful bone union. Hence, this pathology is challenging to manage.

Case presentation

Herein, we report on a 41-year-old male patient who presented with methicillin-resistant Staphylococcus aureus-infected pseudoarthrosis after a primary surgery at another institution. After debridement, cement spacer insertion, and application of an intra-soft tissue antibiotic perfusion (iSAP) system for infection control, the final stage of bone fixation surgery with allogeneic bone grafting was performed. During the postoperative course, low-intensity pulsed ultrasound (LIPUS) was conducted. Ultimately, both infection control and bone union were achieved. At the latest follow-up, the patient had regained normal gait and was able to return to work.

Conclusion

Comprehensive treatment strategies must be considered for challenging pathologies such as infected pseudoarthrosis.

假关节感染需要有效的感染控制和成功的骨愈合。因此，这种病理是具有挑战性的管理。在此，我们报告了一位41岁的男性患者，他在另一家机构接受初级手术后出现耐甲氧西林金黄色葡萄球菌感染的假关节。在清创、骨水泥垫片植入和应用软组织内抗生素灌注（iSAP）系统控制感染后，进行同种异体植骨骨固定手术的最后阶段。术后行低强度脉冲超声（LIPUS）检查。最终，感染控制和骨愈合均得以实现。在最近的随访中，患者恢复了正常的步态并能够重返工作岗位。结论对于感染性假关节等具有挑战性的病变，应考虑综合治疗策略。

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引用次数: 0

A case of Aitken Classification Type A proximal femoral focal deficiency treated with plate fixation for pseudarthrosis 假关节钢板内固定治疗艾特肯A型股骨近端局灶性缺损1例

JOS Case Reports

Pub Date : 2025-03-27 DOI: 10.1016/j.joscr.2025.02.003

Shuro Furuichi, Hirosuke Endo, Shigeru Mitani

Background

Proximal femoral focal deficiency is a rare congenital anomaly with diverse clinical features and significant treatment challenges.

Case presentation

A female patient was diagnosed with Aitken type A proximal femoral focal deficiency at 1 month of age and surgically managed. She began walking after 17 months. At 34 months, she developed progressive varus and flexion deformities of the femur and complained of thigh pain. At 38 months, we excised the pseudoarthrosis, corrected the deformity, and performed plate fixation. At 4 years, growth suppression surgery was performed on the unaffected left leg. At 7 years, the affected lower limb was 13.5 cm shorter than the contralateral limb, requiring a 12-cm shoe lift.

Conclusions

A patient with Aitken type A proximal femoral focal deficiency presented with pseudarthrosis of the femur and was successfully treated surgically, resulting in thigh pain resolution.

背景：股骨近端局灶性缺陷是一种罕见的先天性异常，具有多种临床特征和显著的治疗挑战。一例女性患者在1月龄时被诊断为艾特肯A型股近端局灶性缺陷，并接受手术治疗。17个月后，她开始走路。34个月时，患者出现进行性股骨内翻和屈曲畸形，并主诉大腿疼痛。38个月时，我们切除假关节，矫正畸形，并进行钢板固定。4年时，对未受影响的左腿进行生长抑制手术。7岁时，患病下肢比对侧下肢短13.5 cm，需要抬高12 cm的鞋。结论1例Aitken A型股骨近端局灶性缺损患者表现为股骨假关节，手术治疗成功，大腿疼痛得到缓解。

引用次数: 0

Kaposiform hemangioendothelioma diagnosed following elbow painful contracture in an adolescent patient: A case report 卡波西样血管内皮瘤诊断后肘部疼痛挛缩的青少年患者：1例报告

JOS Case Reports

Pub Date : 2025-03-17 DOI: 10.1016/j.joscr.2025.03.001

Yoko Tanabe , Robert Nakayama , Kayoko Uno , Yutaka Kurebayashi , Yosuke Yamamoto , Satoshi Kamio , Sayaka Yamaguchi , Tomoaki Mori , Naofumi Asano , Yohei Masugi , Taiki Nozaki , Noriko Aramaki , Masaya Nakamura

Background

Kaposiform hemangioendothelioma is a rare, locally invasive vascular tumor of intermediate malignancy that most frequently involves the extremities. Most cases manifest in infancy and are associated with life-threatening consumptive coagulopathy, known as the Kasabach–Merritt phenomenon, acute pain, and functional limitations.

Case presentation

We present an extremely rare case of kaposiform hemangioendothelioma in a 15-year-old girl who had had no remarkable symptoms other than skin erythema until she developed severe pain and elbow contracture during adolescence. Although marginal tumor resection necessitated concurrent triceps tendon resection, her symptoms resolved without recurrence over a 2-year follow-up.

Conclusions

This case highlights that probably congenital kaposiform hemangioendothelioma may not cause significant symptoms until adolescence and the importance of resection for symptomatic resectable lesions.

背景：卡波西样血管内皮瘤是一种罕见的、局部侵袭性的中度恶性血管肿瘤，最常累及四肢。大多数病例表现在婴儿期，并伴有危及生命的消耗性凝血功能障碍，即Kasabach-Merritt现象，急性疼痛和功能限制。病例介绍：我们报告一例极为罕见的卡样血管内皮瘤病例，患者为15岁女孩，除皮肤红斑外无其他显著症状，直到青春期出现严重疼痛和肘部挛缩。虽然边缘肿瘤切除需要同时切除三头肌肌腱，但在2年的随访中，她的症状消失，无复发。结论本病例强调先天性卡斑样血管内皮瘤可能在青春期之前不会引起明显的症状，以及对有症状的可切除病变进行切除的重要性。

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引用次数: 0

Bilateral neglected femoral neck fracture due to vitamin D deficiency osteomalacia treated with total hip arthroplasty: A case report 全髋关节置换术治疗双侧因维生素D缺乏性骨软化而被忽视的股骨颈骨折1例

JOS Case Reports

Pub Date : 2025-03-17 DOI: 10.1016/j.joscr.2025.02.002

Narimichi Takino, Takuya Nakamura, Hideji Nishida

Background

Bilateral femoral neck fractures in young adults are rare and often result from trauma or underlying conditions like osteomalacia. Osteomalacia-related fractures are often treated late due to poor bone quality and untreated metabolic issues. In this case, the patient presented with a high-positioned dislocated hip resulting from old femoral neck fractures, which were successfully treated with total hip arthroplasty (THA).

Case presentation

A 31-year-old man with severe food allergies and atopic dermatitis developed bilateral femoral neck fractures due to vitamin D deficiency-induced osteomalacia. Poor bone quality initially made surgery unfeasible, leaving him wheelchair-bound for 13 years. After treating the vitamin D deficiency and improving bone quality, bilateral THA was performed at age 44. Fifteen weeks postoperatively, the patient was able to walk independently.

Conclusions

Osteomalacia-associated fractures require complex management due to delayed treatment. Recovery in this case was achieved by addressing osteomalacia first, followed by bilateral THA.

背景：年轻人双侧股骨颈骨折很少见，通常由创伤或骨软化等潜在疾病引起。由于骨质量差和未治疗的代谢问题，骨软化相关骨折通常治疗较晚。在本病例中，患者表现为陈旧性股骨颈骨折引起的高位髋关节脱位，经全髋关节置换术（THA）成功治疗。病例介绍：一名患有严重食物过敏和特应性皮炎的31岁男性因维生素D缺乏引起的骨软化症而发生双侧股骨颈骨折。最初，糟糕的骨骼质量使手术无法进行，使他在轮椅上度过了13年。在治疗维生素D缺乏症和改善骨质量后，于44岁行双侧THA。术后15周，患者能够独立行走。结论骨软化相关骨折治疗迟缓，治疗复杂。该病例的恢复是通过首先处理骨软化，然后进行双侧THA。

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引用次数: 0

Glenosphere dissociation combined with nonunion of a clavicular fracture following reverse shoulder arthroplasty 肩关节置换术后关节盂分离合并锁骨骨折不愈合

JOS Case Reports

Pub Date : 2025-03-16 DOI: 10.1016/j.joscr.2025.02.001

Yuki Yoshida, Takeshi Ikegami

Background

Reverse shoulder arthroplasty (RSA) effectively improves outcomes for cuff tear arthropathy but carries a risk of complications. Glenosphere dissociation is a rare complication, and its occurrence with a shoulder girdle fracture has not been reported.

Case presentation

A 77-year-old female who had undergone RSA presented with chronic shoulder pain and a palpable mass. Imaging revealed glenosphere dissociation and clavicular nonunion with scapular malalignment. Surgical intervention included replacing the glenosphere and polyethylene liner, stabilizing the shoulder. Postoperative care involved sling immobilization, leading to pain relief and no recurrent dislocation despite limited functional recovery due to scapular malalignment.

Conclusion

We presented a rare case of glenosphere dissociation combined with clavicular nonunion following RSA. While pain relief was achieved by repairing the dislocation, clavicular nonunion contributing to scapular malalignment may hinder functional recovery. Surgical intervention for clavicular stabilization may be necessary in cases prioritizing shoulder function.

反向肩关节置换术（RSA）有效改善袖带撕裂性关节病的预后，但存在并发症的风险。关节间球分离是一种罕见的并发症，其与肩带骨折的发生尚未见报道。病例介绍：一位77岁女性，接受过RSA手术，表现为慢性肩部疼痛和可触及的肿块。影像学显示关节球分离，锁骨不连伴肩胛骨错位。手术干预包括更换关节球和聚乙烯衬垫，稳定肩部。术后护理包括吊带固定，导致疼痛缓解，尽管由于肩胛骨错位导致的功能恢复有限，但没有复发性脱位。结论我们报告了一例罕见的RSA术后关节盂分离合并锁骨不连的病例。虽然通过修复脱位可以缓解疼痛，但锁骨不连导致肩胛骨错位可能会阻碍功能恢复。在优先考虑肩关节功能的情况下，手术干预锁骨稳定可能是必要的。

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引用次数: 0

Gorham disease presenting as progressive osteolysis subsequent to a femoral neck fracture in a young patient: A rare case report Gorham病在年轻患者股骨颈骨折后表现为进行性骨溶解：一个罕见的病例报告

JOS Case Reports

Pub Date : 2025-02-19 DOI: 10.1016/j.joscr.2025.01.001

Daigo Shiraishi, Junya Shimizu, Makoto Emori, Yasutaka Murahashi, Ima Kosukegawa, Atsushi Teramoto

Background

Gorham disease is characterized by unexplained osteolysis of bones over a period of several months, with the osteolytic areas being replaced by lymphovascular proliferation. The progression of the disease is unpredictable, as the expansion of the lesions may stop abruptly and regress spontaneously. Gorham disease is very rare and difficult to diagnose.

Case presentation

A 19-year-old male patient was referred to our hospital for further examination of osteolytic lesions after a femoral neck fracture. Histopathological analysis of the first biopsy resulted in the diagnosis of a hemangioma. However, because of progressive osteolysis, a second biopsy was performed; and he was diagnosed with Gorham disease. He underwent a wide resection and total hip arthroplasty. Two years postoperatively, he was able to walk unassisted and he had no signs of recurrence.

Conclusions

When osteolytic lesions are present in young patients, the differential diagnosis should include Gorham disease.

背景：gorham病的特点是在几个月内出现不明原因的骨溶解，溶解区被淋巴血管增生所取代。疾病的进展是不可预测的，因为病变的扩张可能突然停止并自发消退。戈勒姆病非常罕见，很难诊断。病例介绍：一名19岁男性患者在股骨颈骨折后转介至我院进一步检查溶骨病变。第一次活检的组织病理学分析导致了血管瘤的诊断。然而，由于进行性骨溶解，进行了第二次活检；他被诊断出患有戈勒姆病他接受了大范围切除和全髋关节置换术。术后两年，患者可以独立行走，无复发迹象。结论年轻患者出现溶骨病变时，鉴别诊断应包括Gorham病。

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引用次数: 0

New visualization of cervical nerve roots by ultrasound: Identification by 0–1 sign 超声显示颈神经根的新方法：0-1标志识别

JOS Case Reports

Pub Date : 2025-01-21 DOI: 10.1016/j.joscr.2024.12.003

Yuyu Ishimoto , Hiroshi Iwasaki , Kotaro Oda , Hiroshi Yamada

Introduction

Ultrasound-guided cervical nerve root block is an effective technique that avoids radiation exposure. However, there is currently no standard technique for visualizing cervical nerve roots using ultrasound. The most common method is to search for the cervical nerve by moving the transducer from the brachial plexus in the direction of the head, using nerves and the scalene muscle as landmarks. However, this approach often poses difficulties for novice ultrasound operators because it can be difficult to identify these landmarks. We propose a new technique to visualize the cervical nerve root by using the common carotid artery and the C6 anterior tubercle as landmarks. Our aim was to quantitatively measure the anatomical positions of these landmarks to facilitate identification by novice ultrasound operators.

Case reports

Included in this study were 32 healthy volunteers (19 men, 13 women; mean age, 34.5 ± 10.5 years) who provided informed consent to inclusion in the study. The new technique called the ‘0–1 sign’ as the common carotid artery and the C6 anterior tubercle are morphologically likened to ‘0’ and ‘1’, respectively. Our aim was to measure the distance between the ‘0’ and ‘1’ and the distance of ‘1’ from the skin so as to allow beginners in ultrasound to quickly locate these landmarks.

Conclusions

Our new procedure for cervical nerve root visualization under ultrasound uses the 0–1 sign as an indicator. The results suggested that the 0–1 sign technique is a simple and effective method for cervical nerve root visualization and may serve as a reliable reference for ultrasound-guided cervical nerve root blocks.

超声引导下颈神经根阻滞是一种有效的避免辐射暴露的技术。然而，目前尚无标准的超声颈神经根显像技术。最常见的方法是将换能器从臂丛向头部方向移动，以神经和斜角肌为标志，寻找颈神经。然而，这种方法往往给新手超声操作员带来困难，因为很难识别这些地标。我们提出一种利用颈总动脉和C6前结节作为标志来观察颈神经根的新技术。我们的目的是定量测量这些地标的解剖位置，以方便新手超声操作员识别。病例报告本研究纳入32名健康志愿者（19名男性，13名女性，平均年龄34.5±10.5岁），他们提供知情同意纳入研究。这项新技术被称为“0 - 1标志”，因为颈总动脉和C6前结节在形态学上分别被比作“0”和“1”。我们的目的是测量“0”和“1”之间的距离以及“1”到皮肤的距离，以便超声初学者能够快速定位这些标志。结论采用0-1征象作为超声显示颈神经根的新方法。结果提示，0-1标志技术是一种简单有效的颈神经根显像方法，可作为超声引导下颈神经根阻滞的可靠参考。

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引用次数: 0