We present a compartment syndrome in the arm that is a very rare location and for which there is hardly any bibliography. The case presented 48 hours after humerus surgery through a posterior approach, although it affected the anterior compartment. With this case we want to highlight the importance of the differential diagnosis in an uncommon location.
A 55-year-old female consulted our service with chronic pain in her right shoulder with no history of trauma. Shoulder X-rays and CT revealed an enchondroma in the proximal humerus without an associated fracture. The MRI also showed a complete rupture of the supraspinatus and infraspinatus tendons. Anchorless arthroscopic transosseous rotator cuff repair was performed. At 12-month follow-up, the patient regained functionality, and the enchondromatous lesion remained stable. Arthroscopic transosseous anchorless repair of a rotator cuff tear could represent a good surgical option for patients whose bone quality makes anchor placement inadequate.
Evidence level III: Level IV; case report.
Show the results obtained, describing the management and experience, knowing that the surgical delay time is much higher than that recommended in the current guidelines.
Retrospective study of consecutive cases of hip fractures in the range of 0–16 years, with a minimum follow-up of 12 months. Where epidemiological variables were analyzed, delay in arrival at the Hospital, delay in surgical treatment, complications and functionality according to the Ratliff criteria.
Twenty-one cases of hip fractures. An average age of 9 years, 71% left-sided involvement, one case of bilateral presentation. The trauma mechanism was 42.8% related to a traffic accident. There were associated injuries in 33.3%. Predominance of type IV and type III according to the Delbet classification. Surgical treatment in 95% of cases. The delay in arrival at the hospital was 1.6 days on average, with a delay in treatment of 5.45 days. Average follow-up of 29 months (12–54 months). Excellent functional results were obtained in 66.6% of cases, fair in 23.8%, and poor results in 9.5. Complications occurred in 7 cases, with NOA in 19% of patients, coxa vara in 8.5%, and length discrepancy in 4% (4%).
They are rare fractures. As pediatric orthopedists, we must be up-to-date in the management of each type of injury, in order to offer the appropriate treatment that reduces the sequelae that may potentially exist. The goal should be to obtain anatomical reductions and stable fixations. And surgical delay is not synonymous with poor results.
Elbow dislocation is a frequent emergency room event. Elbow dislocation diagnosis is based on clinical and radiological examination. The management frequently consists on closed reduction. Occasionally, persistence of instability after reduction becomes a challenge for the physician.
We present the case of a 58-year-old male who required acute surgical intervention due to persistent simple elbow dislocation. The patient had three unsuccessful closed reduction attempts. Although bone involvement was ruled out, the evidence of inadequate joint reduction was the indication for emergent ligament reconstruction.
The patient required open surgical management for ligament reconstruction. After 6 months of follow-up, the patient presents with slight elbow stiffness due to a total range of motion of 50°. The patient did not present new episodes of re-dislocation after ligament reconstruction.
Simple dislocation is the most frequent form of elbow dislocation. Considering joint stability after a closed reduction is very important. A minority of patients require surgical procedures to restore the ligamentous and muscular stabilizers of the elbow. An analysis of the case and the most important aspects are highlighted under the evidence of the literature.
Diffuse large B cell lymphoma is a rare kind of non-Hodgkin's lymphoma that has been associated to HIV infection. This case report presents a male patient with an unusual case of lymphoma in the spine with medullary compression at T12. At the same time, he was diagnosed with a previously unknown HIV infection. The patient is intervened for the acute medullary compression with additional chemotherapy with a R-EPOCH scheme achieving significative improvement after a few weeks.
Randomization protocols in clinical studies of common orthopedic problems and traumatic injuries are challenging to orchestrate. The lack of high-grade clinical evidence from prospective randomized, double-blinded study design is often cited as a primary reason for rejecting proposed therapy advances in orthopedic surgery.
This position paper summarizes the clinical trial limitations in surgical subspecialties. We present a consensus statement on how practicing orthopedic surgeon can produce high-quality clinical evidence to affect changes in practice protocols.
Our literature review revealed that classifications of level of evidence reporting varies between surgical subspecialties. Research in orthopedic- and musculoskeletal trauma care is primarily directed at the diagnosis, preferred treatment, and economic decision analysis, whereas other prognosis-based classifications are preferred in other areas such as plastic surgery. In orthopedics, controlled double-blinded randomization is rare and often unpractical or unethical for a placebo control purpose where patients may be harmed. Crossing over between study groups randomized surgical trials is common. Other obstacles in surgical trials range from lack of organizational and financial support, institutional review or ethics board approval, and registration requirements for clinical trials to insufficient time left outside an already busy clinical schedule to dedicate to this laborious uncompensated task.
Orthopedic surgery is as an experience- and skill-based subspecialty. Many innovations start with entrepreneur surgeons as reporting of opinions or retrospective cohort studies many of which suffer from bias. Prospective observational cohort studies with consistent results may offer higher-grade clinical evidence than poorly executed randomized trials.
Primary acute patellar dislocations (PAPD) account for 3% of all traumatic knee lesions, and several studies have estimated the general incidence of patellar dislocation to be between 2 and 77.4 per 100,000 person-years. Few studies have evaluated the incidence of primary lateral patellar dislocation in Latin America. The aim of the study was to evaluate the incidence of patellar dislocation in patients from a reference center in the Colombian southwest, report trends in the incidence of dislocation, and describe the rate of surgical treatment.
We performed an observational, analytical, cross-sectional study including all patients older than 9 years old with primary lateral patellar dislocation (PLPD), between January 2011 and June 2018, in a tertiary care center in Latin America.
In our population, the incidence of primary lateral patellar dislocation (PLPD) was 32.38 per 100,000 person-years. The age group between 14 and 18 years old had the highest incidence (187.74 per 100.000). In the 10 to 13-year-old group, females had a significantly higher incidence (179.05 vs 59.85 /100,000, p-value < 0.001).
With an incidence of 32.38 per 100,000 person- years, primary patellar dislocation is a frequent orthopaedic injury in our population. The peak incidence by age group was in adolescents between 14 to 18 years old.
Pyomyositis is a subacute suppurative bacterial infection of muscle, caused by hematogenous spread and sometimes accompanied by the formation of abscesses. Although, it is a disease classically observed in tropical areas, in recent years an increase in its incidence has been described in temperate countries, especially in immunosuppressed people.
Its most frequent etiological agent is Staphylococcus aureus. The most common locations are the quadriceps, buttocks, and iliopsoas, the association with septic arthritis and osteomyelitis being exceptional.
In the pediatric population, it usually affects healthy people and athletes, and its appearance is related to intense physical exercise or minor trauma that, in many cases, can go unnoticed. The clinical presentation of acute pyomyositis is usually insidious, and can occur without fever, but with local symptoms such as pain, swelling, and functional limitation. Drainage of the abscess, followed by the administration of antibiotics leads to complete recovery. Primary pyomyositis is rare, and the diagnosis is delayed due to the deep location of the muscle and because the symptoms can confuse the diagnosis with septic arthritis of the hip.
We present this case due to the difficulty of its diagnosis and the complications derived from the delay in its diagnosis.
Diaphyseal fractures of the forearm are common injuries in the pediatric population and can be treated nonoperative. However, there are specific indications for intramedullary fixation with elastic nails with or without open reduction. The objective was to find predictive risk factors for closed reduction failure in children between 5 and 16 years old.
Descriptive observational retrospective study, case series type. The database of the pediatric orthopedics of a children's hospital was reviewed from January 2017 to December 2021. Data from medical records and pre-operative radiographs were collected to analyze the possible variables related to closed reduction failure.
A sample of 51 patients were analyzed, the average age was 10.68 years (±2.62), with a prevalence of males (82.35%). Twenty-two patients (43.14%) underwent open reduction, 20 (39.22%) closed, and 9 (17.65%) mixed. None of the variables were statistically significant. However, the angulation of the radius in the lateral X-ray showed a value of p = 0.07, which approached statistical significance and could be related to failure in closed reduction.
The findings of this paper can help surgeons to make the decision for open reduction, avoiding risks due to excessive manipulation of soft tissues such as compartment syndrome. A study with a larger sample is needed to increase the statistical power to validate predictive risk factors for failure in closed reduction in the management of diaphyseal fractures of the forearm.
Level of evidence: IV.
The incidence of meniscal injuries in adolescents has increased due to the growing tendency to perform sports activities in this age group, greater diagnostic suspicion and improvement in diagnostic methods. They are usually associated with other pathologies, such as anterior cruciate ligament injuries and an important risk factor is the presence of a discoid meniscus. The discoid meniscus, first described by Young in 1889, is a congenital morphological variation of the lateral or medial meniscus, characterized by central hypertrophy and a larger diameter than normal meniscus. It can be asymptomatic or manifest with pain, blockage, clicking and swelling. The historical treatment was complete meniscectomy, which was associated with early degenerative joint changes, nowadays saucerization is recommended as the treatment of choice. In addition, the meniscal transplant is described as a salvage procedure, in case of irreparable meniscal damage. We present the case of a 12-year-old female patient who underwent this procedure with a history of multiple surgical interventions on the left knee, including partial meniscectomy, without a favorable clinical result.
Evidence level: IV.
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