JBJS case connector最新文献

Case: Dorsal dislocations of the distal interphalangeal joint with associated volar base fractures of the distal phalanx are complex injuries that pose challenges for achieving stable reduction and restoring optimal joint function. This case report describes the successful management of a 40-year-old male cardiologist who sustained such an injury after a cricket ball trauma. The treatment involved a combined approach of closed reduction, dorsal extension block pinning, and intrafocal pinning of the volar base fracture.

Conclusion: This combined technique achieved excellent radiological and functional outcomes at 1-year follow-up. The patient regained full range of motion and returned to his preinjury activities without limitations.

Case: A 48-year-old man with multiple injuries sustained a Gustilo type 3A right open distal humerus fracture with a 4-cm wound, contralateral radius shaft, and ilium fractures. Following wound irrigation on the day of injury, second look debridement showed crushed triceps and severe contamination extending into the distal humerus medullary canal. After 6 days of initial plate fixation, he developed signs of deep infection. Radical debridement twice resulted in a 10-cm bone defect, necessitating reconstruction with a Lambda-shaped free vascularized fibula for both columns.

Conclusion: Lambda-shaped column reconstruction using free vascularized fibula flap yields satisfactory clinical and radiographic outcomes in metaphyseal distal humerus bone defects.

Level of evidence: V.

Level of clinical care: Level I Tertiary trauma center.

Case: Thirty-five-year-old man presented with 14 cm segmental tibial defect after crush injury (Gustilo Anderson type-IIIA). Tetrafocal bone transport using Ilizarov frame was performed with 3 osteotomies. Two minor complications-skin invagination and failure at proximal docking site-were addressed. At 18 months, patient exhibited excellent functional outcomes with full range of motion and no signs of limb length discrepancy, infection, or nonunion.

Conclusion: This case highlights the potential of tetrafocal bone transport as an effective treatment for segmental tibial defects, even in resource-limited settings, demonstrating that complex orthopedic challenges can achieve excellent outcomes with proper technique and care.

Case: We present a 42-year-old man who developed extensive left lower extremity arterial thrombosis following COVID-19 pneumonia. Despite multiple revascularization attempts and a below-knee amputation, he faced wound necrosis and insufficient soft tissue coverage. An innovative approach using a pedicled flap and sequential flow-through free flaps was used for limb salvage. Further interventions included through-knee amputation and targeted muscle reinnervation vs. nerve capping to address phantom limb pain.

Conclusion: This case demonstrates the potential of sequential flow-through free flaps in complex limb salvage when traditional revascularization is unfeasible, emphasizing early intervention and vigilant complication management.

Case: A 30-year-old man presented with left proximal tibia fracture (open Grade 3A) and a transverse lateral malleolus fracture (Weber B) following direct impact injury. Computed tomography revealed a rare posteromedial tubercle fibula fracture at the posterior inferior tibiofibular ligament (PITFL) insertion, with syndesmosis disruption. Initial damage control included an external fixator. Definitive surgery, performed 10 days later, used Herbert screws and a tubular plate, along with syndesmotic screws.

Conclusion: This case highlights a unique fracture pattern: PITFL avulsion from the fibular end which we wish to name as Patel-Sharma fragment. Identifying this fragment is essential as it needs to be fixed to ensure posterior syndesmosis ring stability.

Case: A 14-year-old male athlete presented with a 9-month history of low back pain, worse with hyperextension. Nonoperative management for bilateral L4 spondylolysis had been unsuccessful. The patient underwent a novel magnetic resonance imaging (MRI) that generated a synthetic computed tomography (sCT). MRI/sCT revealed nonunion of the spondylolysis with persistent edema. The patient underwent minimally invasive bilateral L4 robot-navigated intralaminar screw fixation. CT at 3 months demonstrated complete healing.

Conclusion: This case is the first to document the use of MRI-generated sCT in the management of pediatric spondylolysis, offering improved assessment of both bony and soft tissue pathology in a single study without the ionizing radiation of traditional CT.

Case: We present the case of a 24-year-old woman who sustained a left midshaft clavicle fracture with acute subclavian artery compression, subclavian vein laceration, and complete brachial plexus palsy after a motor vehicle collision. The patient underwent urgent open reduction internal fixation of the clavicle and repair of the subclavian vein. Two years later, she underwent opponensplasty and flexor digitorum profundus tendon transfers. She regained satisfactory hand function, allowing her to return to full-duty work.

Conclusion: Clavicle fractures with associated acute neurovascular and brachial plexus injuries are rare pathologies that result from high-energy trauma and should undergo urgent fixation.

Case: We describe a 13-year-old adolescent girl experiencing persistent pain and reduced grip strength following nonoperative treatment of a medial epicondyle fracture-dislocation with closed reduction over 5 years before her referral to our clinic. Neurological examination and magnetic resonance imaging of the elbow revealed damage to the median nerve due to an entrapment within the elbow. Surgical release of the nerve resulted in complete pain relief and improved neurological function with normalized nerve conduction.

Conclusion: Persistent neurologic deficits should be investigated following pediatric elbow trauma. Promising results can be achieved with surgical treatment even after long-term entrapment of the median nerve.

Case: We report a case of coccygeal dislocation complicated by defecatory dysfunction and discuss its treatment and mechanisms. A 58-year-old man was presented with coccygeal pain and defecatory dysfunction after sustaining an injury from a 1-m fall. Following diagnosis, a combined approach involving surgical treatment and physiotherapy was adopted, resulting in early symptom improvement and favorable long-term outcomes.

Conclusion: Traumatic anterior dislocation of the coccyx is a rare but significant injury with no clear treatment guidelines. This report suggests the mechanisms underlying the association between defecatory dysfunction and coccygeal dislocation and underscores the therapeutic role of surgical intervention and physiotherapy.

Case: A 60-year-old right-hand-dominant woman experienced progressive enlargement of a mass over the index distal interphalangeal (DIP) joint over 5 years, leading to joint destruction and swan neck deformity. Radiography showed arthritis, erosion, and calcific deposition. Surgical intervention included mass excision, synovectomy, and DIP joint arthrodesis. After initial fixation failure, revision surgery achieved DIP joint fusion, with histology confirming synovial chondromatosis.

Conclusion: This case highlights the diagnostic and treatment challenges of treating rare presentations of synovial chondromatosis in small hand joints, emphasizing early recognition, synovial excision, and joint stabilization in the presence of poor bone quality to prevent recurrence and preserve function.