JBJS case connector最新文献

Case: A 21-year-old man presented with a postoperative arthropathy after anterior cruciate ligament reconstruction with symptoms resembling septic arthritis. After irrigation and debridement (I&D), the definitive diagnosis of a seronegative inflammatory arthropathy was reached and his symptoms resolved with the administration of immunomodulatory medications.

Conclusion: The devastating complications of delayed treatment for septic arthritis often compel surgeons to perform I&Ds before a complete diagnostic workup is completed. This highlights that surgeons must be aware that not all postoperative arthropathies with elevated inflammatory markers are septic arthritis and a broad differential must be maintained to avoid delayed diagnosis and unnecessary procedures.

Case: Spinal epidural lipomatosis (SEL) is the epidural accumulation of adipose tissue, sometimes associated with steroid use. There are limited reported cases of pediatric SEL. The purpose of this case report was to describe a 15-year-old girl with severe sagittal malalignment secondary to steroid-induced SEL associated with cardiac transplant rejection immunotherapy. She underwent multilevel decompression without traditional deformity correction and fusion, which improved her spinal deformity and symptoms. She had improved sagittal alignment and clinical outcomes at 2-year follow-up.

Conclusion: Nonstructural spinal deformities due to SEL can be improved with a limited decompression when nonoperative treatment fails.

Case: Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disorder characterized by progressive heterotopic ossification. Scoliosis may develop and progress rapidly, especially during adolescence. We report 4 patients with FOP and scoliosis during early adolescence: A 12-year-old girl underwent T4-S2 posterior spinal fusion (PSF); another 12-year-old girl underwent T4-S2 PSF; a 13-year-old boy underwent T3-L4 PSF; and a 14-year-old girl was managed nonoperatively because the complex deformity and ankylosed shoulders could not be adequately balanced with surgery.

Conclusion: In patients with FOP, surgical intervention can reduce thoracic deformity and improve pulmonary function but carries substantial risks, including heterotopic ossification.

Case: We report a 13-year-old female karate athlete with chronic varus instability of the left hallux interphalangeal (IP) joint following injury 16 months prior. Surgical reconstruction was performed using plantaris tendon autograft with biotenodesis screws through a single lateral approach. At 1-year follow-up, the patient had complete resolution of symptoms and returned to competitive karate.

Conclusion: Lateral collateral ligament reconstruction using plantaris tendon autograft is an effective treatment option for chronic varus instability of the hallux IP joint, offering minimal donor site morbidity and preservation extremity function.

Case: Hardware complications in the perioperative period of a pilon fracture open reduction internal fixation or fusion procedure present a unique challenge. Revision of hardware can lead to additional complications. In this case report, we share a technique of in situ plate bending to manage damaged hardware in a patient who underwent a primary tibiotalar arthrodesis for a pilon fracture.

Conclusion: Preoperative planning, protection of the soft tissue envelope, and use of the "F" tool are keys to the success of this treatment method. Proper technique allows for a noninvasive method for correcting hardware failure and avoiding further complications.

Case: A 78-year-old man with type 2 diabetes and spinal stenosis complicated by chronic neuropathy suffered an open medial malleolus fracture with proximal tendon rupture after fall from height. Fracture fixation was achieved with cannulated screws. Meticulous repair of the proximal tibialis posterior and flexor digitorum longus tendon avulsions required tunneling into the deep posterior compartment. Postoperatively, the patient was non-weight bearing, responsive to therapy, and discharged home.

Conclusion: This unique case illustrates the importance of maintaining a high index of suspicion for tendinous injury. A careful physical examination, understanding of injury mechanisms, and a high index of suspicion for these associated injuries should be maintained to maximize patient outcomes.

Case: A 21-year-old woman with Langer-Giedion syndrome with insidious onset chronic bilateral shoulder pain exacerbated with overhead activity. Imaging obtained was consistent with distal clavicle osteochondromas with mass effect onto the superior rotator cuff. Staged bilateral open resection was performed with resolution of symptoms without recurrence.

Conclusion: Langer-Giedion syndrome characteristically includes multiple exostoses. These are rarely found in the lateral clavicle, but when present can become symptomatic impinging upon the underlying supraspinatus and causing inflammation of the subacromial bursa due to extrinsic mechanical irritation. This is the first case report to discuss symptomatic bilateral lesions with successful treatment through open resection.

Case: A 15-year-old girl presented with significant right anterior knee pain and a varus-hyperextension gait pattern mimicking knee subluxation. Computed tomography (CT) revealed 44° of femoral anteversion and 35° of external tibial torsion. Magnetic resonance imaging and X-rays failed to demonstrate any abnormalities. Clinical examination supported by CT, EOS, and 3-dimensional gait analysis revealed axial malalignment. Femoral and tibial torsional osteotomies normalized gait, and clinical scores improved.

Conclusion: This case highlights how torsional malalignment can produce dynamic sagittal and coronal gait dysfunction. Rotational correction resolved symptoms, emphasizing the need to include torsion assessment in patients with unexplained knee pain and gait dysfunction.

Case: Two boys, 8-months-old and 10-years-old, presented with hip pain. Orthopedics was consulted for possible infections, but intra-abdominal causes were not considered until after magnetic resonance imaging studies identified an intra-abdominal foreign body in each boy. Both patients underwent successful removal of the foreign bodies with complete symptom resolution.

Conclusion: Both cases represent missed opportunities for early diagnosis of an intra-abdominal foreign body. In the first case, a lateral radiograph was not acquired. In the second case, the child's rectal pain after falling was not investigated with physical examination. Abdominal foreign bodies need to be considered when evaluating a child with hip pain/limping.